Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis Activity adherence and physical function in older adults with functional limitations. Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP) Study protocol of a cluster randomised controlled trial investigating the effectiveness of a tailored energy balance programme for recent retirees Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study. Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459] Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults Physical activity and the menopause experience: a cross-sectional study. Change in lifestyle factors and their influence on health status and all-cause mortality. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Project GRAD: two-year outcomes of a randomized controlled physical activity intervention among young adults. Graduate Ready for Activity Daily. Change in physical activity and weight in relation to retirement: the French GAZEL Cohort Study Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews Exercise and well-being: a review of mental and physical health benefits associated with physical activity Physician-based physical activity counseling for middle-aged and older adults: A randomized trial Peer Volunteers Improve Long-Term Maintenance of Physical Activity With Older Adults: A Randomized Controlled Trial. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) randomized controlled trial: design and methods Beyond hearing aid fitting: improving communication for older adults Promoting physical activity: issues in primary health care. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Text Messaging for Exercise Promotion in Older Adults From an Upper-Middle-Income Country: Randomized Controlled Trial A systematic review of physical activity promotion in primary care office settings.
Objectives The effectiveness of community level interventions depends to a great extent on adherence . Currently , information on factors related to adherence in older adults from developing countries is scarce . Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country . Design , setting and participants Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects ( 65–67.9 years at baseline ) with low to medium socioeconomic status from 10 health centers r and omized to receive a physical activity intervention as part of the CENEX cluster trial ( IS RCT N48153354 ) . Measurements Using a multilevel regression model , the relationship between adherence ( defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months ) and individual , intervention-related and context ual factors was evaluated . We also conducted 40 semi-structured interviews with older adults ( n=36 ) and instructors ( n=4 ) . Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence . Results Adherence to physical activity intervention was 42.6 % ( CI 95 % 39.5 to 45.6 ) . Depression , diabetes mellitus , percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence ( p<0.05 ) while being retired , participation in physical activity prior to the intervention , and green areas per habitant were positively associated with adherence ( p<0.05 ) . The qualitative interviews identified three primary barriers to adherence : current health problems , lack of time due to commitments for caring for family members , and being employed , and two primary facilitators to adherence : the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others . Conclusion In order to enhance effectiveness of community exercise interventions , strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions PURPOSE Lifestyle Interventions and Independence for Elders Pilot ( LIFE-P ) was a trial to examine the effects of a physical activity intervention ( PA ) compared with a health education control ( SA ) on measures of disability risk in sedentary older adults ( N = 424 ) . We examined adherence to the LIFE-P PA intervention for the first 12 months of the trial . METHODS The PA intervention consisted of walking , strength , flexibility , and balance training supplemented with behavioral skills training modules , and it used a phased , center-based schedule of adoption ( 3x wk(-1 ) , weeks 1 - 8 ) , transition ( 2x wk(-1 ) , weeks 9 - 24 ) , and maintenance ( 1x wk(-1 ) , weeks 25 to end of trial ) while transitioning to primarily home-based physical activity . SA consisted of weekly ( weeks 1 - 26 ) transitioning to monthly health education workshops . RESULTS Participation in moderate-intensity physical activity increased from baseline to months 6 and 12 in PA compared with SA ( P < 0.001 ) . At 12 months , PA participants who reported > or = 150 min x wk(-1 ) of moderate activity demonstrated a significantly greater improvement in their Short Physical Performance Battery score compared with participants who reported < 150 min.wk of moderate activity ( P < 0.017 ) . For the PA arm , center-based attendance was 76.3 + /- 24.5 , 65.4 + /- 28.6 , and 49.8 + /- 35.8 % in the adoption , transition , and maintenance phases , respectively . CONCLUSIONS Adherence to physical activity in LIFE-P was associated with greater improvement in SPPB score and was consistent with adherence in physical activity trials of shorter duration in this subgroup of older adults . Older individuals at risk for disability can adhere to a regular program of physical activity in a long-term r and omized trial With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy Background People in transitional life stages , such as occupational retirement , are likely to gain weight and accumulate abdominal fat mass caused by changes in physical activity and diet . Hence , retirees are an important target group for weight gain prevention programmes , as described in the present paper . Methods / Design A systematic and stepwise approach ( Intervention Mapping ) is used to develop a low-intensity energy balance intervention programme for recent retirees . This one-year , low-intensity multifaceted programme aims to prevent accumulation of abdominal fat mass and general