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Development and Validation of an Interactive Internet Platform for Older People: The Healthy Ageing Through Internet Counselling in the Elderly Study.

Susan Jongstra, Cathrien Beishuizen, Sandrine Andrieu, Mariagnese Barbera, Matthijs van Dorp, Bram van de Groep, Juliette Guillemont, Francesca Mangialasche, Tessa van Middelaar, Eric Moll van Charante, Hilkka Soininen, Miia Kivipelto, Edo Richard

Telemedicine journal and e-health : the official journal of the American Telemedicine Association (2016)

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A myriad of Web-based applications on self-management have been developed, but few focus on older people. In the face of global aging, older people form an important target population for cardiovascular prevention. This article describes the full development of an interactive Internet platform for older people, which was designed for the Healthy Ageing Through Internet Counselling in the Elderly (HATICE) study. We provide recommendations to design senior-friendly Web-based applications for a new approach to multicomponent cardiovascular prevention. The development of the platform followed five phases: (1) conceptual framework; (2) platform concept and functional design; (3) platform building (software and content); (4) testing and pilot study; and (5) final product. We performed a meta-analysis, reviewed guidelines for cardiovascular diseases, and consulted end users, experts, and software developers to create the platform concept and content. The software was built in iterative cycles. In the pilot study, 41 people aged ≥65 years used the platform for 8 weeks. Participants used the interactive features of the platform and appreciated the coach support. During all phases adjustments were made to incorporate all improvements from the previous phases. The final platform is a personal, secured, and interactive platform supported by a coach. When carefully designed, an interactive Internet platform is acceptable and feasible for use by older people with basic computer skills. To improve acceptability by older people, we recommend involving the end users in the process of development, to personalize the platform and to combine the application with human support. The interactive HATICE platform will be tested for efficacy in a multinational randomized controlled trial (ISRCTN48151589).


RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years.

K Kelley, C Abraham

Social science & medicine (1982) [59:787-97] (2004)

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A randomised controlled trial was used to evaluate a theory-based health promotion intervention. The intervention, a healthy living booklet, was designed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics. The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour, as well as goal setting prompts. Participants (N = 252, average age=82) were randomly allocated to a control (patient satisfaction questionnaire) or intervention (healthy living booklet) group. Cognitions and behaviour were measured pre-intervention and at a two week follow up. The intervention group made significantly higher gains in perceived behavioural control, intention and behaviour for both target behaviours, suggesting that the intervention was successful. Sixty three of those invited to set goals to eat more healthily (e.g., "to eat five portions of fruit and vegetables a day") did so, and 67% of those who set such goals reported 100% success in acting on them. By contrast, only 34% of intervention participants set an activity goal (e.g., "a five minute walk everyday"), and only 51% reported 100% success in enacting these goals. Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention.


Effects of a social cognitive theory-based hip fracture prevention web site for older adults.

Eun-Shim Nahm, Bausell Barker, Barbara Resnick, Barbara Covington, Jay Magaziner, Patricia Brennan

Computers, informatics, nursing : CIN [28:371-9] ()

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The purposes of this study were to develop a Social Cognitive Theory-based, structured Hip Fracture Prevention Web site for older adults and conduct a preliminary evaluation of its effectiveness. The Theory-based, structured Hip Fracture Prevention Web site is composed of learning modules and a moderated discussion board. A total of 245 older adults recruited from two Web sites and a newspaper advertisement were randomized into the Theory-based, structured Hip Fracture Prevention Web site and the conventional Web sites groups. Outcomes included (1) knowledge (hip fractures and osteoporosis), (2) self-efficacy and outcome expectations, and (3) calcium intake and exercise and were assessed at baseline, end of treatment (2 weeks), and follow-up (3 months). Both groups showed significant improvement in most outcomes. For calcium intake, only the Theory-based, structured Hip Fracture Prevention Web site group showed improvement. None of the group and time interactions were significant. The Theory-based, structured Hip Fracture Prevention Web site group, however, was more satisfied with the intervention. The discussion board usage was significantly correlated with outcome gains. Despite several limitations, the findings showed some preliminary effectiveness of Web-based health interventions for older adults and the use of a Theory-based, structured Hip Fracture Prevention Web site as a sustainable Web structure for online health behavior change interventions.


Improving adherence to multiple medications in older people in primary care: Selecting intervention components to address patient-reported barriers and facilitators.

