Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Community environmental factors are associated with disability in older adults with functional limitations: the MOST study. Maintenance Effects of a DVD-Delivered Exercise Intervention on Physical Function in Older Adults. Effects of Strength Training versus Power Training on Physical Performance in Prefrail Community-Dwelling Older Adults Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: a 5-year prospective cohort study. Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial Recovery from disability among community-dwelling older persons. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. The relationship between physical performance and cardiac function in an elderly Russian cohort. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. Effect of strength and power training on physical function in community-dwelling older adults. Dizziness in community-dwelling older adults: a population-based study. Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. The Effects of Aerobic Training and Nutrition Education on Functional Performance in Low Socioeconomic Older Adults Adaptability to Perturbation as a Predictor of Future Falls: A Preliminary Prospective Study Resistive training and long-term function in older adults. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. The hierarchy of functional loss associated with cognitive decline in older persons. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. The relationship among physical activity, obesity, and physical function in community-dwelling older women. Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass Weight Management Interventions in Adult and Pediatric Asthma Populations: A Systematic Review. Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Effects of change in physical activity on physical function limitations in older women: mediating roles of physical function performance and self-efficacy. Habitual physical activity and health-related quality of life in older adults: interactions between the amount and intensity of activity (the Nakanojo Study) Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. Should physical activity programs be tailored when older adults have compromised function? Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation Is serum leptin related to physical function and is it modifiable through weight loss and exercise in older adults with knee osteoarthritis? Cognitive screening in community-dwelling elders: performance on the clock-in-the-box. Renal function and decline in functional capacity in older adults. Social cognitive influences on physical activity behavior in middle-aged and older adults. Improving Health Related Quality of Life and Independence in Community Dwelling Frail Older Adults through a Client-Centred and Activity-Oriented Program. A Pragmatic Randomized Controlled Trial. The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Driving status and three-year mortality among community-dwelling older adults. Higher levels of objectively measured sedentary behavior is associated with worse cognitive ability: Two-year follow-up study in community-dwelling older adults Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults The long-term effects of a primary care physical activity intervention on mental health in low-active, community-dwelling older adults The Cluster-Randomized BRIGHT Trial: Proactive Case Finding for Community-Dwelling Older Adults Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis.
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 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 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 Objective To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo ( Spain ) . Methods Data were taken from the Toledo Study for Healthy Aging , a population -based study conducted on 2,488 individuals aged 65 years and older . Study participants were selected by a two-stage r and om sampling from the municipal census of Toledo , covering both institutionalized and community dwelling persons from rural and urban setting s. Data were collected from 2006 to 2009 , and included information on social support , activities of daily living , comorbidity , physical activity , quality of life , depressive symptoms , and cognitive function . In addition , a nurse collected  anthropometric data  , conducted tests of physical performance ( walk speed , upper and lower extremities strength , and the st and - and -sit from a chair test ) and obtained a blood sample . The diagnosis of the frailty syndrome was based on the Fried criteria ( weakness , low speed , low physical activity , exhaustion , and weight loss ) . Results In total , 41.8 % ( 95 % confidence interval [ CI ] 39.4–44.2 % ) of the study participants were prefrail , and 8.4 % ( 95 % CI 7.1–9.8 % ) were frail . There were no differences in the prevalence of frailty by sex , level of education , occupation , marital status , or place of residence . The frequency of the frailty syndrome increased with age , and was higher in those with disability , depression , hip fracture and other comorbidity , such as cardiovascular disease and disorders of the central nervous system . Conclusions The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other population s in the Mediterranean basin 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 We investigated the therapeutic benefits ( i.e. , sense of purpose and meaning in life ) of the Living Legends program , which includes life review writing and an intergenerational exchange , compared with life review writing alone , for community-dwelling older adults . METHOD This study was a r and omized controlled trial with a connected qualitative component . We analyzed quantitative data using independent- sample s t tests and written descriptions of program experiences using Collaizi 's qualitative methodology ; we then used a triangulation protocol to integrate the qualitative and quantitative data . RESULTS For participants in the writing workshop plus intergenerational exchange , sense of purpose and meaning in life increased significantly ( p<.0001 ) compared with those in the writing workshop alone . Qualitative themes revealed additional program benefits . CONCLUSION Living Legends enhanced participants ' sense of purpose and meaning in life , a factor known to prevent cognitive loss and disability , compared with life review writing alone 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 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 BACKGROUND Exercise training has been demonstrated to enhance physical function and to have a protective effect against  functional limitations and disability in older adults . PURPOSE The objective of this study was to determine whether the effects of a home-based , DVD-delivered exercise intervention on functional performance and limitations were maintained 6-month postintervention termination . METHODS Follow-up assessment s of functional performance and limitations were conducted in a sample of community-dwelling older adults ( N = 237 ) who participated in a 6-month r and omized controlled exercise trial . Participants were initially r and omized to a DVD-delivered exercise intervention or an attentional control condition . The Short Physical Performance Battery , measures of flexibility and strength , and functional limitations were assessed immediately before and after the intervention and then again 6 months later . Analyses of covariance were conducted to examine changes in physical function between the two conditions at the end of the intervention to 6-month follow-up . RESULTS There were statistically significant adjusted group differences in the Short Physical Performance Battery ( η(2 ) = 0.03 , p = .01 ) , upper-body strength ( η(2 ) = 0.03 , p = .005 ) , and lower-body flexibility ( η(2 ) = 0.02 , p = .05 ) , indicating that gains brought about by the intervention were maintained 6 months later . CONCLUSIONS A DVD-delivered exercise program specifically design ed to target elements of functional fitness in older adults can produce clinical ly meaningful gains in physical function that are maintained beyond intervention cessation Background : It has been unclear which training mode is most effective and feasible for improving physical performance in the risk group of prefrail community-dwelling older adults . Objective : The purpose of the present study was to compare the effects of