weight gain by increasing awareness of energy balance and influencing related behaviours of participants ' preference . These behaviours are physical activity , fibre intake , portion size and fat consumption . The effectiveness of the intervention programme is tested in a cluster r and omised controlled trial . Measurements of anthropometry , physical activity , energy intake , and related psychosocial determinants are performed at baseline and repeated at 6 months for intermediate effect , at 12 months to evaluate short-term intervention effects and at 24 months to test the sustainability of the effects . Discussion This intervention programme is unique in its focus on retirees and energy balance . It aims at increasing awareness and takes into account personal preferences of the users by offering several options for behaviour change . Moreover , the intervention programme is evaluated at short-term and long-term and includes consecutive outcome measures ( determinants , behaviour and body composition ) There is increased recognition that determinants of health should be investigated in a life-course perspective . Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population . The authors examined the effect of retirement on changes in physical activity in the GLOBE Study , a prospect i ve cohort study known by the Dutch acronym for " Health and Living Conditions of the Population of Eindhoven and surroundings , " 1991 - 2004 . They followed respondents ( n = 971 ) by postal question naire who were employed and aged 40 - 65 years in 1991 for 13 years , after which they were still employed ( n = 287 ) or had retired ( n = 684 ) . Physical activity included 1 )  work-related transportation , 2 ) sports participation  , and 3 ) nonsports leisure-time physical activity .  Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation ( odds ratio ( OR ) = 3.03 , 95 % confidence interval ( CI ) : 1.97 , 4.65 ) , adjusted for sex , age , marital status , chronic diseases , and education , compared with remaining employed . Retirement was not associated with an increase in sports participation ( OR = 1.12 , 95 % CI : 0.71 , 1.75 ) or nonsports leisure-time physical activity ( OR = 0.80 , 95 % CI : 0.54 , 1.19 ) . In conclusion , retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity Background Ageing is associated with a decrease in physical activity . This decrease particularly occurs during specific transitional life stages . Especially during adolescence and young adulthood a steep decrease in physical activity is observed . Inactive people are often not aware of their inactivity . Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle . Methods In a r and omized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined . Outcome measures are level of physical activity , determinants of physical activity , quality of life , empowerment , aerobic fitness and body composition .  Participants are relatively inactive adolescents and young adults who are measured at baseline , after 3 months intervention and 5 months after the end of the intervention . In addition , facilitating and hindering factors for implementation of the intervention will be investigated . Discussion The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level . It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors Background . Overweight and obese older adults have high sedentary time . We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonr and omized one-arm design . Methods . Participants ( N = 25 , mean age = 71.4 , mean body mass index = 34 ) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-st and transitions . An inclinometer ( activPAL ™ ) measured the primary outcomes , change in total sitting time and sit-to-st and transitions . Secondary outcomes included physical activity ( ActiGraph GT3X+ accelerometer ) , self-reported sedentary behaviors , physical function ( Short Physical Performance Battery ) , depressive symptoms ( 8-item Patient Health Question naire ) , quality of life ( PROMIS ) , and study satisfaction . Paired t tests examined pre – post test changes in sitting time , sit-to-st and transitions , and secondary outcomes . Results . Inclinometer measured sitting time decreased by 27 min/day ( p < .05 ) and sit-to-st and transitions increased by 2 per day ( p > .05 ) , while st and ing time increased by 25 min/day ( p < .05 ) . Accelerometer measured sedentary time , light-intensity , and moderate-to-vigorous physical activity improved ( all p values ≤ .05 ) . Self-reported sitting time , gait speed , and depressive symptoms also improved ( all p values < .05 ) . Effect sizes were small . Study satisfaction was high . Conclusions . Reducing sitting time is feasible , and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity . R and omized trials of sedentary behavior reduction in overweight and obese older adults , most of whom have multiple chronic conditions , may be promising A r and omly selected community cohort of 2000 Australian born women aged 45 to 55 were interviewed on the telephone and information obtained on their health and well-being . These women were divided into pre- , peri- , natural and surgical menopausal groups on their menstrual history . A physical activity question naire was sent to 1181 women in the first three of these groups . These question naires were completed and returned by 61.6 % of the women . The response rate in all groups was significantly associated with the years of education , employment status , body mass index ( BMI ) and self-rated health of the participants . The aim of the study was to test the hypothesis that physical activity is a major contributor to health and well-being by establishing the relationships between physical activity and certain health outcomes , such as menopausal symptoms , psychological well-being , self-rated health and BMI in this cohort of mid-life women . The inter-relationship between physical activity and other variables , including menopausal status , interpersonal stress , health related and preventive health behaviours was examined . Levels of  physical activity  were significantly associated with better self-rated health , lower BMI measurements , moderate alcohol intake and self-breast examination . There was no significant association between levels of physical activity , psychological well-being and women 's experience of symptoms during the natural menopause transition BACKGROUND The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980 - 1981 to another in 1988 - 1989 influence self-reported health status . Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time . METHOD The cross-sectional and the longitudinal analyses are based on the same simple r and om sample of 3,843 adults , aged 25 - 74 , interviewed in 1980 - 1981 and 1988 - 1989 and is part of the Swedish Annual Level-of-Living Survey . About 85 % of the respondents in the first interview participated in a second interview in 1988 - 1989 . Cross-sectional odds ratios , based on a marginal model , were estimated using the generalized estimating equations . The transitional models were analysed using unconditional logistic regression . A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality . RESULTS Physical inactivity , being a current or former smoker and obesity ( women only ) were strong risk factors for poor health either as main effects and /or combined ( interactions ) . There was a strong interaction between physical activity and smoking , and for women , also between body mass index ( BMI ) and physical activity . Smoking , physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking , physically active , and normal-weight women . The corresponding risk for men was about five times higher . Physically active , but smoking and obese individuals showed only moderately increased risks for poor health status . The transitional model showed that those who were physically inactive in 1980 - 1981 , but did exercise in 1988 - 1989 , improved their health after adjustments for sociodemographic and other lifestyle factors . Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality ( 1.6 , 1.9 and 1.8 , respectively ) than those who reported that they were in good status at both points in time . CONCLUSIONS We found that physical activity protects against poor health irrespective of an increased BMI and smoking . The major clinical implication s are the long-st and ing benefits of physical activity and not smoking BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults INTRODUCTION Project Graduate Ready for Activity Daily evaluated a program to promote physical activity through the transition of university graduation in a r and omized controlled trial . METHODS Three hundred thirty-eight university seniors participated in either a cognitive-behavioral intervention course or a knowledge-oriented general health course during the semester before graduation .  Behaviorally oriented phone and mail follow-up was delivered to the intervention group for 18 months . Physical activity outcomes and mediating variables were assessed at baseline , 1 and 2 years ( 93 % retention rate ) . RESULTS There were no significant intervention effects on physical activity outcomes at 2 years for either men or women . Experiential and behavioral processes of change were significantly improved for intervention women over 2 years . CONCLUSIONS Despite excellent participation in a theoretically based , well-attended intervention , few long-term effects on physical activity or its mediators were found . Additional research is needed to determine optimal interventions for physical activity and to vali date or alter current behavior change theory Objectives To examine the trajectories of physical activity from preretirement to postretirement and to further clarify whether the changes in physical activity are associated with changes in body weight . Design Prospect i ve . Setting French national gas and electricity company ( GAZEL cohort ) . Participants From the original sample of 20 625 employees , only those retiring between 2001 and 2008 on a statutory basis were selected for the analyses ( analysis 1 : n=2711 , 63 % men ; analysis 2 : n=3812 , 75 % men ) . Persons with data on at least one preretirement and postretirement measurement of the outcome were selected . Primary and secondary outcome measures All outcome data were gathered by question naires . In analysis 1 , the annual prevalence of higher physical activity ( walking ≥5 km/week ) 4 years before and after retirement was analysed . In analysis 2 , changes in leisure-time sport activities ( engagement , frequency and manner ) from preretirement to postretirement were analysed with simultaneous changes in body weight ( kilogram ) . Results In analysis 1 ( n=2711 ) , prevalence estimates for 4 years before and 4 years after retirement showed that higher leisure-time physical activity ( walking at least 5 km/week ) increased by 36 % in men and 61 % in women during the transition to retirement . This increase was also observed among people at a higher risk of physical inactivity , such as smokers and those with elevated depressive symptoms . In a separate sample ( analysis 2 , n=3812 ) , change in weight as a function of preretirement and postretirement  physical activity was analysed . Weight gain preretirement to postretirement was 0.85 ( 95 % CI 0.48 to 1.21 ) to 1.35 ( 0.79 to 1.90 ) kg greater among physically inactive persons ( decrease in activity or inactive ) compared with those physically active ( p<0.001 ) . Conclusions Retirement transition may be associated with beneficial changes in lifestyle and may thus be a good starting point to preventive interventions in various groups of individuals in order to maintain long-term changes PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim 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 Sedentary behavior among older adults increases risk for chronic diseases . Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients . The Physically Active for Life ( PAL ) project was a r and omized , controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels . The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory . Twenty-four community-based primary care medical practice s were recruited into the study ; 12 were r and omized to the Intervention condition and 12 to the Control condition . Physicians in the Intervention practice s received training in the delivery of brief physical activity counseling . Subjects in the Intervention practice s ( n=181 ) received brief activity counseling matched to their stage of motivational readiness for physical activity , a patient manual , a follow-up appointment with their physician to discuss activity counseling , and newsletter mailings . Subjects in the Control practice s ( n=174 ) received st and ard care .  Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly ( PASE ) were administered to subjects in both conditions at baseline , 6 weeks following their initial appointment , and at 8 months . Results showed that at the 6-week follow-up , subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition . This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores . Results suggest that more intensive , sustained interventions may be necessary to promote the adoption of physical activity among sedentary , middle-aged , and older adults in primary care medical practice BACKGROUND Using peer volunteers as delivery agents may improve translation of evidence -based physical activity promotion programs for older adults . This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior . METHODS Participants were r and omized to 2 16-week , group-based  programs : ( 1 ) peer-delivered , theory-based support for physical activity behavior change ; or ( 2 ) an intervention typically available in community setting s ( basic education , gym membership , and pedometer for self-monitoring ) , attention-matched with health education .  Moderate-to-vigorous physical activity ( MVPA ) was assessed via daily self-report logs at baseline , at the end of the intervention ( 16 weeks ) , and at follow-up ( 18 months ) , with accelerometry validation ( RT3 ) in a r and om sub sample . RESULTS Seven peer volunteers and 81 sedentary adults were recruited .  Retention at the end of the trial was 85 % and follow-up at 18 months was 61 % . Using intent-to-treat analyses , at 16 weeks , both groups had similar significant improvements in MVPA . At 18 months , the group supplemented with peer support had significantly more MVPA . CONCLUSIONS Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention . This approach has great potential to be adapted and delivered inexpensively in community setting The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity , frailty , and increased risk of functional impairment . Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society , novel strategies should be devised to preserve adequate levels of function and independence in late life . The development of mobility disability , an early event in the disablement process , precedes and predicts more severe forms of inability . Its prevention is , therefore , critical to impede the transition to overt disability . For this reason , the Sarcopenia and Physical fRailty IN older people : multi-componenT Treatment strategies ( SPRINTT ) project is conducting a r and omized controlled trial ( RCT ) to test a multicomponent intervention ( MCI ) specifically design ed to prevent mobility disability in high-risk older persons . SPRINTT is a phase III , multicenter RCT aim ed at comparing the efficacy of a MCI , based on long-term structured physical activity , nutritional counseling/dietary intervention , and an information and communication technology intervention , versus a healthy aging lifestyle education program design ed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months . The primary outcome of the SPRINTT trial is mobility disability , operationalized as the inability to walk for 400 m within 15 min , without sitting , help of another person , or the use of a walker . Secondary outcomes include changes in muscle mass and strength , persistent mobility disability , falls and injurious falls , disability in activities of daily living , nutritional status , cognition , mood , the use of healthcare re sources , cost-effectiveness analysis , quality of life , and mortality rate . SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives . The findings are also projected to pave the way for major investments in the field of disability prevention in old age Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids , and many do not choose to wear hearing aids . Two group communication education programs aim ed at such older people are described . The ‘ Keep on Talking ’ program has a health promotion focus , and is aim ed at maintaining communication for older adults living in the community . An experimental group ( n=120 ) attended the program , and a control group ( n = 130 ) received a  communication assessment but no intervention . Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills . At the follow-up evaluation at 1 year , 45 % of the experimental group , compared to 10 % of the control group , had acted to improve their communication skills . The ‘ Active Communication Education ’ program focuses on the development of problem-solving strategies to improve communication in everyday life situations . Preliminary outcomes have been assessed on a small scale ( n=14 ) to date . It is concluded that communication programs represent an important adjunct to , or supplement for , the traditional approach that focuses on hearing aid fitting In the past few years , alliances between primary care and leisure services have become a popular strategy for exercise promotion in the Engl and . ' GP Referral Schemes ' typically involve referral to a local leisure centre by a General Practitioner ( GP ) , whereupon patients are inducted into a 10 - 12 week exercise programme at a reduced fee . Referred patients are usually white , middle aged and apparently healthy