Deborah Patton, Cathal Cadogan, Cristín Ryan, Jill Francis, Gerard Gormley, Peter Passmore, Ngaire Kerse, Carmel Hughes

Health expectations : an international journal of public participation in health care and health policy (2017)

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Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst multimorbid older people prescribed multiple medications. Interventions targeting adherence often lack a theoretical underpinning and this may impact on effectiveness. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence. This study aimed to (i) identify determinants (barriers, facilitators) of adherence to multiple medications from older people's perspectives; (ii) identify key domains to target for behaviour change; and (iii) map key domains to intervention components [behaviour change techniques (BCTs)] that could be delivered in an intervention by community pharmacists. Focus groups were conducted with older people (>65 years) receiving ≥4 medications. Questions explored the 12 domains of the TDF (eg "Knowledge," "Emotion"). Data were analysed using the framework method and content analysis. Identification of key domains and mapping to intervention components (BCTs) followed established methods. Seven focus groups were convened (50 participants). A wide range of determinants were identified as barriers (eg forgetfulness, prioritization of medications) and facilitators (eg social support, personalized routines) of adherence to multiple medications. Eight domains were identified as key targets for behaviour change (eg "Social influences," "Memory, attention and decision processes," "Motivation and goals") and mapped to 11 intervention components (BCTs) to include in an intervention [eg "Social support or encouragement (general)," "Self-monitoring of the behaviour," "Goal-setting (behaviour)"]. This study used a theoretical underpinning to identify potential intervention components (BCTs). Future work will incorporate the selected BCTs into an intervention that will undergo feasibility testing in community pharmacies.


Development of an intervention to improve appropriate polypharmacy in older people in primary care using a theory-based method.

Cathal Cadogan, Cristín Ryan, Jill Francis, Gerard Gormley, Peter Passmore, Ngaire Kerse, Carmel Hughes

BMC health services research [16:661] (2016)

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It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported. However, previous interventions aimed at ensuring that older people receive appropriate polypharmacy have lacked details on their development. This study formed part of a multiphase research project which aimed to develop an intervention to improve appropriate polypharmacy in older people in primary care. The target behaviours for the intervention were prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners (GPs) and community pharmacists. Intervention development followed a systematic approach, including previous mapping of behaviour change techniques (BCTs) to key domains from the Theoretical Domains Framework that were perceived by GPs and pharmacists to influence the target behaviours. Draft interventions were developed to operationalise selected BCTs through team discussion. Selection of an intervention for feasibility testing was guided by a subset of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria. Three draft interventions comprising selected BCTs were developed, targeting patients, pharmacists and GPs, respectively. Following assessment of each intervention using a subset of the APEASE criteria (affordability, practicability, acceptability), the GP-targeted intervention was selected for feasibility testing. This intervention will involve a demonstration of the behaviour and will be delivered as an online video. The video demonstrating how GPs can prescribe appropriate polypharmacy during a typical consultation with an older patient will also demonstrate salience of consequences (feedback emphasising the positive outcomes of performing the behaviour). Action plans and prompts/cues will be used as complementary intervention components. The intervention is designed to facilitate the prescribing of appropriate polypharmacy in routine practice. A GP-targeted intervention to improve appropriate polypharmacy in older people has been developed using a systematic approach. Intervention content has been specified using an established taxonomy of BCTs and selected to maximise feasibility. The results of a future feasibility study will help to determine if the theory-based intervention requires further refinement before progressing to a larger scale randomised evaluation.


Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial.

LL Lee, A Arthur, M Avis

Preventive medicine [44:160-6] (2007)

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To study the effect of a community-based walking intervention on blood pressure among older people. The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure. At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19). Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.


What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial.

Julia Wolff, Lisa Warner, Jochen Ziegelmann, Susanne Wurm

Psychology & health [29:915-32] (2014)

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Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention. Randomised controlled trial with three groups aged 65+: Intervention for physical activity with 'views-on-ageing'-component (n = 101; IGVoA), and without 'views-on-ageing'-component (n = 30; IG), and active control intervention for volunteering (n = 103; CG). Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5 months after the intervention. Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable. A 'views-on-ageing'-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.


Testing the Senior Exercise Self-efficacy Project (SESEP) for use with urban dwelling minority older adults.

Barbara Resnick, Daria Luisi, Amanda Vogel

Public health nursing (Boston, Mass.) [25:221-34] ()

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To test the feasibility and effectiveness of the Senior Exercise Self-efficacy Project (SESEP). A feasibility study using a randomized control trial. The total sample included 166 persons, with a mean age of 73 years (SD=8.2 years), the majority of whom were female (81%), African American (72%), unmarried (86%), had at least a high school education (64%), and were retired (77%). There were 100 participants in the intervention group and 66 in the comparison group. The SESEP was a combined physical activity and efficacy-enhancing intervention for community-dwelling minority older adults. The primary outcomes included self-efficacy, outcome expectations, exercise, and overall physical activity, and the secondary outcomes were mental and physical health-related quality of life, depressive symptoms, pain, fear of falling, mobility, and chair rise time. Data were collected at baseline and following the 12-week intervention. There were statistically significant improvements in outcome expectations (p=.02), time spent in exercise (p=.04), and depressive symptoms (p=.02). Overall, there was a 77% rate of participation in classes. Although there was good participation in the SESEP among minority older adults, the primary outcomes were only minimally supported and there was even less support for the secondary outcomes.


Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients.

Zakkoyya Lewis, Kenneth Ottenbacher, Steve Fisher, Kristofer Jennings, Arleen Brown, Maria Swartz, Elizabeth Lyons

JMIR research protocols [5:e59] (2016)

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Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users. The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer. Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders. The study started recruitment in October 2015 and is scheduled to be completed by October 2016. This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level. ClinicalTrials.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT).


Evaluation of CHAMPS, a physical activity promotion program for older adults.

A Stewart, K Mills, P Sepsis, A King, B McLellan, K Roitz, P Ritter

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine [19:353-61] (1997)

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We evaluated physical activity changes resulting from a six-month public health model intervention that encouraged seniors (N = 89) 62-91 years of age (mean = 76) living in two low-income congregate housing facilities to increase their physical activity by participating in existing community-based physical activity classes and programs of their choice. The program was offered to everyone regardless of their health problems. Enrollees were encouraged to adopt activities tailored to their preferences, physical abilities, health status, income, and transportation resources. Using a comparison-group design, the intervention group was more active for all comparison months of the intervention period (p values < .05). The intervention also was associated with improvements in self-esteem (p < .05), though not with an array of other measures of health-related quality-of-life. Those who adopted and maintained a new physical activity over the six-month intervention period experienced improvements in anxiety, depression, and overall psychological well-being relative to those who did not. The intervention was subsequently replicated through a senior center (N = 22). A much larger proportion of the senior center sample adopted and maintained a new activity for six months (68%) compared to the congregate facilities sample (35%), which may have been due to differences in recruitment methods and sample characteristics in the two settings. An intervention promoting increased physical activity through the use of existing community resources may help increase physical activity in older adults.


Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors.

Wendy Demark-Wahnefried, Miriam Morey, Elizabeth Clipp, Carl Pieper, Denise Snyder, Richard Sloane, Harvey Cohen

Controlled clinical trials [24:206-23] (2003)

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The U.S. population is aging, bringing with it an increased prevalence of chronic disease and concomitant declines in physical function. The risk of developing cancer increases significantly with age, and functional decline is much more likely once a cancer diagnosis is rendered. Thus, functional status in later life is a key concern, one that is heightened among elders who have been diagnosed with cancer. To date, however, there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients, and to our knowledge, none has focused on preserving or enhancing physical functioning. This paper describes the study design and methodological considerations of a randomized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer. This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline, but also as a "teachable moment" - an opportune time when elders may be more receptive to making beneficial lifestyle changes. Undoubtedly, as cure rates for cancer increase and intersect with ever-growing numbers of elderly, there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome. In reporting our methods, we hope to give others "a leg up," so that they can hurdle with greater ease the barriers we experienced, and thus advance the field more rapidly.


Acceptability of a theory-based sedentary behaviour reduction intervention for older adults ('On Your Feet to Earn Your Seat').

Raluca Matei, Ingela Thuné-Boyle, Mark Hamer, Steve Iliffe, Kenneth Fox, Barbara Jefferis, Benjamin Gardner

BMC public health [15:606] (2015)

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Adults aged 60 years and over spend most time sedentary and are the least physically active of all age groups. This early-phase study explored acceptability of a theory-based intervention to reduce sitting time and increase activity in older adults, as part of the intervention development process. An 8-week uncontrolled trial was run among two independent samples of UK adults aged 60-75 years. Sample 1, recruited from sheltered housing on the assumption that they were sedentary and insufficiently active, participated between December 2013 and March 2014. Sample 2, recruited through community and faith centres and a newsletter, on the basis of self-reported inactivity (<150 weekly minutes of moderate-to-vigorous activity) and sedentary behaviour (≥ 6 h mean daily sitting), participated between March and August 2014. Participants received a booklet offering 16 tips for displacing sitting with light-intensity activity and forming activity habits, and self-monitoring 'tick-sheets'. At baseline, 4-week, and 8-week follow-ups, quantitative measures were taken of physical activity, sedentary behaviour, and habit. At 8 weeks, tick-sheets were collected and a semi-structured interview conducted. Acceptability was assessed for each sample separately, through attrition and adherence to tips, ANOVAs for behaviour and habit changes, and, for both samples combined, thematic analysis of interviews. In Sample 1, 12 of 16 intervention recipients completed the study (25% attrition), mean adherence was 40% (per-tip range: 15-61%), and there were no clear patterns of changes in sedentary or physical activity behaviour or habit. In Sample 2, 23 of 27 intervention recipients completed (15% attrition), and mean adherence was 58% (per-tip range: 39-82%). Sample 2 decreased mean sitting time and sitting habit, and increased walking, moderate activity, and activity habit. Qualitative data indicated that both samples viewed the intervention positively, found the tips easy to follow, and reported health and wellbeing gains. Low attrition, moderate adherence, and favourability in both samples, and positive changes in Sample 2, indicate the intervention was acceptable. Higher attrition, lower adherence, and no apparent behavioural impact among Sample 1 could perhaps be attributable to seasonal influences. The intervention has been refined to address emergent acceptability problems. An exploratory controlled trial is underway.


A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.

Nicola Fairhall, Catherine Sherrington, Ian Cameron, Susan Kurrle, Stephen Lord, Keri Lockwood, Robert Herbert

Journal of physiotherapy [63:40-44] (2017)

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What is the effect of a multifactorial intervention on frailty and mobility in frail older people who comply with their allocated treatment? Secondary analysis of a randomised, controlled trial to derive an estimate of complier average causal effect (CACE) of treatment. A total of 241 frail community-dwelling people aged ≥ 70 years. Intervention participants received a 12-month multidisciplinary intervention targeting frailty, with home exercise as an important component. Control participants received usual care. Primary outcomes were frailty, assessed using the Cardiovascular Health Study criteria (range 0 to 5 criteria), and mobility measured using the 12-point Short Physical Performance Battery. Outcomes were assessed 12 months after randomisation. The treating physiotherapist evaluated the amount of treatment received on a 5-point scale. 216 participants (90%) completed the study. The median amount of treatment received was 25 to 50% (range 0 to 100). The CACE (ie, the effect of treatment in participants compliant with allocation) was to reduce frailty by 1.0 frailty criterion (95% CI 0.4 to 1.5) and increase mobility by 3.2 points (95% CI 1.8 to 4.6) at 12 months. The mean CACE was substantially larger than the intention-to-treat effect, which was to reduce frailty by 0.4 frailty criteria (95% CI 0.1 to 0.7) and increase mobility by 1.4 points (95% CI 0.8 to 2.1) at 12 months. Overall, compliance was low in this group of frail people. The effect of the treatment on participants who comply with allocated treatment was substantially greater than the effect of allocation on all trial participants. Australian and New Zealand Trial Registry ANZCTRN12608000250336. [Fairhall N, Sherrington C, Cameron ID, Kurrle SE, Lord SR, Lockwood K, Herbert RD (2016) A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial.Journal of Physiotherapy63: 40-44].


Physical activity with spiritual strategies intervention: a cluster randomized trial with older African American women.

Karen Joy Anderson, Carol Pullen

Research in gerontological nursing [6:11-21] (2013)

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A cluster randomized study was conducted using a convenience sample of four Christian faith communities from which 27 African American women 60 and older were recruited. The purpose was to determine whether African American women receiving a physical activity intervention with spiritual strategies compared to a control group would demonstrate differences over time in physical activity behaviors and biomarkers, in self-efficacy for physical activity, and in barriers to physical activity. Results with baseline and 12-week measurements included significant between-group findings at 12 weeks on muscle strength activity (minutes per week, z = -3.269, p = 0.001; days per week, z = -3.384, p = 0.001), favoring the intervention group. There were significant between-group findings in 6-minute walk change scores (z = -2.546, p = 0.009), favoring the intervention group. Barriers were significantly reduced within the intervention group (z = -2.184, p = 0.029). Evidence suggests a physical activity intervention with spiritual strategies increases physical activity behavior. The Health Promotion Model can be used to develop physical activity interventions with spiritual strategies for older African American women in faith communities, thus, supporting Healthy People 2020 goals.


Revisiting self-regulatory techniques to promote physical activity in older adults: null-findings from a randomised controlled trial.

