Actical Accelerometry Cut-points for Quantifying Levels of Exertion in Overweight Adults

The purpose of this study was to develop Actical count cut-points for overweight adults that correspond to moderate and vigorous intensity exercise. The standard definitions of moderate (3 METS) and vigorous (6 METS) were used. Cut-points in overweight subjects (OW) were also compared to cut-points in normal weight (NW) subjects. Thirty overweight (BMI >25 kg/m) male and female adults completed a progressive submaximal exercise session on a treadmill while oxygen uptake was measured. The activity count cut-point derived from ROC curves for moderate intensity was 1839 for OW and 1994 for NW and cut-points for vigorous intensity were 3900 for OW and 4381 for NW. Activity count thresholds were greater in the NW compared to the OW subjects at both moderate and vigorous intensities

Actical Accelerometry Cut-points for Quantifying Levels of Exertion: Comparing Normal and Overweight Adults

Int J Exerc Sci 5(2) : 170-182, 2012. Weight, body fatness and ambulatory pattern all have the potential to affect accelerometer output and cause differences in output between overweight and normal-weight adults. The purpose of this study was to determine if Actical (Philips Respironics, Bend, OR) activity count cut-points for moderate and vigorous intensity exercise are different for overweight adults compared to normal-weight adults. Overweight adults with BMI \u3e25 kg/m² (n=29) and Normal-Weight adults (n=25) walked at 3.2 and 4.8 km∙h-1 and ran at 6.4 km∙h-1 on a treadmill while simultaneously wearing an Actical accelerometer and obtaining measurements of oxygen uptake. Counts per minute (counts∙min-1) were determined at 3 METS (moderate) and 6 METS (vigorous) using ROC curves. The counts∙min-1 at 3 METs was 1726 and 1923 counts∙min-1 for Overweight and Normal-Weight groups, respectively. The cut-points at 6 METs were 4117 and 4032 counts∙min-1 for Overweight and Normal-Weight groups, respectively. The differences between groups were not statistically significant (p\u3e0.73 for both). Correlations between BMI and counts∙min-1 were not significant (p\u3e0.05) at any speed for the Normal-Weight group but were significant at 3.2 and 4.8 km∙h-1 for the Overweight group. Although there appears to be some relationship between activity counts∙min-1 and BMI, the results suggest that similar cut-points may be used for normal weight and overweight adults. However, the greater variability in counts at each speed and lower ROC curve areas for overweight adults suggest that it is harder to classify the activity intensity of overweight subjects compared to normal weight subjects

Physical Functioning, Physical Activity, and Variability in Gait Performance during the Six-Minute Walk Test

Instrumenting the six-minute walk test (6MWT) adds information about gait quality and insight into fall risk. Being physically active and preserving multi-directional stepping abilities are also important for fall risk reduction. This analysis investigated the relationship of gait quality during the 6MWT with physical functioning and physical activity. Twenty-one veterans (62.2 ± 6.4 years) completed the four square step test (FSST) multi-directional stepping assessment, a gait speed assessment, health questionnaires, and the accelerometer-instrumented 6MWT. An activity monitor worn at home captured free-living physical activity. Gait measures were not significantly different between minutes of the 6MWT. However, participants with greater increases in stride time (ρ = −0.594, p p p p < 0.05) during the 6MWT required more time to complete the FSST. Participants needing at least 15 s to complete the FSST meaningfully differed from those completing the FSST more quickly on all gait measures studied. Instrumenting the 6MWT helps detect ranges of gait performance and provides insight into functional limitations missed with uninstrumented administration. Established FSST cut points identify aging adults with poorer gait quality

An innovative educational clinical experience promoting geriatric exercise

Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. The experience consists of a single 2 1/2 hour session, in which learners are partnered with geriatric patients engaged in a formal supervised exercise program. The learners are guided through an evidence-based exercise regimen tailored to functional status. This experience provides learners with an opportunity to interact with geriatric patients outside the hospital environment to counterbalance the typical geriatric rotation in which geriatric patients are often seen in clinics or hospitals. In this experience, learners are exposed to fit and engaged geriatric patients successfully living in the community despite chronic or disabling conditions. A survey of 105 learners highlighted positive responses to the experience, with 96% of survey respondents indicating that the experience increased their confidence in their ability to serve as advocates for physical activity for older adults, and 89.5% of responders to a follow-up survey indicating that the experience changed their perception of geriatric patients. Modifications to the experience, implemented at partnering facilities are described. The positive feedback from this experience warrants consideration for implementation in other settings

Longitudinal analysis of physical function in older adults: The effects of physical inactivity and exercise training.

Lack of exercise contributes to systemic inflammation and is a major cause of chronic disease. The long-term impact of initiating and sustaining exercise in late life, as opposed to sustaining a sedentary lifestyle, on whole-body health measures such as physical performance is not well known. This is an exploratory study to compare changes in physical performance among older adults initiating exercise late in life versus inactive older adults. Data from two observational cohorts were included in this analysis, representing two activity groups. The Active group cohort comprises older adults (n = 318; age 72.5 ± 7.2 years) enrolled in a supervised exercise program, Gerofit. The inactive group comprises older adults (n = 146; age 74.5 ± 5.5 years) from the Italian study Act on Ageing (AOA) who self-reported being inactive. Participants in both groups completed physical performance battery at baseline and 1-year including: 6-min walk test, 30-s chair stand, and timed up-and-go. Two-sample t-tests measured differences between Gerofit and AOA at baseline and 1-year across all measures. Significant between-group effects were seen for all performance measures (ps = 0.001). The AOA group declined across all measures from baseline to 1 year (range -18% to -24% change). The Gerofit group experienced significant gains in function for all measures (range +10% to +31% change). Older adults who initiated routine, sustained exercise were protected from age-related declines in physical performance, while those who remained sedentary suffered cumulative deficits across strength, aerobic endurance, and mobility. Interventions to reduce sedentary behaviors and increase physical activity are both important to promote multi-system, whole-body health

Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program

Exercise provides a wide range of health‐promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long‐lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long‐standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow‐up, improvements in well‐being, and a 10‐year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8‐foot up and go 8.7 ± 6.7 seconds, 30‐second chair stands 10.7 ± 5.1, 6‐minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow‐up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1‐year outcomes. We suggest that such programs be considered essential elements of healthcare systems

Mobility Improvements Are Found in Older Veterans After 6 Months of Gerofit Regardless of Body Mass Index Classification

Veterans represent a unique population of older adults, as they are more likely to self-report a disability and be overweight or obese compared with the general population. We sought to compare changes in mobility function across the obesity spectrum in older veterans participating in 6 months of Gerofit, a clinical exercise program. A total of 270 veterans (mean age: 74 years) completed baseline, 3-, and 6-month mobility assessments and were divided post hoc into groups: normal weight, overweight, and obese. The mobility assessments included 10-m walk time, 6-min walk distance, 30-s chair stands, and 8-foot up-and-go time. No significant weight × time interactions were found for any measure. However, clinically significant improvements of 7–20% were found for all mobility measures from baseline to 3 months and maintained at 6 months (all ps <05). Six months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility in older veterans at high risk fordisability, regardless of weight status

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19.

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects