Health Promotion Through Primary Care: Enhancing Self-Management With Activity Prescription and mHealth Predictors of long-term exercise adherence in a community-based sample of older women. Exercise on Prescription: trial protocol and evaluation of outcomes A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial) The Los Angeles Lift Off: a sociocultural environmental change intervention to integrate physical activity into the workplace. Prescribing exercise at varied levels of intensity and frequency: a randomized trial. Exercise and well-being: a review of mental and physical health benefits associated with physical activity A Walking Program for Outpatients in Psychiatric Rehabilitation: Pilot Study Smoking cessation program with exercise improves cardiovascular disease biomarkers in sedentary women. A personalized approach to exercise promotion in adolescents with type 1 diabetes. Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings. An Exercise Program for Women Who Are Caring for Relatives With Dementia 'Physical activity at home (PAAH)', evaluation of a group versus home based physical activity program in community dwelling middle aged adults: rationale and study design A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. Adherence to a home-walking prescription in patients with chronic obstructive pulmonary disease. At cancer diagnosis: a ‘window of opportunity’ for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer Prescribing Physical Activity Through Primary Care: Does Activity Intensity Matter? Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: A Phase II Preclinical Exploratory Trial
Abstract Background : It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention . Remote monitoring technologies ( ie , mHealth ) hold promise for engaging patients in self-management of many chronic diseases . The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity ( eg , exercise , sedentary behavior , or both ) for improving physiological and behavioral markers of lifestyle-related disease risk . Methods : Forty-five older adults ( aged 55–75 years ; mean age 63 ± 5 years ) were r and omly assigned to receive a personal activity program targeting changes to either daily exercise , sedentary behavior , or both . All participants received an mHealth technology kit including smartphone , blood pressure monitor , glucometer , and pedometer . Participants engaged in physical activity programming at home during the 12-week intervention period and su bmi tted physical activity ( steps/day ) , blood pressure ( mm Hg ) , body weight ( kg ) , and blood glucose ( mmol/L ) measures remotely using study -provided devices . Results : There were no differences between groups at baseline ( P > 0.05 ) . The intervention had a significant effect ( F(10 488 ) = 2.947 , P = 0.001 , ηP2 = 0.057 ) , with similar changes across all groups for physical activity , body weight , and blood pressure ( P > 0.05 ) . Changes in blood glucose were significantly different between groups , with groups prescribed high-intensity activity ( ie , exercise ) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone ( P < 0.05 ) . Conclusions : Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women . Results support the novel approach of prescribing changes to sedentary behaviors ( alone , and in conjunction with exercise ) to reduce risk of developing lifestyle-related chronic conditions BACKGROUND Few studies have examined long-term exercise adherence in older women . The purpose of this study was to assess predictors of adherence to an intervention involving walking and balance exercises . METHODS This was a r and omized controlled trial with 2-year follow-up . Sedentary women ( n = 137 ) aged > or = 70 r and omized to the exercise intervention were evaluated in their homes . The exercise prescription included walking 30 minutes per day 5 days per week and completing 11 balance exercises twice per week . The main outcome measure was  exercise adherence  of the intervention group only . RESULTS The average number of minutes walked per week was 95.2 ( SD 68.8 ) ; 17 % walked the recommended 150 minutes or greater . The average number of times the balance exercises  were done was 1.5 ( SD 1.6 ) per week . Results of regression analysis for walking adherence showed clinical variables accounted for the greatest variance ( 17 % ) of all the blocks , and cognitive variables were second highest ( 12 % ) . The final model explained 19 % of the variance in predicting adherence to walking . Results of regression analysis for adherence to balance exercises showed health-related quality of life ( HRQOL ) variables accounted for the greatest variance ( 14 % ) , followed by cognitive variables ( 12 % ) . The final model explained 24 % of the variance in predicting adherence to balance exercises . CONCLUSIONS Adherence to exercise was below recommended goals , although this study demonstrated that sedentary women can adopt and continue regular exercise long term . Predictors of adherence varied with different forms of exercise . Individually tailored exercise interventions may be most amenable to older women Background In many countries exercise prescriptions are used in an attempt to initiate a physically active lifestyle in sedentary population s. Previous studies have primarily evaluated low intensive exercise prescription interventions and found moderately positive effects on physical activity and aerobic fitness . In a highly intensive Danish exercise prescription scheme called ' Exercise on Prescription ' ( EoP ) the general practitioners can prescribe EoP to sedentary patients with lifestyle diseases . The aim of this r and omized trial is to assess the short- and long-term effects of the EoP scheme . Thus , the aim of this paper is to describe the r and omized controlled trial design ed for evaluating effectiveness of EoP , and to present results from validations of outcome measures . Methods / Design EoP involves a 16-week supervised training intervention and five counselling sessions ( health profiles ) .  