Lisa Warner, Julia Wolff, Jochen Ziegelmann, Ralf Schwarzer, Susanne Wurm

Psychology & health (2016)

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A randomised controlled trial (RCT) was conducted to evaluate a three-hour face-to-face physical activity (PA) intervention in community-dwelling older German adults with four groups: The intervention group (IG) received behaviour change techniques (BCTs) based on the health action process approach plus a views-on-ageing component to increase PA. The second intervention group 'planning' (IGpl) contained the same BCTs, only substituted the views-on-ageing component against an additional planning task. An active control group received the same BCTs, however, targeting volunteering instead of PA. A passive control group (PCG) received no intervention. The RCT comprised 5 time-points over 14 months in N = 310 participants aged 64+. Self-reported as well as accelerometer-assessed PA. Neither PA measure increased in the IG as compared to the other groups at any point in time. Bayes analyses supported these null-effects. A possible explanation for this null-finding in line with a recent meta-analysis is that some self-regulatory BCTs may be ineffective or even negatively associated with PA in interventions for older adults as they are assumed to be less acceptable for older adults. This interpretation was supported by observed reluctance to participate in self-regulatory BCTs in the current study.


An extended theory of planned behavior intervention for older adults with type 2 diabetes and cardiovascular disease.

Katherine White, Deborah Terry, Carolyn Troup, Lynn Rempel, Paul Norman, Kerry Mummery, Malcolm Riley, Natasha Posner, Justin Kenardy

Journal of aging and physical activity [20:281-99] (2012)

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A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease.


Effects of health risk assessment and counselling on physical activity in older people: A pragmatic randomised trial.

Anna Herghelegiu, André Moser, Gabriel Ioan Prada, Stephan Born, Matthias Wilhelm, Andreas Stuck

PloS one [12:e0181371] (2017)

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Interventions to increase physical activity (PA) among older community-dwelling adults may be enhanced by using multidimensional health risk assessment (HRA) as a basis for PA counselling. The study was conducted among nondisabled but mostly frail persons 65 years of age and older at an ambulatory geriatric clinic in Bucharest, Romania. From May to July 2014, 200 participants were randomly allocated to intervention and control groups. Intervention group participants completed an initial HRA questionnaire and then had monthly counselling sessions with a geriatrician over a period of six months that were aimed at increasing low or maintaining higher PA. Counselling also addressed the older persons' concomitant health risks and problems. The primary outcome was PA at six months (November 2014 to February 2015) evaluated with the International Physical Activity Questionnaire. At baseline, PA levels were similar in intervention and control groups (median 1089.0, and 1053.0 MET [metabolic equivalent of task] minutes per week, interquartile ranges 606.0-1401.7, and 544.5-1512.7 MET minutes per week, respectively). Persons in the intervention group had an average of 11.2 concomitant health problems and risks (e.g., pain, depressive mood, hypertension). At six months, PA increased in the intervention group by a median of 180.0 MET minutes per week (95% confidence interval (CI) 43.4-316.6, p = 0.01) to 1248.8 MET minutes per week. In the control group, PA decreased by a median of 346.5 MET minutes per week (95% CI 178.4-514.6, p<0.001) to 693.0 MET minutes per week due to a seasonal effect, resulting in a difference of 420.0 MET minutes per week (95% CI 212.7-627.3, p< 0.001) between groups. The use of HRA to inform individualized PA counselling is a promising method for achieving improvements in PA, and ultimately health and longevity among large groups of community-dwelling older persons. International Standard Randomized Controlled Trial Number: ISRCTN11166046.


A randomized controlled trial of an office-based physical activity and physical fitness intervention for older adults.

Janet Purath, Colleen Keller, Sterling McPherson, Barbara Ainsworth

Geriatric nursing (New York, N.Y.) [34:204-11] ()

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This primary care-based study aimed to evaluate the efficacy and feasibility of a 24-week intervention on physical activity and physical fitness in a group of community-dwelling older adults. Secondary aims were to determine the effect of the intervention on self-efficacy and barriers to physical activity. Intervention participants (n = 36) received an exercise prescription based on physical fitness test results and personal choice. Comparison participants (n = 36) received a nutrition intervention. Both groups received 10 follow-up telephone calls. Repeated measures ANOVA analyses showed no direct effects of the intervention on the primary outcomes of physical activity or physical fitness in the intervention group (p > 0.05). Secondary analyses with ANCOVA that included potential moderating variables of age, gender, income, BMI, and support for physical activity showed that the intervention group significantly increased frequency of all physical activity (F = 3.50, p < 0.05) as well as the fitness outcomes of lower body strength (F = 3.63, p < 0.05) and aerobic endurance (F = 4.03, p < 0.05). This is one of the first studies to evaluate the use of fitness measures to increase physical activity and fitness in the primary care setting. The intervention improved some aspects of physical activity and fitness for selected participants.


Long-term impact of Fit and Strong! on older adults with osteoarthritis.