strength training ( ST ) versus power training ( PT ) on functional performance in prefrail older adults . This study was registered at clinical trials.gov as NCT00783159 . Methods : 69 community-dwelling older adults ( > 65 years ) who were prefrail according to the definition of Fried were included in a 12-week exercise program . The participants were r and omized into an ST group , a PT group and a control group . All participants were supplemented with vitamin D3 orally before entering the intervention period . The primary outcome was the global score on the Short Physical Performance Battery ( SPPB ) . Secondary outcomes were muscle power , appendicular lean mass ( aLM ) measured by dual energy X-ray absorptiometry and self-reported functional deficits ( Short Form of the Late-Life Function and Disability Instrument , SF-LLFDI ) . Results : Regarding changes in the SPPB score during the intervention , significant heterogeneity between the groups was observed ( p = 0.023 ) . In pair-wise comparisons , participants in both training groups significantly ( PT : p = 0.012 , ST : 0.009 ) increased their SPPB score ( PT : Δmean = 0.8 , ST : Δmean = 1.0 ) compared to the control group , with no statistical difference among training groups ( p = 0.301 ) . No statistical differences were found in changes in aLM ( p = 0.769 ) , muscle power ( p = 0.308 ) and SF-LLFDI ( p = 0.623 ) between the groups . Muscle power significantly increased ( p = 0.017 ) under vitamin D3 intake . Conclusions : In prefrail community-dwelling adults , PT is not superior to ST , although both training modes result ed in significant improvements in physical performance . With regard to dropout rates , ST appears to be advantageous compared to PT . The high prevalence of vitamin D3 deficiency and the slight improvement of physical performance under vitamin D3 supplementation among study participants underline the relevance of this approach in physical exercise interventions OBJECTIVE This study aim ed to clarify the longitudinal relationship between leisure activities and cognitive decline  among Japanese community-dwelling older adults , using a 5-year prospect i ve cohort study design . METHODS A total of 567 men and women , aged 70years and over , participated in the study . The  Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function . The change in cognitive function from baseline to follow-up was determined , and cognitive decline over 5years was used as the outcome variable .  Leisure activities ( hobby , social activity , and physical activity )  were assessed at baseline and used as independent variables . Age , gender , number of years of education , presence of chronic diseases , instrumental activities of daily living , depressive symptoms , smoking , hearing deficits , and level of cognitive function at baseline were used as covariates . RESULTS Multivariate logistic regression analysis , adjusted for potential confounders , showed that non-participation in a hobby  was significantly and independently associated with cognitive decline ( odds ratio : 1.87 , 95 % confidence interval : 1.16 - 3.02 , p<0.01 ) . There were no significant relationships between social activity , physical activity and cognitive decline . CONCLUSIONS Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals , suggesting that engaging in a hobby in later life can contribute to preserving cognitive function Objective : To determine whether information about an older person 's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes . Design : A r and omized controlled trial was undertaken ; the assessors were not blinded to the group allocation . Setting : The study took place in a clinic within a hospital setting . Participants : Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units . Interventions : The intervention group received assessment s of physical function with feedback to the participant and the participant 's family physician or functional assessment s alone over 18 months .  Self-report measures for health status using the Short Form-36 ( SF-36 ) and pre clinical disability were used together with performance measures which included the lower extremity performance test and muscle strength . Results : There were small , statistically significant group/time interactions which included disability scores , F=4.78 , P ≤0.05 ) , and the vitality subscale of the SF-36 , F=7.47 , P ≤0.01 ) . Conclusion : Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups CONTEXT Previous studies have found that a sizeable minority of newly disabled older persons recover independent function ; however , long intervals between assessment s have led to difficulty in determining the true incidence and duration of disability , and therefore in accurately characterizing the probability and course of recovery . OBJECTIVES To determine the rate of and time to recovery of independent function in community-dwelling older persons who become newly disabled in their activities of daily living ( ADLs ) , to determine the duration of recovery , and to compare the likelihood of recovery among pertinent subgroups of older persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , with monthly assessment s of  ADL function , for 754 initially nondisabled , community-dwelling persons aged 70 years or older , performed in a small urban area from March 1998 to May 2003 . MAIN OUTCOME MEASURES Demographic features , chronic conditions , cognitive function , and physical frailty were determined during comprehensive assessment s at 18-month intervals . Disability , defined as needing personal assistance with 1 or more key ADLs ( bathing , dressing , walking , and transferring ) , was assessed during monthly telephone interviews . RESULTS A total of 420 participants ( 56 % ) experienced disability during a median follow-up of 51 months . Of these participants , 399 ( 81 % ) recovered ( ie , regained independence in all 4 ADLs ) within 12 months of their initial disability episode , and a majority ( 57 % ) of these maintained independence for at least 6 months . Among participants who experienced 3 or more consecutive months of disability , a majority ( 60 % ) recovered , but only a third of these maintained independence for at least 6 months . Persons who were cognitively impaired , physically frail , or severely disabled ( ie , in 3 - 4 ADLs ) at onset were less likely to recover than those who were cognitively intact , nonfrail , or mildly disabled , respectively . Nonetheless , a majority of participants within each subgroup recovered . CONCLUSIONS Newly disabled older persons recover independent ADL function at rates far exceeding those that have been previously reported . Recovery from disability , however , is often short-lasting , suggesting that additional efforts are warranted to maintain independence in this high-risk group OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone This study aims to determine the cardiac dysfunction prevalence , to investigate the relationship between the Short Physical Performance Battery ( SPPB ) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population . A r and om sample of 284 community-dwelling adults aged 65 and older were selected from a population -based register and divided into two age groups ( 65 - 74 and ≥75 ) .  