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PURPOSE: To examine the effect of a long-term structured physical activity (PA) intervention on accelerometer-derived metrics of activity pattern changes in mobility-impaired older adults., METHODS: Participants were randomized to either a PA or health education (HE) program. The PA intervention included a walking regimen with strength, flexibility, and balance training. The HE program featured health-related discussions and a brief upper body stretching routine. Participants (n = 1341) wore a hip-worn accelerometer for >=10 h.d for >=3 d at baseline and again at 6, 12, and 24 months postrandomization. Total PA (TPA)-defined as movements registering 100+ counts per minute-was segmented into the following intensities: low-light PA (LLPA; 100-759 counts per minute), high light PA (HLPA; 760-1040 counts per minute), low moderate PA (LMPA; 1041-2019 counts per minute), and high moderate and greater PA (HMPA; 2020+ counts per minute). Patterns of activity were characterized as bouts (defined as the consecutive minutes within an intensity)., RESULTS: Across groups, TPA decreased an average of 74 min.wk annually. The PA intervention attenuated this effect (PA = -68 vs HE: -112 min.wk, P = 0.002). This attenuation shifted TPA composition by increasing time in LLPA (10+ bouts increased 6 min.wk), HLPA (1+, 2+, 5+, and 10+ bouts increased 6, 3, 2, and 1 min.wk, respectively), LMPA (1+, 2+, 5+, and 10+ bouts increased: 19, 17,16, and 8 min.wk, respectively), and HMPA (1+, 2+, 5+, and 10+ bouts increased 23, 21, 17, and 14 min.wk, respectively)., CONCLUSIONS: The PA intervention increased PA by shifting the composition of activity toward higher-intensity activity in longer-duration bouts. However, a long-term structured PA intervention did not completely eliminate overall declines in total daily activity experienced by mobility-impaired older adults.
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OBJECTIVES: To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education. DESIGN: Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013. PARTICIPANTS: Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341). MEASUREMENTS: Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (¡100 counts/min; ¿= 1, ¿= 10, ¿= 30, ¿= 60 minute lengths) and activity (¿= 100 counts/min; ¿= 1, ¿= 2, ¿= 5, ¿= 10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment. RESULTS: Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ¿= 4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (¿= 1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ¿= 4 cumulative hospital days; ¿= 2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ¿= 4 cumulative hospital days; ¿= 5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ¿= 4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p ¿ .41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p ¿ .26). CONCLUSION: Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization.