Purpose

Yoga is a physical activity that appeals to many older people, however yoga-based research involving older people is scarce. Our previous research demonstrates a positive impact of yoga on balance and mobility (Youkhana et al, 2015), showing yoga has potential as a fall prevention strategy, yet its validity for preventing falls has not been tested. Our research is investigating the role of yoga for promoting healthy ageing and preventing falls in people aged 60+.

Methods

We surveyed older people’s perceptions of a yoga program scenario compared with their perceptions of two other fall prevention program scenarios: Tai Chi and Otago home-based Exercise Programme. We also conducted a pilot RCT (n=54, mean age 68) to determine the impact of a 12-week yoga program on balance and mobility among community-dwellers aged 60+. We recently obtained NHMRC funding and commenced the first international trial to determine the effectiveness and cost-effectiveness of yoga on falls (primary outcome) in people aged 60+.

Results

Our survey (n=235, mean age 69) showed that a yoga-based program was perceived to be as attractive and relevant as Tai Chi and the Otago Programme. In our pilot RCT (n=54, mean age 68) the yoga intervention led to significant improvements in all measures of balance and mobility, which have previously been associated with an increased risk of falling. The yoga program was appealing, with 83% average class attendance, and safe, with no serious adverse events. Importantly, the seniors' yoga classes that were commenced for our pilot trial, are still run today, on a fee for attendance basis, seven years after trial completion, demonstrating sustainability. Recruitment has commenced for our NHMRC-funded trial of yoga with fall rates as the primary outcome (44/560 randomised so far).

Conclusion

Yoga is positively perceived by older people. Our research shows that yoga significantly improves balance and mobility, is well received and safe to participate. Research to measure the effect of yoga on falls in older age is warranted and the first trial internationally is currently underway in Sydney.

PURPOSE: Older adults spend approximately 65-80% of waking hours in sedentary behavior (SB) with most sedentary pursuits occurring in the home. Replacing SB time with physical activity (PA) is linked to better geriatric-related health outcomes, but reported effectiveness of interventions are limited. The primary purpose of this study was to determine the effectiveness of using a seated elliptical pedaling device (SED) to replace SB with PA in the homes of older adults. A secondary purpose was to determine the intervention effects on physical function.

METHODS: Twenty-six older adults were randomized into an 8-week home-based SB intervention group (EG) or a control group (CG). Baseline and follow-up assessments for PA and SB were performed using self-report and hip-worn accelerometers. A Short Physical Performance Battery (SPPB) was used to assess physical functioning. The intervention group progressively increased pedaling duration goals from 30 minutes per day to 60 minute per day. Both intention-to-treat and per-protocol analyses using mixed models were performed.

RESULTS: Twenty-one older adults (14 females; 76.9 ± 6.7 years) completed baseline and 8-week follow-up. At baseline, participants spent approximately 78% of waking hours in SB and lower-extremity functional limitations ranged from moderate to minimal (SPPB range: 5-12). In the per-protocol analysis, participants that remained in the EG (n=8) were able to meet their goals with 7 of 8 reporting 80% adherence or better. There was a significant group by time interaction effect for daily SB (p=0.002) and LPA (p=0.002) indicating the effectiveness of the intervention to reduce daily SB and increase LPA. Specifically, individuals in the EG experienced a 9.6% reduction in daily SB which translated to a 9.2% increase in daily LPA across the 8-week period. No significant intervention effect was identified for physical function with most measures having small effect sizes.

CONCLUSIONS: A SED appears to be an effective and practical approach to reduce SB in the homes of this small sample of older adults. Future studies should explore more intensive behavioral change strategies to improve adherence and examine other geriatric-related health outcomes in a larger sample size. 