The SPPB test , echocardiography and all-cause mortality were measured . The prevalence of cardiac dysfunction was 12 % in the 65 - 74 group and 23 % in the ≥75 group . The multivariate models could explain 15 % and 23 % of the SPPB score total variance for the 65 - 74 and ≥75 age groups , respectively . In the younger age group , the mean follow-up time was 2.6±0.46 years , and the adjusted hazard ratio ( HR ) for risk of mortality from cardiac dysfunction was 4.9 . In the older age group , the mean follow-up time was 2.4±0.61 years , and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality ( adjusted HR=3.4 and adjusted HR=4.2 , respectively ) . The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to , or even lower than , reported prevalences for Western countries . Furthermore , the observed correlations between echocardiographic abnormalities and SPPB scores were limited . Cardiac dysfunction was shown to be a strong mortality predictor in both age groups , and poor physical performance was identified as an independent mortality predictor in the oldest subjects 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 BACKGROUND The performance of daily tasks , such as stair climbing or lifting an object , requires both muscle strength and power . Age-associated reductions in strength and power can affect an older adult 's ability to complete daily tasks such as stair climbing and lifting a child . METHODS The purpose s of this study were to determine whether power training was more efficacious than strength training for improving whole-body physical function in older adults and to examine the relationship between changes in anaerobic power and muscle strength and changes in physical function . Thirty-nine men and women ( mean age + /- SD = 72.5 + /- 6.3 years ) with below-average leg extensor power were r and omly assigned to control ( C , n = 15 ) , strength-training ( ST , n = 13 ) or power-training ( PT , n = 11 ) groups . The ST and PT groups met 3 days per week for 16 weeks ; the C group maintained usual activity and attended three lectures during the course of the study . Primary outcome measures included the Continuous Scale Physical Functional Performance test , maximal strength , and anaerobic power . RESULTS After baseline was controlled for , the Continuous Scale Physical Functional Performance test total score was significantly greater for the PT group than for the ST ( p = .033 ) and C ( p = .016 ) groups . Maximal strength was significantly greater for the ST group than for the C group ( p = .015 ) after the intervention . There was no significant difference between groups for peak anaerobic power . CONCLUSIONS Power training was more effective than strength training for improving physical function in community-dwelling older adults UNLABELLED Dizziness is a common complaint among older adults . AIM To identify the prevalence of dizziness and its related factors in a sample of community-dwelling older adults . METHODS A prospect i ve population -based study with a representative sample of older adults aged 65 years and over . A multidimensional question naire and a battery of measures were used for assessing physical function . RESULTS The prevalence of dizziness was 45 % . Vertigo was found in 70.4 % of older adults with dizziness and 43.8 % of them referred vertigo crises along life . A significant association was found between dizziness and female gender ( p=0.004 ) , memory difficulties complaints ( p=0.015 ) , bad health perception ( p=0.001 ) , depression ( p<0.0001 ) , five or more comorbidities ( p=0.021 ) , self-reported fatigue ( p<0.0001 ) , recurrent falls ( p=0.001 ) , excessive sleepiness ( p=0.003 ) , fear of falling ( p<0.0001 ) , left leg unipedal stance ( p=0.002 ) and Short Performance Physical Battery score ( p=0.009 ) . CONCLUSION Dizziness is a common complaint among older adults and it is associated with limiting clinical conditions , such as depression , fatigue , excessive sleepiness and impaired memory . It is highlighted the association between dizziness and recurrent falls , fear of falling and lower performance in physical function tests , which can restrict independence . These data suggest the importance of a multifactorial approach to dizziness in older adults Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults Background Self-rated health ( SRH ) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older population s concerning future health , functional decline , disability , and mortality . The aim of this study was to use the theoretical framework of the International Classification of Functioning , Disability and Health ( ICF ) to create a better underst and ing of factors associated with SRH among community-dwelling older people in urban and rural areas . Methods The study design was population -based and cross-sectional . Participants were 185 Icel and ers , r and omly selected from a national registry , community-dwelling , 65 - 88 years old , 63 % urban residents , and 52 % men . Participants were asked : " In general , would you say your health is excellent , very good , good , fair , or poor ? " Associations with SRH were analyzed with ordinal logistic regression . Explanatory variables represented aspects of body functions , activities , participation , environmental factors and personal factors components of the ICF . Results Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables . Multivariate analysis , however , demonstrated that SRH had an independent association with five variables representing ICF body functions , activities , and personal factors components : The likelihood of a better SRH increased with advanced lower extremity capacity ( adjusted odds ratio [ adjOR ] = 1.05 , p < 0.001 ) , upper extremity capacity ( adjOR = 1.13 , p = 0.040 ) , household physical activity ( adjOR = 1.01 , p = 0.016 ) , and older age ( adjOR = 1.09 , p = 0.006 ) ; but decreased with more depressive symptoms ( adjOR = 0.79 , p < 0.001 ) . Conclusions The results highlight a collection of ICF body functions , activities and personal factors associated with higher SRH among community-dwelling older people . Some of these , such as physical capacity , depressive symptoms , and habitual physical activity are of particular interest due to their potential for change through public health interventions . The use of ICF conceptual framework and widely accepted st and ardized assessment s should make these results comparable and relevant in an international context 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 Purpose : To describe the population in terms of risk for disability and compare the effects of a walking intervention and nutrition education intervention on risk modification and functional performance in lower socioeconomic older adults using a r and omized controlled study . Methods : Twenty‐six community‐dwelling older adults aged 60 and older were r and omly assigned to a 16‐week walking exercise group or a nutrition education control group .  Peak aerobic capacity and physical function were measured at baseline and post intervention . Physical function was measured using the Medical Outcomes Study Short Form Health Survey Physical Function subscale , Short Physical Performance Battery , Physical Performance Test , and Continuous Scale Physical Functional Performance 10 item test ( CS‐PFP10 ) . Results : Eighty‐five percent of the participants were at risk for pre clinical disability of which 50 % were at risk for moderate disability . The walking exercise group significantly improved in peak aerobic capacity ( 18.9 % ) , physical function ( 25 % ) using the CS‐PFP10 compared to the control group . Conclusion : These findings highlight the importance of physical activity and indicate that walking , a simple exercise that can be done without specialized exercise leader or equipment can significantly increase peak aerobic capacity and physical function in just 4 months Background Falls often result from failed responses to unexpected , externally applied perturbations . Whether performance-based , reaction-based , and /or adaptation-based assessment tools can predict future falls among community-dwelling older adults is unknown . Purpose This preliminary prospect i ve study examined the relationship between older adults ' future fall risk and their reactive responses and adaptations to repeated slips , and their functional status . Methods Thirteen community-dwelling adults ( > 64 years ) were exposed initially to a session of repeated slips . About 30 months later , self-reported falls experience data were collected for the preceding year from these participants . Slip outcome ( fall , loss of balance , or recovery ) , slip score ( weighted sum of slip outcomes ) , Timed Up and Go scores , and future fall incidence were recorded . Results Four participants who reported at least 1 fall had significantly higher slip scores than the rest . In contrast , neither failed recovery on the first slip nor a higher TUG score predicted greater odds of future falls . Conclusion Community-dwelling older adults ' adaptability to externally imposed perturbations may reveal their future fall risk The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults .  A repeated- measures experimental research design was employed as a sample of 55 apparently healthy , older , community-dwelling volunteers ( 30 exercisers- 25 women and 5 men ; 25 comparisons- 16 women and 9 men ) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function . Strength and function were evaluated at 6-month intervals . The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention . Furthermore , a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons OBJECTIVES We studied a representative cohort of community-dwelling elderly persons to ( i ) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses , ( ii ) compare the cognitive status of participants who have and have not lost independence in these functional activities , and ( iii ) determine whether a hierarchical scale of functional loss is associated with declining cognitive status . METHODS A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed . At baseline and 5 years later ,  cognitive status with the Modified Mini-Mental State Examination ( 3MS ) and functional status with 14 Older American Re sources and Services ( OARS ) items were measured . For each OARS functional item , the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared . RESULTS For each functional item , the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent ( e.g. , ability to do finances ) , with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence . A hierarchy of functional items existed , with instrumental activities of daily living ( ADLs ) ( e.g. , shopping , banking , and cooking ) being lost at higher cognitive scores than basic ADL items ( e.g. , eating , dressing , and walking ) , although there was some overlap . CONCLUSIONS This is the first prospect i ve study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks . Clear cognitive thresholds at which development of dependency in OARS functional items occurred . By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items , a natural hierarchy of functional loss associated with cognitive decline emerged . For caregivers , clinicians , and health policy makers , this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition , potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning BACKGROUND Strength loss is strongly associated with functional decline and is reversible with exercise . The effect of increased strength on function has not been clearly established . The purpose of this study was to determine whether strength gain is associated with improvement in physical performance and disability . METHODS One hundred functionally impaired community-dwelling men and women ( 77.6 + /- 7.6 yrs ) were tested at baseline and outcome for lower extremity strength , physical performance , and disability . After r and om group assignment , exercise participants received strengthening exercises in their homes three times a week for 10 weeks while control subjects continued their normal activities . Using multiple regression techniques , the relationship between strength gain and improvement in physical performance and disability was assessed , controlling for age , depression , and baseline strength . RESULTS A significant impact of strength gain on mobility skills ( p = .0009 ) was found . The impact of strength gain on chair rise performance was significant in participants who were more impaired ( p = .04 ) . Strength gain was associated with gain in gait speed ( p = .02 ) and in falls efficacy ( p = .05 ) , but not with other balance , endurance , or disability measures . CONCLUSIONS Lower extremity strength gain is associated with gains in chair rise performance , gait speed , and in mobility tasks such as gait , transfers , stooping , and stair climbing , but not with improved endurance , balance , or disability . Strength gain is also associated with improvement in confidence in mobility . Factors that may influence the ability of strength gain to affect function are initial level of frailty and specificity of exercise . These results support the idea that strength training is an intervention that can potentially improve physical health status in many frail elders OBJECTIVES To determine the efficacy of a complementary analgesic modality , percutaneous electrical nerve stimulation ( PENS ) , for the treatment of chronic low back pain ( CLBP ) in community-dwelling older adults . DESIGN R and omized , controlled clinical trial . SETTING University of Pittsburgh Pain Evaluation and Treatment Institute . PARTICIPANTS Thirty-four English speaking , community-dwelling adults aged 65 and older with CLBP of at least moderate intensity experienced every day or almost every day . INTERVENTION Subjects were r and omized to receive twice-weekly PENS and physical therapy ( PT ) or sham PENS and physical therapy for 6 weeks . MEASUREMENTS At baseline , immediately after the 6-week intervention period , and 3 months later , the primary outcome measures pain intensity and pain-related disability were assessed . The secondary outcome measures physical performance ( timed chair rise , functional reach , gait speed , static and isoinertial lifting ) , psychosocial factors ( mood , sleep , and life control ) , and cognitive function ( measures of attention , concentration , and mental flexibility ) were also collected . RESULTS Subjects r and omized to PENS plus PT displayed significant reductions in pain intensity measures from pre- to posttreatment ( P < .001 ) , but the sham PENS plus PT group did not ( P = .94 ) . These pain reduction effects were maintained at 3-month follow-up . Similarly , significant reductions in pain-related disability were observed at posttreatment ( P = .002 ) for the PENS plus PT group and were maintained at follow-up , but the sham PENS plus PT group did not show reductions in pain-related disability ( P = .81 ) . Of the secondary outcome measures , psychosocial function , timed chair rise , and isoinertial lifting endurance also improved significantly at posttreatment for the PENS plus PT group , and their improvement was sustained at 3-month follow-up , but the sham PENS plus PT did not display significant changes on these measures after treatment . CONCLUSION This preliminary study suggests that PENS may be a promising treatment modality for community-dwelling older adults with CLBP , as demonstrated by reduction in pain intensity and self-reported disability , and improvement in mood , life control , and physical performance . Larger studies with longer duration of follow-up are needed to vali date these findings and support the use of PENS in clinical practice BACKGROUND The relationship between obesity and physical function is not well understood . Physical activity may be a key factor impacting on the relationship between obesity and physical function . METHODS Subjects included 171 community-dwelling women ( mean age = 74.3 , SD = 4.3 ) participating in a 14-year follow-up study to a walking intervention trial .  Measures of obesity [ body mass index ( BMI ) ] and physical activity ( Modified Paffenbarger Question naire ) were collected in 1982 , 1985 , 1995 , and 1999 . Physical function was assessed in 1999 using the Functional Status Question naire ( FSQ ) and gait speed . RESULTS Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999 . However , hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995 , and not obesity from 1982 to 1995 , was an independent predictor of physical function ( FSQ : adjusted R2 = 0.09 , F = 4.68 , P < 0.001 ; gait speed : adjusted R2 = 18.0 , F = 9.41 , P < 0.0001 . CONCLUSION  Physical activity  appears to be as important if not more important than body weight in predicting future physical function The purpose of the study was to compare the effects of three different types of group-based exercise programs ( resistance training , agility training and general stretching ) on back pain and health-related quality of life in older ( aged 75–85 years ) community-dwelling women with low bone mass ( i.e. , osteopenia or osteoporosis ) . The design was a 25-week r and omized controlled trial . Participating were 98 community-dwelling women with low bone mass between the ages of 75 to 85 years old . We assessed back pain and its related disability and health-related quality of life . All three types of group-based exercise programs significantly reduced back pain and its related disabilities , but only resistance and agility training significantly improved health-related quality of life in community-dwelling older women with low bone mass . Baseline physical activity level and class attendance were significant predictors of change in health-related quality of life . Change in back pain and its related disabilities after 25 weeks of exercise intervention was significantly correlated with change in health-related quality of life and changes in the domains of pain and physical function . Resistance and agility training