Volume 24 Supplement June 2016 - World Congress on Active Ageing ...

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Jun 28, 2016 - Journal of Aging and Physical Activity, 2016, 24(Suppl.), S3 -3 .... 'start the conversation' with older people about being more physically ... 'Agents for Change' offers a new way to reach out to older people ... S6 WCAA 2016 Abstracts ...... the Hallym University Medical Centers, Samsung Medical Center, and ...
Volume 24

Supplement

Journal of

June 2016

Aging and Physical Activity IN THIS ISSUE Abstracts for the 9th World Congress on Active Ageing

HUMAN KINETICS ISSN 1063-8652 journals.HumanKinetics.com/JAPA

Journal of Aging and Physical Activity Editor Philip D. Chilibeck University of Saskatchewan

Editorial Assistant Julianne Gordon University of Saskatchewan Past Editors

Associate Editors Patricia Alpert University of Nevada, Las Vegas Cynthia M. Castro Sweet Stanford Prevention Research Center Giuseppe De Vito University College Dublin Patricia Heyn University of Colorado, Denver Shanthi Johnson University of Regina Tom Overend University of Western Ontario

Caterina Pesce University of Rome “Foro Italico” Cassandra Phoenix University of Exeter Michelle Porter University of Manitoba Barbara Resnick University of Maryland School of Nursing Dawn Skelton Glasgow Caledonian University Mary Frances Visser Minnesota State University, Mankato

Editorial Board Bruce E. Becker Washington State University Melissa Bopp The Pennsylvania State University John Campbell University of Otago Medical School Sebastien Chastin Glasgow Caledonian School of Health and Life Science Wojtek Chodzko-Zajko University of Illinois at Urbana–Champaign Jennifer L. Copeland University of Lethbridge Jennifer L. Etnier University of North Carolina at Greensboro Ellen Freiberger University Erlangen-Nürnberg Institute for Biomedicine of Aging Bevan C. Grant University of Waikato Carolyn Anne Greig University of Birmingham Jack M. Guralnik National Institute on Aging Courtney Hall East Tennessee State University Jeffrey Hallam Kent State University

Wojtek Chodzko-Zajko (Founding Editor: 1993–2002) C. Jessie Jones (2003–2005) Debra J. Rose (2003–2006) Anthony A. Vandervoort (2007–2009) Jennifer L. Etnier (2009–2012) Diane E. Whaley (2012­–2016)

Keith Hill La Trobe University Anthony P. Marsh Wake Forest University Miriam C. Morey VA Medical Center, Durham, NC Matthew J. Peterson Wright State University Roberta Rikli California State University, Fullerton Debra J. Rose California State University, Fullerton Tamar Semerjian San José State University Liza Stathokostas University of Western Ontario Kiyoji Tanaka University of Tsukuba Emmanuelle Tulle Glasgow Caledonian University Anthony A. Vandervoort University of Western Ontario Jannique Van Uffelen University of Queensland Claudia Voelcker-Rehage Chemnitz University of Technology Diane E. Whaley University of Virginia

JOURNAL OF AGING AND PHYSICAL ACTIVITY The Journal of Aging and Physical Activity (JAPA) is a multidisciplinary journal that publishes peer-reviewed original research reports, scholarly reviews, and professional-application articles on the relationship between physical activity and the aging process. The journal encourages the submission of articles that can contribute to an understanding of (a) the impact of physical activity on physiological, psychological, and social aspects of older adults and (b) the effect of advancing age or the aging process on physical activity among older adults. In addition to publishing research reports and reviews, JAPA publishes articles that examine the development, implementation, and evaluation of physical activity programs among older adults. Articles from the biological, behavioral, and social sciences, as well as from fields such as medicine, clinical psychology, physical and recreational therapy, health, physical education, and recreation, are appropriate for the journal. Studies using animal models do not fit within our mission statement and should be submitted elsewhere. JAPA consists of three peer-reviewed sections: Original Research, Scholarly Reviews, and Professional Applications. The Original Research section contains scientific studies and investigations, systematic clinical observations, and controlled case studies. The Scholarly Reviews section publishes reviews that synthesize research and practice on important issues in the study of physical activity and aging. Articles based on experience in working with older populations and the available scientific evidence that focus on program development, program activities, and application of exercise principles are appropriate for the Professional Applications section. JAPA also includes an editorial section for exchange of viewpoints on key issues affecting physical activity and older adults. Editor:

Human Kinetics contact information:

Philip D. Chilibeck College of Kinesiology University of Saskatchewan Saskatoon, SK, Canada [email protected]



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Journal of Aging and Physical Activity Vo l u m e 2 4 • S u p p l e m e n t • J u n e 2 01 6

Abstracts for the 9th World Congress on Active Ageing Welcome from the Congress Chair.................................................................................................................................................. S1 Organising Committee...........................................................................................................................................................................S1 Scientific Committee..............................................................................................................................................................................S1 International Advisory Committee.........................................................................................................................................................S2 Tuesday 28th June 2016: Preconference......................................................................................................................................... S3 Keynote...................................................................................................................................................................................................S3 Wednesday 29th June 2016: People................................................................................................................................................. S4 Keynote...................................................................................................................................................................................................S4 Invited Speakers.....................................................................................................................................................................................S4 Symposia................................................................................................................................................................................................S5 Oral Presentations................................................................................................................................................................................S11 Posters..................................................................................................................................................................................................S30 Thursday 30th June 2016: Policy.................................................................................................................................................... S48 Keynote.................................................................................................................................................................................................S48 Invited Speakers...................................................................................................................................................................................S48 Symposia..............................................................................................................................................................................................S49 Oral Presentations................................................................................................................................................................................S59 Posters..................................................................................................................................................................................................S70 Friday 1st July 2016: Practice........................................................................................................................................................... S89 Keynotes...............................................................................................................................................................................................S89 Symposia..............................................................................................................................................................................................S89 Oral Presentations..............................................................................................................................................................................S100

The Journal of Aging and Physical Activity is an official publication of the International Coalition for Aging and Physical Activity.

Don’t miss a single issue! The Journal of Aging and Physical Activity (JAPA) focuses on the aging process and the role of physical activity in promoting health and preventing or delaying the onset of disability. Original research articles explore the aging process from psychological, physiological, and sociological perspectives. JAPA is the official journal of the International Society for Aging and Physical Activity.

HUMAN KINETICS

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Journal of Aging and Physical Activity, 2016, 24(Suppl.), S1  -2 http://dx.doi.org/10.1123/japa.2016-0156 © 2016 Human Kinetics, Inc.

WELCOME

Welcome from the Congress Chair I offer my personal welcome to you for the 2016 World Congress on Active Ageing (WCAA) in wonderful Melbourne, and to this special issue of the Journal of Aging and Physical Activity! This is a global event hosted by Victoria University’s Institute of Sport, Exercise and Active Living (ISEAL) and is the 9th such Congress to be held. The Congress brings a superb range of keynote, invited, and submitted presentations, along with plenty of opportunities for discussion and observation of posters, exhibits, and demonstrations, as well as networking. The Congress is now a significant event in the busy calendar of meetings focusing on active living, physical activity, and health. With the increasing importance of understanding how we can enhance the physical levels of adults as they age, this field will only grow. For the Congress this year, we have the three over-arching themes of ‘people’, ‘policy’, and ‘practice’, and the organisation of the program reflects this through themed days, submitted symposia, and, of course, the invited speakers. To ensure the success of the Congress we have engaged government departments, partner Universities across Australia, Active Ageing stakeholders, and the Melbourne Convention Bureau. It is these partnerships, along with our professional conference organisers and our sponsors, who will form the cornerstone of what we anticipate will be a benchmark World Congress on Active Ageing. We are also grateful to Human Kinetics for working with us in producing this special issue of the Journal of Aging and Physical Activity. Finally, I would like to thank my colleagues at Victoria University for their hard work in getting us this far. Let’s hope we are all rewarded with an outstanding event in a great location! Stuart Biddle Professor of Active Living & Public Health Institute of Sport, Exercise & Active Living Victoria University Congress Chair

Organising Committee Professor Stuart Biddle (Chair), Professor and Research Leader, Active Living & Public Health, Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Melbourne, Australia Dr. Jannique van Uffelen, Senior Research Fellow, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia Professor Hans Westerbeek, Dean, College of Sport and Exercise Science, and Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia Dr. Ineke Vergeer, Research Fellow, Institute of Sport, Exercise, and Active Living (ISEAL), Victoria University, Melbourne, Australia Dr. Glen Wiesner, Research Fellow, Institute of Sport, Exercise, and Active Living (ISEAL), Victoria University, Melbourne, Australia Mr. Michael Clayton, Manager Industry Community & Sport Engagement for Victoria University’s College of Sport and Exercise Science

Scientific Committee Professor Stuart Biddle (Chair), Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Melbourne, Australia Professor Warren Payne, Pro Vice-Chancellor, Research and Research Training, Victoria University, Australia Professor Rosemary Calder AM, Director, Australian Health Policy Collaboration, College of Health and Biomedicine, Victoria University, Australia Professor Maximillian de Courten, Director, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Australia Professor Rezaul Begg, College of Sport & Exercise Science/ISEAL, Victoria University, Australia Dr. Jason Bennie, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia Associate Professor Pazit Levinger, College of Sport & Exercise Science/ISEAL, Victoria University, Australia Dr. Ineke Vergeer, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia Dr. Glen Wiesner, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia S1

S2  WCAA 2016 Abstracts

International Advisory Committee Professor Takashi Arao, Waseda University, Japan Professor Wendy Brown, University of Queensland, Australia Professor Fiona Bull, University of Western Australia, Australia Professor Tim Cable, Aspire Academy, Qatar Professor Rosemary Calder AM, Victoria University, Australia Professor Ester Cerin, Australian Catholic University, Australia Professor Wojtek Chodzko-Zajko, University of Illinois, USA Dr. Elizabeth Cyarto, National Ageing Research Institute, Australia Associate Professor Ellen Freiberger, Friedrich-Alexander University, Germany Professor Reinhard Fuchs, University of Freiburg, Germany Professor Keith Hill, Curtin University, Australia Dr. Gareth Jones, University of British Columbia, Canada Professor Ngaire Kerse, University of Auckland, New Zealand Professor Nicola Lautenschlager, University of Melbourne, Australia Bob Laventure, Consultant, UK Dr. Sandra Matsudo, Universidad Mayor, Chile Associate Professor Dafna Merom, University of Western Sydney, Australia Professor Yael Netz, Zinman College, Wingate Institute, Israel Professor Koichiro Oka, Waseda University, Japan Associate Professor Chae-Hee Park, Korea National Sport University, South Korea Professor Marijke Hopman Rock, Free University Amsterdam, The Netherlands Professor Harri Sievanen, UKK Institute, Finland Professor Dawn Skelton, Glasgow Caledonian University, Scotland Dr. Elizabeth Skinner, The Australian Institute for Musculoskeletal Science, Australia Professor Kiyoji Tanaka, University of Tsukuba, Japan Professor Pedro Teixeira, Technical University of Lisbon, Portugal Professor Anthony Vandervoort, University of Western Ontario, Canada

JAPA Vol. 24, Suppl., 2016

Journal of Aging and Physical Activity, 2016, 24(Suppl.), S3  -3 © 2016 Human Kinetics, Inc.

WCAA ABSTRACTS

Tuesday 28th June 2016: Preconference Keynote The 8 80 City: Vibrant Cities, Healthy Communities, Happier People Gil Penalosa Founder and Chair of the Board, 8 80 Cities How can we create vibrant and healthy cities for everyone, regardless of age or social status? What is the role of streets—the largest public space in any city? How can great parks and public spaces improve people’s health and well-being across the lifespan? Gil answers these questions while also explaining a simple and effective principle for inclusive city building: ensuring the safety and joy of children and older adults (from 8-year-olds to 80-year-olds) are at the forefront of every decision we make in our cities. Gil will talk about his experience as Commissioner in Bogota in the late 1990s, where he helped lead the city through a positive transformation that saw huge investments in public spaces and sustainable mobility. Since his tenure as Commissioner in Bogota, Gil has used his experience to inspire and assist more than 200 cities around the world. His approach is both practical and aspirational. In his presentation, he highlights best practices from cities leading the way in improving the quality of life for their citizens while at the same time addressing the modern challenges of increasing urban population growth, shifting demographics, increases in lifestyle diseases, and a changing global economy.

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Journal of Aging and Physical Activity, 2016, 24(Suppl.), S4  -47 © 2016 Human Kinetics, Inc.

WCAA ABSTRACTS

Wednesday 29th June 2016: People Keynote Lifestyle Activity as Mediators for Healthy Brain Ageing—It’s Never Too Late to Start! Linda Lam Professor and Chair, Department of Psychiatry of the Chinese University of Hong Kong Population ageing is an undeniable global trend. It is of both personal and societal interest that ageing is not associated with degeneration and disabilities, but filled with productivity and joy. While it is important to maintain good physical health, a completely disease-free state may not be easily reachable. For the majority of mature adults, the maintenance of independent functioning, intact cognitive abilities, and good mental and mood status could be the most important achievements in late life. The old wisdom of living with active and healthy lifestyles has been revalidated with large-scale prospective studies on the determinants of healthy ageing. The apparent common sense is now filled with empirical evidence that food consumption with modesty and participation in physical activity and intellectual activities are important modifiers for cognitive decline and dementia in late life. Although the exact mechanisms still await further exploration, advances in neuroscience research and technology give additional support that lifestyles do modify our brain resilience to degeneration. Clinical trials on physical exercise in healthy older adults and people with mild cognitive impairment suggested that there are positive benefits on cognition. Fewer studies are available for intellectual activity interventions, but recent reports suggested that specially-designed computer cognitive training may carry transferrable benefits to different cognitive abilities. Limitations of most available studies have been the short duration of observation for outcome of degeneration. There is a great need for long-term studies to evaluate if structured lifestyle activity intervention is logistically feasible, and if the effect sizes in modifying cognitive decline differ in people with different genetic and health profiles.