Susan Hughes, Rachel Seymour, Richard Campbell, Gail Huber, Naomi Pollak, Leena Sharma, Pankaja Desai

The Gerontologist [46:801-14] (2006)

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We present final outcomes from the multiple-component Fit and Strong! intervention for older adults with lower extremity osteoarthritis. A randomized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement (n=115) with a wait list control (n=100) at 2, 6, and 12 months. Fit and Strong! combined flexibility, aerobic walking, and resistance training with education and group problem solving to enhance self-efficacy for exercise and maintenance of physical activity. All participants developed individualized plans for long-term maintenance. Relative to controls, treatment participants experienced statistically significant improvements in self-efficacy for exercise (p=.001), minutes of exercise per week (p=.000), and lower extremity stiffness (p=.018) at 2 months. These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time (p=.001), reduced pain (p=.040), and a marginally significant increase in self-efficacy for arthritis pain management (p=.052). Despite a substantially smaller sample size at 12 months, significant treatment-group effects were maintained on self-efficacy for exercise (p=.006) and minutes of exercise per week (p=.001), accompanied by marginally significant reductions in lower extremity stiffness (p=.056) and pain (p=.066). No adverse health effects were seen. Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713, and 0.905 and 0.669, respectively, in the treatment group at 6 and 12 months. This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis.


The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults.

Dori Rosenberg, Nancy Gell, Salene Jones, Anne Renz, Jacqueline Kerr, Paul Gardiner, David Arterburn

Health education & behavior : the official publication of the Society for Public Health Education [42:669-76] (2015)

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Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre-post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising.


On Your Feet to Earn Your Seat: pilot RCT of a theory-based sedentary behaviour reduction intervention for older adults.

Isabelle White, Lee Smith, Daniel Aggio, Sahana Shankar, Saima Begum, Raluca Matei, Kenneth Fox, Mark Hamer, Steve Iliffe, Barbara Jefferis, Nick Tyler, Benjamin Gardner

Pilot and feasibility studies [3:23] (2017)

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Of all age groups, older adults spend most of the time sitting and are least physically active. This sequential, mixed-methods feasibility study used a randomised controlled trial design to assess methods for trialling a habit-based intervention to displace older adults' sedentary behaviour with light activity and explore impact on behavioural outcomes. Eligibility criteria were age 60-74 years, retired, and ≥6 h/day leisure sitting. Data were collected across four sites in England. The intervention comprised a booklet outlining 15 'tips' for disrupting sedentary habits and integrating activity habits into normally inactive settings, and eight weekly self-monitoring sheets. The control was a non-habit-based factsheet promoting activity and sedentary reduction. A computer-generated 1:1 block-randomisation schedule was used, with participants blinded to allocation. Participants self-reported sedentary behaviour (two indices), sedentary habit, physical activity (walking, moderate, vigorous activity) and activity habit, at pre-treatment baseline, 8- and 12-week follow-ups and were interviewed at 12 weeks. Primary feasibility outcomes were attrition, adverse events and intervention adherence. The secondary outcome was behavioural change. Of 104 participants consented, 103 were randomised (intervention N = 52, control N = 51). Of 98 receiving allocated treatment, 91 (93%; intervention N = 45; control N = 46) completed the trial. One related adverse event was reported in the intervention group. Mean per-tip adherence across 7 weeks was ≥50% for 9/15 tips. Qualitative data suggested acceptability of procedures, and, particularly among intervention recipients, the allocated treatment. Both groups appeared to reduce sedentary behaviour and increase their physical activity, but there were no apparent differences between groups in the extent of change. Trial methods were acceptable and feasible, but the intervention conferred no apparent advantage over control, though it was not trialled among the most sedentary and inactive population for whom it was developed. Further development of the intervention may be necessary prior to a large-scale definitive trial. One possible refinement would combine elements of the intervention with an informational approach to enhance effectiveness. ISRCTN47901994 (registration date: 16th January 2014; trial end date 30th April 2015).


Tailored and Adaptive Computerized Cognitive Training in Older Adults at Risk for Dementia: A Randomized Controlled Trial.

Alex Bahar-Fuchs, Shannon Webb, Lauren Bartsch, Linda Clare, George Rebok, Nicolas Cherbuin, Kaarin Anstey

Journal of Alzheimer's disease : JAD [60:889-911] (2017)