women , with the main reason for referral being overweight . The schemes are characterised by their lack of formal evaluation , making conclusions about effectiveness impossible . In the US , physicians advice to exercise has been the focus of interventions to date . Two controlled trials , one r and omised , have provided some evidence that exercise behaviour can be changed , at least in the short term . The ability to recruit sufficient numbers of patients , who have potentially the most to gain from increased physical activity , is the biggest barrier to primary care based interventions . One contributing factor to this problem , may be doctors and nurses ' knowledge about the benefits of physical activity Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO Background : Mobile technology to promote exercise is effective ; however , most evidence is from studies of younger groups in high-income countries . Investigating if short message service ( SMS ) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones . Objective : The main objective was to examine the short- and long-term effects of  SMS text messaging on exercise frequency in older adults . Secondary objectives were to investigate how SMS text messages impact study participants ’ exercise frequency and the effects of the intervention on secondary outcomes . Methods : The Malaysian Physical Activity for Health Study ( myPAtHS ) was a 24-week , 2-arm , parallel r and omized controlled trial conducted in urban Malaysia . Participants were recruited via health talks in resident associations and religious facilities . Older Malaysians ( aged 55 - 70 years ) who used mobile phones and did not exercise regularly were eligible to participate in the study . Participants r and omly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks . The content of the SMS text messages was derived from effective behavior change techniques . The non-SMS texting arm participants received only the exercise booklet . Home visits were conducted to collect outcome data : ( 1 ) exercise frequency at 12 and 24 weeks , ( 2 ) secondary outcome data ( exercise self-efficacy , physical activity-related energy expenditure , sitting time , body mass index , grip and leg strength ) at baseline and at 12 and 24 weeks . Intention-to-treat procedures were applied for data analysis . Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24 . Results : In total , 43 participants were r and omized into the SMS texting arm ( n=22 ) and the non-SMS texting arm ( n=21 ) . Study -unrelated injuries forced 4 participants to discontinue after a few weeks ( they were not included in any analyses ) . Overall retention was 86 % ( 37/43 ) . After 12 weeks , SMS texting arm participants exercised significantly more than non-SMS texting arm participants ( mean difference 1.21 times , bias-corrected and accelerated bootstrap [ BCa ] 95 % CI 0.18 - 2.24 ) . Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers . They described the SMS text messages as being encouraging , a push , and a reminder . After 24 weeks , there was no significant difference between the research arms ( mean difference 0.74 , BCa 95 % CI –0.30 to 1.76 ) . There were no significant effects for secondary outcomes . Conclusions : This study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country . Although the effects were not maintained when SMS text messaging ceased , the results are promising and warrant more research on behavioral mobile health interventions in other regions OBJECTIVE To assess the efficacy of physical activity promotion in primary care office setting s. DESIGN Systematic review of clinical trials in which the efficacy of physical activity promotion was investigated in a primary care office setting with at least one month of follow up . SUBJECTS A total of 13,981 adults , aged 17 - 85 + , were included from 203 practice s in eight trials assessing physical activity promotion in primary care office setting s. MAIN OUTCOME MEASURES Odds ratios and 95 % confidence intervals were calculated comparing the number of participants who increased their physical activity or were active at follow up in the intervention group with a control group for each study . RESULTS Five of eight trials where positive with statistically significant results ( range 0.91 - 6.56 ) , but significant biases or limited clinical relevance of the outcomes were found in all trials . Short term trials of less than one year ( four of four were positive ) , single-risk-factor trials ( three of three were positive ) , r and omised clinical trials ( two of three were positive ) , and those assessing moderate levels of physical activity ( three of four were positive ) were most likely to find benefit . Only one of four trials lasting longer than a year were positive . CONCLUSION There is limited evidence from well design ed trials that office based physical activity promotion in primary care setting s is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits
There was no evidence for a relationship between intervention effectiveness and mode of delivery or number of intervention contacts ; however , interventions which involved individually tailoring with personalized activity goals or provision of information about local opportunities in the environment may be more effective .
Conclusions Interventions in adults aged 55 to 70 years led to long term improvements in physical activity at 12 months ; however , maintenance beyond this is unclear .
Identified physical activity improvements are likely to have substantial health benefits in reducing the risk of age-related illnesses .
Background Retirement represents a major transitional life stage in middle to older age .
Changes in physical activity typically accompany this transition , which has significant consequences for health and well-being .
The aim of this systematic review was to evaluate the evidence for the effect of interventions to promote physical activity in adults aged 55 to 70 years , focusing on studies that reported long-term effectiveness .