significantly enhanced health-related quality of life and may have done so by increasing social interactions and support , enhancing self-efficacy of physical abilities and modifying the experience of back pain . These data provide valuable insight into the specifics of exercise prescription for older women with low bone mass . Future studies may wish to use individualized quality of life measures to further delineate the effects of different types of exercise on quality of life in older adults with low bone mass BACKGROUND Ample evidence suggests a dose-response relationship between increasing weight and level of asthma risk or reduced asthma control . To establish reversibility , several r and omized controlled trials ( RCTs ) have recently been published to investigate the impact of weight management on asthma . This systematic review synthesizes evidence from these RCTs on the effects of weight management ( weight loss , weight maintenance , maintenance of lost weight , or weight gain prevention ) interventions on  asthma outcomes in both adult and pediatric population s. METHODS We search ed Medline , CINAHL , PsychInfo , and Cochrane for studies published between 1950 and November 2014 . Two research ers independently rated the included studies using the quality assessment tool for RCTs as outlined in the 2013 Obesity Treatment Guideline . Discrepancies were resolved by consensus after discussion between the raters and , if needed , with the senior author . RESULTS Four RCTs in adults and 3 in children and adolescents were included . The adult studies seem to consistently support the benefit of substantial weight loss , but a threshold effect may exist such that only weight loss beyond a minimal amount will likely lead to clinical ly important improvement in asthma outcomes . Three of them suggest that the threshold may lie between 5 - 10 % of weight loss . RCTs in youth suggest that modest calorie reductions alone or combined with increased physical activity , or even a healthy normocaloric diet , may lead to improved asthma outcomes . However , most RCTs review ed were limited by small sample size , short intervention duration s , and short follow-up periods . CONCLUSION Trial evidence shows the promise of weight loss interventions for asthma control in adults and youth . More adequately-powered , long-term RCTs are needed to eluci date the role of weight loss and other weight management interventions in asthma control and prevention . Definitive data are needed to guide clinical and public health practice to effectively address the dual epidemic of obesity and asthma BACKGROUND Cognitive impairment is an important contributor to disability . Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function ( CF ) . We report results of a pilot study to provide estimates of the relative impact of physical activity ( PA ) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability . METHODS Sedentary persons ( 102 ) at increased risk for disability ( aged 70 - 89 years ) were r and omized to moderate-intensity PA or health education .  Participants were administered the  Digit Symbol Substitution Test ( DSST ) , Rey Auditory Verbal Learning Test ( RAVLT ) , modified Stroop test , and Modified Mini-Mental State Examination  at baseline and 1 year . RESULTS Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function . Specifically , the DSST significantly correlated with change in the Short Physical Performance Battery score ( r = .38 , p = .0002 ) , in chair st and score ( r = .26 , p = .012 ) , in balance score ( r = .21 , p = .046 ) , and in 400-m gait speed ( r = .15 , p = .147 ) . Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair st and and balance , respectively . CONCLUSIONS These results provide further support for the benefits of exercise on CF in older adults . An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to exp and the indications for prescribing exercise for prevention of decline in brain function 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 OBJECTIVES To examine the hypothesis that changes in self-efficacy and functional performance mediate , in part , the beneficial effect of physical activity on functional limitations over time . DESIGN Prospect i ve , observational study . SETTING Community-based . PARTICIPANTS Two hundred forty-nine community-dwelling older women . MEASUREMENTS Participants completed measures of  self-reported physical activity , functional limitations , and self-efficacy .  Four measures of  physical function performance  were also assessed . Measures were completed at baseline and 24 months . Data were analyzed using a panel model within a covariance modeling framework . RESULTS Results indicated that increases in physical activity over time were associated with greater improvements in self-efficacy , which was associated in turn with improved physical function performance , both of which mediated the association between physical activity and functional limitations . Fewer functional limitations at baseline were also associated with higher levels of self-efficacy at 24 months . Age , race , and health status covariates did not significantly change these relationships . CONCLUSION The findings support the mediating roles of self-efficacy and physical function performance in the relationship between longitudinal changes in physical activity and functional limitations in older women Purpose This study examined relationships between health-related quality of life ( HRQOL ) and objective assessment s of habitual physical activity in older adults , focusing on interactions between the amount and intensity of activity . Methods Subjects were healthy Japanese aged 65–85 years ( 74 men and 109 women ) .  Pedometer/accelerometers measured their step counts and the intensity of physical activity in metabolic equivalents ( METs ) continuously 24 h per day for 1 year . Each individual ’s final HRQOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) instrument . Results The daily step count and the daily duration of physical activity at an intensity > 3 METs were quite closely correlated ( quadratic r2 = 0.93 , P < 0.05 ) . After controlling for age , sex , and daily step count , the overall SF-36 score and four constituent dimensions ( physical functioning , freedom from pain , vitality , and mental health ) were all significantly higher in individuals spending > 25 % of their total activity at an intensity > 3 METs . However , engagement in activity > 3 METs was not significantly associated with the remaining SF-36 components ( physical limitations , general health , social functioning , and emotional limitations ) . Conclusions Associations between moderate-intensity physical activity and HRQOL in older adults merit further evaluation by prospect i ve studies and /or r and omized controlled trials BACKGROUND In Japan , older adults are assessed by frailty checklist for care prevention . However , the effect of care prevention programs in community-dwelling frail older adults is still unclear . OBJECTIVES The purpose of this study was to investigate whether the care prevention program would reduce care and disability and to measure its cost-effectiveness in frail older adults . DESIGN This is a prospect i ve study using propensity score matching . SETTING AND SUBJECTS A total of 610 community-dwelling older adults were recruited in 2 cities of Japan . INTERVENTION Subjects in the  exercise group ( n = 305 ) attended physical exercise sessions once a week for 16 consecutive weeks . The exercise sessions were in a st and ardized format consisting of moderate-intensity aerobic exercise , progressive strength training , flexibility and balance exercises , and cool-down activities . The control group ( n = 305 ) received only screening evaluation . MEASUREMENTS Primary outcome was long term care insurance requirement certification during the 1-year follow-up period . Secondary outcome measurements were changes of frailty checklist , and care and medical cost . RESULTS Twenty-five subjects ( 8.1 % ) in the exercise group and 55 ( 18 % ) in the control group were newly certified for long-term care insurance service requirement in 1 year after the intervention ( RR = 2.16 , 95 % CI = 1.46 - 3.20 ) . Consequently , the health care cost for the subjects in the exercise group was significantly lower than in the control group ( P < .001 ) . Moreover , subjects in the exercise group had significant improvements in total scores of the frailty checklist compared with the control group that worsened after 1 year ( exercise group : from 7.41 ± 3.98 to 7.11 ± 4.00 , control group : from 7.34 ± 4.27 to 8.02 ± 4.81 , F = 12.84 , P < .001 ) . CONCLUSION These results suggested that physical exercise is effective in preventing the progression of frailty and further disability in older adults living in the community . We could save heath care costs by our care prevention program The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function Background : Regular physical activity has been consistently related to improvements in health- related quality of life ( HRQL ) in older adults . Nevertheless , systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse . Purpose : The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program ( GMCB ) to a traditional cardiac rehabilitation program ( CRP ) with regard to changes in HRQL in a community-dwelling sample of older adults . Methods : This r and omized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms . Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 ( SF-36 ) from the Medical Outcomes Study . Results : Mixed-model analyses yielded significant Baseline × Gender × Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36 . Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment . Conclusions : Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment , gender , and initial mental health status . Results are discussed in terms of the implication s for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL OBJECTIVE : To determine the effect of weight loss and exercise interventions on serum leptin and to investigate the relationship of physical function and osteoarthritis ( OA ) severity with serum leptin in older overweight and obese adults with knee OA . In addition , the study examined if serum leptin predicts weight loss . DESIGN : Longitudinal , controlled clinical trial of weight loss and exercise interventions .SUBJECTS : Community dwelling , older , overweight and obese adults ( n=316 ; > 60 years of age ; body mass index ≥28.0 kg m−2 ) with symptomatic knee OA and self-reported difficulty in performing selected physical activities were recruited . INTERVENTIONS : Participants were r and omized into one of four groups for the 18-month study duration : Healthy Lifestyle Controls , Dietary Weight Loss ( Diet ) , Exercise Training ( Exercise ) , and a combination of Dietary Weight Loss and Exercise Training ( Diet+Exercise ) . The weight loss goal for the two Diet groups was 5 % from baseline at 18 months . Participants in the Exercise groups were trained for 3 days week−1 , 60 min day−1 . MEASUREMENTS : Body weight , body mass index , serum leptin , physical function , and OA severity were measured at baseline , 6 months , and 18 months . RESULTS : Diet and Diet+Exercise groups lost 5.3 and 6.1 % of their weight , respectively , at 18 months with the Exercise group losing 2.9 % . There was a significant main effect of weight loss on serum leptin with a decrease in serum leptin averaged across the 6- and 18-month time points for the Diet and Diet+Exercise groups compared to the other two groups ( β=0.245 ; P<0.01 ) . No main effect  for exercise training was observed . Serum leptin was related to self-reported physical function . In all participants , a mixed model analysis demonstrated that lower levels of baseline serum leptin predict larger weight loss ( β=−2.779 ; P=0.048 ) . CONCLUSION : Decreases in serum leptin may be one mechanism by which weight loss improves physical function and symptoms in OA patients BACKGROUND The Clock-in-the-Box is a rapid ( 2-minute ) cognitive screening tool . The purpose of this study was to compare the Clock-in-the-Box with the Mini-Mental State Exam and neuropsychologic tests ; to determine Clock-in-the-Box score normative values by age and education group ; and to determine if the Clock-in-the-Box score is associated with measures of physical function . METHODS Community-dwelling older participants in the Boston area were recruited for a prospect i ve , longitudinal study in which they completed a variety of cognitive and functional assessment s. RESULTS At baseline , participants ( n=798 ; mean age [ ± st and ard deviation]=78.2 [ ±5.5 ] years ; 14 [ ±3 ] mean years of education ) completed in-home assessment s of cognition ( Clock-in-the-Box and Mini-Mental State Exam ) , measures of independent function ( Activities of Daily Living and Instrumental Activities of Daily Living ) , and measures of physical function ( Short Physical Performance Battery ) . The mean Mini-Mental State Exam score was 27.1 ( ±1.6 ; range 0 - 30 [ 0 worst ] ) , and the mean Clock-in-the-Box score was 6.2 ( ±1.6 ; range 0 - 8 [ 0 worst ] ) . Performance on the Clock-in-the-Box was correlated ( Spearman ) with the Mini-Mental State Exam ( r=0.49 , P<.001 ) and neuropsychologic measures ( r=0.37 - 0.50 ; P<.001 ) . Higher Clock-in-the-Box score was significantly associated with no difficulty in Activities of Daily Living ( χ(2 ) = 39.6 , P<.001 ) and Instrumental Activities of Daily Living ( χ(2 ) = 35.5 , P<.001 ) . In addition , higher Clock-in-the-Box scores were associated with higher scores on the Short Physical Performance Battery ( F=5.4 , P<.001 ) . CONCLUSION The Clock-in-the-Box is a brief cognitive screening test that is correlated with the Mini-Mental State Exam , neuropsychologic tests , and measures of independent and physical function in community-dwelling older adults BACKGROUND longitudinal relationship between renal function , disability and mortality has not been evaluated . OBJECTIVE we investigated the temporal association between renal function and disability , and aim ed to identify the influence of disability on mortality according to renal function in a cohort of older Koreans . DESIGN / SETTING Korean Longitudinal Study on Health and Aging is a prospect i ve , population -based cohort . SUBJECTS community-dwelling Koreans ≥65 years of age . MAIN OUTCOME MEASURES  Korean version of activities of daily living ( ADL ) , Instrumental activities of daily living ( IADL ) and all-cause mortality . RESULTS a total of 984 participants were followed for 5 years with a 70.9 % participation rate . The participants were categorized into three groups according to their baseline estimated glomerular filtration rates ( eGFRs ) ( Group I , ≥60 ; Group II , 45 - 59 ; and Group III , < 45 ml/min/1.73 m(2 ) ) . Baseline eGFR was higher in participants who maintained functional status compared with participants who died or had disability at follow-up examination . The incidence of ADL/IADL decline was 13 , 12.5 and 29.5 % in participants who showed improvement , no change , and decline in renal function , respectively ( P = 0.01 ) . The hazard ratio for mortality in the subgroup with IADL disability was 1.87 ( 95 % CI : 1.10 - 3.20 , P = 0.022 ) in Group I , and 2.53 ( 95 % CI : 1.57 - 4.09 , P<0.001 ) in Groups II and III after adjustment . CONCLUSIONS impaired renal function was related to disability and ADL/IADL decline . The effect of ADL/IADL disability on mortality was more prominent in participants with impaired eGFR OBJECTIVES The purpose of the current study was to prospect ively test the utility of a social cognitive theory ( SCT ) model of physical activity behavior over an 18-month period in middle-aged and older adults ( N = 321 ; M age = 63.8 years ) . METHODS Participants completed measures of self-efficacy , disability limitations , goals , outcome expectations , and physical activity at baseline and follow-up . Self-efficacy was hypothesized to influence physical activity both directly and indirectly through goals and outcome expectations . Relationships were examined using panel analysis within a covariance modeling framework . RESULTS The model provided an excellent fit to the data ( χ(2 ) = 36.16 , df = 30 , p = .20 ; comparative fit index = 1.00 ; root mean square error of approximation = .03 ) . At baseline , self-efficacy was directly related to outcome expectations , disability limitations , goals , and physical activity and indirectly related to physical activity through physical outcome expectations . Changes in self-efficacy were significantly related to residual changes in outcome expectations , disability limitations , goals , and physical activity and indirectly related to residual changes in physical activity through changes in physical and social outcome expectations . DISCUSSION These results