Invited Speakers Optimising Cognitive Health to Support Active Ageing Nicola T. Lautenschlager Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia; and NorthWestern Mental Health, Melbourne Health, Melbourne, Australia Cognitive health, defined as optimal cognitive function, is next to mental and physical health as a key component of wellbeing at any age. Especially in middle age and older age, it is essential to support active ageing. It enables individuals to stay productive and socially engaged and to effectively selfmanage chronic disease. Cognitive health promotion needs to be part of the global strategy for the prevention of cognitive decline and dementia risk reduction. Cognitive health promotion aims to optimise cognitive health in healthy individuals and minimise cognitive decline among individuals who already experience cognitive impairment. This paper will introduce the recently established multi-site Australian Centre of Research Excellence (CRE) in Cognitive Health, which aims to address the topic of cognitive health within a socio-ecological framework. This CRE aims to address the topic of cognitive health on an individual (including lifestyle, biological, and genetic factors, as well as chronic disease), environmental, community, and social level. This presentation will give an overview on our current knowledge base of protective and risk factors for cognitive health and cognitive decline and highlight current knowledge gaps. It will discuss, with a focus on physical activity, one of the strongest protective factors, how in this time of still limited evidence, current knowledge could be communicated more effectively to allow better knowledge translation to the community and clinical settings while further research evidence is gathered. Fit For Your Life: Optimal Approaches to the Prevention and Treatment of Frailty Prof Maria Fiatarone Singh, MD, FRACP The rationale for the integration of a physical activity prescription into geriatric health care for the prevention and treatment of frailty is based on four essential concepts. First, there is a great similarity between the physiologic changes which are attributable to disuse (sarcopenia, osteopenia, central and generalized adiposity, low fitness, insulin resistance, etc.) and those that have been typically observed in aging populations, leading to the speculation that the way in which we age may in fact be greatly modulated with attention to activity levels. Second, chronic diseases increase with age, and exercise has now been shown to be an independent risk factor and/or potential treatment for most of the major causes of morbidity and mortality in industrialized societies, a potential which is currently vastly underutilized. Third, traditional medical interventions do not typically address frailty and disuse syndromes accompanying chronic disease, which may be responsible for much of their associated disability. Exercise is particularly good at targeting these syndromes of disuse and frailty. Finally, many pathophysiologic aberrations that are central to a disease or its treatment may be equally or better addressed by exercise than by pharmacologic therapy (e.g., the visceral adiposity and insulin resistance of metabolic syndrome), which therefore deserves a place in the mainstream of medical care, not as an optional adjunct. Thus, optimum approach to “successful aging” or to health care in the older population cannot ignore the overlap of sub-optimal activity levels and the emergence of frailty over the lifespan. In some cases, exercise can be used to avert “age-related” decrements in physiologic function and thereby maximize function and quality of life in the elderly. On the other hand, the combination of exercise and sound nutrition, particularly in relation to favorable alterations in body composition, will have numerous important effects S4

Wednesday 29th June   S5

on risk factors for chronic disease as well as the disability that accompanies such conditions. Therefore, understanding the effects of aging on exercise capacity and how habitual physical activity can modify this relationship in the older adult, including its specific utility in treating medical diseases, is critical for health care practitioners of all disciplines. Exercise is integral to the prevention, treatment, and rehabilitation strategies necessary for the care of older adults. Exercise should be prescribed, as is all other medical treatment, with consideration of risks and benefits, knowledge of appropriate modality and dose (intensity, frequency, volume), monitoring for drug interactions and benefits and adverse events, and utilization of the strongest possible behavioral medicine techniques known to optimize adoption and adherence. The emerging recommendations to reduce overall sitting time or length of uninterrupted sitting bouts will likely not be sufficient to oppose the significant age-related changes in physiology and function commonly observed, although such behaviour is linked to mortality, obesity, and cardio-metabolic risk in some studies. However, recommendations focusing on simply reducing sedentary behavior are unlikely to emerge as a robust treatment of established disease, such as depression, diabetes, cardiovascular disease, sarcopenia/wasting syndromes, osteoporosis, arthritis, chronic lung disease, Parkinson’s disease, stroke, etc., whereas the evidence for the benefits of targeted exercise prescription and adherence for treatment of these and many other conditions is very strong. There is no age above which physical activity ceases to have benefits across a wide range of diseases and disabilities. Insufficient physical activity and excess sedentary behavior are lethal conditions; physical activity is the antidote, and health care practitioners should be well-educated leaders and role models in the effort to enhance functional independence, psychological well-being, and quality of life through promotion of exercise for the aged, both fit and frail.

Symposia Changing Hearts and Minds: Strategies to Improve Exercise Perceptions and Behaviours Laventure, Bob1; Hetherington, Sharon2; Street, Richelle3; Penington, Alison4 University, Loughborough, United Kingdom; [email protected] & Sports Science Australia, Brisbane, Australia; [email protected] 3Blue Care, Brisbane, Australia; [email protected] 4Helping Hand, Adelaide, Australia; [email protected] 1Loughborough 2Exercise

An abundance of evidence exists surrounding the benefits of exercise for community-dwelling older people; however, less is known about how to encourage and support the elderly to be more physically active. Further, evidence for the benefits of exercise, and behavior-change mechanisms, does not extend to those living within an aged care facility, in particular, those people with advanced dementia. In this symposium we discuss four novel approaches to facilitate increased physical activity for people in aged care. ‘Care […] about Physical Activity’ is a Scotland-wide approach to increasing participation in physical activity in residential care facilities. Supported by a regional professional group, the program has developed a series of educational resources and training activities which can be used by residential home managers and by front line care staff. The resource is based upon the WHO concept of Healthy Settings and seeks to influence the culture of the residential sector and improve community links and provider skills. The ‘Agents for Change’ training educates staff and volunteers working in the aged care sector about the specific benefits of exercise for older people. The training also equips participants with the knowledge and tools to ‘start the conversation’ with older people about being more physically active. The ‘Helping Hand’ project aims to change the attitudes and behaviors of residential care staff toward implementing exercise with residents. Project staff are investigating how the benefits of exercise within the aged care facility impacts the burden of care for staff and how it changes staff attitudes toward residents. Also under investigation are the benefits of providing exercise to residents living with advanced dementia, particularly how it impacts their quality of life and the flow-on effect to their families’ perceptions of care. ‘Healthy Brains’ was developed by Blue Care to address the increased demand for cognitive assessments and interventions for people with early signs of cognitive decline. Healthy Brains is a multi-disciplinary group program that brings together cognitive training and exercise to encourage participants to be more socially, mentally, and physically active. The 8-week program is delivered collaboratively by an occupational therapist, speech pathologist, and exercise physiologist. Agents for Change: An Education Program for Aged Care Workers Hetherington, Sharon Exercise & Sports Science Australia, Brisbane, Australia; [email protected] The experience of ageing is a highly individual and subjective experience dependent on a multitude of factors such as the presence of illness or injury, physical capacity, mental health, social support, social participation, socioeconomic status, residential location and personal and societal preconceptions of the ageing journey. Terms such as ‘successful ageing’, ‘healthy ageing’, and ‘active ageing’ have risen in prominence in the gerontology literature of late. With an increasingly ageing Australian population, the need is to promote those factors that contribute to ‘successful ageing’ so that extra longevity can be enjoyed rather than endured. It has been demonstrated that both physical health and emotional wellbeing are amenable to improvement through regular participation in physical activity. This is because regular bouts of physical activity offer protection against chronic diseases, maintain functional capacity, elevate mood, and improve general wellbeing. If it is accepted that physical activity can offer these health and wellbeing benefits and contribute to ‘successful ageing’ then it is important to explore ways of enhancing older people’s participation. The ‘Agents for Change’ training educates staff and volunteers working in the aged care sector about the specific benefits of exercise for older people and equips participants with the knowledge and tools to ‘start the conversation’ with older people about being more physically active. The training package was developed in consultation with a health promotion professional and an exercise physiologist and incorporates the latest techniques for promoting behaviour change. ‘Agents for Change’ is delivered by an exercise physiologist and the duration of the training is 90 minutes; this includes time for discussing case studies and ideas for local implementation of activity programs. To date, 12 training courses have been conducted involving 125 participants. Surveys were conducted with 28 participants preand post-training to ascertain the efficacy of the knowledge transfer and changes in confidence to speak with older people about being more physically active. Significant improvements in both knowledge and confidence were reported. ‘Agents for Change’ offers a new way to reach out to older people who are not physically active, who are not seeking opportunities to be active, and who are unaware of the health benefits of regular physical activity. JAPA Vol. 24, Suppl., 2016

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Extending the Benefits of Exercise Physiology in Aged Care Beyond the Resident Penington, Alison University of South Australia, Adelaide, Australia; and Alzheimer’s Australia SA, Adelaide, Australia; [email protected] Introduction: Accredited Exercise Physiologists (AEP) are allied health professionals that specialise in exercise and chronic disease management. As successful as their input has been within the community, there is little information on their role for people in a residential aged care environment living with the symptoms of dementia and related functional decline. In ongoing research conducted by Helping Hand, it is emerging that in addition to residents receiving exercise physiology (EP) mediated interventions that benefit their quality of life, there is a positive knock on effect experienced by family members and care staff. Another contribution of EP involvement is changing perceptions of EP students on the aged care environment by developing their skills to work with this population. Methods: Helping Hand is using a mixed methodological approach to demonstrate the benefits of EP to the Aged Care organisation. A systematic literature review has highlighted the limited evidence around the benefits EP has with an older population living with the symptoms of dementia, as well as care staff and families, in residential facilities. The project is tracking functional and cognitive outcomes of EP services and quality of life as reported by staff and family members of residents. Results: Staff and family members are beginning to see benefit of EP mediated activity for residents with advanced stages of dementia. This includes maintaining residents’ independence, providing purposeful activities, and enhancing quality of life. The organisation is seeing change in minds of staff and families to upskill themselves in order to provide a sustainable health change to residents. The University of South Australia is encouraging aged care components in their courses and EP students can see their potential to work with this cohort. Conclusion: There is great potential for EP mediated programs to be involved in the everyday care of residents living with cognitive decline within a residential facility. Quality of life is increased through purposeful and engaging activities which are showing potential to have a positive impact on career and family support for those residents. These outcomes are enhanced by EP student programs. Interactive Games for Active Ageing Miao, Chunyan1; Leung, Cyril2; Chen, Yiqiang3; Yu, Han1 NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore; ascymiao@ntu. edu.sg, [email protected]

1Joint

2The

University of British Columbia, Vancouver, Canada; [email protected]

3Institute

of Computing Technology, Chinese Academy of Sciences, Beijing, China; [email protected]

Introduction: The ageing of the global population has posed significant challenges to how societies care for senior citizens. By the year 2050, the number of senior citizens (i.e., those aged 65 and older) will reach around 2 billion, which equates to those below the age of 15 (Harper, 2014). Such a worrying trend is increasing strains on healthcare systems and public health budgets. Recently, interactive games have moved from relying on a mouse and keyboard for user input toward gesture-based input. Examples include Nintendo Wii, Microsoft Kinect, and the Leap Motion device. These devices have made it possible for people who are not technically savvy, such as senior citizens, to enjoy computer games. Leveraging body gesture-based games to unobtrusively study the progression of medical conditions and individual wellness trends has shown great promise. With interactive games, population-level health screening can be performed remotely and efficiently at each senior citizen’s home. Methods: The prevailing method used in current game-based active aging research often involves collaborations between interactive game researchers and healthcare professionals. Games are often designed for specific health conditions (e.g., Parkinson’s disease). To the players, games often appear as fun experiences, without the concern that underlying health issues are being studied. The in-game behavior trajectory big data generated by the players when they interact with game activities are the target of analytics. The results from data analytics are often compared with standard medical examinations for the specific health conditions to evaluate the effectiveness of the game platform. Results: In our latest study using an interactive game to estimate people’s risk of developing stroke symptoms, we found that by combining in-game motor features extracted from a player’s behavior trajectory big data with their previous medical records, the estimation accuracy can be significantly increased from 74% to almost 100% (Chen et al., 2015). Conclusion: In this symposium, we aim to bring researchers involved in the interdisciplinary field of game-based active aging research to share their experience, methods, and findings. We hope to bring this emerging field to the attention of the research community, and promote international collaborations. References: Harper, S. (2014). Economic and social implications of aging societies. Science, 346(6209), 587–591. Chen, Y., Yu, H., Miao, C., Chen, B., Yang, X., & Leung, C. (2105). Using motor patterns for stroke detection. Science, (Advances in Psychophysiology), 12–13. Acknowledgments: This research is supported by the National Research Foundation Singapore under its Interactive Digital Media (IDM) Strategic Research Programme and the Lee Kuan Yew Post-Doctoral Fellowship Grant. Studying Efficient Management Strategies for Productive Aging Through Serious Games Yu, Han Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore; [email protected] Introduction: The emerging trend of global population aging has prompted many researchers and engineers to shift their focus toward the development of technologies serving senior citizens. However, the common perception among this community is that the elderly are physically and cognitively frail. Such a mentality has resulted in the majority of the so-called age-friendly technologies existing as essentially assistive technologies in nature (Rashidi & Mihailidis, 2013). Today, many senior citizens enjoy years of good health after retirement thanks to improvements in nutrition and healthcare. In search of personal fulfillment, many of them are interested in productive aging activities, such as volunteer work (Tan, 2007). Productive aging initiatives often have social or economic objectives that need to be achieved. This pushes them to look for senior citizens with target skills and experience. On the other hand, senior citizens may have different wellness conditions which may limit their availability and level of participation. How to engineer efficient management decision support technologies to resolve the potential conflicts between the objectives of the productive aging activity organizers and the senior participants with heterogeneous backgrounds is a challenging research problem. Methods: Currently, the management of productive aging activities is mostly performed by community and volunteer organizations. The involvement of information technologies concentrates on the stage of participant registration. The actual scheduling of activities and recommendations for senior citizens’ participation are performed manually. This requires heavy JAPA Vol. 24, Suppl., 2016