All patients referred to EoP were eligible for the trial and were offered participation during the baseline health profile . Comparisons between the EoP group and the control group were made at baseline , and after four and ten months . Physiological measures used were maximal oxygen uptake ( VO2max ) , glycosylated haemoglobin ( HbA1c ) , bodyweight , and BMI . Patient-reported measures used were physical activity , health-related quality of life , amount and intensity of exercise , compliance with national guidelines for physical activity , and physical fitness . The validation of the cycle ergometer test found a strong correlation between maximal work capacity and VO2max , and acceptable test-retest reliability at group level . Calibration of the HbA1c apparatus was stable over ten weeks with minimal use , and test-retest reliability was good . High agreement percents were found for test-retest reliability for the self-administered question naire . Discussion The trial is design ed to provide information about the effectiveness of the EoP scheme . The trial is part of a health technology assessment of EoP , which besides the effectiveness covers the patient perspective , the organization , and the health economy . All three methods vali date d were found useful for the EoP trial Background Chronic low back pain ( CLBP ) is a persistent disabling condition with rising significant healthcare , social and economic costs . Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery . While international clinical guidelines and systematic review s for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost , barriers to their delivery include space and time restrictions in healthcare setting s and poor patient attendance . The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP . Walking may be an ideally suited form of individualized exercise prescription as it is easy to do , requires no special skills or facilities , and is achievable by virtually all ages with little risk of injury , but its effectiveness for LBP is unproven . Methods and design This study will be an assessor-blinded r and omized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy , which will act as the control group , in people with chronic low back pain . A sample of 246 patients will be recruited in Dublin , Irel and through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP . Patients will be r and omly allocated to one of the three groups in a concealed manner . The main outcomes will be functional disability , pain , quality of life , fear avoidance , back beliefs , physical activity , satisfaction and costs , which will be evaluated at baseline , and 3 , 6 and 12 months [ follow-up by pre-paid postage ] . Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants ' experiences of the interventions and trial participation , and to inform interpretation of the quantitative data . Planned analysis will be by intention to treat ( quantitative data ) and thematic analysis ( qualitative data ) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registration Current controlled trial IS RCT PURPOSE To present the development and feasibility testing of a sociocultural environmental change intervention strategy aim ed at integrating physical activity into workplace routine . DESIGN R and omized , controlled , post-test only , intervention trial . Setting . Los Angeles County Department of Health Services ' worksites . PARTICIPANTS Four hundred forty-nine employees , predominantly sedentary , overweight , middle-aged women of color , distributed across 26 meetings . INTERVENTION A single 10-min exercise break during work time involving moderate intensity , low-impact aerobic dance and calisthenic movements to music . MEASURES Primary -level of participation , particularly among sedentary staff ; secondary -self-perceived health status , satisfaction with current fitness level , and mood/affective state . RESULTS More than 90 % of meeting attendees participated in the exercises . Among completely sedentary individuals , intervention participants ' self-perceived health status ratings were significantly lower than controls ' ( OR = 0.17 ; 95 % CI = 0.05 , 0.60 ; P = 0.0003 ) . Among all respondents not regularly physically active , intervention participants ' levels of satisfaction with fitness were more highly correlated with self-ranked physical activity stage of change ( r = 0.588 ) than the control participants ' ( r = 0.376 , z = -2.32 , p = 0.02 ) . Among the completely sedentary , control participants reported significantly higher levels of energy than did intervention participants ( P < 0.01 ) . CONCLUSIONS Captive audiences may be engaged in brief bouts of exercise as a part of the workday , regardless of physical activity level or stage of change . This experience may also