A Diabetes Prevention Program Provided by Home Care Nurses to Residents of Public Housing Communities

The purpose of this pilot study was 1) to modify the Diabetes Prevention Program protocol collaboratively with home care nurses, health professionals, and residents of public housing: 2) to evaluate the feasibility (reach and implementation) and the preliminary efficacy of the modified diabetes prevention program (mDPP) provided by home care nurses to adults at-risk for T2D on clinical, behavioral, and psychosocial outcomes compared to an enhanced standard care control group. A mixed-method sequential design was used. The sample (n=67) was primarily female (79%), with a mean age of 40 years, and of diverse race and ethnicity (76% non-White). Home care nurses were able to implement the program in public housing community centers, with a protocol adherence of 83% across classes and groups. There was sub-optimal attendance by participants. In a repeated measure mixed model analysis controlling for gender, race/ethnicity, and baseline score, there was no difference between groups on clinical, behavioral, or psychosocial outcomes. Participants of both groups improved significantly with respect to healthy eating, physical activity, triglycerides, and psychosocial outcomes. Brief, culturally relevant diabetes prevention programs that include behavioral and psychosocial support are greatly needed for residents of public housing

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included “game”, “exercise”, and “aged”, and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. Conclusion: Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.© 2015 Elsevier Ireland Ltd. All rights reserved. This is the authors' accepted and refereed manuscript to the article. Locked until januar 2017-01-01 due to the copyright restrictions

The road to reducing dementia onset and prevalence: are diet and physical activity interventions worth investing in?

In Australia, deaths as a result of dementia have now taken over cerebrovascular disease as the second leading cause of death. At present, over a quarter million Australians suffer from dementia and projected estimates indicate that the figure can reach a high of nearly one million by 2050. Diet and physical activity have been shown to promote brain health and offer some protection against cognitive decline. Moreover, they have also been recognised as risk factors for developing other conditions such as cardiovascular disease, diabetes, hypertensive diseases and certain cancers all of which are leading causes of death in Australia. Research shows that higher ratios of saturated fat to monounsaturated fats are predictive of negative mental function. In addition, high mid-life serum cholesterol levels and excessive caloric intake have been found to be associated with impaired cognitive function. Increased intakes of fish, vegetables and legumes, antioxidant rich foods and adequate amounts of certain B-vitamins have been reported to have a protective brain effect. Increased levels of physical activity have been found to promote neuro-protective changes in the hippocampus of the brain – a region central to learning and memory. This brain region is one of the first areas affected by dementia. Most studies have demonstrated that a high level of physical activity in adults with no dementia is associated with a 30% to 50% reduction in the risk of cognitive decline and dementia. Some studies have also theorised that poor physical function may precede the onset of dementia and Alzheimer’s disease and higher levels of physical function may be associated with delayed onset. Results from the Australian Bureau of Statistics National Health Survey (2011 – 2013) show that many Australian adults do not meet the National Physical Activity Guidelines (to do at least 30 minutes of moderate intensity physical activity on most days) as more than half the population is inactive. Further, two-thirds of Australians are now overweight/obese and a large proportion of total energy consumed comes from foods considered to be of little nutritional value. An intervention that focuses on improving diet and physical activity habits therefore has the ability to produce inestimable benefits. There are many factors that must be considered when developing a successful diet and physical activity intervention. These span a gamut of issues from carefully defining the target audience, utilising a multidisciplinary approach, tailoring content and materials, determining forms of delivery and identifying specific behaviour change techniques to determining financial costs in relation to health benefits and training staff. The success of any intervention also relies on the setting and method that will be employed in its implementation. Policy-makers must be cognizant of the fact that no singular government intervention/policy, operating on its own, can have the effect of directly reducing dementia onset/prevalence and changing lifestyle habits. Six actions for policy-makers are identified in this issues brief which have the potential to have immeasurable benefits: i) development of a comprehensive dementia prevention strategy, ii) establishment of a body whose aim is to keep track of scientific research (central to this will be the establishment of a national digital dementia research repository), iii) ensuring a multisectoral approach is adopted in the fight against dementia that includes both ‘traditional’ and ‘incidental’ health agencies, iv) continued investment into research and innovation, v) identifying incentives beyond the health domain and vi) development of longevity literacy programs. These actions all have as their foundation the Health in all Policies Initiative and social determinants of health approach

Influence of the use of Wii games on physical frailty components in institutionalized older adults

Producción CientíficaAging is a multifactorial physiological phenomenon in which cellular and molecular changes occur. These changes lead to poor locomotion, poor balance, and an increased falling risk. This study aimed to determine the impact and effectiveness of the use of the Wii® game console on improving walking speed and balance, as well as its influence on frailty levels and falling risk, in older adults. A longitudinal study was designed with a pretest/post-test structure. The study population comprised people over 75 years of age who lived in a nursing home or attended a day care center (n = 80; 45 women; 84.2 ± 8.7 years). Forty of them were included in the Wii group (20 rehabilitation sessions during 8 consecutive weeks), and the other 40 were in the control group. Falling risk and frailty were evaluated using the Downton scale and Fried scale; balance and walking speed were assessed with the Berg Balance scale and the Gait Speed Test, respectively, as well as the Short Physical Performance Battery (SPPB). The results showed that there was no significant association between Frailty Phenotype and study groups in baseline. However, there was significant association between Frailty Phenotype and study groups at the end of study. Moreover, a significantly higher and negative percentage change (Δ) in the Wii group with respect to the control group on the in falling risk (−20.05 ± 35.14% vs. 7.92 ± 24.53%) and in walking speed (−6.42 ± 8.83% vs. −0.12 ± 4.51%) during study, while there was a higher and positive significant percent change in static balance (6.07 ± 5.74% vs. 2.13 ± 4.64%) and on the SPPB (20.28 ± 20.05% vs. 0.71 ± 7.99%) after 8 weeks of study. The main conclusion of this study was that the use of the Wii® video console for 8 weeks positively influenced walking speed, falling risk, static balance, and frailty levels in older adults. Through a rehabilitation program with the Wii® game console in the older adults, frailty levels are reduced, accompanied by a reduction in falling risk and an increase in static balance and walking speed