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effort from the organizers and often results in inefficiencies. Results: In our latest study leveraging information tracking and stochastic network queuing theories, we found that track record-based metrics such as computational reputation evaluation and self-reported information on participants’ eagerness to participate and level of effort commitment can be used to algorithmically compute near optimal recommendations of activities to participants. We have designed a series of different recommendation strategies which works well under centralized, decentralized, and hierarchical networks of participant organizational structures which make efficient utilization of the collective manpower while satisfying individual participants’ preferences. Conclusion: We have developed a serious game platform to study how the proposed strategies perform against real-world players under different conditions. The game has been played by more than 900 people, close to 9,000 times. The result shows that the proposed strategies outperform human decisions 67% of the time. References: Rashidi, P., & Mihailidis, A. (2013). A survey on ambient assisted living tools for older adults. IEEE Journal of Biomedical and Health Informatics 17(3), 579–590. Tan, C.K. (2007). Engaging senior volunteers: A guide for non-profit organizations. Technical report, National Volunteer and Philanthropy Centre, Singapore. Acknowledgments: This research is supported by the National Research Foundation, Prime Minister’s Office, Singapore, under its IDM Futures Funding Initiative, and the Lee Kuan Yew Post-Doctoral Fellowship. Infusing Familiarity Design into Wellness Games Pan, Zhengxiang Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore; panz0012@ntu. edu.sg Introduction: Population aging has enormous economic and social consequences which need to be addressed urgently in order to mitigate their future impact. Currently, aging technologies such as wellness games face the challenge of the digital divide. The elderly have a hard time interacting with technology and often express “technophobia”. In this paper, we study the impact of familiarity design (Leonardi et al., 2008) on the adoption of wellness games for the elderly. We propose a familiarity design framework with three dimensions: (1) symbolic familiarity; (2) cultural familiarity; and (3) actionable familiarity. Methods: Based on this three-stage model of familiarity, we propose a framework of familiarity design for human-computer interactions. It consists of three dimensions of familiarity design elements: Symbolic Familiarity: objects, activities, or processes commonly occurring in an elderly adult’s daily life shall be infused into the design of a wellness game. Cultural Familiarity: concepts, artefacts, patterns, traditions, or rituals commonly appearing in the elderly adult’s social context are infused into the design of a game. Actionable Familiarity: the acts of interacting with the symbolic familiarity and cultural familiarity elements in a game shall be similar to the acts of interacting with these elements in real life. Depending on the degree of fidelity in replicating the symbolic and cultural familiarity objects in a game, and the similarity between interacting with these elements in the system compared to interacting with them in real life, a given wellness game can be quantitatively evaluated according to these three dimensions of familiarity design. Results: We conducted a focus group study involving 10 people aged between 65 and 85 years, with a mean age of 74.6 and a standard deviation of 6.80. The study participants played two wellness games containing different sets of familiarity design elements. The results show that familiarity design improves the perceived satisfaction and adoption likelihood significantly among the elderly players. Conclusion: Our findings have important implications for the adoption of wellness games for the elderly. With the proposed framework, researchers who need to design wellness games can have a method to analyze which dimension of familiarity design fits the target system well. References: Leonardi, C., Mennecozzi, C., Not, E., Pianesi, F., & Zancanaro, M. (2008). Designing a familiar technology for elderly people. Gerontechnology 7(2). Acknowledgments: This research is supported by the National Research Foundation, Prime Minister’s Office, Singapore under its IDM Futures Funding Initiative. Inter-Generational Interactions Through Aging-in-Place Technologies Leung, Cyril Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore; and Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada; [email protected] Introduction: Rapid population aging is an increasingly urgent issue for many countries around the world. One of the most challenging problems is the emerging phenomenon of “empty nest families” in which the younger generation left their homes to seek opportunities elsewhere, leaving their elderly parents to fend for themselves. Current institution-based healthcare models are not sustainable in the long-term. Technological solutions to facilitate aging in place are needed to deliver quality care and services to the elderly in their homes. Existing camera-based home monitoring systems suffer from two main drawbacks (Leung et al., 2012): (1) the elderly users often refuse to accept them due to perceived loss of privacy, and (2) video footage consumes large computational power during transmission and analysis. In this paper, we propose an aging-in-place technology framework which replaces cameras with multiple heterogeneous sensors to perform activities of daily living (ADL) trajectory tracking and analytics. Methods: Our framework consists of three major elements. The first is unobtrusive sensing. Many types of commercially-available sensors (e.g., for monitoring temperature, humidity, pressure, luminosity, motion) can be used to capture an elderly adult’s ADLs in their living environments. We conduct human factors studies (Helander, 2006) to design sensor deployment strategies that maximize coverage at the lowest cost. Secondly, based on the sensor data stream, we conduct research in machine learning to identify conditions and trends related to an elderly adult’s physical, emotional, and cognitive wellbeing (e.g., mobility level, likelihood of falling, mood). Thirdly, we develop a data-driven visualization platform to enable relatives to review an animated version of an elderly adult’s ADLs tagged with various analysis results over a selected period of time. The actions performed by the 3D avatar are controlled by the data received from the sensors, while the annotations of the elderly person’s possible mental and physical states at different points in time are based on analytics results from the proposed machine learning algorithm. Results: We are currently in the process of evaluating the proposed technology framework in several test users’ homes in Singapore. Initial analysis has shown that the ADL data collection approach is viable in practice and has been well received by the test users. Conclusion: By leveraging on ADL behaviour analytics and novel interactivity design, the proposed technology has the potential to improve inter-generational understanding and support cost-effective personalized care for aging in-place. References: Leung, C., Miao, C., Yu, H., & Helander, M. (2012). Towards an ageless computing ecosystem. International Journal of Information Technology, 18(1). Helander, M. (2006) A Guide to Human Factors and Ergonomics. CRC Press, Taylor & Francis Group, p. 408. Acknowledgments: This research is supported by the National Research Foundation, Prime Minister’s Office, Singapore under its IDM Futures Funding Initiative. JAPA Vol. 24, Suppl., 2016

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Sarcopenia and Function in the Oldest Old Freiberger, Ellen1; Landi, Francesco2; Bautmans, Ivan3; Henwood, Tim4 Erlangen-Nürnberg, Germany; [email protected] Cattolica del Sacro Cuore, Rom Italy; [email protected] 3Vrije Universiteit Brussel, Brussel, Belgium; [email protected] 4The University of Queensland, Brisbane, Australia; [email protected] 1Friedrich-Alexander-University, 2Universita

With population ageing will come a significant increase in national health care expenditures given the projected increase in comorbidities and physical and cognitive disability. In Australia alone, it is predicted that the demand for nursing care placement will treble by 2050, with the associated health care spending doubling by 2031. Sarcopenia will contribute significantly to this spending and service utilization increase and is a common cause of nursing home entry. Since a redefining of the definition in 2010, sarcopenia has received a resurgence of research interest. The purpose of this symposium is to explore the prevalence, risk factors, and consequences of sarcopenia (Henwood, Landi) and the importance of targeted interventions to reduce sarcopenic risk and improve individual function among community-dwelling and institutionalized adults with care needs (Bautmans, Henwood, Freiberger). Specifically, one presentation will describe the outcomes of the longitudinal ilSIRENTE study (N = 364, age = 85 ± 5 years) (Landi); the second presentation will describe the influence of strength training on circulating levels of brain-derived neurotrophic factor and inflammatory mediators in older persons (N = 107, age = 71.3 ± 5.2 years; N = 31, age = 68.4 ± 5.4 years; N = 40, age = 62–72 years; N = 56, age = 68 ± 5 years) (Bautmans); the third presentation will investigate effects of exercise training in the nursing home setting (N = 45, age = 85.9 ± 7.5 years) (Henwood); and the last presentation will investigate the longitudinal effects (24 months) of a multicomponent exercise program in older functional limited persons (N = 269, age = 78.3 ± 5.9 years) (Freiberger). Presentations will be followed by a panel discussion that aims to identify means of bringing evidence-based exercising into the aged care sector that can reduce sarcopenic prevalence and enhance functional wellbeing. Implication for active ageing: Evidence is strong that with timely and targeted intervention, sarcopenia prevalence can be reduced among older populations and physical function can be improved. Yet exercise as an intervention remains underutilized. This symposium holds important information for stakeholders and policy makers passionate about improving the trajectory of health of the old and very old population. References: Forti, L.N., Van Roie, E., Njemini, R., Coudyzer, W., Beyer, I., Delecluse, C., Bautmans, I. (2015). Dose-and gender-specific effects of resistance training on circulating levels of brain derived neurotrophic factor (BDNF) in community-dwelling older adults. Experimental Gerontology, 70:144–149. Steering Committee for the Review of Government Service Provision. Report on Government Services 2012. In: Productivity Commission; Australian Government, Canberra 2012. Landi, F., Liperoti, R., Russo, A., Giovannini, S., Tosato, M., Capoluongo, E., et al. (2012). Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study. Clinical Nutrition. 31(5):652–658. The Effects of Resistance Training on Circulating Markers of Inflammation and BDNF in Older Persons Bautmans, Ivan Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Frailty in Ageing Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium; and Geriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium; [email protected] Introduction: Ageing is associated with a chronic low-grade inflammatory profile (CLIP). Physical exercise could counteract the negative effects of CLIP by influencing circulating inflammatory mediators and neurotrophic growth factors. Methods: In a series of four intervention studies including 243 elderly individuals, we assessed the effects and dose-response relationships of resistance training (RT) on circulating BDNF and inflammatory cytokines (IL-6, IL-1beta, L-1ra, sTNFR1, IL-8, GM-CSF, IL-10): (1) n = 31 aged 68 ± 5 years, 6 weeks RT (3 × 10 repetitions at 80% 1RM; Bautmans et al., 2005); (2) n = 40 aged 67 ± 7 years, 12 weeks RT (3 × 10 repetitions at 80% 1RM) compared to matched controls (Forti et al., 2014); (3) n = 56 aged 68 ± 5 years, 12 weeks HIGH (2 × 10–15 repetitions at 80%1RM), LOW (1 × 80–100 repetitions at 20%1RM), or LOW+ (1 × 60 repetitions at 20%1RM followed by 1 × 10–20 repetitions at 40%1RM), followed by 24 weeks detraining (Forti et al., 2016; unpublished data); (4) n = 116 aged 71 ± 5 years, 12 weeks IST (3 × 10 repetitions at 80%1RM), SET (2 × 30 repetitions at 40%1RM) or FT (4 × 60 seconds muscle stretching; unpublished data). Results: We observed significant RT-induced effects on inflammatory markers and BDNF in a dose-dependent and gender-specific manner. After 24 weeks detraining, effects on BDNF returned back to baseline. Conclusion: Six to 12 weeks RT has considerable neurotrophic and anti-inflammatory effects in older persons. We suggest that exercising until volitional fatigue is the main trigger for exercise-induced responses. Continuous exercise adherence seems to be needed to sustain the training-induced effects on BDNF in older persons. References: Bautmans, I., Njemini, R., Vasseur, S., Chabert, H., Moens, L., Demanet, C., & Mets, T. (2005). Biochemical changes in response to intensive resistance exercise training in the elderly. Gerontology, 51(4), 253–265. Forti, L.N., Njemini, R., Beyer, I., Eelbode, E., Meeusen, R., Mets, T., & Bautmans, I. (2014). Strength training reduces circulating interleukin-6 but not brain-derived neurotrophic factor in community-dwelling elderly individuals. Age, 36(5), 9704. Forti. L., Van Roie, E., Njemini, R., Coudyzer, W., Beyer, I., Delecluse, C., & Bautmans, I. (2016). Load-specific inflammation mediating effects of resistance training in older persons. JAMDA. Epub ahead of print. Sarcopenia in the Aged Care Setting: Prevalence, Consequences and the Impacts of Resistance Training Henwood, Tim1; Keogh, J2; Senior, S3; Hewitt, J4 Solutions and The University of Queensland, Brisbane, Australia; [email protected] University, Gold Coast Australia; [email protected] 3Massey University, Auckland, New Zealand; [email protected] 4Feros Care and The University of Sydney, Sydney, Australia; [email protected]

1AgeFIT 2Bond

Background: For older adults sarcopenia has a number of negative consequences including bringing significant personal burden and financial implications. Since sarcopenia was redefined in 2010 to be inclusive of below normal muscle mass, muscle strength and/or physical performance, a body of work has developed describing prevalence and risk factors across populations. However, work done in the residential aged care (RAC) and Australian JAPA Vol. 24, Suppl., 2016

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context are still emerging. To address this, my group has progressed a series of studies in the RAC setting investigating sarcopenic prevalence and consequences at long-term survival, as well as piloting interventions to reverse this geriatric syndrome. Methods: Prevalence, risk factors, and long-term follow-up consequence data were collected from a baseline sample of 102 adults residing in 11 RAC facilities in South East Queensland. In addition to markers of sarcopenia, demographic, physical and mental health, nutritional status, and falls risk were assessed. Long-term follow-up occurred 18 months post baseline assessment. In a separate study, 45 RAC adults were randomised to twice weekly resistance training or control for 24 weeks and assessed for change in sarcopenia (Hassan et al., 2016; Henwood, Keogh, Reid, Jordan, & Senior, 2014; Senior, Henwood, Beller, Mitchell, & Keogh, 2015). Results: Sarcopenia prevalence was 40.2% in RAC, and increased with long-term survival (51.7% at follow-up). Univariate risk factors were low body mass index (BMI), low physical performance, nutritional status, and sitting time, but only low BMI (OR = 0.80; 95% CI 0.65–0.97) remained predictive in the multivariate model. A sarcopenia diagnosis at baseline was associated with a greater negative change in depression status (p < .001), but not mortality risk, with age a stronger predictor (p = .054). Resistance training led to a decrease in BMI and increase in grip strength (p < .007), but sarcopenia status remained unchanged. Conclusion: Sarcopenia prevalence is high in the RAC setting and increases with long-term survival, but appears not to be a primary cause of mortality. While resistance training proved an ineffective strategy in reversing sarcopenia, more work is needed to control for factors influential of gains in muscle mass in the RAC setting. References: Hassan, B. H., Hewitt, J., Keogh, J.W.L., Bermeo, S., Duque, G., & Henwood, T.R. (2016). Impact of resistance training on sarcopenia in nursing care facilities: A pilot study. Geriatric Nursing, 37(2):116–121. Henwood, T.R., Keogh, J.W., Reid, N., Jordan, W., & Senior, H.E. (2014). Assessing sarcopenic prevalence and risk factors in residential aged care: methodology and feasibility. Journal of Cachexia, Sarcopenia and Muscle, 5(3):229–236. Senior, H., Henwood, T., Beller, E., Mitchell, G., & Keogh, J. (2015). Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas, 82, 418–423. Impact of Physical Function Impairment and Multimorbidity on Mortality Among Community-Living Older Persons with Sarcopenia: Results from the ilSIRENTE Prospective Cohort Study Landi, Francesco, MD, PhD;* Calvani, Riccardo, PhD; Tosato, Matteo, MD; Martone, Anna Maria, MD; Ortolani, Elena, MD; Savera, Giulia, BS; Bernabei, Roberto, MD; Marzetti, Emanuele, MD, PhD Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy Objective: Sarcopenia and physical function impairment may have a greater effect on survival than other clinical characteristics, including multimorbidity. We evaluated the impact of sarcopenia on all-cause mortality and the interaction among muscle loss, physical function impairment, and multimorbidity on mortality risk over 10 years in older community dwellers. Design and Setting: The ilSIRENTE study is a prospective cohort study conducted in the mountain community living in the Sirente geographic area (L’Aquila, Abruzzo), in Central Italy. The study was designed by the Department of Geriatrics, Neurosciences and Orthopaedics of the Catholic University of Sacred Heart (Rome, Italy) and developed by the teaching nursing home “Opera Santa Maria della Pace” (Fontecchio, L’Aquila, Italy), in a partnership with local administrators and primary care physicians of Sirente Mountain Community Municipalities. Participants: A preliminary list of persons living in the Sirente area was obtained at the end of October 2003 from the Registry Offices of the 13 municipalities involved in the study. Potential participants were identified by selecting all persons born in the Sirente area before the 1st of January 1924 and living locally at the time of the survey. Among the eligible persons (n = 429), the prevalence of refusal was very low (16%). The overall sample population enrolled in the ilSIRENTE study consisted of 364 persons. The present analysis was conducted in 354 participants, after excluding 10 persons with missing data for the variables of interest. Participants were categorised as sarcopenic or non-sarcopenic based on the European Working Group on Sarcopenia in Older People criteria. Primary and Secondary Outcome Measures: (1) All-cause mortality over 10 years according to the presence of sarcopenia; (2) impact of physical function impairment, assessed using the Short Physical Performance Battery (SPPB), and multimorbidity on 10-year mortality risk in persons with sarcopenia. Results: The median age of the 354 participants was 84.2 (range: 80-102) years, with 236 (67.0%) women. Sarcopenia was identified in 103 participants (29.1%). A total of 253 deaths were recorded over 10 years: 90 among sarcopenic participants (87.4%) and 162 among non-sarcopenic persons (65.1%; p < .001). Participants with sarcopenia had a higher risk of death than those without sarcopenia (HR = 2.15; 95% CI = 1.02–4.54). When examining the effect of sarcopenia and physical function impairment on mortality, participants with low physical performance levels showed greater mortality. Conversely, the mortality risk was unaffected by multimorbidity. Conclusions: Our findings show that physical function impairment, but not multimorbidity, is predictive of mortality in older community-dwellers with sarcopenia. Hence, in sarcopenic older persons, interventions against functional decline may be more effective at preventing or postponing negative health outcomes than those targeting multimorbidity. Sarcopenia and Function in the Oldest Old: Long-Term Effects of a Multi-Component Exercise Program in the General Practitioner Setting (PreFalls) Freiberger, E, PhD (in the name of the PreFalls Team) Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Germany; [email protected] Background: Evidence demonstrated the positive results of exercise on function and mobility. One major barrier to achieve the positive results is to integrate older persons into exercise programs. We therefore addressed older persons with functional limitation and high risk of falling in the general practitioner setting. The aim of the cluster-randomized trial was to evaluate the effects of a 16-week multi-component exercise program regarding physical function, falls, and fear of falling. Methods: Participants were eligible for the study if they were aged 65 years and older, reported a fall in the last 12 months, or showed functional limitation or fear of falling and living independently. Patients in the intervention groups (IG, n = 222) took part in the 16-week training program (1 hour per week), which consisted of strength and balance training, exercises for improving one’s body perception, self-efficacy, and activities of daily living, as well as a 12-week home training program. The control group received usual care (CG, n = 156). At the start of the study and after 12, as well as 24 months, physical function was assessed by the Timed-Up-and-Go-Test (TUG), Chair-Rise-Test (CRT), and the modified Romberg-Test. Fear of falls was assessed by the Falls Efficacy Scale International (FES-I). Results: In total, 378 patients of 33 general practices (93 men, 77.7 ± 5.8 years; 285 women, 78.2 ± 5.9 years) took part in the exercise program. Twelve months after the start of the study the multi-component intervention demonstrated significant effects. Patients in the intervention groups showed significant improvements in functional (TUG and balance) as well as psychological (FoF) endpoints (TUG: –2.39 s, CI: –3.91 to –0.87, p = .014; mRomberg: 1.70 s, CI: 0.35 to 3.04, p = 0.037; fear JAPA Vol. 24, Suppl., 2016

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of falling: –2.28 points, CI: –3.87 to –0.69, p = .022) compared to usual care. Twenty-four months after inclusion the abovementioned, improvements remained stable. Conclusions: The results of the PreFalls study confirmed that the implementation of a multi-component exercise intervention in the primary care setting can significantly improve function in older persons over two years. The observed improvements in fear of falling are important as fear of falling often results in reduced physical activity. References: Blank, W.A., Freiberger, E., Siegrist, M., et al. (2011). An interdisciplinary intervention to prevent falls in community- dwelling elderly persons: protocol of a cluster-randomized trial (PreFalls). BMC Geriatrics, 11:7. Freiberger, E., Blank, W.A., Salb, J., Geilhof, B., Hentschke, C., Landendoerfer, P., Halle, M., Siegrist, M. (2013). Physiological and psychological effects of a multi-modal intervention on fall risk: a cluster randomized controlled trial in the general practitioner setting [PreFalls NCT01032252]. Clin. Interv Aging. Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landendoerfer, P., Linde, K., Halle, M., Blank, W.A. (2016). Fall prevention in a primary care setting— The effects of a targeted complex exercise intervention in a cluster randomized trial. Dtsch Arztebl Int. The Effect of Exercise and Sedentary Behaviour on the Older Adult Erickson, Kirk1; Johnson, Liam2; English, Coralie3; Owen, Neville4 Aging and Cognitive Health Laboratory, Department of Psychology, University of Pittsburgh, USA; [email protected] of Sport, Exercise and Active Living (ISEAL), Victoria University, and the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; [email protected] 3School of Health Sciences, University of Newcastle, Australia; [email protected] 4Behavioural Epidemiology Laboratory, Baker IDI Heart and Diabetes Institute, Australia; [email protected]

1Brain

2Institute

Physical activity is a powerful stimulus for the prevention of many chronic diseases, including cardiovascular disease, heart failure, cancer, osteoporosis, and stroke. Muscle strength and cardiorespiratory fitness exert a protective effect against the risk of death, and, compared to inactive adults, people who exercise enjoy a higher quality of life and enhanced mood. Active people also enjoy better cognitive performance, with brain structure and function improved by physical activity. Moreover, exercise can be as effective as drugs in treating chronic diseases such as diabetes, stroke, and heart disease. Sedentary behaviour is a risk factor for adverse health outcomes, with poor cardiometabolic markers characteristic of those who spend too much time sitting, even if they meet the accepted physical activity guidelines for adults. Stroke is the leading cause of disability in older adults, and stroke survivors are typically inactive and are at an increased risk of future adverse cardiovascular events and recurrent stroke. Incorporating exercise training and strategies to reduce sedentary behaviour into stroke rehabilitation can moderate these risks and enhance the neuroplasticity important for recovery. Attendees of this symposium will gain a better understanding of: (1) the beneficial impact that physical activity can have on ageing brain function and morphology, (2) the current evidence for the implementation of exercise in the recovery of stroke survivors, (3) the importance and feasibility of reducing sedentary behaviour in stroke survivors, and (4) new approaches to reducing inactivity in the ageing population. This symposium is open to anyone interested in the influence of physical activity on the brain and physical health of older adults, and the potential of reducing inactivity as a strategy for improving health and well-being. Aging, Exercise, and Brain Plasticity Erickson, Kirk I., PhD University of Pittsburgh; [email protected] Introduction: A growing body of evidence suggests that physical activity may be effective for preventing and treating neurocognitive problems in late adulthood. Despite the recognition that physical activity may be a powerful method to enhance brain health, there is continued confusion about what the extant research has discovered. Methods: I will discuss the current research on exercise, fitness, and brain health and focus on several potential moderators of the effects of exercise on neurocognitive function. I will discuss these results from four different experimental paradigms: (a) animal research, (b) epidemiological studies, (c) cross-sectional associations, (d) randomized clinical trials. Results: Randomized clinical trials of moderate exercise in healthy older adults has found that exercise increases the volume of regions that typically shrink with age and that are associated with memory and executive functioning deficits. These interventions have also found that the connectivity between these regions is enhanced after several months of regular exercise. We, and others, have also found that higher fitness levels are associated with greater white matter integrity, which in turn is associated with better cognitive performance. Greater structural volume in these regions has been associated with a reduced risk of experiencing cognitive impairment. Conclusions: I conclude that in late life physical activity reduces cognitive decline, improves function, and increases regional brain volume, especially in the frontal cortex and hippocampus, and that we are beginning to have a better understanding of the factors that moderate and mediate these associations. Overall, physical activity is an important modifiable lifestyle that carries significant consequences for learning, memory, and brain health for people of all ages. Liam Johnson: Physical Activity and Exercise After Stroke: Stroke is a leading cause of disability in adults and accounts for a large burden of disease. Regular participation in physical activity after stroke is recommended to improve functional capacity and vascular risk factors, and reduce the risk of recurrent strokes. Impaired neuromotor control and cardiorespiratory function experienced after stroke provide a unique challenge when prescribing exercise rehabilitation. Best practice guidelines, including when to begin exercise training after stroke, and what this training should consist of, remain elusive. I will provide an insight into the current understanding of exercise prescription after stroke and examine the evidence for the early initiation of exercise training after stroke. This will include a brief account of the work our group is doing in establishing exercise capacity early after stroke, and how this work might inform future guidelines in stroke rehabilitation. Coralie English: Reducing Sedentary Behaviour After Stroke: Did you know one in six Australians will suffer a stroke in their lifetime? Of the 420,000 Australians currently living with stroke-related disability, over 40% will suffer a recurrent stroke. Lack of adequate physical activity is the second highest risk factor for stroke, but the barriers to achieving adequate levels of physical activity in this group are immense. Reducing prolonged sitting time may be a more achievable target. Our group has been working on a program of research to investigate sitting time in people with stroke. We have found that stroke survivors are more sedentary than their age-matched peers, spending around 75% of their waking hours sitting down, the majority of that in prolonged

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bouts. We have also demonstrated that it is possible to reducing sitting time in this population. Our current work focuses on the acute cardiometabolic benefits of breaking up prolonged sitting time in this group. Understanding and Influencing the Determinants of Too Much Sitting in Ageing Adults Owen, Neville Baker IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected] Introduction: For the general adult population, there is now an emerging—but nevertheless modest—body of evidence on the factors that may influence sedentary behaviours and on what might be changed in order to address sitting time, in order to improve health outcomes in middle-aged and older adults. Methods: Approaches to reducing sedentary behaviour are likely to be more effective if they are context-specific: middle-aged and older adults can sit for prolonged periods of time at work and during volunteering activities; in private automobiles; in front of screens in the home environment; and, in a variety of community contexts. Within an ecological model of health behaviour, these contexts of sitting time may be characterized as ‘behaviour settings’ (environments in which people spend their time, where certain behaviours are proscribed and others are strongly encouraged). Thus there will be distinct environmental, social, organizational, and normative attributes that have the potential to be changed in order to reduce and break up prolonged sitting time. Results: For ageing adults, the relevant attributes of local neighbourhoods, domestic and transportation environments, as well as health-related, personal, and social factors need to be identified, as they can act as ‘determinants’ of their time that is spent sitting. Core principles of the ecological model as they may be applied to middle-aged and older adults’ sitting time are: (1) There are multiple levels of influence (intrapersonal, interpersonal, organizational, community/built environment, and public policy) on sedentary behaviours; (2) the influences on sedentary behaviors interact across these levels; (3) environmental attributes act as significant determinants of sedentary behaviors; (4) ecological models should be specific, addressing particular behaviours in particular settings; (5) multi-level interventions should be most effective in changing sedentary behaviors to improve health. Conclusion: Insights potentially relevant to ageing adults, based on an ecological model of sedentary behaviour include an explicit focus on how particular environmental and social attributes are likely to influence the time that people spend sitting. An account of some of the implications for future research will be provided, and how this perspective might help to identify innovative aspects of policy and practice will be addressed. References: Owen, N., Sugiyama, T., Eakin, E.E., Gardiner, P.A., Tremblay, M.S., Sallis, J.F. (2011). Adults’ sedentary behavior: Determinants and interventions. American Journal of Preventive Medicine, 41(2):189–196. Van Cauwenberg, J., Van Holle, V., De Bourdeaudhuij, I., Owen, N., Deforche, B. (2015). Diurnal patterns and correlates of older adults’ sedentary behavior. PLOS One, 10(8). Kikuchi, H., Inoue, S., Sugiyama, T., Owen, N., Oka, K., Shimomitsu, T. (2013). Correlates of prolonged television viewing time in older Japanese men and women. BMC Public Health, 13(1): 213.

Oral Presentations Walking as a Pathway Between the Environment and Positive Mental Wellbeing Among Older Adults in the Context of Regeneration Curl, Angela1; Mason, Phil2 1University 2University

of Canterbury, Christchurch, New Zealand; [email protected] of Glasgow, Glasgow, United Kingdom; [email protected]

Introduction: In this paper we explore the relationship between environment, mobility, and wellbeing among older adults living in deprived communities of Glasgow, UK. As part of the regeneration process it is important to consider how the environment can be designed to foster mobility and positive mental wellbeing, given the strong links between mobility and wellbeing for older adults. The importance of the environment for mobility and wellbeing and the importance of mobility for wellbeing are both well-established conceptually and empirically, but there is limited empirical evidence exploring walking as the pathway between the environment and wellbeing. Methods: Our study was conducted in Glasgow as part of the GoWell Research and Learning Programme, an ongoing investigation into the consequences of major residential, neighbourhood, and community regeneration programmes. The questionnaire sought information about respondents’ personal and residential circumstances, their physical and mental health, their recent physical activity, and their opinions and experiences of their homes, neighbourhoods, and communities. 4,269 Glasgow residents were interviewed in their homes in the spring or summer of 2011. The overall response rate achieved was 45.4%. For the purpose of the analyses presented here, we selected respondents who were British citizens aged 60 years or older, giving an analytical sample of 1,071 respondents. Given that the overall objective of this paper is to explore whether walking is a pathway between the environment and wellbeing, we use a structural equation modelling approach to explore the simultaneous direct and indirect relationships between neighbourhood perceptions and mental wellbeing with walking as a mediator. Results: The strength of the relationship between walking and wellbeing is not as strong as might be expected. There are direct and indirect relationships between the perceived environment and wellbeing. Walking partially mediates relationships between social contact, neighbourhood quality, use of local amenities, safety, and mental wellbeing. Although neighbourhood problems and the quality of local services and amenities are associated with mental wellbeing, walking is not the explanatory pathway in our model. Conclusion: While promoting mobility as a means of achieving positive mental wellbeing amongst older adults is important, it is also necessary to consider the context in which this takes place, recognising that walking is not the only pathway between environment and wellbeing. Yoga-Based Exercise Improves Balance and Mobility in People Aged 60 and Over: A Systematic Review and Meta-Analysis Youkhana, Sabrina1; Dean, Catherine1; Wolff, Moa2; Sherrington, Catherine3; Tiedemann, Anne3 University, Sydney, Australia; [email protected], [email protected] University, Lund, Sweden; [email protected] 3The George Institute for Global Health, The University of Sydney, Sydney, Australia; [email protected], atiedemann@georgeinstitute. org.au 1Macquarie

2Lund

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Introduction: One-third of community-dwelling older adults fall annually (Lord, Sherrington, Menz, & Close, 2006). Exercise that challenges balance is proven to prevent falls (Sherrington, Tiedemann, Fairhall, Close, & Lord, 2011). Little is known about yoga’s effect on independence in older age, measured by balance and mobility, and no randomised controlled trials have evaluated the impact of yoga on falls in older age. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years. Methods: Searches for eligible trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database, and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences (SMD, Hedges’ g) and 95% confidence intervals (CI) were calculated using random-effects meta-analysis models. Methodological quality of trials was assessed using the 11-point PEDro Scale. Results: Six trials of relatively high methodological quality (mean PEDro Scale score = 6.7), totaling 307 participants, were identified and provided data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (SMD = 0.40, 95% CI 0.15–0.65, I2 = 0%, P = 0.615, 6 trials) and a medium effect on physical mobility (SMD = 0.50, 95% CI 0.06–0.95, I2 = 51.8%, P = 0.126, 3 trials). Conclusion: Yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people. PROSPERO Registration number CRD42015015872. References: Lord, S.R., Sherrington, C., Menz, H.B., & Close, J.C.T. Falls in Older People: Risk Factors and Strategies for Prevention. Cambridge: Cambridge University Press; 2006. Sherrington, C., Tiedemann, A., Fairhall, N., Close, J.C.T., & Lord, S.R. (2011). Exercise to prevent falls in older adults: an updated metaanalysis and best practice recommendations. NSW Public Health Bulletin, 22:78–83. Can Low Active Older Adults Living With and Without Mild Cognitive Impairment Regulate their Exercise Intensity With Perceived Exertion? Smith, AE1; McAuliffe, L1; Gray, C1; Keage, HAD2; Eston, RG1; Parfitt, GC1 1Alliance

for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia; [email protected] Neuroscience Laboratory, University of South Australia, Adelaide, Australia

