Short Orals: Physical activity for older adults

Background Only 42% of Australians aged 65+ meet physical activity (PA) guidelines (ABS 2022). Research to increase PA in this demographic is important yet recruitment of large representative samples is challenging. Purpose Outline strategies from three large PA trials to boost recruitment of older people. Methods Coaching for Healthy Ageing (CHAnGE) (cluster randomised controlled trial [RCT, n=605]) recruited people aged 60+ through in-person presentations to community groups in metropolitan and regional NSW, Australia. It compared health coaching and activity trackers to a healthy eating program. Coaching and Exercise for Better Walking (ComeBACK) RCT (n=512) recruited from the community (e.g. newsletters, radio, social media) and health services (e.g. community rehabilitation, outpatient clinics). It compares the effect of health coaching against motivational text messages on PA in adults with self-reported walking difficulties. Successful AGEing (SAGE) RCT (n=700) recruited people aged 60+ from the community. It compared the effect of yoga-based exercise to a seated yoga relaxation program on falls. Results CHAnGE recruitment strategies allowed participants to build value expectancy and rapport with staff, and provided a sense of achievability and understanding of older peoples’ PA needs. Recruiting existing groups enhanced social connectedness and accountability. To boost health service recruitment, ComeBACK identified site champions, held recruitment site presentations, and provided regular recruitment updates. SAGE advertised on Facebook and in senior’s online newsletters, providing extensive geographical reach. These strategies were successful as they recruited from spaces older people were already present (online and in-person), providing opportunities they may not have sought themselves. Conclusions Understanding the needs of older people and providing accessible, relatable and clear content helps boost recruitment of older people in PA trials. Practical Implications By implementing these strategies, we attracted older participants with a range of functional abilities from different geographical regions. Funding All trials received funding from NHMRC of Australia.

Background: The CHAnGE (Coaching for Healthy AGEing) trial [1] tested the effectiveness of an intervention that aimed to increase physical activity and prevent falls in 605 community-dwelling people aged 60+. Following home visits, empowerment-focused health coaching was delivered by telephone, fortnightly for 6 months, then monthly for 6 months. The intervention was found to increase physical activity, improve wellbeing and quality of life, and reduce disability. Purpose: This qualitative study aimed to explain experiences of therapeutic alliance in the coaching relationships and identify the practical strategies involved in delivering effective physiotherapist-led telephone health coaching. Methods: We conducted semi-structured interviews with 32 purposively sampled participants (mean age 72, 22 females) in the CHAnGE trial. Following thematic analysis of the data, we held a focus group with the physiotherapists who delivered health coaching in that trial (n = 3) to explain participants’ experience of therapeutic alliance. Results: Participants described highly supportive relationships with their health coaches which sustained their commitment to physical activity. We identified key strategies in the practical delivery of health coaching that fostered this therapeutic alliance. A suite of motivational coaching techniques encouraged collaborative decision-making and helped develop person-centred trusting relationships. This was underpinned by empowerment-focused health coaching training. Professional credibility and structural supports were important assets. Therapeutic alliance was also strengthened by home visits, consistency in the coaching format and provision of free activity monitors. Conclusions: Therapeutic alliance is a central element in physiotherapist-delivered health coaching for promoting physical activity in older people. The delivery of effective health coaching relies on key techniques which can be learnt and refined in practice. Practical implications: Therapeutic alliance in health coaching can empower older people in active ageing. Funding: The CHAnGE study was funded by the NHMRC in Australia. 1. Oliveira JS, et al BJSM 2024 doi: 10.1136/bjsports-2023-107027

Background: Regular physical activity intervention programs are known to prevent and reverse frailty. However, the sustainability of these improvements after cessation of the programs need to be better understood. Purpose: This study aimed to evaluate the impact of a 10-week community-based physical activity program on frailty levels in older adults and to determine if the effects of the intervention program were maintained six months following cessation of the program. Methods: Twenty-one older adults (mean age: 70.1±4.9 years), including 20 females, participated in this study. Participants completed a self-reported 34-item frailty index: each item was coded as 0 [no deficit] or 1 [deficit], with the total calculated as the accumulated deficits divided by the number of deficits measured). Physical functions were measured as step counts (Fitbit) and the six-minute walk test (6MWT) before the intervention, immediately after the 10-week intervention, and six months post-intervention. Results: The analysis revealed an increase in participants’ step counts and 6MWT distances from the pre-intervention phase to immediately after the intervention (p < 0.001 and p = 0.01, respectively). However, there were no significant changes in both metrics six months post-intervention compared to pre-intervention (p = 0.7 and p = 0.5, respectively). The data indicate a decline in frailty levels from pre-intervention (0.080 ± 0.047) to immediate post-intervention (0.058 ± 0.035) (p = 0.03). However, no significant changes in frailty levels were observed six months after the intervention compared to pre-intervention (0.078 ± 0.011) (p = 0.2). Conclusions: The implemented program enhanced physical function and reduced frailty of older adults temporarily; however, these improvements did not persist over time. Practical implications: This research underscores the need to create methods to encourage continuous participation in physical activities, which is essential for maintaining improvements in frailty levels among older adults.

