Use of Distance Delivery Interventions (web-based, mHealth, telehealth) for Hard-to-reach, Vulnerable Midlife and Older Individuals

As older adults may lack access to professional services and/or have limited transportation to seek care, the increasing availability of technologies for self-monitoring, safety, and/or preventive or therapeutic management may show promise for reaching vulnerable older adults. This presentation will describe several types of distance delivery platforms, such as web-based, mHealth, and/or telehealth, which may have applications to older adults in arenas of education, clinical practice or research. This session will highlight the benefits and limitations of these technologies, and will summarize current research about the effectiveness of using these technologies with midlife and older individuals. Objectives: Identify benefits and limitations of various technologies for use with hard-to-reach, vulnerable midlife and older adults. Discuss literature findings about the feasibility, acceptability and effectiveness of various forms of distance delivery interventions for self-monitoring, safety and behavior change among midlife and older adults. Identify regulatory and other concerns when using telehealth and other distance delivery technologies for managing patient/client care

A preliminary study on the reliability of physical performance measures in older day-care center clients with dementia.

BACKGROUND: Decline in physical functional ability is an intrinsic component of the dementia syndrome. Reductions in muscle mass and strength represent a major factor in the loss of functional ability Although resistance exercise has been studied as a method for maintaining/recovering function in populations of frail older adults, people with dementia have been systematically excluded because of uncertainty about the reliability of outcome measurements. OBJECTIVE: The purpose of this study was to determine the test-retest reliability of a battery of established performance-based measures of strength and function among subjects with dementia. SETTING: A hospital-affiliated adult day-care facility. SUBJECTS: Twelve of 28 older subjects with dementia of various etiologies were available for two assessments prior to implementation of a resistance-exercise intervention. METHODS: Subjects underwent an assessment of lower extremity strength and physical function consisting of two recorded trials of bilateral isometric strength of the knee extensor, hip flexor, and dorsiflexor muscles, as well as hand grip strength; repeated chair stands, evaluation of usual- and maximal safe-gait speed over a 6-m course, and the Timed-Up-and-Go Test. The entire assessment was repeated approximately 1 week later. An average of the trials for each measurement was computed for each of the two assessment periods, and intraclass correlation coefficients (ICCs) for these paired measurements were estimated using STATA. RESULTS: ICCs ranged from .56 for left iliopsoas to .77 for left dorsiflexors among the strength measures whereas measures of function ranged from .80 for number of steps in usual gait to .95 for time of fast gait. CONCLUSIONS: Performance-based measures of strength and function can be reliably assessed in older people with dementia, although measures of function appear to be more reliable than measures of strength

Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial.

Background Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40–69, with prehypertension. Methods 289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity. Results Mean blood pressure reduction ranged from 3.8 (SD = 9.8) mm Hg to 8.1 (SD = 10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p = .11 and p = .09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p = .017 and p = .016, respectively); % daily calories from fat (p = .018 and p = .030) and saturated fat (p = .049 and p = .013); daily servings of fruit and vegetables (p = .008 and p \u3c .005); and low fat dairy (p \u3c .001 and p = .002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p = .048) and estimated VO2max (p = .037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups. Conclusions Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status

User Engagement Associated with Web-Intervention Features to Attain Clinically Meaningful Weight Loss and Weight Maintenance in Rural Women

Objective: Purely web-based weight loss and weight-loss maintenance interventions show promise to influence behavior change. Yet, little is known about user engagement with features of web-based interventions that predict clinically meaningful weight loss (≥5% bodyweight loss). This study examines level of website feature engagement with the likelihood of attaining ≥5% bodyweight loss after 6 and 18 months participation in a web-based intervention, among rural women at high risk of obesity-related diseases and disability. Methods: In this secondary analysis of clinical trial data of 201 rural women, we examined weight change and user engagement, measured as clicks on specific web-based intervention features (messaging and self-tracking), as associated with clinically meaningful weight loss (baseline to 6 months) and weight-loss maintenance (6 to 18 months). Results: Generalized estimating equations, adjusted for age, intervention group, and intervention phase, revealed high engagement with messaging predicted whether women achieved ≥5% weight loss at 6 months and at 18 months. There was no effect of self-tracking. Conclusions: Being engaged with messages was associated with attaining clinically meaningful short-term and longer-term weight loss. This trial is registered with NCT01307644

Integrating Best Evidence into Practice: Outcomes of a Community-Based 12-week Exercise and Education Intervention in Women with Cancer