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Computerized Cognitive Training (CCT) has been shown to improve cognitive function in older adults with mild cognitive impairment (MCI) or mood-related neuropsychiatric symptoms (MrNPS), but many questions remain unresolved. To evaluate the extent to which CCT benefits older adults with both MCI and MrNPS, and its effects on meta-cognitive and non-cognitive outcomes, as well as establish whether adapting difficulty levels and tailoring to individuals' profile is superior to generic training. Older adults with MCI (n = 9), MrNPS (n = 11), or both (MCI+, n = 25) were randomized into a home-based individually-tailored and adaptive CCT (n = 21) or an active control condition (AC; n = 23) in a double-blind design. Interventions lasted 8-12 weeks and outcomes were assessed after the intervention, and at a 3-month follow-up. Participants in both conditions reported greater satisfaction with their everyday memory following intervention and at follow-up. However, participants in the CCT condition showed greater improvement on composite measures of memory, learning, and global cognition at follow-up. Participants with MrNPS in the CCT condition were also found to have improved mood at 3-month follow-up and reported using fewer memory strategies at the post-intervention and follow-up assessments. There was no evidence that participants with MCI+ were disadvantaged relative to the other diagnostic conditions. Finally, informant-rated caregiver burden declined at follow-up assessment in the CCT condition relative to the AC condition. Home-based CCT with adaptive difficulty and personal tailoring appears superior to more generic CCT in relation to both cognitive and non-cognitive outcomes. Mechanisms of treatment effect and future directions are discussed.


Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: an exploratory systematic review.

Benjamin Gardner, Ana Jovicic, Celia Belk, Kalpa Kharicha, Steve Iliffe, Jill Manthorpe, Claire Goodman, Vari Drennan, Kate Walters

BMJ open [7:e014127] (2017)

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To identify trials of home-based health behaviour change interventions for frail older people, describe intervention content and explore its potential contribution to intervention effects. 15 bibliographic databases, and reference lists and citations of key papers, were searched for randomised controlled trials of home-based behavioural interventions reporting behavioural or health outcomes. Participants' homes. Community-dwelling adults aged ≥65 years with frailty or at risk of frailty. Trials were coded for effects on thematically clustered behavioural, health and well-being outcomes. Intervention content was described using 96 behaviour change techniques, and 9 functions (eg, education, environmental restructuring). 19 eligible trials reported 22 interventions. Physical functioning was most commonly assessed (19 interventions). Behavioural outcomes were assessed for only 4 interventions. Effectiveness on most outcomes was limited, with at most 50% of interventions showing potential positive effects on behaviour, and 42% on physical functioning. 3 techniques (instruction on how to perform behaviour, adding objects to environment, restructuring physical environment) and 2 functions (education and enablement) were more commonly found in interventions showing potential than those showing no potential to improve physical function. Intervention content was not linked to effectiveness on other outcomes. Interventions appeared to have greatest impact on physical function where they included behavioural instructions, environmental modification and practical social support. Yet, mechanisms of effects are unclear, because impact on behavioural outcomes has rarely been considered. Moreover, the robustness of our findings is also unclear, because interventions have been poorly reported. Greater engagement with behavioural science is needed when developing and evaluating home-based health interventions. ID=CRD42014010370.


Jigsaw Puzzles As Cognitive Enrichment (PACE) - the effect of solving jigsaw puzzles on global visuospatial cognition in adults 50 years of age and older: study protocol for a randomized controlled trial.

Patrick Fissler, Olivia Küster, Laura Loy, Daria Laptinskaya, Martin Rosenfelder, Christine AF von Arnim, Iris-Tatjana Kolassa

Trials [18:415] (2017)

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Neurocognitive disorders are an important societal challenge and the need for early prevention is increasingly recognized. Meta-analyses show beneficial effects of cognitive activities on cognition. However, high financial costs, low intrinsic motivation, logistic challenges of group-based activities, or the need to operate digital devices prevent their widespread application in clinical practice. Solving jigsaw puzzles is a cognitive activity without these hindering characteristics, but cognitive effects have not been investigated yet. With this study, we aim to evaluate the effect of solving jigsaw puzzles on visuospatial cognition, daily functioning, and psychological outcomes. The pre-posttest, assessor-blinded study will include 100 cognitively healthy adults 50 years of age or older, who will be randomly assigned to a jigsaw puzzle group or a cognitive health counseling group. Within the 5-week intervention period, participants in the jigsaw puzzle group will engage in 30 days of solving jigsaw puzzles for at least 1 h per day and additionally receive cognitive health counseling. The cognitive health counseling group will receive the same counseling intervention but no jigsaw puzzles. The primary outcome, global visuospatial cognition, will depict the average of the z-standardized performance scores in visuospatial tests of perception, constructional praxis, mental rotation, processing speed, flexibility, working memory, reasoning, and episodic memory. As secondary outcomes, we will assess the eight cognitive abilities, objective and subjective visuospatial daily functioning, psychological well-being, general self-efficacy, and perceived stress. The primary data analysis will be based on mixed-effects models in an intention-to-treat approach. Solving jigsaw puzzles is a low-cost, intrinsically motivating, cognitive leisure activity, which can be executed alone or with others and without the need to operate a digital device. In the case of positive results, these characteristics allow an easy implementation of solving jigsaw puzzles in clinical practice as a way to improve visuospatial functioning. Whether cognitive impairment and loss of independence in everyday functioning might be prevented or delayed in the long run has to be examined in future studies. ClinicalTrials.gov, NCT02667314 . Registered on 27 January 2016.