appropriately erode sedentary individuals ' self-perception of good health and fitness , providing motivation for adoption of more active lifestyles BACKGROUND Regular physical activity produces beneficial effects on health , but the exercise prescription needed to improve cardiovascular disease risk factors in free-living sedentary individuals remains unclear . METHODS Sedentary adults ( N = 492 , 64.0 % women ) were r and omized to 1 of 4 exercise-counseling conditions  or to a  physician advice comparison group . The duration ( 30 minutes ) and type ( walking ) of exercise were held constant , while exercise intensity and frequency were manipulated to form 4 exercise prescriptions : moderate intensity-low frequency , moderate intensity-high frequency ( HiF ) , hard intensity (HardI)-low frequency , and HardI-HiF. Comparison group participants received physician advice and written material s regarding recommended levels of exercise for health . Outcomes included 6- and 24-month changes in cardiorespiratory fitness ( maximum oxygen consumption ) , high-density lipoprotein cholesterol ( HDL-C ) level , and the total cholesterol-HDL-C ratio . RESULTS At 6 months , the HardI-HiF , HardI-low-frequency , and moderate-intensity-HiF conditions demonstrated significant increases in maximum oxygen consumption ( P < .01 for all ) , but only the HardI-HiF condition showed significant improvements in HDL-C level ( P < .03 ) , total cholesterol-HDL-C ratio ( P < .04 ) , and maximum oxygen consumption ( P < .01 ) compared with physician advice . At 24 months , the increases in maximum oxygen consumption remained significantly higher than baseline in the HardI-HiF , HardI-low-frequency , and moderate-intensity-HiF conditions and in the HardI-HiF group compared with physician advice ( P < .01 for all ) , but no significant effects on HDL-C level ( P = .57 ) or total cholesterol-HDL-C ratio ( P = .64 ) were observed . CONCLUSIONS Exercise counseling with a prescription for walking at either a HardI or a HiF produced significant long-term improvements in cardiorespiratory fitness . More exercise or the combination of HardI plus HiF exercise may provide additional benefits , including larger fitness changes and improved lipid profiles Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life The purpose s of this quasi-experimental pilot study were to determine adherence to a 12-week group-based moderate-intensity walking program for sedentary adult out patients with serious and persistent mental illness and to examine change from baseline to after the walking program in health status ( mental and physical health , mood , and psychosocial functioning ) and exercise motivation ( exercise outcomes expectancies , exercise decisional balance ) .  The 15 volunteers in this study were aged 21 to 65 years and enrolled in psychosocial rehabilitation ; they participated in a 12-week walking program meeting three times per week for 1 hr , supplemented with four health information workshops delivered at the beginning of the study . Participants received individual exercise prescriptions determined by preprogram fitness testing and used heart rate monitors during walking sessions .  Thirteen participants ( 87 % ) completed the study and attended 76 % of the walking sessions . Overall , they walked at lower intensity than prescribed , with pulses within target heart rate ranges 35 % of the time during Weeks 1 through 4 , 26 % of the time during Weeks 5 through 8 , and 22 % of the time during Weeks 9 through 12 . However , mood improved ( Profile of Mood States , t = -2.51 , two-tailed , df = 12 , p = .02 ) , as did psychosocial functioning ( Multnomah Community Ability Scale , two-tailed , df = 12 , t = 2.49 , p = .02 ) . The findings indicate a walking group may be feasible for rehabilitation programs . In addition to the known cardiovascular risk-reduction benefits of regular walking , walking may improve mood and psychosocial functioning in adults with serious and persistent mental illness BACKGROUND Several cardiovascular disease ( CVD ) biomarkers sensitive to tobacco exposure have been identified , but how tobacco use cessation impacts them is less clear . We sought to investigate the effects of a smoking cessation program with an exercise intervention on CVD biomarkers in sedentary women . METHODS This is a cohort study on a sub sample of a 2 × 2 factorial r and omized controlled trial ( RCT ) ( exercise setting : home vs. facility ; level of exercise counseling : prescription only vs. prescription and adherence counseling ) conducted January 2004 through December 2007 . The analyses were completed in October 2010 . In the greater Boston area , 130 sedentary female smokers aged 19 - 55 completed a 15-week program . All participants received nicotine replacement therapy ( transdermal patch ) and brief behavioral counseling for 12 weeks . They all received an exercise prescription on a moderate intensity level . All exercise interventions lasted for 15 weeks , from 3 weeks precessation until 12 weeks postcessation . Main outcome measures were selected CVD biomarkers hypothesized to be affected by smoking cessation or exercise measured at baseline and 12 weeks postcessation . RESULTS Independent of tobacco abstinence , improvement was seen in inflammation ( white blood cells [ WBC ] ) , prothrombotic factor ( red blood cells [ RBC ] ) , and cardiovascular fitness level ( maximum oxygen consumption [ Vo(2)max ] ) . This suggests that even if complete abstinence is not achieved , reduction in tobacco exposure and increase in exercise can improve the cardiovascular risk profile . A significant decrease was seen for total cholesterol and the total cholesterol high-density lipoprotein cholesterol ( HDL-C ) : ratio only among the abstainers . The heart rate was reduced among all participants , but this decrease was more profound among abstainers . A significant weight gain and body mass index ( BMI ) increase were observed among abstainers and those who relapsed . We also found an increase in hemoglobin A1c ( Hb A1c ) , although significant only when the groups were combined . CONCLUSIONS A smoking cessation intervention including exercise  reduced tobacco-induced cardiovascular damage selectively within 3 months PURPOSE This exploratory study tested the feasibility of conducting a novel , personalized exercise intervention based upon the current fitness levels of adolescents with type 1 diabetes ( T1DM ) . The relationships of perceptions of benefits and barriers to exercise , exercise self-efficacy and family support to exercise adherence and changes in cardiovascular ( CV ) fitness , quality of life ( QOL ) , and glycemic control were studied . METHODS Adolescents who were sedentary received a grade d exercise test to determine their current fitness level ( VO(2peak ) ) . A 16-wk personalized exercise program was developed for each adolescent based upon individual fitness level and exercise preferences . Pretest and posttest measures of exercise self-efficacy , benefits and barriers to exercise , family support , and diabetes QOL were completed . A1c levels were obtained using the DCA2000 . Adherence to exercise  was measured using the Actigraph Accelerometer . RESULTS Twelve adolescents completed the study . Accelerometry data revealed adherence to 60 min of moderate-to-vigorous physical activity ( MVPA ) per day for a mean of 45.5 ( SD = 23.9)% of the days the accelerometer was worn . Adolescents ' perceptions of family support for exercise improved following the intervention ( p = 0.03 ) . Adolescents who had more daily bouts of exercise lasting 60 min increased their CV fitness ( r = 0.59 , p = 0.04 ) . A1c remained unchanged . CONCLUSIONS Encouraging 60 min of accumulated exercise bouts/d can improve fitness levels in adolescents with T1DM , minimizing future CV risks . Although physical activity increased in adolescents , family based strategies are required to promote current physical activity recommendations Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities . This study r and omly assigned overweight , sedentary , economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center , a large inner-city health facility providing numerous options for exercise . Within the tenets of Social Action Theory , the Health Opportunities with Physical Exercise ( HOPE ) trial will test the efficacy of two behavior change models , social support and patient-provider interaction , to increase physical activity . In addition to a st and ard care condition , in which patients have open access to Hope and Healing physical activity programming , patients were assigned to one of two behavior change interventions . Those assigned to patient-peer receive face-to-face , systematic and scheduled encouragement from study -trained ' peer ' interventionists at the facility . Patients assigned to patient-provider receive face-to-face , systematic and scheduled encouragement provided by study -trained ' provider ' interventionists also at the facility . The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline , 6 , 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up . Intervention conditions will be compared on psychosocial mediators including motivational appraisal s , ratings of social support , rapport , problem solving and self-efficacy for overcoming barriers to increased physical activity . Novel aspects of this intervention include : ( 1 ) delivery of socially based physical activity interventions to an economically disadvantaged urban population , ( 2 ) reduction of environmental barriers to be physically active and ( 3 ) emphasis on social interactions influencing health habit change . Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aim ed at reducing sedentary behavior and health disparities in high-risk , underserved population Objective This study describes factors related to retention and adherence to an exercise program for women caregivers . Methods One hundred sedentary women ( average age = 62 years ) caring for relatives with dementia were r and omly assigned to an exercise program or an attention control ( nutrition education ) condition . Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week , for at least 30 minutes per session . Adherence was tracked through monthly exercise logs , vali date d in a sub sample by ambulatory heart rate and motion monitors . Participants also completed a psychosocial question naire battery at baseline and 12 months after r and omization . Results Participants achieved a 12-month average exercise adherence rate of 74 % ( ie , three exercise sessions per week ) with an average of 35 minutes per session . At 12 months , the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition . Both groups significantly improved in perceived stress , burden , and depression from baseline to posttest . Women who were older , less depressed , and more anxious at baseline showed better program retention , and lower baseline depression was associated with better exercise adherence . Conclusions This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population . Given the independent risk factors of caregiving and physical inactivity on mortality , programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role Background It is well recognised that the adoption and longer term adherence to physical activity by adults to reduce the risk of chronic disease is a challenge . Interventions , such as group and home based physical activity programs , have been widely reported upon . However few studies have directly compared these interventions over the longer term to determine their adherence and effectiveness . Participant preference for home based or group interventions is important . Some evidence suggests that home based physical activity programs are preferred by middle aged adults and provide better long term physical activity adherence . Physiotherapists may also be useful in increasing physical activity adherence , with limited research on their impact . Methods ' Physical Activity at Home ' is a 2 year pragmatic r and omised control trial , with a non-r and omised comparison to group exercise .  Middle-aged adults not interested in , or unable to attend , a group exercise program  will be targeted . Sedentary community dwelling 50 - 65 year olds with no serious medical conditions or functional impairments will be recruited via two mail outs using the Australian federal electoral roll . The first mail out will invite participants to a 6 month community group exercise program . The second mail out will be sent to those not interested in the  group exercise program inviting them to take part in a home based intervention .  Eligible home based participants will be r and omised into a 6 month physiotherapy-led home based physical activity program or usual care . Outcome measures will be taken at baseline , 6 , 12 , 18 and 24 months . The primary outcome is physical activity adherence via exercise diaries . Secondary outcomes include the Active Australia Survey , accelerometry , aerobic capacity ( step test ) , quality of life ( SF-12v2 ) , blood pressure , waist circumference , waist-to-hip ratio and body mass index . Costs will be recorded prospect ively and qualitative data will be collected . Discussion The planned 18 month follow-up post intervention will provide an indication of the effectiveness of the group and home based interventions in terms of adherence to physical activity , health benefits and cost . If the physiotherapy-led home based physical activity program is successful it could provide an alternative option for physical activity program delivery across a number of setting s . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : BACKGROUND Women diagnosed with gestational diabetes mellitus ( GDM ) are at substantially increased risk of developing type 2 diabetes and obesity , currently at epidemic rates in the United States . GDM , therefore , identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder . It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes . To date , however , primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder . METHODS The aims of this study are to investigate the effects of a motivationally targeted , individually tailored 12-week physical activity intervention on ( 1 ) development of GDM , ( 2 ) serum biomarkers associated with insulin resistance , and ( 3 ) the adoption and maintenance of exercise during pregnancy .  Women at high risk of GDM are recruited in early pregnancy and r and omized to either an individually tailored exercise intervention or a comparison health and wellness intervention . RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle . CONCLUSIONS The intervention takes into account the specific social , cultural , economic , and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic background BACKGROUND Although exercise parameters such as intensity and format have been shown to influence exercise participation rates and physiological outcomes in the short term , few data are available evaluating their longer-term effects . The study objective was to determine the 2-year effects of differing intensities and formats of endurance exercise on exercise participation rates , fitness , and plasma HDL cholesterol levels among healthy older adults . METHODS AND RESULTS Higher-intensity , group-based exercise training ; higher-intensity , home-based exercise ; and lower-intensity , home-based exercise were compared in a 2-year r and omized trial . Participants were 149 men and 120 postmenopausal women 50 to 65 years of age who were sedentary and free of cardiovascular disease . Recruitment was achieved through a r and om digit-dial community telephone survey and media promotion . All exercise occurred in community setting s. For higher-intensity exercise training , three 40-minute endurance training sessions per week were prescribed at 73 % to 88 % of peak treadmill heart rate . For lower-intensity exercise , five 30-minute endurance training sessions per week were prescribed at 60 % to 73 % of peak treadmill heart rate . Treadmill exercise performance , lipoprotein levels and other heart disease risk factors , and exercise adherence were evaluated at baseline and across the 2-year period . Treadmill exercise test performance