provide further support for the use of SCT to physical activity behavior in middle-aged and older adults  . Self-efficacy influenced physical activity both directly and indirectly via outcome expectations , suggesting that these variables should be targeted in physical activity interventions for middle-aged and older adults INTRODUCTION AND AIM In the ageing society , a considerable part of the older adults are frail . Frailty has a major impact on the individual 's quality of life , independence and also on his environment . This study aim ed to investigate - as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults . It was hypothesized that this program could be effective in improving basic Activities of Daily Living ( b-ADL ) and increasing Health Related Quality of Life ( HRQoL ) . METHOD This study was a single blind r and omized controlled trial with an intervention and a control group ( pre-test-post-test control group design ) . Analysis of covariance ( ANCOVA ) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate . Data were analysed using the intention-to-treat principle . RESULTS The intervention group ( n = 86 ) experienced more improvement on b-ADL and HRQoL compared with the control group ( n = 82 ) . These effects were statistically significant for the b-ADL index ( p = 0.013 ) and the ' physical subscale pain ' ( p = 0.049 ) . DISCUSSION AND CONCLUSION These positive results can be seen as promising for further development of intervention strategies , although follow-up study should be conducted to determine long term effectiveness This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty BACKGROUND Driving cessation can lead to myriad negative consequences for older adults . The purpose of these analyses was to examine driving status as a predictor of mortality among community-dwelling older adults . METHODS This prospect i ve cohort study included 660 community-dwelling adults ranging in age between 63 and 97 years . Between 2000 and 2004 , participants completed performance-based assessment s of vision , cognition , and physical abilities and indexes of health , depression , self-efficacy , and driving habits . Follow-up telephone interviews were completed approximately 3 years later . RESULTS Among community-dwelling older adults , older age , health , poor near visual acuity , depressive symptoms , compromised cognitive status , and being a nondriver are associated with increased risk for a 3-year mortality . Nondrivers were four to six times more likely to die than drivers during the subsequent 3-year period . CONCLUSIONS The ability to drive represents both a sign of cherished independence and underlying health and well-being for older adults . Retaining this ability is an important health concern in the United States Background : A number of cross‐sectional studies have suggested that higher levels of  sedentary behavior ( SB ) are associated with worse cognitive abilities  in older age . There is a paucity of longitudinal studies investigating this relationship utilizing objective ly assessed SB . This study investigated the relationship between objective ly assessed SB and future cognitive abilities in a cohort of older adults . Methods : A longitudinal study over 22.12 ± 1.46 months including 285 community‐dwelling older adults across 14 regions in Taiwan was undertaken . Cognitive ability was ascertained using a Chinese version of the Ascertain Dementia 8‐item Question naire ( AD8 ) and SB captured by 7 days accelerometer data . Multivariable negative binomial regression models adjusted for confounders were undertaken . Results : 274 community‐dwelling older adults finished the study ( age = 74.6 ± 6.2 , % female = 54.4 % ) . At baseline , 20.1 % ( n = 55 ) , 48.5 % ( n = 133 ) and 31.4 % ( n = 86 ) of the sample engaged in high ( 11 + h ) , medium ( 7–10.99 h ) and low ( < 7 h ) of SB respectively . In the fully adjusted model , higher levels of SB were associated with an increased risk of worse cognitive ability at follow up ( adjusted rate ratio (ARR)1.09 ( 95%CI:1.00–1.19 ) ) , with the strongest relationship evident in those engaging in over 11 h of SB ( ARR 2.27 ( 95%CI:1.24–4.16 ) ) . The relationship remained evident after adjusting for depressive symptoms and physical activity . Conclusion : Our data suggests that objective ly assessed SB , particularly when over 11 h a day , is independently associated with worse cognitive ability over a two year period . Our data adds to the pressing reasons to reduced SB in older age . HighlightsFirst prospect i ve study to investigate objective  ly sedentary behavior ( SB ) and cognition in older adults . Higher levels of objective SB were independently associated with worse cognitive ability over two years . This relationship was most pronounced in older people spending over 11 h a day being sedentary OBJECTIVES The prospect i ve relationships between self-efficacy beliefs , in conjunction with measures of knee pain and knee strength , and subsequent decline in both physical performance and self-reported disability among older adults with knee pain were examined . METHODS In this prospect i ve epidemiological trial , 480 men and women aged 65 years and older who had knee pain on most days of the week and difficulty with daily activity were followed for 30 months . RESULTS There was a significant interaction of baseline self-efficacy with baseline knee strength in predicting both self-reported disability and stair climb performance . Participants who had low self-efficacy and low strength at baseline had the largest 30-month decline in these outcomes . DISCUSSION These data underscore the important role that self-efficacy beliefs play in underst and ing functional decline with chronic disease and aging . Self-efficacy beliefs appear to be most important to functional decline in older adults when they are challenged by muscular weakness in the lower extremities BACKGROUND The frailty syndrome is as a well-established condition of risk for disability . Aim of the study is to explore whether a physical activity ( PA ) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability . METHODS Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot , a r and omized controlled trial enrolling 424 community-dwelling persons ( mean age=76.8 years ) with sedentary lifestyle and at risk of mobility disability . Participants were r and omized to a 12-month PA intervention versus a successful aging education group . The frailty phenotype ( ie , ≥3 of the following defining criteria : involuntary weight loss , exhaustion , sedentary behavior , slow gait speed , poor h and grip strength ) was measured at baseline , 6 months , and 12 months . Repeated measures generalized linear models were conducted . RESULTS A significant ( p = .01 ) difference in frailty prevalence was observed at 12 months in the PA intervention group ( 10.0 % ; 95 % confidence interval = 6.5 % , 15.1 % ) , relative to the successful aging group ( 19.1 % ; 95 % confidence interval = 13.9%,15.6 % ) . Over follow-up , in comparison to successful aging participants , the mean number of frailty criteria in the PA group was notably reduced for younger subjects , blacks , participants with frailty , and those with multimorbidity . Among the frailty criteria , the sedentary behavior was the one most affected by the intervention . CONCLUSIONS Regular PA may reduce frailty , especially in individuals at higher risk of disability . Future studies should be aim ed at testing the possible benefits produced by multidomain interventions on frailty Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking . A task-oriented , motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed , but whether the intervention also improves activity and participation has not been demonstrated . Objective The objective of this study was to compare the impact of a task-oriented , motor sequence learning exercise ( TO ) intervention and the impact of an impairment-oriented , multicomponent exercise ( IO ) intervention on activity and participation outcomes in older adults with mobility limitations . The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined . Design This study was a single-blind , r and omized controlled trial . Setting The study was conducted in an ambulatory clinical research training center . Participants The study participants were 47 older adults ( mean age=77.2 years , SD=5.5 ) with slow and variable gait . Intervention The intervention was