Objective Cancer-related fatigue is the most commonly reported side effect of cancer treatment, affecting 70-100% of patients and current literature suggests exercise is an important component of managing this side effect. The specific objective of this project was to evaluate the effectiveness of a 12-week evidence-based cancer exercise and education intervention on outcomes of fatigue, pain, depression, sleep disturbance and quality of life for women with cancer; the intervention was delivered by an interprofessional team in a medically-based wellness center. Methods The team was led by a physical therapist and included medical and radiation oncologists, general surgeons, nurses and cancer survivors, who developed the structure, content and format of this 12-week community-based intervention. The intervention consisted of group exercise sessions and education. Women with any type of cancer were eligible to enroll regardless of whether or not they were on active cancer treatment. Women were not eligible to enroll if they had any contraindication to exercise. Groups of no more than 15, completed hour-long supervised group exercise sessions twice weekly that were led by a physical therapist or exercise specialist. These sessions included resistance training, aerobic, flexibility, balance, aquatic or yoga exercises. The weekly education sessions included topics such as nutrition, sleep disturbance, depression, coping, lymphedema, exercise habits, healing arts, women’s health, spirituality, and stress management. This intervention was offered at no cost to participants, with funding provided by the hospital foundation. Participants reported their pre- and post-intervention perceptions of fatigue, pain, depression, sleep disturbance and quality of life on a 0 -10 point Likert scale (0 = none, 10 = worst). We used the related-sample Wilcoxon Signed Rank test to compare pre- and post- intervention scores and independent sample Mann-Whitney U test to compare change scores between those on and off treatment. Results Approximately 80% (n=139) of the women having a mean age of 53.6 years (SD=11.8; range 23-87) completed the 12-week intervention. Upon completion, we found significant decreases in the perceptions of self-reported fatigue (-5.5, p\u3c.001), pain (-0.5, p=.017), depression (-1.0, p\u3c.001), sleep disturbance (-0.5, p\u3c.001), and quality of life (-1.4, p\u3c.001). However, a subgroup analysis revealed that the impact of the intervention varied according to treatment status. Specifically, perceptions of fatigue decreased significantly for the 49 women who were on treatment (-1.4 vs. -0.03 p=.007) as compared to the 90 women who had completed treatment. Women on active treatment reported significantly higher levels of fatigue at the start of the intervention than did the women who had completed treatment (6.4 vs. 5.0, p\u3c.0001). Our findings indicate that implementation of an evidence-based exercise and education intervention in a medically-based wellness center is effective in improving self-reported outcomes for women with cancer. The most significant impact of the intervention appeared to be in decreasing fatigue for women on active cancer treatment

A Web-Based Intervention is Feasible for Supporting Weight Loss and Increased Activity in Rural Women with Arthritis

Rural women have well documented health disparities, with higher prevalence of obesity and chronic conditions, including arthritis. Change in weight and actigraph-recorded data were examined in a subset of 63 of 82 women with physician-diagnosed arthritis who completed a 30-month web-based clinical trial. Repeated measures analyses showed women lost weight from baseline to six months, slowly regained at 18 and 30 months, ending with a lower weight than baseline F(1,62)=40.89, p\u3c0.001, η2p =0.40. Of 53 women with complete data, activity increased at six months, decreased at 18 months, and increased at 30 months F(1,52)=4.14, p =.04, η2p=0.07. Women showed improved change in weight and activity from baseline at six, 18 and 30 months. This study adds support that web-based programs may promote weight loss and activity in a hard-to-reach, underserved population of midlife and older rural women with arthriti

Erratum to ‘‘Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in Rural Women with Prehypertension’’

In the original paper, the authors discovered a computer coding error that resulted in 33 of the women’s ages being incorrectly recorded. All analyses were repeated for this paper using the corrected age dataset, as all our logistic regression analyses in the published paper were adjusted for age.The repeated analyses, using the corrected dataset, lead to minor changes that needed to be reported to the results in the published paper. These corrections did not change the conclusion of the published paper.The authors apologize for any inconvenience

Nonlinear dynamics indicates aging affects variability during gait

Objective. To investigate the nature of variability present in time series generated from gait parameters of two different age groups via a nonlinear analysis. Design. Measures of nonlinear dynamics were used to compare kinematic parameters between elderly and young females. Background. Aging may lead to changes in motor variability during walking, which may explain the large incidence of falls in the elderly. Methods. Twenty females, 10 younger (20–37 yr) and 10 older (71–79 yr) walked on a treadmill for 30 consecutive gait cycles. Time series from selected kinematic parameters of the right lower extremity were analyzed using nonlinear dynamics. The largest Lyapunov exponent and the correlation dimension of all time series, and the largest Lyapunov exponent of the original time series surrogated were calculated. Standard deviations and coefficient of variations were also calculated for selected discrete points from each gait cycle. Independent t-tests were used for statistical comparisons. Results. The Lyapunov exponents were found to be significantly different from their surrogate counterparts. This indicates that the fluctuations observed in the time series may reflect deterministic processes by the neuromuscular system. The elderly exhibited significantly larger Lyapunov exponents and correlation dimensions for all parameters evaluated indicating local instability. The linear measures indicated that the elderly demonstrated significantly higher variability. Conclusions. The nonlinear analysis revealed that fluctuations in the time series of certain gait parameters are not random but display a deterministic behavior. This behavior may degrade with physiologic aging resulting in local instability. Relevance Elderly show increased local instability or inability to compensate to the natural stride-to-stride variations present during locomotion. We hypothesized that this may be the one of the reasons for the increases in falling due to aging. Future efforts should attempt to evaluate this hypothesis by making comparisons to pathological subjects (i.e. elderly fallers), and examine the sensitivity and specificity of the nonlinear methods used in this study to aid clinical assessment

Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in RuralWomen with Prehypertension

This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group. Methods. Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40–69, enrolled in a healthy eating and activity communitybased clinical trial for reducing blood pressure. Results. Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m2), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m2) cited in current literature. Hierarchical logistic regression models, adjusted for age, income, and education, revealed that higher percentage body fat (P \u3c 0.001) was associated with greater prevalence of metabolic syndrome. Alone, higher fitness lowered the odds of metabolic syndrome by 7% (P \u3c 0.001), but it did not lower the odds significantly beyond the effects of body fat. When dichotomized into “fit” and “unfit” groups, women categorized as “fat” had lower odds of metabolic syndrome if they were “fit” by 75% and 59%, for percentage body fat and revised BMI, respectively. Conclusion. Among rural women with prehypertension, obesity and fitness were associated with metabolic syndrome. Obesity defined as ≥25 kg/m2 produced results more consistent with percentage body fat as compared to the ≥30 kg/m2 definition