Methods: ECI (≥65 years) with at least one chronic condition were recruited from 7 municipalities. Comparable neighborhoods within a municipality were randomly allocated to the intervention (N=260) or waiting list control group (N=325). Active Plus participants received three computer-tailored PA advice. Baseline and followup measurements after 6 and 12 months assess objectively measured LPA and MVPA min/week, and self-report MVPA min/week on common types of PA (household, walking, cycling, gardening, DIY, sports). Multilevel linear regression analyses were conducted.

Results: After 12 months, 432 participants completed follow up (dropout=26%). Preliminary analyses showed the intervention improved self-reported walking (B=66.9, 95%CI=5.1;128.7, p=.034) and cycling (B=70.0, 95%CI=17.2;122.9, p=.009) at six months, and DIY behavior (B=96.9.0, 95%CI=7.28;186.5, p=.034) after 12 months. Additionally, the intervention increased objectively measured MVPA (B=28.8, 95%CI=0.35;57.2, p=.047) and LPA (B=102.1, 95%CI=4.3;199.8, p=.041) after 12 months for ECI with a higher BMI.

Conclusions: The Active Plus intervention improved self-reported walking and cycling at six months. These are two very common types of PA in daily life which were targeted in the intervention. No overall intervention effects on objectively measured PA were found, although persons with a higher BMI benefitted from the intervention. Active Plus is perhaps not sufficient enough for the general ECI population on its own, and blended care is advised.

Most older adults fail to adhere to the multicomponent (aerobic, muscle strengthening, balance training) physical activity (PA) guidelines. Thus, effective and sustainable multicomponent PA programs that promote adherence in older adults remains a public health priority, especially for females given their higher rates of physical inactivity and risk for physical disability compared to males. PURPOSE: To examine if sex/gender influences the effects of a multicomponent 10-week PA intervention grounded in Social Cognitive Theory and augmented with social media (Facebook) on program attendance and engagement, PA behaviors, muscle capacity, and physical function (PFx) in older adults. METHODS: Physically inactive older adults (71.3 ± 4.3 yo; n=28, 64% female) completed a 10-week multicomponent PA program that included 1) a twice weekly supervised exercise class (muscle strength and balance training) with PA behavior education, 2) Facebook engagement, and 3) an unsupervised walking prescription. PA behaviors were assessed via accelerometers, questionnaires, and pedometer step count logs. Conventional measures of leg strength and power along with a battery of PFx tests were also employed [6-minute walk (6MW), 8-foot up and go (UPGO), chair stands (CHAIR), and transfer task (TRANSFER)]. A two-way [Gender (G) x Time (T)] ANOVA was utilized to determine significance of change. RESULTS: There was a trend for higher class attendance in females compared to males (96.7±3.8% vs. 92.0±6.7%, p=0.06). Females also had a 2.3-fold greater engagement in Facebook compared to males (p=0.01). Males and females improved PA behaviors similarly (T p<0.05; GxT and G p>0.05). Muscle capacity improved similarly (T p<0.05) with males, as expected, having higher leg strength and power (G p<0.05; GxT p>0.05). Regarding PFx, improvements occurred in 6MW, UPGO and TRANSFER (T p<0.05; GxT p>0.05) with males also having higher functional capacity, as anticipated, in 6MW, UPGO, and CHAIR (G p<0.05). CONCLUSION: A 10-week PA program improves PA behavior, muscle capacity, and PFx similarly in older males and females. More research is needed to develop effective and sustainable multicomponent PA programs for older adults which may differ by social factors in females compared to males. 

Purpose: Australian private health insurance members with obesity-related chronic disease successfully lose weight during an 18-week behavioural lifestyle program addressing healthy eating and physical activity. An evidence-based, extended-contact maintenance-phase using behaviour change strategies, was added to address the challenge of maintaining weight-loss. Research of real-world weight-loss maintenance programs in this setting and of weight change patterns is sparse. We investigated a) the impact of 6-and 12-months of participation in the maintenance phase on anthropometric and lifestyle risk behaviours, and b) weight-change patterns to identify sub-groups who may benefit from service modification.