a 12-week , physical therapist – guided program of TO or IO . Measurements Measures of activity ( gait speed over an instrumented walkway ; daily physical activity measured with an accelerometer ; confidence in walking determined with the Gait Efficacy Scale ; and physical function determined with the total , basic lower-extremity , and advanced lower-extremity components of the Late-Life Function and Disability Instrument [ Late-Life FDI ] ) and participation ( disability limitation dimension and instrumental role [ home and community task performance ] domain components of the Late-Life FDI ) were recorded before and after the intervention . The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state st and ardized by walking speed . An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model , with baseline and change in energy cost of walking added to the model to test for mediation . Tests were used to determine the significance of the mediating effects . Results Activity improved in TO but not in IO for confidence in walking ( Gait Efficacy Scale ; mean adjusted difference=9.8 [ SD=3.5 ] ) and physical function ( Late-Life FDI basic lower-extremity component ; mean adjusted difference=3.5 [ SD=1.7 ] ) . Improvements in TO were marginally greater than those in IO for gait speed , physical activity , and total physical function . Participation improved marginally more in TO than in IO for disability limitations and instrumental role . Limitations The older adults were r and omized to the intervention group , but differences in baseline measures had to be accounted for in the analyses . Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations Background Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults . We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments . Objective We aim ed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas . Methods To address the above evaluation goal , we carried out the “ Smart Walk ” program , a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center . We r and omly selected older adults who had enrolled in a population -based , prospect i ve cohort study of aging , the Aging Study of Pyeongchang Rural Area . The “ Smart Walk ” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching , 1 month of rest , and 6 months of self-management . We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program . We also performed intergroup analysis according to adherence of wearable devices . Results We recruited 22 participants ( 11 robust and 11 prefrail older adults ) . The two groups were similar in most of the variables , except for age , frailty index , and Short Physical Performance Battery score associated with frailty criteria . After a 6-month coaching program , the prefrail group showed significant improvement in usual gait speed ( mean 0.73 [ SD 0.11 ] vs mean 0.96 [ SD 0.27 ] , P=.02 ) , International Physical Activity Question naire scores in kcal ( mean 2790.36 [ SD 2224.62 ] vs mean 7589.72 [ SD 4452.52 ] , P=.01 ) , and European Quality of Life-5 Dimensions score ( mean 0.84 [ SD 0.07 ] vs mean 0.90 [ SD 0.07 ] , P=.02 ) , although no significant improvement was found in the robust group . The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period ( 5,584,295.83 vs 1,289,084.66 , P<.001 ) . We found that participants in the “ long-self ” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 ( SD 1.317 ) and mean 0.097 ( SD 0.513 ) , respectively , compared with the other groups . Conclusions Our “ Smart Walk ” program  improved physical fitness , anthropometric measurements , and geriatric assessment categories in a small group of older adults in rural areas with limited re sources for monitoring . Further validation through various rural public health centers and in a large number of rural older adults is required Background Evidence on the relation between leisure-time physical activity ( LTPA ) and health-related quality of life ( HRQoL )  in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons . Moreover , there is no evidence on whether leisure-time sedentary behavior ( LTSB ) is associated with HRQoL independently of LTPA . This study examined the longitudinal association between LTPA , LTSB , and HRQoL in older community-dwelling adults in Spain . Methods Prospect i ve cohort study of 1,097 persons aged 62 and over . In 2003 LTPA in MET-hr/week was measured with a vali date d question naire , and LTSB was estimated by the number of sitting hours per week . In 2009 HRQoL was measured with the SF-36 question naire . Analyses were done with linear regression and adjusted for the main confounders . Results Compared with those who did no LTPA , subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning ( β 5.65 ; 95 % confidence interval [ CI ] 1.32 - 9.98 ; p linear trend < 0.001 ) , physical role ( β 7.38 ; 95 % CI 0.16 - 14.93 ; p linear trend < 0.001 ) , bodily pain ( β 6.92 ; 95 % CI 1.86 - 11.98 ; p linear trend < 0.01 ) , vitality ( β 5.09 ; 95 % CI 0.76 - 9.41 ; p linear trend < 0.004 ) social functioning ( β 7.83 ; 95 % CI 2.89 - 12.75 ; p linear trend < 0.001 ) , emotional role ( β 8.59 ; 95 % CI 1.97 - 15.21 ; p linear trend < 0.02 ) and mental health ( β 4.20 ; 95 % CI 0.26 - 8.13 ; p linear trend < 0.06 ) . As suggested by previous work in this field , these associations were clinical ly relevant because the β regression coefficients were higher than 3 points . Finally , the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales , which was also clinical ly relevant . Conclusions Greater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults Objectives : To examine the effect that physical activity delivered via two different versions of the Green Prescription ( a primary care physical activity scripting program ) had on depressive symptomatology and general mental health functioning over a 12-month period in non-depressed , low-active , community-dwelling older adults . Method : Two hundred and twenty-five participants from the Healthy Steps study took part in the present study . Healthy Steps participants were r and omized to receive either the st and ard time-based or a modified pedometer-based Green Prescription .  Depression , mental health functioning and physical activity were measured at baseline , post-intervention ( 3 months post-baseline ) and at the 9-month follow-up period . Results : At post-intervention , a positive association was found between increases in leisure-time physical activity and total walking physical activity and a decrease in depressive symptomatology ( within the non-depressed range of the GDS-15 ) and an increase in perceived mental health functioning , regardless of intervention allocation . These improvements were also evident at the follow-up period for participants in both intervention allocation groups . Conclusion : Our findings suggest that the st and ard time-based Green Prescription and a modified pedometer-based Green Prescription are both effective in maintaining and improving mental health in non-depressed , previously low-active older adults 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 Physical inactivity is a major health problem in the United States , particularly in elderly and disabled population s. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis ( MS ) . We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental , self-efficacy and functional limitations in underst and ing physical activity levels among elderly women and women with MS . Older women ( n=136 ) and women diagnosed with MS ( n=173 ) were recruited to participate in separate cross-sectional studies . Individuals completed a battery of question naires and wore an activity monitor for 7 days . All measures were issued and collected through the mail with the use of self-addressed , pre-paid envelopes . Initial correlational analyses indicated that self-efficacy , functional limitations and environmental perceptions were significantly related to physical activity . Among older women , self-efficacy , functional limitations and street connectivity demonstrated independent contributions to physical activity behavior . Only self-efficacy and functional limitations demonstrated significant associations among women with MS . The prospect i ve contributions of the environment and individual factors to changes in physical activity need to be determined
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 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 .