Computerized cognitive training for older diabetic adults at risk of dementia: Study protocol for a randomized controlled trial.

Rachel Bloom, Michal Schnaider-Beeri, Ramit Ravona-Springer, Anthony Heymann, Hai Dabush, Lior Bar, Shirel Slater, Yuri Rassovsky, Alex Bahar-Fuchs

Alzheimer's & dementia (New York, N. Y.) [3:636-650] (2017)

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Older adults with type 2 diabetes are at high risk of cognitive decline and dementia and form an important target group for dementia risk reduction studies. Despite evidence that computerized cognitive training (CCT) may benefit cognitive performance in cognitively healthy older adults and those with mild cognitive impairment, whether CCT may benefit cognitive performance or improve disease self-management in older diabetic adults has not been studied to date. In addition, whether adaptive difficulty levels and tailoring of interventions to individuals' cognitive profile are superior to generic training remains to be established. Ninety community-dwelling older (age ≥ 65) diabetic adults are recruited and randomized into a tailored and adaptive computerized cognitive training condition or to a generic, nontailored, or adaptive CCT condition. Both groups complete an 8-week training program using the commercially available CogniFit program. The intervention is augmented by a range of behavior-change techniques, and participants in each condition are further randomized into a global or cognition-specific phone-based self-efficacy (SE) condition, or a no-SE condition. The primary outcome is global cognitive performance immediately after the intervention. Secondary outcomes include diabetes self-management, meta-memory, mood, and SE. This pilot study is the first trial evaluating the potential benefits of home-based tailored and adaptive CCT in relation to cognitive and disease self-management in older diabetic adults. Methodological strengths of this trial include the double-blind design, the clear identification of the proposed active ingredients of the intervention, and the use of evidence-based behavior-change techniques. Results from this study will indicate whether CCT has the potential to lower the risk of diabetes-related cognitive decline. The outcomes of the trial will also advance our understanding of essential intervention parameters required to improve or maintain cognitive function and enhance disease self-management in this at-risk group.


Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT.

Kate Walters, Rachael Frost, Kalpa Kharicha, Christina Avgerinou, Benjamin Gardner, Federico Ricciardi, Rachael Hunter, Ann Liljas, Jill Manthorpe, Vari Drennan, John Wood, Claire Goodman, Ana Jovicic, Steve Iliffe

Health technology assessment (Winchester, England) [21:1-128] (2017)

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Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) ( = 44), carers ( = 12) and health/social care professionals ( = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). Community settings in London and Hertfordshire, UK. A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68;  = 0.004), better grip strength (+6.48 kg;  = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92;  = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. A large, definitive RCT of the HomeHealth service is warranted. This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.


Development and evaluation of a structured programme for promoting physical activity among seniors with intellectual disabilities: a study protocol for a cluster randomized trial.

Marieke van Schijndel-Speet, Heleen Evenhuis, Pepijn van Empelen, Ruud van Wijck, Michael Echteld

BMC public health [13:746] (2013)

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Older people with intellectual disabilities have very low physical activity levels. Well designed, theory-driven and evidence-based health promotion programmes for the target population are lacking. This paper describes the design of a cluster-randomised trial for a systematically developed health promotion programme aimed at improving physical activity and increasing fitness among seniors with intellectual disabilities. The Intervention Mapping protocol was used for programme development. After defining the programme's objectives, the following behavioural techniques were selected to achieve them: Tailoring, Education, Modelling, Mirroring, Feedback, Reinforcement and Grading. With professionals and managers of provider services for people with intellectual disabilities, we translated these strategies into a structured day-activity programme, that consisted of a physical activity and an education programme. The programme will be executed in five day-activity centres in groups of eight to ten seniors during eight months, whereas seniors in five other centres receive care as usual. The physical activity level, as measured in number of steps a day, will be used as primary outcome measurement. Secondary outcome measurements include motor fitness, cardio respiratory fitness, morphological and metabolic fitness, ADL, functional deterioration and depressive symptoms. Differences in the primary and secondary outcome measures between participants and controls will be analysed using generalized estimation equations, correcting for day-activity center as cluster. This paper provides insight into the development and content of a theory-driven intervention aimed at behavioural change in a population with a low intellectual level. Its evaluation design is described. The programme's applicability to other populations is discussed.