Methods: Participants (n=490) provided demographic and weight-related information at six time-points to 12-months. Pre-post telephone surveys conducted at maintenance-phase baseline, 6- and 12-months with a sub-sample of participants (n=101) collected lifestyle risk behaviour information. We used generalised linear mixed models for repeated measures to determine the program effect on weight-loss and lifestyle risk behaviours. We also examined trends in weight-loss maintenance over the first 12-months.

Results/findings: After initially losing on average 9.1kg (p<0.001), maintenance-phase participants regained 0.9kg (p<0.001) at 6-months and 1.3kg (p<0.001) at 12-months. Weight-loss maintenance was achieved by 76% of participants at 3-months and 62% at 6-months, stabilising at 55% and 56% at 9 (OR=0.22, 95%CI 0.12-0.39, p<0.001) and 12 months (OR=0.08, 95%CI 0.04-0.17, p<0.001) respectively. Greater initial weight-loss was associated with weight-loss maintenance at 12 months (5-9.9%: OR=2.65, 95% CI 0.99-7.07, p=0.018; ≥10%: OR=27.70 95% CI 6.60-116.23, p<0.001). Participants <55 years demonstrated consistent weight-loss maintenance over this time but the odds for successful weight-loss maintenance for those ≥55 years continued to decrease over time. At maintenance-baseline, 68.3% of participants had sufficient physical activity for health; 61.4% and 19.8% met recommended fruit and vegetable consumption respectively. Lifestyle risk behaviours were maintained; aside from vegetable consumption which increased by 0.4 serves/day (p=0.009) at 12-months.

Conclusions: Weight loss maintenance is undisputedly challenging; so too is sustaining lifestyle behaviours necessary to manage weight. A program extending support strategies for maintaining weight-related behaviour can successfully support these changes in some participants over 12-months. There is a potentially important opportunity for targeted intervention at 6-9 months, particularly in mid-older participants.

Purpose: Most adults are insufficiently active and have poor diet quality, contributing to the global epidemic of chronic disease. Assisting people to successfully modify their lifestyle involves many behaviour change strategies (e.g. education, goal-setting, cues, feedback, overcoming setbacks) ideally over a sustained period. Traditionally, such support is provided by health professionals, who are in high demand and are expensive, limiting their availability. Advances in technology mean such personalised support may now be provided using artificial intelligence, with promise for scalability. This study focused on evaluating a 12-week lifestyle modification program for older adults using an artificially intelligent health coach.

Methods: The program was developed using IBM Watson virtual assistant software, which is capable of natural language processing (i.e. users are able to converse with the coach using their own free text, rather than multiple-choice). The artificially-intelligent virtual health coach, Paola, was accessed via Slack software and used in conjunction with a custom website and Garmin wearable. Paola guided participants through an introductory goal-setting session, prompted participants to complete a weekly check-in with goal revision, and was available 24/7 to answer questions. A total of 31 inactive community-dwelling adults aged 45-75 years participated in a pre-post study to evaluate feasibility and preliminary efficacy for changing physical activity and diet at 0, 6 and 12 weeks. Secondary outcomes were weight, waist-circumference and blood pressure.

Results: Feasibility of recruitment (recruitment was saturated in 3 weeks), and retention (90% at 12 weeks) was confirmed. From 0-12 weeks, physical activity increased by a mean 110 weekly minutes (95% CI 2 to 218) and diet quality scores increased by 5·7 points (on a 14 point scale; 95% CI 4·2 to 7·3). Participants lost an average 1·3kg (95% CI -0·1 to -2·5kg) and 2·1cm in waist circumference (95% CI -3·5 to -0·7cm).

Conclusions: These positive results support the need for ongoing research effort in this area, both for our program, but also more generally. There is vast scope for artificial intelligence technology to deliver personalised health services, particularly in areas that have traditionally been underserviced (e.g. primary and secondary prevention) due to health budget constraints.