2Cognitive

Introduction: Regulating the intensity of aerobic activity based on individual perceptions of effort may improve cardiorespiratory fitness and increase long-term exercise adherence. In active and sedentary young and middle aged adults individually regulating exercise at a somewhat-hard intensity (equivalent to a rating of perceived exertion of 13 on the 6–20 Borg scale) can improve both cardiorespiratory fitness and result in positive affective responses. However, it is largely unknown if low active older adults (with and without cognitive impairment) can regulate their exercise intensity consistently using perceived exertion. In this study we investigated the physiological and affective responses during a continuous 21-minute perceptually regulated exercise session in low active older adults with and without cognitive impairment. Methods: Twenty-four low active older adults (71.83 ± 5.30, 13 females) participated in a single continuous 21-minute exercise session at three different intensities (7 minutes at RPE 9 [very light], 7 minutes at RPE11 [light], and 7 minutes at RPE 13 [somewhat hard]). Physiological variables (heart rate [HR]) and oxygen uptake (VO2) and affective responses were recorded throughout the session. Cognitive testing with the Addenbrooke Cognitive Examination (ACE-III) was used to separate the participants into two cognitive performance groups (age appropriate cognitive function and mild cognitive impairment [MCI]) based on the clinical cut off (MCI < 83). Results: Repeated measures analysis of variance revealed an expected increase in exercise intensity for both HR and VO2 across the three exercise intensities (RPE 9, RPE 11, and RPE 13) (P < .05). Affect reduced across the 21-minute session but remained positive throughout the duration of the test (P < .05). Importantly there were no main effects or interactions for cognitive group for either physiological or affective variables. In line with evidence in young adults, exercise intensity at RPE 13 was around the ventilatory threshold. Conclusion: These findings provide initial support for the use of perceptually-regulated exercise prescription in older adults, both with and without cognitive impairment. Patterning of Physiological and Affective Responses in Older Adults During Self-Selected Exercise and a Graded Exercise Test Smith, AE; Eston, RG; Tempest, G; Parfitt, GC Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia; [email protected] Introduction: Both the physiological response during exercise and the feelings of pleasure or displeasure should be considered when setting an exercise intensity. Research conducted in younger adults demonstrates higher intensities of exercise are associated with displeasure, which can be detrimental to long-term exercise engagement. In this study we examined the relationship between exercise intensity and physiological and affective responses in active older adults during both a maximal graded exercise test and a 20-minute exercise session at a self-selected preferred intensity, conducted on separate days. Methods: Eighteen participants (60–74 years; 64.4 ± 3.8; 8 women) completed both exercise sessions. Since time to exhaustion in the GXT differed between participants, physiological variables (heart rate [HR] and oxygen uptake [VO2]), ratings of perceived exertion (RPE) and affective responses were expressed relative to individually determined ventilatory thresholds (VT). In the self-selected session, physiological and affective variables were collected at 5-minute intervals (5, 10, 15, and 20 min). Results: During the GXT, VO2, HR, and RPE increased linearly (all P < .01). Affect declined initially (but remained positive) (P = 0.03), stabilised around VT (still positive) (P > .05) and became negative toward the end of the test (P < .01). In the self-selected 20-minute bout of exercise (at a preferred intensity) participants initially chose to exercise below VT (88.2 ± 17.4 %VO2 at VT), however the intensity was adjusted to work at, or above VT (107.7 ± 19.9 %VO2 at VT) after 10 minutes (P < .001), whilst affect remained positive. Conclusion: Together, these findings indicate that exercise around VT, whether administered during an exercise test, or self-selected by the participant, are likely to result in positive affective responses in active older adults. Short-Term Effects of a Pole Walking Program on Physical Capacities in Community-Dwelling Older Adults Baptiste, Fournier1,2,5; Marie-Ève, Mathieu1; Johanne, Filiatrault2,3,4; Nathalie, Bier3,4; Manon, Parisien2; Sophie, Laforest1,2,5 1Department of Kinesiology, Université de Montréal, Montréal, Canada; [email protected], [email protected], sophie.laforest@ umontreal.ca

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for Research and Expertise in Social Gerontology (CREGÉS), Integrated Health and Social Services University Network for West-Central Montreal, Montréal, Canada; [email protected], [email protected] 3School of Rehabilitation, Université de Montréal, Montréal, Canada; [email protected] 4Research Centre of the Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Canada 5Université de Montréal Public Health Research Institute (IRSPUM), Montréal, Canada Introduction: In recent years, an interest toward pole walking (PW) has been observed. It appears to be an activity that can produce many health benefits, including among older adults. To our knowledge, no study has assessed a PW program specifically designed for older people and offered by community organizations until now. Consequently, a biweekly program of 12 weeks of PW was developed, and enhanced by complementary exercises and strategies promoting an active lifestyle. This study aimed to examine the short-term effects of this new program on physical capacities among communitydwelling older adults. Methods: This quasi-experimental study involved six community organizations that were responsible for recruiting 63 people aged 60 years and older. Community organizations and participants were either assigned to the experimental group (participating in the program, two 60-min sessions/week) or to the control group (three-month waiting list). Participants were assessed before and after the PW program through several tests measuring walking speed, upper and lower limb muscle strength and flexibility, balance, mobility, grip strength, and cardiovascular endurance. Comparisons between groups over time were evaluated using a two-way ANOVA with repeated measures adjusted for age, living alone, and height. Results: Seventy-eight percent of participants came to the post-test (n = 49; mean age: 70 years; 86% women). Groups were different at baseline for living alone, height, balance, and lower limb muscle strength. The multilevel analysis indicated significantly greater improvement in upper and lower limb strength in the experimental groups compared to control groups (p < .05). In fact, participants from the experimental groups were, on average, able to do 10.6% more repetitions in the 30-s arm curl test after the program, whereas control participants had a decrease of 4.5%. Regarding lower limb strength, a mean increase of 8.9% was found in the number of repetitions in the 30-s chair stand test for the experimental groups compared to the control groups who had a 3.1% decrease. Conclusion: The PW program seems to have contributed to a significant improvement in the participants’ upper and lower limb strength. Preliminary data from this study are promising. The Effect of a 12-Week Supervised Multimodal Exercise Training Program on Lower Trunk Muscle Morphology and Functional Ability in Healthy Older Adults: A Randomized Controlled Trial Shahtahmassebi, Behnaz1; Hecimovich, Mark2; Hebert, Jeffrey1; Fairchild, Timothy1 1Murdoch

University, Perth, Australia; [email protected], [email protected], [email protected] of Northern Iowa, Iowa, United States; [email protected]

2University

Introduction: Aging-related decrements in trunk muscle morphology and function are associated with decreased balance and increased falls risk (Granacher, Gollhofer, Hortobagyi, Kressig, & Muehlbauer, 2013; Granacher, Lacroix, Muehlbauer, Roettger, & Gollhofer, 2013). Previously, balance and/or resistance training of the peripheral musculature have demonstrated good efficacy for prevention of falls in older adults (Lee & Park, 2013). However, the efficacy of training the lower trunk musculature remains largely unexplored. Therefore, the purpose of this study was to assess changes in trunk muscle morphology and functional ability following a 12-week supervised multimodal exercise training program amongst healthy older individuals. Methods: We conducted a single-blinded parallel group randomised clinical trial to investigate the effectiveness of a 12-week exercise program on trunk muscle size and functional ability in healthy older individuals. Sixty-four individuals (mean [SD] age: 69.8 [7.5] years; 59.4% female) were randomised to receive a multimodal exercise program comprising walking and balance exercises with or without strength/motor control training of the trunk muscles. Lower trunk muscle size was measured using ultrasound imaging. Functional ability was assessed using the six-minute walk test, the Berg Balance test, the 30 Second Chair Stand, and the Timed Up and Go. All participants completed baseline, six-week, and 12-week assessments. Consistent with the intentionto-treat principle, all data was analysed using a linear mixed model, and the main effects of exercise group and the exercise group by time interactions explored. Results: Participants performing the trunk exercises experienced greater increases (mean difference [95% CI]) in trunk muscle hypertrophy (1.6 [1.0, 2.2]) at the end of the 12-week training program. In addition, participants performing the trunk exercises showed significantly greater improvements in their 30 Second Chair Stand (5.9 [3.3, 8.4] repetitions) and Timed Up and Go (–0.74 [–1.40, –0.03] s) performance when compared to the exercise group which did not incorporate the trunk muscle exercises. Conclusion: These findings support the inclusion of strength/motor control training of the trunk muscles as part of a multimodal exercise program in older individuals. References: Granacher, U., Gollhofer, A., Hortobagyi, T., Kressig, R.W., & Muehlbauer, T. (2013). The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: A systematic review. Sports Medicine, 43(7), 627–641. Granacher, U., Lacroix, A., Muehlbauer, T., Roettger, K., & Gollhofer, A. (2013). Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology, 59(2), 105–113. Lee, I.H., & Park, S.Y. (2013). Balance improvement by strength training for the elderly. J Phys Ther Sci, 25(12), 1591–1593. The Role of Genetic Factors in Modifying the Relationship Between Physical Activity and Measures of Alzheimer’s Disease Risk Brown, Belinda1; Rainey-Smith, Stephanie1; Laws, Simon1; Villemagne, Victor2; Bourgeat, Pierrick3; Peiffer, Jeremiah4; Porter, Tenielle1; Taddei, Kevin1; Macaulay, Lance3; Rowe, Christopher2 ; Ames, David5; Masters, Colin5; Martins, Ralph1 Cowan University, Perth, Western Australia; [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] 2Austin Health, Melbourne, Victoria; [email protected], [email protected] 3CSIRO, Brisbane, Queensland; [email protected], [email protected] 4Murdoch University, Perth, Western Australia; [email protected] 5University of Melbourne, Melbourne, Victoria; [email protected], [email protected]

1Edith

Introduction: Previous research suggests regular physical activity is associated with better cognitive function, less brain beta-amyloid (Aβ; a toxic protein implicated in Alzheimer’s disease), and larger hippocampal volume. However, it is apparent that some people receive more benefit from physical JAPA Vol. 24, Suppl., 2016

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activity than others, a finding that could be due to genetic variances. This research has investigated the moderating effect of a number of genetic factors on the relationship between physical activity and measures of brain health. Methods: Data was collected from cognitively healthy participants aged 60 years and older from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing. A battery of neuropsychological tests was administered to all participants. A subset of participants also underwent neuroimaging in the form of [11C] Pittsburgh compound-B positron emission tomography (PiB PET; to determine brain Aβ load) and volumetric magnetic resonance imaging (MRI; to determine hippocampal volume). Cross-sectional analysis utilising univariate linear models was used to examine the moderating effects of apolipoprotein E (APOE), brain-derived neurotrophic factor Valine66Methionine polymorphism (BDNF Val66Met), and Catechol-O-methyltransferase (COMT) genotypes on the relationship between physical activity and brain Aβ, hippocampal volume, and cognition. Results: We report a significant moderating effect of APOE genotype on the relationship between higher physical activity levels and lower brain Aβ: APOE ε4 carriers appear to receive the greatest benefit from physical activity in terms of lower Aβ. The BDNF Val66Met polymorphism moderated the relationship between physical activity and larger hippocampal volume: only Val/Val homozygotes had a significant association between higher physical activity and larger hippocampal volume. Furthermore, we also observed a relationship between higher intensity physical activity and higher composite scores of attention, language, visuospatial functioning, and global cognition, a finding that was only salient in Met carriers of the COMT gene. Conclusion: The multiple effects of physical activity on the ageing brain are likely influenced by genetic factors. It is clear that the relationship between physical activity, genetics, and the brain is complex and requires further investigation. Consistent corroboration of these findings could be used to inform individually-tailored lifestyle advice to maximize a reduction in cognitive decline and Alzheimer’s disease risk. Engaging Older People in Physical Activity–An Evidence-Based Best Practice Framework for Community-Based Organisations Smith, Ben1; Nolan, Genevieve2; Menzies, David3; De Silva, Renee2 1Monash

University, Melbourne, Australia; [email protected], [email protected]

2Arthritis

and Osteoporosis Victoria, Melbourne, Australia; [email protected]

3Fitness

Australia, Melbourne, Australia; [email protected]

Introduction: Community-based organisations are major providers of physical activity opportunities for older people and yet little work has been undertaken to develop guidelines and frameworks to steer organisational policy and practice (King, 2001). Such tools would assist in maximising the appropriateness, accessibility, and acceptability of these organisations and their programs for older people. An evidence-based best practice framework for community-based organisations will be developed as a key initiative of the Victorian Active Ageing Partnership, a three-year Victorian Government initiative to increase physical activity opportunities for older Victorians, especially in areas of socio-economic disadvantage and among isolated, lonely older people not currently involved in physical activity. Methods: The international literature was reviewed to identify the features of programs, organisations, and organisational settings which act as barriers and facilitators to the engagement of older people in physical activity programs. To avoid duplication of effort, a search for existing evidence-based best practice frameworks was also undertaken. With the evidence synthesis to be completed early in 2016, a draft evidence-based best practice framework for community-based organisations will be developed. Feedback from community-based organisations will be sought regarding the usability and feasibility of the framework to enhance its successful translation into practice. Results: Initial work indicates that an evidence-based best practice framework is able to be developed and is likely to cover the areas of organisational policy and leadership, program design and implementation, workforce, integration with other community resources and organisations, and evaluation. Conclusion: An evidence-based best practice framework for community-based organisations will assist policy-makers, managers, and staff to maximise the accessibility, appropriateness, and acceptability of their physical activity programs for older people. Reference: King, A. (2001). Interventions to promote physical activity by older adults. Journals of Gerontology: Series A. 56A(Special Issue II), 36–46. Effects of a Visual–Verbal Stroop-Test on Balance Performance of Older Adults Wollesen, Bettina1; Voelcker-Rehage, Claudia2; Regenbrecht, Tobias1; Mattes, Klaus1 of Hamburg, Department of Human Movement Science, Hamburg, Germany; [email protected] (corresponding author), [email protected], [email protected]

1University

2Chemnitz

University of Technology, Department of Human and Social Science, Chemnitz, Germany; [email protected]