Background: The World Health Organization recommends adults to undertake 150-300 minutes/week of moderate-intensity physical activity (PA). PA positively affects balance, strength and bone health, which could prevent physical function limitation or fall-related injuries. However, physical function limitation, fall-related injuries could lessen PA participation. Purpose: To examine bi-directional prospective relationships between PA and physical function limitation, and PA and falls. Methods: Women born 1946-51 in the Australian Longitudinal Study on Women’s Health; self-reported physical activity, physical function limitation (Short-Form-36 physical functioning subscale), and falls every three years between 1996 (mean age: 48 years) and 2019 (71 years). Generalised estimating equations examined bi-directional population-averaged prospective associations between PA and physical function limitation, and PA and falls at multiple timepoints with three-year intervals (n=13,714). Results: Compared with women who reached recommended levels of PA, women without the recommended levels of PA had a higher odds of subsequent physical function limitation (Odds ratios(OR)0min: 3.3, 95% CI 3.08-3.53; OR1-<150min:1.44, 95%CI 1.36-1.54). Women who reported ≥300 minutes/week of PA had lower odds of developing physical function limitation. Women who reported physical function limitation had higher odds of undertaking no activity (OR 3.32, 95% CI 3.1-3.55) or some PA (1-<150 minutes/week,1.42, 95% CI 1.33-1.51) and lower odds of undertaking 300+ minutes/week of physical activity. Participation in recommended levels of PA was associated with reduced injurious falls risk (OR:0.73, 95% CI 0.67-0.80), compared to no physical activity. However, compared to women without falls, women who had injurious falls were less likely to undertake PA of 1-<150 (OR:0.75, 95% CI 0.68-0.82), 150-<300 (OR:0.69, 95% CI 0.63-0.75) or ≥300 minutes/week (OR:0.64, 95% CI 0.59-0.70). Conclusions: Prospective associations between PA and physical function, and PA and falls are bi-directional. Practical implications: Programmes and strategies are needed to ameliorate the cycle of physical function limitation, falls and low physical activity participation. Funding:not-applicable

Background: Active travel, i.e., making journeys in physically active ways, is one way to accumulate daily physical activity. Green spaces have shown to promote active travel. Purpose: This longitudinal study examined the associations between usable green space exposure (e.g., forests and parks) and accelerometer-measured physical activity during active travel. Methods: The associations were examined separately for workdays, days off and days after retirement among participants in the Finnish Retirement and Aging study (n=102, mean age 63.3 years). Physical activity intensity was measured with waist-worn accelerometer and active travel identified with GPS methodology using average trip speed to determine active travel. Linear regression analyses with generalized estimating equations (GEE) were used to examine the associations. Results: We observed a total of 38 min/day of active travel on workdays, 48 min/day on days off and 51 min/day after retirement. One standard deviation increase in usable green space exposure was associated with 11 min/day increase in total physical activity during active travel on days off and 12 min/day increase on days after retirement. Similarly, there was 8 min/day increase in moderate-to-vigorous physical activity (MVPA) during active travel on days off and 9 min/day increase on days after retirement. No associations were observed for workdays. Conclusions: We observed positive associations between usable green space exposure and total physical activity and MVPA during active travel on days off and days after retirement, but not on workdays. Our results indicate that in leisure time, people in their 60s seem to prefer to engage in active travel in green spaces. Practical implications: Accessible green spaces may facilitate active travel. Encouraging active travel may be a feasible way to promote physical activity among aging populations. Funding: Funding was provided by the Academy of Finland, Finnish Ministry of Education and Culture, Juho Vainio Foundation and Turku University Hospital.

