BACKGROUND Slow gait is predictive of adverse health outcomes and increased health service utilization. Physical activity counseling (PAC) may enhance mobility among elders. Primary care settings are appropriate for PAC because most older adults see their primary care physician annually. Innovative use of automated telephone messaging facilitates physician counseling. OBJECTIVE To determine the effects of multi-component PAC promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial of 398 male veterans, ages 70 and over receiving primary care at the Veterans’ Affairs Medical Center of Durham, N.C. INTERVENTION Twelve months of usual care (UC) or multi-component PAC consisting of baseline in-person and biweekly then monthly telephone counseling by a lifestyle counselor, one-time clinical endorsement of PA and monthly automated telephone messaging by primary care provider, and quarterly tailored mailings of progress in PA. MEASUREMENTS Gait speed (usual and rapid), self-reported PA, function and disability at baseline, 3, 6 and 12 months. RESULTS Although no between-group differences were noted for usual gait speed, rapid gait speed improved significantly more for the PAC group (1.56 (0.41) m/s to 1.68 (0.44) m/s) compared to UC (1.57 (0.40) m/sec to 1.59 (0.42) m/sec, p = 0.04). Minutes of moderate/vigorous PA increased significantly in the PAC group (from a mean (SD) 57.1 (99.3) min/wk to 126.6 (142.9) min/week) compared to the UC group (from 60.2 (116.1) to 69.6 (116.1) min/wk, p < 0.001). Changes in other functional/disability outcomes were small. CONCLUSIONS In this group of older male veterans, multi-component PA significantly improved rapid gait and PA. Translation from increased PA to overall functioning was not observed. Integration with primary care was successful.
Fish were sampled individually, at rest, following air exposures of up to 8 min, during recovery from a 5 min air exposure or after a 5 minute chase. The spleen was photographedin vivo at rest and following 5 min air exposure in one fish. The effect of individual versus serial sampling from the same tank and of MS222 anaesthesia was also examined. Spleen hemoglobin content (SpHb), spleen somatic index (100 × spleen weight/body weight; SSI), blood hemoglobin concentration (Hb), and hematocrit (Ht), were measured. Mean cell hemoglobin concentration (MCHC), erythrocyte reservoir size, and relative contributions of reservoir release, erythrocyte swelling, and plasma water loss to hemoconcentration were calculated. The splenic reservoir contained 0.54 g Hb/kg body (21% of total body Hb), most of which it released between 1 and 3 minutes after the onset of air exposure. The spleen released more than 95% of the erythrocytes it contained at rest within 8 min. The release accounted for 31% of the 5.65 g/dl rise in Hb and 23% of the 26.6% observed increase in Ht after 8 minutes of air exposure. The balance of the increase was caused by erythrocyte swelling and fluid shifts reducing plasma volume. Animals exercised for 5 min showed changes similar to those in fish air exposed for 5 min. Recovery of all parameters was complete in 3 to 6 h, with the exception of MCHC which recovered in 30 min. Serial sampling produced a decrease in SpHb, and R1Wt and induced a significant hemoconcentration. MS222 did not cause erythrocyte release, but failed to prevent it after handling. Many previous reports of Ht and Hb in resting fish are probably high because they were taken under conditions that would cause the spleen to release its contents.
OBJECTIVES-To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa. DESIGN-Pooled data.SETTING-Two 6-month randomized controlled trials aimed at increasing PA in adults. PARTICIPANTS-Adults aged 65 to 94 (N 5 357). INTERVENTION-PA counseling over the telephone and through mailed materials.MEASUREMENTS-Self-reported PA dichotomized at 150 minutes/week and PF using the Medical Outcomes Study 36-item Short Form Questionnaire PF subscale.RESULTS-At baseline, individuals reporting 150 minutes or more of moderate PA/week had mean PF scores that were 20.3 points higher than those who did not (Po<.001). Change in PA minutes from above threshold to below threshold or from below threshold to above threshold from baseline to 6 months resulted in an average change in PF of 11.18 (P<.001) and +5.10 (P =.05), respectively. CONCLUSION-These findings suggest that PA is an important predictor of functional status. Older sedentary adults can improve PF by meeting recommended PA levels. Conversely, dropping below recommended PA levels has a deleterious effect on PF. Given the importance of PF in maintenance of independence and quality of life in older adults, adherence to recommended PA guidelines should be endorsed. Author Contributions: MCM, RS, CFP, MJP, MPP, CCE, and GMC participated in the concept, design, acquisition of subjects and/or data analysis, and interpretation of data for Project LIFE. MCM, RS, CFP, WDW, DCS, ECC, and HJC participated in the concept, design, acquisition of subjects and/or data analysis, and interpretation of data for Project LEAD. MCM, RS, CRP, MJP, MPP, CCE, GMC, WDW, DCS, and HJC participated in the preparation of the manuscript.Sponsor's role: Limited to approval and funding of the research. In 1996, in one of the first government recognitions of the potential health benefit of physical activity (PA), the Surgeon General (SG) endorsed guidelines for practice. 1 The report represented a consensus statement aimed at facilitating a public health recommendation for PA that would be acceptable to the majority of Americans in lieu of previous recommendations that emphasized vigorous exercise. The primary message was simple and directed at all ages -to accumulate 30 minutes or more of moderate PA on 5 or more days of the week. Although the SG report was detailed and addressed known PA benefits for different segments of the population or for specific medical conditions, no distinction was made relative to a recommendation for older adults. The report indicated that more research was needed to determine the types of PA necessary to preserve strength and physical function (PF) in this population. 1 NIH Public AccessThe ensuing decade produced a large amount of PA research directed at the older adult. 2-8 An abundance of evidence indicated that PA was consistently associated with better fitness par...
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