improved for all three training conditions during year 1 and was successfully maintained during year 2 , particularly for subjects in the higher-intensity , home-based condition . Subjects in that condition also showed the greatest year 2 exercise adherence rates ( P < .003 ) . Although no significant increases in HDL cholesterol were observed during year 1 , by the end of year 2 subjects in the two home-based training conditions showed small but significant HDL cholesterol increases over baseline ( P < .01 ) . The increases were particularly pronounced for subjects in the lower-intensity condition , whose exercise prescription required more frequent exercise sessions per week . For all exercise conditions , increases in HDL cholesterol were associated with decreases in waist-to-hip ratio in both men and women ( P < .04 ) . CONCLUSIONS While older adults can benefit from initiating a regular regimen of moderate-intensity exercise in terms of improved fitness levels and small improvements in HDL cholesterol levels , the time frame needed to achieve HDL cholesterol change ( 2 years ) may be longer than that reported previously for younger population s. Frequency of participation may be particularly important for achieving such changes . Supervised home-based exercise regimens represent a safe , attractive alternative for achieving sustained participation BACKGROUND We know little about long-term exercise behavior and adherence in patients with chronic obstructive pulmonary disease ( COPD ) . PURPOSE The study 's purpose was ( 1 ) to describe exercise behavior and adherence to a home-walking exercise prescription over 12 months in a sample of patients with COPD ; and ( 2 ) to vali date categories of exercise adherence over time in this population . DESIGN This was a secondary analysis of a r and omized controlled trial . SUBJECTS A total of 103 participants with COPD who were r and omly assigned to one of three versions of a dyspnea self-management program participated .  MEASURES The components of exercise frequency , duration , and intensity were measured by exercise/dyspnea daily logs , and participants were classified into categories on the basis of their pattern of exercise adherence over the year . RESULTS Participants walked an average of 3 days per week initially , with a decline to 2.5 days per week over the year . On average , participants walked longer than the prescribed duration of 20 minutes per session . Dyspnea intensity at the end of the walk tended to remain stable at a mean level of 4 over the year . Classification by adherence category distinguished differences in 6-minute walk distance , endurance treadmill test time , Short Form-36 physical function , and Short Form-36 mental health , with endurance treadmill test time and physical function improvements mirroring increases in exercise adherence , and mental health highest among occasional lapse and lowest among relapser and recycle categories . CONCLUSIONS This investigation provides a description of long-term exercise behavior and adherence in a sample of patients with COPD . The categories suggest that physical benefits are related to consistent adherence , whereas mental health improvements are related to regular exercise with some flexibility in the schedule . Future research should test interventions to improve exercise adherence in patients with COPD and identify characteristics of patients who are most likely and least likely to adhere over time Introduction Challenges exist in identifying , recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels . We hypothesise that the onset period of adjuvant chemotherapy can be ‘ the open window of opportunity ’ to identify and motivate sedentary patients with breast and colon cancers , at risk for developing coronary heart disease , to initiate and sustain lifestyle changes . Aims To investigate the feasibility of oncologists/nurses screening for physical inactivity , in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy . Furthermore , the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks ; ( 1 ) hospital-based , high intensity , group exercise intervention ( 2 ) home-based , low intensity , individual , pedometer intervention . Both arms will be compared with a control group . Methods and analyses All newly referred patients will be screened for sedentary behaviour , using national recommendations . Testing at baseline , 6 , 12 and 39 weeks will include ; ( 1 ) physiological testing ( VO2-peak , one repetition maximum muscle strength and lung function ( 2 ) fasting full body dual-energy X-ray absorptiometry scan ( 3 ) fasting blood glucose , insulin , lipids and cholesterols , ( 4 ) psychometric question naires ( general well-being , quality of life , anxiety and depression , motivational readiness ) . The r and omised controlled trial feasibility design is selected in order to examine barriers for recruitment , programme adherence , safety aspects and potential efficacy to the interventions during adjuvant chemotherapy . Ethics and dissemination The Scientific Committee of the Capital Region ( case No. H-1 - 2011 - 131 ) and the Danish Data Protection Agency ( j. No. 2011 - 41 - 6349 ) approved the study . Data will be entered and locked into a data base hosted by the Copenhagen Trial Unit , Rigshosptialet . Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test . Results will be published in peer- review ed scientific journals . Trial registration Current Controlled Trials IS RCT N24901641 Abstract Background : Physical activity guidelines recommend engaging in moderate- and vigorous-intensity physical activity to elicit health benefits . Similarly , these higher intensity ranges for activity are typically targeted in healthy living interventions ( ie , exercise prescription ) . Comparatively less attention has been focused on changing lower intensity physical activity ( ie , sedentary activity ) behaviors . The purpose of this study was to explore the effects of prescribing changes to physical activity of various intensities ( ie , sedentary through exercise ) through the primary care setting . Methods : Sixty older adults ( aged 55–75 years ; mean age 63 ± 5 years ) volunteered to participate , and were r and omly assigned to 4 groups : 3 receiving an activity prescription intervention targeting a specific intensity of physical activity ( exercise , sedentary , or both ) , and 1 control group . During the 12-week intervention period participants followed personalized activity programs at home . Basic clinical measures ( anthropometrics , blood pressure , aerobic fitness ) and blood panel for assessing cardiometabolic risk ( glucose , lipid profile ) were conducted at baseline ( week 0 ) and follow-up ( week 12 ) in a primary care office . Results : There were no differences between groups at baseline ( P > 0.05 ) . The intervention changed clinical ( F(5 , 50 ) = 20.458 , P = 0.000 , ηP2 = 0.672 ) and blood panel measures ( F(5 , 50 ) = 4.576 , P = 0.002 , ηP2 = 0.314 ) of cardiometabolic health . Post hoc analyses indicted no differences between groups ( P > 0.05 ) . Conclusion : Physical activity prescription of various intensities through the primary care setting improved cardiometabolic health status . To our knowledge , this is the first report of sedentary behavior prescription ( alone , or combined with exercise ) in primary care . The findings support the ongoing practice of fitness assessment and physical activity prescription for chronic disease management and prevention Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence  in 269 healthy , initially sedentary adults ages 50 - 65 years . Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year . Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later . Predictors of short-term ( 1-year ) adherence were generally similar to predictors of 2-year adherence . Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention 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 Individuals with multiple sclerosis ( MS ) are more sedentary than the general population , increasing their propensity for reduced functional ability , mobility , and activities of daily living . Self-efficacy has been one of the most consistent determinants of physical activity across population s , including those with MS . However , no studies exist that have attempted to influence self-efficacy in MS patients , in an effort to improve physical activity participation . We conducted a three-month r and omised , controlled trial ( n = 26 ) , contrasting the effects of an efficacy-enhancement exercise condition and a control exercise condition on exercise adherence , well-being , and affective responses to exercise .  Analyses indicated that individuals in the efficacy enhancement condition attended more exercise sessions , reported greater levels of well-being and exertion , and felt better following exercise than individuals in the st and ard care condition . Regardless of treatment condition , individuals with a stronger sense of exercise self-efficacy , who reported more enjoyment following the exercise sessions , demonstrated significantly greater adherence with the  exercise program  . We believe this to be the first empirical attempt to change physical activity behavior in persons with MS using a well-established theoretical framework to drive the intervention . Continued examination of self-efficacy as a determinant of behavior change in individuals with MS is needed . Multiple Sclerosis 2007 ; 13 : 652 - 659 . Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time
This review summarised in detail the effects  SD exercise interventions had on sedentary middle-aged individuals alongside the adherence to the prescriptions .
SD exercise was seen to be beneficial for improving metabolic outcomes physical characteristics , cardiorespiratory fitness and functional measures
Many chronic diseases and illnesses are caused by the lifestyle , including the physical activity habits , of an individual .
As such , consistent high levels of exercise should be encouraged across the lifespan , to limit the risk of developing one of these conditions and allowing for healthy aging to occur .
Exercise prescriptions that encourage high completion and adherence rates in an independent manner and improve health related outcomes should be provided to individuals .
To date , no review has identified optimal prescriptions of exercise to achieve this in sedentary middle-aged adults and this is important , given the higher risk of developing illnesses in this population as they age .
This review examines the effects prescriptions of self-directed ( SD ) exercise has on adherence and health related outcomes in sedentary middle-aged individuals in good general health currently and aims to identify the most suitable forms of planned SD exercise that can be carried out independently .