Introduction: More than 30% of people over 65 fall at least once per year, mostly as a result of instability (Granacher et al., 2010). The examination of fall risk while standing and walking is important to identify the interplay between internal factors of postural control and to develop appropriate training programs. The dual task (DT) paradigm is used to investigate balance decrements. However, there are inconsistent findings whether performance decreases or increases in DT situations (Holtzer, Wang, & Verghese, 2014). Following different theories (e.g., limited resource hypothesis, cross domain competition model), these findings can be explained by task settings and task complexity. This study explores which theoretical model is suitable to explain changes in balance performance for a visual–verbal Stroop task. Methods: DT performance of 28 participants (> 65 years) in a Stroop test was compared while standing (sway velocity [v], Kistler; Winterthur Germany, 100HZ) and walking (step length, step width [SW], peak forces of heel, mid- and forefoot, h/p/cosmos treadmill Zebris; Isny, Germany: FDM-T, 100HZ). One-way ANONA statistics were evaluated using SPSS 22 (IBM statistics, Armonk, NY). Results: SW and v increased from ST to DT conditions and step length decreased (left: F[1,27] = 13.09, p = .001, ηp ² = .326; right: F[1,27] = 12.36, p = .002, ηp² = .314). Peak forces of the forefoot were reduced (left: F[1,27] = 9.82, p = .004, ηp² = .267; right: F[1,27] = 10.38, p = .003, ηp² = .278) whereas forces of the midfoot increased (left: F[1,27] = 4.19, p = .051, ηp² = .134; right: F[1,27] = 4.31, p = .048, ηp² = .138). Correct answers of the Stroop test decreased from the baseline condition to DT walking (F[1,27] = 5.59, p = .025, ηp² = .025). Discussion: For both conditions (standing and walking), the limited resources hypothesis fits best. Moreover, not all modified gait variables could be defined as negative DT costs. Increased SW and decreased step length might be used to compensate influences on lateral stability while demands on motor-cognitive resources increase. Further, drawing conclusions from a standing task on walking conditions might lead to misinterpretations. References: Granacher, U., Bridenbaugh, S.A., Muehlbauer, T., Wehrle, A. & Kressig, R.W. (2010). Age-related effects on postural control under JAPA Vol. 24, Suppl., 2016

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multi-task conditions. Gerontology, 57, 247–255. Holtzer, R., Wang, C. & Verghese, J. (2014). Performance variance on walking while talking tasks: theory, findings, and clinical implications. Age, 36, 373–381. Physical Activity, Sedentary Behaviour, and Depressive Symptoms in Hong Kong Chinese Older Adults Zhang, Casper JP1; Cerin, Ester1,2; Barnett, Anthony2; Sit, Cindy HP3; Johnston, Janice M1; Lee, Ruby SY4 University of Hong Kong, Hong Kong, China; [email protected], [email protected], [email protected] Catholic University, Melbourne, Australia; [email protected] 3The Chinese University of Hong Kong, Hong Kong, China; [email protected] 4Department of Health, Hong Kong, China; [email protected]

1The

2Australian

Introduction: Higher levels of physical activity (PA) and lower levels of sedentary behavior (SB) have sometimes been associated with better mental health and lower risk of depressive symptoms in older adults (Hamer & Stamatakis, 2014; Yoshida et al., 2015). Yet, the dose-response relationships remain unclear and appear to depend on behavioral attributes, such as domain, intensity, and type of PA, and on individual attributes such as sex, age, socio-economic status, and health indicators (Cerin et al., 2009). Additionally, they may depend on culture (preference for certain activities) and environmental context. As information on relationships of PA and SB with depressive symptoms in Chinese older adults living in ultra-dense environments is lacking, the aims of this study were to examine (1) the associations of aspects of objectively-assessed and self-reported PA and SB in Hong Kong Chinese older community dwellers and (2) the moderating effects of sex, age, neighborhood-level socio-economic status, and number of diagnosed chronic conditions other than depression. Methods: A sample of 402 Chinese cognitively-intact older adults (69% females; mean age = 75.5 ± 6.2 years) living in Hong Kong neighborhoods stratified by median household income and walkability were recruited. Participants were asked to wear an accelerometer for seven consecutive days and participate in an interviewer-administered survey including questions about socio-demographics, PA habits, and SB (International Physical Activity Questionnaire–Short; Neighborhood Walking Questionnaire for Chinese Seniors). Generalized additive mixed models were used to estimate the PA/SB–depressive symptoms associations and the moderating effects of socio-demographic and health characteristics. Results: No significant associations of objectively-assessed PA and SB with depressive symptoms were found. Total self-reported weekly minutes on non-walking PA and sitting time were respectively negatively and positively associated with depressive symptoms. Also, weekly frequency of walking for transport and total weekly minutes of walking for recreation were negatively associated with depressive symptoms. No significant moderating effects were found. Conclusion: Only certain types and aspects of PA and SB may have an effect on the risk of depressive symptoms in Hong Kong Chinese older adults. Further studies are needed to cross-validate these findings and elucidate the underlying mechanisms responsible for the observed differences in associations. References: Yoshida, Y., Iwasa, H., Kumagai, S., Suzuki, T., Awata, S., & Yoshida, H. (2015). Longitudinal association between habitual physical activity and depressive symptoms in older people. Psychiatry Clin Neurosci, 69(11), 686–692. Hamer, M., & Stamatakis, E. (2014). Prospective study of sedentary behavior, risk of depression, and cognitive impairment. Med Sci Sports Exerc, 46(4), 718–723. Cerin, E., Leslie, E., Sugiyama, T., & Owen, N. (2009). Associations of multiple physical activity domains with mental well-being. Mental Health Phys Act, 2, 55–64. Exercise to Prevent Falls in Older Adults: An Updated Systematic Review and Meta-Analysis Sherrington, C1; Michaleff, ZA1; Fairhall, N1; Paul, SS1; Tiedemann, A1; Whitney, J2; Cumming, RG3; Herbert, RD4; Close, JCT4; Lord, SR4 1The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected], zmichaleff@

george.org.au, [email protected], [email protected], [email protected] Age Research Unit, King’s College Hospital, London, United Kingdom; [email protected] 3School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected] 4Neuroscience Research Australia, University of New South Wales, Sydney, Australia; [email protected], [email protected], [email protected] 2Clinical

Introduction: Previous meta-analyses have found that exercise can prevent falls in older people. This study aimed to test whether this effect is still present when new trials are added and it explores whether certain characteristics of the trial design, sample, or intervention are associated with greater fall prevention effects. Methods: For this updated systematic review, the Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from May 2010 to June 2015. We included randomised controlled trials that compared fall rates in older people who were randomised to receive exercise as a single intervention with fall rates in those randomised to control groups. The data were analyzed with random effects meta-analysis and meta-regression. Results: One hundred comparisons from 89 trials with 20,547 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.74 to 0.85, p < .001, I2 48%, 69 comparisons) with greater effects seen from exercise programs that challenged balance and involved more than three hours per week of exercise. These two variables explained 67% of the between-trial heterogeneity and, in combination, were associated with a 39% reduction in rate of falls (IRR 0.61, 95% CI 0.52 to 0.72, p < .001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson’s disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p = .001, I2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p = .004, I2 21%, 3 comparisons), but there was no evidence of effect in residential care settings or among stroke survivors, people with severe visual impairment, or people recently discharged from hospital. Conclusion: Exercise as a single intervention can prevent falls in community-dwelling older people. Programs that challenged balance and were of a higher dose had larger effects. The impact of exercise as a single intervention in other clinical groups and aged care facility residents requires further investigation, but promising results have been seen in people with Parkinson’s disease and cognitive impairment. Sport and Ageing: Benefits and Barriers of Sport Participation for Adults Aged 50+ Years Jenkin, Claire1; van Uffelen, Jannique1; Westerbeek, Hans1; Eime, Rochelle1,2 1Victoria

University, Melbourne, Australia; [email protected], [email protected], [email protected] University, Ballarat, Australia; [email protected]

2Federation

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Introduction: Active participation in health-enhancing physical activity has proven health benefits (Warburton, Nicol, & Bredin, 2006) and contributes toward maintaining a healthy lifestyle. Despite this, participation tends to decline with age (Australian Bureau of Statistics, 2013–14). In an ageing population, there is a need to diversify physical activity options to encourage older adults (adults aged 50 and older) to maintain a healthy lifestyle. Sport, as a moderate or vigorous form of physical activity, can diversify these options. Methods: Eight focus group interviews (total n = 49) were held with representatives of national sporting organisations, older sport club members, and older non-sport club members. The representatives were asked for their perceptions on the benefits to, and barriers of, sport participation for older adults. Data were analysed using thematic and content analyses, with the socio-ecological model used as a conceptual and analytical framework. This model recognises that sport participation is multi-faceted, as it considers the intrapersonal, interpersonal, organizational, and policy factors that can influence participation. Results: The most prominent benefits discussed in the interviews focused on the intrapersonal and interpersonal factors of participation. Social interaction was the most commonly reported benefit for older adults. Other benefits of participation included to improve physical health and to provide intergenerational opportunities to bond with their families. The most prominent barriers discussed correlated with the intrapersonal, interpersonal, and organisational factors of participation. Time constraints, physical health, and lack of appropriate playing opportunities were the most reported barriers for sport participation. Conclusion: In an ageing population, sport can play a significant and interesting role in active ageing. Sport and sport clubs provide a natural setting for social interaction, which can help sport differentiate itself from other forms of physical activity. This should be widely promoted by sporting organisations to increase the active participation of this age group. Whilst older adults may not be the highest priority group for sporting organisations, there is a great opportunity for organisations to engage with this age group and contribute to the active ageing agenda. References: Australian Bureau of Statistics. (2013–14). Participation in Sport and Physical Recreation [online]. Retrieved from http://www.abs.gov.au/ausstats/[email protected]/mf/4177.0. Warburton, D.E., Nicol, C.W., & Bredin, S.S. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal, 174(6), 801–809. Dancing and the Ageing Brain: Are We Overstating Dance Benefits? Merom, Dafna1; Coubard, Olivier2; Se-Hong Kim3 Sydney University, Sydney, Australia; [email protected] Neuropsychological Laboratory CNS-Fed, Paris, France; [email protected] 3College of Medicine, The Catholic University of Korea; [email protected] 1Western

2The

A physically active lifestyle has the potential to prevent cognitive decline and dementia, yet the optimal type of physical activity remains unclear. Dance has been highlighted as a potentially superior activity for maintaining or improving cognitive ability. Dancing for humans has been equated to the effect on neurogenesis in animals living in an enriched environment. Cognitively, dance requires learning of complex motor sequences, procedural memory, attention, visuomotor integration, synchronisation in space and time (rhythm movements), and emotional expression. In recent years neuroscientists have used dance as a model for studying neural processes implicated in the execution, expression, and observation of skilled movement. This research, however, has been devoted to comparison between young professional dancers and non-dancers, but some processes identified may apply to an older population. In addition, dance is fundamentally a social activity that has been shown to promote social engagement in older people, which is in turn associated with better cognitive outcome in observation studies. The objectives of this symposium are to: (1) present findings from dance-based interventions and their effect on various cognitive capabilities of older adults; (2) discuss differences between observational studies and intervention studies and what may explain these differences; and (3) discuss future research direction to understand the benefits of dance for ageing brain. This symposium will present findings from dance-based interventions conducted with community-dwelling seniors from France, Korea, and Australia. The first speaker (Coubard Olivier) will review the theoretical basis for dance benefits on attentional control and will present results of dance studies with the aging population in this area. The second presenter (Se-Hong Kim) will present results on the effects of dance exercise on cognitive tests of Korean seniors diagnosed with metabolic syndrome. The third presenter (Merom Dafna) will discuss the outcomes of a pragmatic randomised controlled trial comparing the effects of ballroom dancing to walking on executive function of older participants at three time points. Video demonstrating seniors at the dance sessions will be part of the presentation. Body Composition Changes after 12 Months of FES Cycling: Case Report of a 60-Year-Old Female with Paraplegia Dolbow, David1; Gorgey, Ashraf2; Gater, David3; Moore, Jewel2 of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi, USA; [email protected] Cord Injury Research, McGuire VA Medical Center, Richmond, Virginia, USA 3Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA

1School 2Spinal

Introduction: Functional electrical stimulation (FES) has been used as a safe method for the external stimulation of paralyzed muscles in the clinical setting for over two decades; however, the effects of long-term home-based FES cycling on an older adult with paraplegia has not been reported (Dolbow et al., 2014). The purpose of this case report is to document body composition changes in a 60-year-old female with chronic paraplegia after 12 months of FES lower extremities cycling. Methods: After screening and approval from the participant’s medical physical, 12 months of thrice weekly FES cycling (40–60 minutes per session) was completed. Body composition measurements for lean mass, fat mass, bone mineral density, and body fat percentage (BF%) were taken pre- and post-cycling program with dual-energy x-ray absorptiometry (DXA). Results: There was a 7.7% increase in total body lean mass and a 4.1% increase in leg lean mass. There was a 1.2% decrease in total body fat mass and a 9.9% decrease in leg fat mass. BF% decreased from 48.4 to 46.3 and bone mineral density increased from 0.934 to 1.023 g/cm2, which resulted in an improvement in the DXA T-score from –2.4 to –1.3. Conclusion: Desirable body composition changes after 12 months of FES cycling support the idea that long-term FES cycling can help restore undesirable body composition changes after spinal cord injury. Measured Mobility Status is Strongly Associated with Functional Independence in Community-Dwelling Older People: An Observational Cross-Sectional Study Lester, David; Tiedemann, Anne; Sherrington, Catherine JAPA Vol. 24, Suppl., 2016