Background: Physical activity prevents cardiometabolic risk factors, but high sedentary time (SED) and insufficient sleep pose health risks. Despite their interdependence, 24-hour movement behaviors, including sleep, SED, and light and moderate-to-vigorous physical activity (LPA, MVPA), have often been studied in isolation. Purpose: The aim was to examine associations between 24-h movement behaviors and 3-year incident cardiometabolic risk factors. Methods: In total 866 adults (mean age 62.4 years, SD 1.1) from FIREA study, free of cardiometabolic risk factors, underwent 24-h wrist-accelerometry measurements. Incident cardiometabolic risk factors including hypertension, dyslipidemia and type 2 diabetes were obtained from national registers, and obesity from annual surveys. The follow-up time was 3 years. Compositional Cox proportional hazards models were adjusted for age, sex, occupation, smoking and risky alcohol consumption. Results: During the follow-up, 84 (17%) participants developed hypertension, 66 (9%) dyslipidemia, 28 (3%) type 2 diabetes and 43 (6%) obesity. Compared to mean composition (sleep 7.8 h, SED 11.0 h, LPA 4.2 h, MVPA 60 min), having 10 min more MVPA was associated with 5−7% risk reduction in hypertension and 9−12% in obesity. Among the least active participants (sleep 7.9 h, SED 12.1 h, LPA 3.6 h, MVPA 24 min), the risk reduction in hypertension and obesity was nearly twofold. Longer sleep and lower SED and LPA tended to associate with lower risk of type 2 diabetes. No significant associations were observed for dyslipidemia. Conclusions: Our findings suggest that daily MVPA maybe important in preventing development of hypertension and obesity. Intervention studies are warranted to confirm these findings. Practical implications: Even small increase in daily MVPA may help in reducing development of cardiometabolic risk factors, especially among the least active older adults. Funding: The study was supported by the Research Council Finland, Finnish Ministry of Education and Culture, Juho Vainio Foundation, the Turku University Hospital.

Background: Brief advice (BA) is crucial for promoting leisure-time physical activity (LTPA) within primary care, as recommended in health promotion services. In Thailand, BA programs such as NCDs Clinic and DPAC (Diet & Physical Activity Clinic) are implemented. Therefore, it’s vital to examine the effect of brief advice on changing LTPA behavior among pre-older and older adults, given its importance in health promotion initiatives. Purpose: This study examines the effect of brief advice on LTPA in pre-older adults and older adults. Methods: The study used data from Thailand’s Surveillance on Physical Activity (SPA) 2023, sampling 4,198 Thai adults aged 45 or older through multistage random sampling to achieve a nationally representative sample. LTPA was assessed subjectively using the Global Physical Activity Questionnaire (GPAQ) version 2.0 (Thai version). Results: The proportion of pre-older and older adults in Thailand who have received advice on physical activity (PA) stands at 49.3%, which is lower than the proportion of those who have never (50.7%). Regarding LTPA behavior, individuals who have ever received PA advice were 1.15 times more likely to engage in LTPA compared to those who have never received advice. Furthermore, residents in communities with health spaces were 1.57 times more likely to engage in LTPA than those without. Conclusions: BA provided in primary health care regarding PA, as well as age-friendly cities and communities of health space, have an impact on LTPA among pre-older adults and older adults. Practical implications: Promoting the establishment of an efficient service system and service package of BA with nationwide coverage will serve as another approach to encourage older adults to participate in sufficient PA and improve their quality of life even further. Funding: The SPAs were funded by Thai Health Promotion Foundation grant number 66–00232.

Background: Older adults often experience functional decline during hospitalisation. Adoption of early mobility interventions in acute care settings is paramount in mitigating such adverse effects. Purpose: This study aimed to examine the effectiveness of mobility-focused intervention in improving independence in activities of daily living and mobility of older adults during hospitalisation, and to evaluate its implementation. Methods: This was a quasi-experimental study where patients aged ≥75 years were assigned to either the intervention or control group. Both groups received usual clinical care. Using the 4Ms (Mobility, Mentation, Medication, What Matters) framework, the intervention group additionally received a comprehensive geriatric assessment, frequent mobilisation, and group-based programs (physiotherapy and art therapy) during hospitalisation. Modified Barthel Index (MBI), gait speed (GS) and maximum walking distance (MWD) of patients were measured upon hospital admission and discharge. Linear regression was used to examine the differences in clinical outcome change between groups. Semi-structured interviews were conducted with 18 implementers (healthcare professionals) to explore their experiences on the implementation. Interviews were transcribed and analysed inductively using thematic analysis. Results: 76 patients (82.4±5.4years) were recruited. The intervention group (n=38) improved their MBI (β=4.19[0.60,7.79], p=0.023) and MWD (β=30.05[-0.23,60.33], p=0.052) compared to the control group (n=38). Both groups showed similar GS change (β=0.04[-0.02,0.10], p=0.209). Implementers’ narratives highlighted two themes a) enhanced patient care and professional autonomy; and b) competing duties and patients’ condition challenged implementation feasibility. Generally, the mobility intervention was acceptable to healthcare professionals but manpower constraint challenged the feasibility of implementation. Conclusion: While the mobility-focused intervention showed promising results on MBI and possibly MWD of patients, manpower adaptation and improved buy-in from staff are needed to improve feasibility and sustainability of interventions. Practical implications: Mobility-focused interventions can be safely implemented in the acute care settings to improve functional outcomes of older adults. Funding: GERI Intramural Grant (GERI1627)