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The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia; [email protected] atied, emann@ georgeinstitute.org.au csher, [email protected] Introduction: Independence and living at home are goals of most older people; government and wider society agree, if there is no excessive burden. This attitude assumes that if an older person has poor mobility they will require supportive services. There is no objective data in the literature that quantify this specific relationship. This study tested the hypothesis that the more impaired a person’s objectively measured mobility, the greater their use of formal and informal supportive services. Methods: An observational cross-sectional study of 70 people aged 80 years or older living in rural NSW, Australia was conducted. Recruitment was via local media and invitation by health professionals. The primary outcome was the total hours per month of formal and informal service use. Predictor variables were the Short Physical Performance Battery ordinal scoring (SPPB) and re-scaled continuous scores (SPPBcont), Four Square Step Test (FSST), Usual Gait Speed over 4 meters (UGS4m), and the de Morton Mobility Index. Negative binomial regression analysis assessed the relationship between outcome and predictor variables. Logistic regression assessed the relationship between predictor variables and total hours of service use dichotomized at the median (5 hours). Results: After accounting for potential confounders (age, gender, education, living alone, comorbidities, medications, pain, vision, Mini-Nutritional Assessment, Positive and Negative Affect Scale) each predictor variable was found to be independently and significantly associated with the primary outcome. Strongest associations were UGS4m (IRR .06, 95%CI .02–.19, p < .001), FSST (IRR .18, 95%CI .05–.57, p = .004), and SPPBcont (IRR .32, 95%CI .16–.64, p = .001). The strongest associations with the use of five or more hours/month were UGS4m (OR .005, 95%CI .0003–.07, p < .001) and SPPBcont (OR .10, 95%CI .02–.60, p = .012). Conclusion: This study provides the first direct evidence of an association between an older person’s measured mobility status and their use of supportive services. Sample size and cross-sectional study design limit the strength of the conclusions. Investigation of the impact of maintenance or re-attainment of normal gait speed, lower limb strength, and balance on maintaining independence while continuing to live at home is warranted, as a positive impact would minimize financial and care demands on government and society. Establishing the Reliability of the Modified Fullerton Advanced Balance (mFAB) Scale Rose, DJ; Payton, M; White, E; Reyes, T California State University, Fullerton, California, USA; [email protected], [email protected], [email protected], [email protected] Introduction: The purpose of the study was to establish the inter-rater reliability of a modified version of the Fullerton Advanced Balance (mFAB) scale. Specifically, five of the 10 test items from the original scale were modified (Rose, Lucchese, & Wiersma, 2006). Revisions to certain test items were warranted for the following reasons: (a) reduce ceiling effects (i.e., test item 1); (b) increase the safety of the person being tested (i.e., replace test item 8, modify test instructions for test item 10); (c) better evaluate the balance dimension of interest (i.e., test items 2 and 7) and; (d) include a test of agility (substituted test item 8). Methods: The test administration instructions and/or scoring criteria for each of the five test items to be revised or substituted on the mFAB scale were created and then pilot tested with 10 higher functioning older adults (60–90 years). Further revisions were made to the mFAB scale prior to conducting the reliability phase of the study. A sample of 31 older adults (60–80 years) and three trained test administrators were subsequently recruited for the purpose of establishing the inter-rater reliability of the revised scale. Participants meeting the eligibility criteria were tested using the mFAB scale during a 30-minute testing session. A lead test administrator, experienced in both the administration of the original and modified scale, administered the mFAB scale to each participant while two additional raters, also trained in the administration and scoring of both scales, observed and also scored the performance of each participant on each test item of the revised scale. Inter-rater reliability (IRR) was determined using Spearman-Rank correlation analyses. IRR was established by comparing each pair of rater scores (i.e., rater 1 versus rater 2; rater 2 versus rater 3; rater 1 versus rater 3). Results: The correlation coefficients for the total mFAB score were .98 (rater 1 versus 2), .96 (rater 2 versus 3), and .97 (rater 1 versus 3), respectively. Individual test item correlations ranged from .63 to 1.00 across the three pairs of raters. The lowest correlations (.63 to 1.00) were observed for test item 2 (i.e., Reach for an Object), while the highest correlations (1.00) were observed for test item 7 (Stand on foam with Eyes Closed). Conclusion: The inter-rater reliability coefficients observed across the three pairs of raters compared favorably with those obtained for the original FAB scale for both the total score and individual test item scores. Moreover, the ceiling effect associated with the original test item 1 was no longer evident in the current sample and the substitution of a high-risk with low-risk test item evaluating agility resulted in very good inter-rater reliability (.88 to .94). The modifications made to the original FAB scale will enhance the scale’s efficacy as a multidimensional measure of balance in higher functioning older adults. References: Rose, D.J., Lucchese, N., & Wiersma, L.D. (2006). Development of a multidimensional balance scale for use with functionally independent older adults. Archives of Physical Medicine & Rehabilitation, 87, 1478–1485. Resistance Training: Why Some Older People Participate and Others Don’t Burton, Elissa1; Hill, Keith1; Lewin, Gill1; Pettigrew, Simone1; Hill, Anne-Marie1; Marston, Ken2; Airey, Phil2; Bainbridge, Liz1; Farrier, Kaela1 University, Perth, Australia; [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] 2Council on the Ageing (WA), Perth, Australia; [email protected], [email protected] 1Curtin

Introduction: The rates of older people participating in resistance training are low, with fewer than 15% meeting the World Health Organization’s recommended two sessions per week (National Center for Health Statistics, 2015). Yet, resistance training increases muscle strength and bone density, improves function and the ability to complete activities of daily living, and, when coupled with balance training, has been shown to reduce the rate of falls (Warburton, Nicol, & Bredin, 2006). To encourage older people to start or continue participating in resistance training, it is important to identify the factors that motivate and prevent them from doing so. This study compared motivational factors and barriers between older people who do and do not participate in resistance training to explore the differences and identify aspects needing greater focus to increase the number of people undertaking resistance training on a regular basis. Methods: This was a cross-sectional study using a questionnaire mailed to three categories of participants: those receiving home care services, members of a peak non-government seniors’ organization, and those already participating in a national resistance training program. Participants were aged 60 years and older, living in the community. Those who were home care clients were receiving either domestic assistance JAPA Vol. 24, Suppl., 2016

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or social care services. In total, 3,120 questionnaires were posted, with an overall response rate of 42.5%. Results: Respondents ranged between 60 and 100 years of age, with an average of 76 years. The home care clients were older than the other two groups (average age of 82 years). Motivators for taking up resistance training among those not participating related primarily to health and wellbeing, preventing falls and advice from a health professional. Those currently participating did so because of the positive physical and mental benefits and enjoyment. Major barriers included pain, injury, and illness. Conclusion: The results suggest that efforts to increase the number of older people participating in resistance training may need to focus on highlighting the positive effects, even in the presence of chronic disease and that a collaborative approach by researchers, older people, and health professionals is required. References: National Center for Health Statistics. (2015). Health, United States, 2014: With special feature on adults aged 55–64. Retrieved from Hyattsville, MD: http://www.cdc.gov/nchs/data/hus/hus14.pdf. Warburton, D., Nicol, C., & Bredin, S. (2006). Health benefits of physical activity: The evidence. CMAJ, 174(6), 801–809. Effects of Progressive Resistance Training and Weight Loss Versus Weight Loss Alone on Inflammatory and Endothelial Biomarkers in Older Adults with Type 2 Diabetes: A 12-month Randomised Controlled Trial Miller, Eliza G1; Sethi, Parneet2; Dunstan, David W2; Daly, Robin M1 University, Melbourne, VIC; [email protected] IDI Heart and Diabetes Institute, Melbourne, VIC

1Deakin 2Baker

Introduction: Circulating markers of inflammation and endothelial function are often increased in people with type 2 diabetes (T2D), and have been associated with increased risk of cardiovascular disease and diabetes-related complications. Aerobic exercise has been shown to improve these biomarkers in adults with T2D, but whether high-intensity progressive resistance training (PRT) with weight loss (WL) is effective remains uncertain. In this 12-month randomized controlled trial we investigated the effects of PRT+WL versus WL alone on systemic and endothelial markers of inflammation, including serum interleukin-10 (IL-10), IL-6, tumor necrosis factor (TNF)-α, adiponectin, intercellular adhesion molecule-1 (ICAM-1), and resistin in older overweight adults with T2D. Methods: Sedentary, overweight adults aged 60–80 years with poorly controlled T2D were randomised to six months of supervised PRT+WL (n = 19) or a supervised stretching (sham) program plus WL (n = 17) followed by six months of home-training without dietary modification. DXA was used to assess total body fat mass (FM) and lean mass (LM). Fasted blood samples were collected at baseline and subsequent three-month intervals. Markers of inflammation were measured using a Milliplex immunoassay assay kit. Results: Exercise compliance was similar between groups (phase 1, 86%; phase 2, 75%). Both groups lost similar amounts of weight and FM (P < .01) during the supervised training, but PRT+WL had a net 0.9 kg gain in LM compared to WL (P < .05). These results were not maintained during the home-based training with similar increases in both groups for weight and FM (P range < .05–.01). There were no within-group changes or between-group differences for any inflammatory or endothelial biomarker during the supervised training. In contrast, there was a greater reduction in IL-10 at nine months and TNF-α and ICAM-1 at 12 months in the PRT+WL relative to WL group (all P < .05). Serum adiponectin also increased in the PRT+WL relative to WL group after 12 months (P < .05). All results were adjusted for age, weight, sex, diabetes duration, medication use, and change in medication. Conclusion: Long-term participation in PRT, independent of weight loss, can result in modest improvements in certain inflammatory and endothelial markers in older adults with T2D. A Systematic Review of the Literature Concerning Social Support, Loneliness, and Physical Activity in Older Adults Lindsay Smith, Gabrielle1; Banting, Lauren1; Eime, Rochelle1,2; van Uffelen, Jannique1 1Victoria

University, Melbourne, Australia; [email protected] University, Ballarat, Australia

2Federation

Introduction: The promotion of active and healthy ageing is becoming more important as the population ages. Physical activity (PA) is known to reduce all-cause mortality in adults by approximately 30% compared to being inactive (Physical Activity Guidelines Advisory Committee, 2008) and contributes to the prevention of many chronic illnesses. However, the proportion of people who are ‘sufficiently active’ to gain health benefits globally is low (55%) and decreases with age (World Health Organisation, 2014). Studies have shown that social support can improve PA in older adults (Carlson et al., 2012). However, the association has not been systematically reviewed. This review had two aims: (1) systematically review the association between social support or loneliness and PA in older adults, and (2) clarify which type of social support (SS) is associated with PA. Methods: Studies examining the association between SS or loneliness and PA in older adults were included if they met the following criteria: Population: Healthy, communitydwelling, mean age 60 years. Design: Quantitative studies only. PA measure: PA intervention or PA measured objectively. Validated SS or loneliness measure. Results: General SS studies: Of seven studies, 70% found at least one positive association between general SS and PA (may have been for one gender or family or friends or summary scores). Studies examining SS for PA: Of 20 studies, 65% found at least one significant positive result. Loneliness: Of six studies, 66% found a negative association between loneliness and physical activity (greater loneliness associated with less physical activity). Conclusion: In older adults there are more studies which have examined the association between SS for PA and levels of PA than general SS and PA. High variability in measurement methods used to assess both SS and PA made it difficult to compare studies. Overall, the quality of studies was moderate to low. It seems that LTPA is more affected by SS than overall PA (including transport, occupational, other). Future research in the field would benefit from consistent measurement methods and high-quality longitudinal studies on SS for PA and PA as well as general SS and PA. References: Carlson, J.A., Sallis, J.F., Conway, T.L., Saelens, B.E., Frank, L.D., Kerr, J., Cain, K.L., King, A. C. (2012). Interactions between psychosocial and built environment factors in explaining older adults’ physical activity. Preventive Medicine: An International Journal Devoted to Practice and Theory, 54(1), 68–73. Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines advisory committee report. Washington, DC: US. Retrieved from http://www.health.gov/paguidelines/Report/. World Health Organisation. (2014). Prevalence of insufficient physical activity: Situation and trends. Global Health Observatory (GHO). Retrieved 15 March, 2014, from http://www.who.int/gho/ncd/risk_factors/physical_activity_text/en/. Physical Activity Literacy for Older Adults: A Systematic Review Jones, Gareth1; Stathokostas, Liza2; Wister, Andrew3; Chau, Shirley4; Young, Brad5; Clark, Patricia6; Duggan, Mary7; Norland, Peter8; Kriellaars, Dean9 1School

of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; [email protected] JAPA Vol. 24, Suppl., 2016

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of Kinesiology, Western University, London, Ontario, Canada; [email protected] of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada 4School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada 5School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada 6Active Living Coalition for Older Adults, Canada 7Canadian Society for Exercise Physiology, Canada 8Canada 55plus Games, Canada 9College of Rehabilitation Sciences, University of Manitoba, Canada 2School

3Department

Introduction: Physical Activity Literacy (PAL) is a promising strategy to increase physical activity and sport participation across the lifespan. PAL is defined as “the disposition in which individuals have the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for maintaining purposeful physical pursuits throughout the life course” (Whitehead, 2010). A growing body of evidence suggests that PAL is effective at increasing physical activity and sport participation in children and youth; however, to our knowledge no PAL model currently exists for older adults. In advance of creating an older adult PAL model we completed a systematic literature review to identify, appraise, and synthesize studies related to PAL in older adult populations. Methods: Relevant studies were gleaned from the grey literature and the following bibliographic databases: CINAHL (1982–January 2016), SPORTDiscus (1980–January 2016), MEDLINE (1966–January 2016), and PsycINFO (1967–January 2016). To determine which studies would be included, two members independently screened the title and abstracts of the articles that will be extracted from the literature search. The methodological quality was assessed. Results: Inclusion/exclusion criteria were applied and abstracted data was evaluated and summarized. The results of our systematic review are presented and discussed toward structuring and developing a model of PAL for older adults. Conclusion: In order to have a meaningful impact on the health of our aging population, a different approach must be taken to address the identified and long-standing problem of physical inactivity. The development of a PAL model for older adults will assist health promotion experts with increasing physical activity levels toward evidence-based recommended levels. A PAL model for older adults has the potential to significantly impact quality of life, mobility, function, and the health of those over the age of 65 years. References: Whitehead, M.E. (Ed.). (2010). Physical Literacy: Throughout the Lifecourse. London: Routledge. Physical Activity Literacy: A Model for Older Adults Jones, Gareth1; Stathokostas, Liza2; Wister, Andrew3; Chau, Shirley4; Young, Brad5; Clark, Patricia6; Duggan, Mary7; Norland, Peter8; Kriellaars, Dean9 of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; [email protected] of Kinesiology, Western University, London, Ontario, Canada; [email protected] 3Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada 4School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada 5School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada 6Active Living Coalition for Older Adults, Canada 7Canadian Society for Exercise Physiology, Canada 8Canada 55plus Games, Canada 9College of Rehabilitation Sciences, University of Manitoba, Canada

1School 2School

Introduction: Physical inactivity is a major public health concern, with those over age 65 being the most inactive segment of our population. The promotion of physical activity literacy (PAL) is emerging as a promising strategy to increase lifelong physical activity participation in younger age groups of the population (Mandigo et al., 2009). Others have established an association between PAL and long-term sport participation in children and youth (Longmuir et al., 2015). However, a paucity of available research exists that examines the influence of PAL upon sport and physical activity participation in older adults. This presentation outlines the developmental process of creating a PAL model for older adults. Methods: An expert team of researchers and knowledge users were assembled and guided by the ‘knowledge to action model’ (Graham et al., 2006). This involved three meetings: (1) planning meeting; (2) working meeting; and (3) consensus meeting. Overall, these meetings were used to explore and identify the multi-disciplinary factors contributing to older adult sport participation. To increase the rigor and confidence, a Delphi survey was conducted with knowledge experts (e.g., active aging researchers, master athletes, coaches, exercise instructors, and active older adults). Results: Delphi survey results were used to reassess theoretical observations and finalize the emerging PAL model for older adults. The model represents specific components that support PAL in the older adult. The lessons learned from this unique group of older adults are anticipated to be applied to active aging programs for encouraging sport participation in the broader older adult population and may assist with identification of enablers of sport participation. Conclusion: The proposed study provides insight into the further development of physical activity and sport policies and programs that target increased participation by older adults. Older adults are the fastest growing segment of the population, yet the least likely to participate in sport and/or physical activity related programs. These results will lay the foundation toward formal evaluation and dissemination of the model among moderately active older adults toward further exploring effective means of increasing physical activity participation among the general aging population. References: Mandigo, J., Francis, N., Lodewyk, K., & Lopez, R. (2009). Position Paper Physical Literacy for Educators. Physical and Health Education Canada. Longmuir, P.E., Boyer, C., Lloyd, M., Yang, Y., Boiarskaia, E., Zhu, W., & Tremblay, M.S. (2015). The Canadian Assessment of Physical Literacy: methods for children in grades 4 to 6 (8 to 12 years). BMC Public Health, 15(1):767. Graham, I.D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., Robinson, N. (2006). Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 26(1):13–24. The LIILAC Trial: Effects of Aerobic Exercise and Mediterranean Diet on Cognition in Cognitively Healthy Older People Living Independently Within Aged Care Facilities Kennedy, Greg1; Hardman, Roy1; Macpherson, Helen1,2; Meyer, Denny1; Scholey, Andrew1; Pipingas, Andrew1 JAPA Vol. 24, Suppl., 2016

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for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia; [email protected] of Exercise and Nutrition Sciences, Faculty of Health, Deakin University

The LIILAC trial is investigating the potential for cognitive change in a cohort of cognitively healthy individuals between the ages of 60 and 90 years, living in independent accommodation within Australian aged care facilities. This four-arm trial, involving 102 participants, examines the effect on mental functioning following the introduction of a Mediterranean style of diet and/or aerobic exercise, in the form of regular walking. It is hypothesised that exercise and diet interventions, both individually and in combination, will result in improvements in cognitive performance compared with controls. Additionally, the mechanisms by which these changes may occur will be investigated. Participants are assessed at baseline and six months with a battery of computer-based cognitive assessments as well as an assessment of their diet and walking ability. Mood, general health, perceived wellness, and sleep quality are also assessed in relation to lifestyle interventions. Potential mechanisms are investigated through cardiovascular measures assessing arterial stiffness as well as peripheral and central blood pressure, while blood biomarker testing examines changes in metabolic profiles, including brain derived neurotrophic factor (BDNF), inflammatory factors, and insulin sensitivity. Preliminary baseline analysis suggests that greater ambulatory fitness was associated with better performance, specifically across the memory components of the cognitive assessment. Baseline findings and change at six months, focusing mainly on exercise and fitness, will be discussed, as will associated mechanisms of action. This research has the potential to provide an evidence base for simple diet and exercise interventions to improve brain health and cognitive outcomes for older individuals living independently. Is Quadriceps Muscle Strength a Determinant of the Physical Function of the Elderly? Altubasi, Ibrahim The University of Jordan, Amman, Jordan; [email protected] Introduction: Several studies examined the relationship between quadriceps strength and physical function. It is known that quadriceps strength is a determinant of physical performance. Studies showed that the time to reach maximum torque is around 400–600 ms. However, this time is longer than is needed to prevent a fall incident. Therefore, rapid rise in torque development might be more important than maximum torque during limited time actions. To our knowledge, there are no studies that examined the association of physical function with time to peak torque and the rate of torque development. The purpose of this study is to determine the relationship of quadriceps rate of toque development and time to peak torque to physical functional activities in elderly people. Methods: Baseline data from 21 subjects (age 71.29 ± 4.6, 13 females [61.9%]) who participated in a randomized clinical trial to study the effect of neuromuscular electrical stimulation in inducing type II muscle fiber hypertrophy in elderly people was included in this study. Quadriceps strength was measured using a maximum isometric torque test and a maximum isokinetic torque test at 60 degrees/s. Time to peak torque and rate of torque development were calculated from the torque time curve of the isokinetic and isometric torque tests, respectively. Physical functional activities were measured using the timed stair climbing test, timed ramp up test, timed up and go test, and 4-meter walking time test. Pearson correlation coefficients were used to examine the relationships among the variables. Results: Time to peak torque was able to explain 20.3–35.2% of the variability of physical activity tests. Rate of torque development was able to explain 32.6% of the variability of the stair climbing test. However, isometric and isokinetic peak torques were able to explain .5–14.3% and .3–9% of the variability of the physical functional tests, respectively. Conclusion: Time to reach maximum torque and the rate of torque development might be more important measures than peak torque in determining the physical functional status of elderly people. References: Aagaard, P., Simonsen, E.B., Andersen, J.L., Magnusson, P., & Dyhre-Poulsen, P. (2002). Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol, 1318–1326. Alexander, N., Fry-Welch, D., Marshall, L., Chung, C., & Kowalski, A. (1995). Healthy young and old women differ in their trunk elevation and hip pivot motions when rising from supine to sitting. Journal of the American Geriatrics Society, 338–343. Suetta, C., Aagaard, P., Rosted, A., Jakobsen, A. K., Duus, B., Kjaer, M., & Magnusson, S. P. (2004). Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. J Appl Physiol, 1954–1961. The Potential of Holistic Movement Practices to Support Successful Ageing: Participation Experiences of Yoga Teachers Vergeer, Ineke; O’Sullivan, Grant Victoria University, Melbourne, Australia; [email protected], [email protected] Introduction: As a holistic movement practice, yoga offers both a physical practice and an underlying philosophy that links it to psychological and spiritual outcomes. While population studies show growing yoga participation in all age groups over the last decades (Clarke et al., 2015), and studies are increasingly investigating the physical health effects of yoga, the holistic dimension of yoga and its implications for participants’ experiences has received very limited attention. To shed light on what yoga can offer beyond the physical, this paper presents preliminary results of a study on participation experiences of yoga teachers, chosen because they were assumed to have both expert knowledge and extensive experience of the holistic dimension of yoga. Methods: Semi-structured interviews were conducted with experienced yoga teachers (n = 7; ages 47–67 years; yoga practice experience 9–40 years; yoga teaching experience 3–25 years), focusing on what made them become and remain involved in yoga, first as a practitioner and then as a teacher. Interviews were recorded and transcribed, and subjected to a thematic analysis. Results: Four main themes covered an ongoing dynamic relationship between teachers and their practice: (1) teachers’ needs and interests—what teachers bring to the practice, e.g., an initial interest in physical benefits, a conscious or dormant struggle with spiritual questions; (2) doing the practice—the necessity of repetitively engaging in yoga practice, physically and mentally; (3) experiences within yoga—processes of yoga involvement that supports personal development, e.g., observation of self, noticing more subtly; and (4) development through yoga—perceived changes and growth over time, e.g., changed relationship to one’s body, increased self-knowledge, spiritual clarity. Conclusion: The holistic dimension of yoga contains a range of processes that can support personal development, bodily awareness, and spiritual meaning-making. Yoga thus has the potential to facilitate successful ageing not only through physical exercise but also through improving holistic well-being. References: Clarke, T.C., Black, L.I., Stussman, B.J., Barnes, P.M., & Nahin, R.L. (2015). Trends in the use of complementary health approaches among adults: United States, 2002-2012. National Health Statistics Reports, 79. Hyattsville, MD: National Center for Health Statistics. Ultrasound Measures of Lower Limb Muscle Architecture are Associated with Functional Performance in Older Adults Selva Raj, Isaac1; Bird, SR1; Shield, AJ2 JAPA Vol. 24, Suppl., 2016

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of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia; [email protected] of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia

1Discipline 2School

Introduction: It is well known that ageing is associated with sarcopenia, which is characterised by decreased skeletal muscle mass, strength, and functional capacity (Doherty, 2003). With an ageing population, time and budget constraints mean that it is important to identify simple and efficient tools that can be used to quantify functional capacity in the clinical and research settings. The aim of this study was to determine if ultrasound measures of pennation angle (θ), fascicle length (Lf) and thickness of the vastus lateralis (VL), rectus femoris (RF), and gastrocnemius medialis (GM) muscles can predict performance in measures of functional capacity in older adults. Methods: Thirty-six healthy older adults (average age 68.2 ± 5.3 years; 20 males, 16 females) undertook the 6 meter fast walk (6mFWT), timed up and go (TUG), stair climb and descent, and vertical jump tests. Ultrasound images (probe frequency 10 MHz) of the vastus lateralis (VL) and rectus femoris (RF) muscles were obtained at two sites on the thigh, with participants seated with the knee at 90º flexion. Ultrasound images of the GM muscle were obtained while participants lay prone with the ankle fixed at 15º dorsiflexion. Results: After entering age, sex, and BMI into the multiple regression models, GM thickness was a significant independent contributor to the model predicting performance in the TUG (R = .723; P < .01), stair climb (R = .791; P < .05) and descent (R = .798; P < .01), and vertical jump tests (R = .785; P < .01). In addition, VL thickness (R = .781; P < .05) and GM θ (R = .773; P < .05) were significant independent contributors to the model predicting performance in the stair descent test. Conclusion: Ultrasound measures of GM muscle thickness can predict the performance of older adults in the TUG, stair climb and descent, and vertical jump tests. Ultrasound measures of VL thickness and GM pennation angle can also predict the performance of older adults in the stair descent test. Ultrasound is a simple, safe, non-invasive, and efficient bedside tool that can be used to predict the functional capacity of older adults. References: Doherty, T.J. (2003). Invited review: Aging and sarcopenia. Journal of Applied Physiology, 95(4), 1717–1727. Falls Prevention and Quality of Life in Residential Aged Care: Using Exercise to Grow Bold, Not Old Hewitt, Jennie1,2; Refshauge, Kathryn1; Henwood, Tim3; Goodall, S4; Clemson, L1 University of Sydney, Sydney, Australia; [email protected], [email protected] Care, Coolangatta, Australia; [email protected] 3The University of Queensland, Brisbane, Australia; [email protected] 4University of Technology, Sydney, Australia; [email protected]

1The

2Feros

Introduction: Falls are common among older adults, particularly for residents of aged care facilities. It is reported that approximately 60% fall each year. This is a major cause of morbidity and mortality and poses a significant burden on the health system. Residents also report reduced quality of life associated with fear of falling and activity restriction. Among community-dwelling older adults, exercise appears an effective countermeasure, but results have been inconsistent among studies in residents of aged care facilities. This presentation will describe a randomized controlled trial that has tested the efficacy of The Sunbeam Strength and Balance Program on falls and quality of life in residential aged care. Methods: A single blinded, two-group cluster randomized trial was performed with 220 residents living in 16 aged care facilities. Clusters were randomized to receive either the intervention or to continue with usual care. The intervention consisted of 50 hours of progressive resistance and balance training under the guidance of a physiotherapist over a six-month period, followed by a facility-guided maintenance training program for six months. Clusters randomized to the usual care group continued with their usual activity programs. Measurements included: number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive wellbeing, and cost-effectiveness. Measurements were taken at baseline, six months, and twelve months. Results: Final follow-up measurements will be completed in March 2016. This presentation will provide video and documented feedback from people who participated in the program, including stories about how the exercise program affected confidence, strength, and quality of life. Preliminary quantitative results will also be presented. Conclusion: This study addresses a significant shortcoming in aged care research and has the potential to impact a substantial individual and international healthcare problem. Outcomes will be used to inform care provider and healthcare policy. Conclusions about the efficacy of the quantitative data will be submitted for peer review and publication later in 2016. References: Cameron, I.D., Murray, G.R., Gillespie, L.D., Robertson, M.C., Hill, K.D., Cumming, R.G., Kerse, N (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews, CD005465. Hewitt, J., Refshauge, K., Goodall, S., Henwood, T., Clemson, L. (2014). Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program. Clinical Interventions in Ageing, 9:2165–2176. Sherrington, C., Tiedemann, A., Fairhall, N., Close, J.C., Lord, S.R. (2011) Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 22:78–83. The Effects of International Poi and Tai Chi on Physical and Cognitive Function in Healthy Older Adults Riegle van West, Kate University of Auckland, Auckland, New Zealand; [email protected] Introduction: The purpose of my research is to determine if International Poi (iPoi), a weight on the end of a cord spun in circular patterns around the body, can maintain or improve physical and cognitive function in healthy older adults. I believe it has the potential to do so because: (1) iPoi is a physical activity that draws upon the key components of fitness and is highly customizable; (2) iPoi is intrinsically playful, and play is proven to have a vital role in keeping the mind and body healthy; (3) iPoi is rhythmic, and may tap into the same benefits of rhythmic, active music therapy such as drumming; and (4) activities such as juggling and Tai Chi, which share many characteristics with iPoi (e.g. ambidexterity, rhythm, and meditative movement), are proven to have a positive effect on maintaining both physical and cognitive ability in older adults. Methods: The following hypotheses will be tested in a clinical trial. Hypothesis 1: Healthy older adults will experience an improvement in physical and cognitive function following four weeks of training in either iPoi or Tai Chai, and these improvements will be greater for participants who complete iPoi training. Hypothesis 2: The effects of four weeks of iPoi and Tai Chi training on physical and cognitive function will be sustained one month after training. During the trial, participants will be randomly allocated to take lessons in iPoi (treatment group) or Tai Chi (control group). Participants will also take part in a series of pre- and post-tests, measuring bimanual coordination, blood pressure, cognitive flexibility, complex attention, heart rate, manual dexterity, psychomotor speed, psychological wellbeing, upper limb range of motion, grip strength, lower body strength, and working memory. Results: The trial will be conducted from January–May JAPA Vol. 24, Suppl., 2016

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of 2016. Conclusion: By conducting the first research study on iPoi, I hope to pave the way for future research in the field of Poi and health, and for implementing iPoi into healthcare facilities. I believe iPoi is a simple, cost-effective, customizable, and undeniably fun solution for keeping the mind and body active, and potentially improving and prolonging quality of life. Physical Activity and Quality of Life in Older Women with Depressive Symptoms Heesch, Kristi1; van Gellecum, Yolanda2; van Uffelen, Jannique3; Burton, Nicola4; Brown, Wendy4 1Queensland University of Technology, Institute of Health & Biomedical Innovation and the School of Public Health and Social Work, Brisbane, Australia; [email protected] 2The University of Queensland, School of Human Movement Studies & Nutrition Sciences, Brisbane, Australia; [email protected] 3Victoria University, Institute of Sport, Exercise and Active Living, Melbourne, Australia; [email protected] 4The University of Queensland, School of Human Movement Studies and Centre for Research on Exercise, Physical Activity and Health, Brisbane, Australia; [email protected], [email protected]

Introduction: Physical activity (PA) shows a positive association with health-related quality of life (HRQL) in older adult populations. It is not evident, however, whether this association applies to older adults with depressive symptoms. This study examined concurrent and nine-year prospective associations between PA and HRQL in older women who reported depressive symptoms. Methods: Participants were 555 women, aged 73–78 years in 1999, who reported on a postal survey that year for the Australian Longitudinal Study on Women’s Health that they had depressive symptoms (scored > 10 points on the Center for Epidemiology Studies Depression questionnaire). They completed additional surveys in 2002, 2005, and 2008. For each survey, participants reported the minutes spent in three types of PA in the previous week: walking, moderate PA, and vigorous PA. A summary PA score was computed that accounted for differences in energy expenditure among the three PA types: walking by 3.0 METs; moderate by 4.0 METs and vigorous by 7.5 METs. Women were then categorized based on total MET×min/week into: none (< 40), insufficient (40 to < 600), and sufficient (600+). Participants also completed the Medical Outcomes Study Short-Form 36 Health Status Survey (SF-36) as the HRQL measure. Random effects mixed models, adjusted for socio-demographic and health-related variables, were computed to examine concurrent and lagged associations between PA level and each of the 10 HRQL measures (eight SF-36 subscales and two composite scales). Results: Concurrently, higher levels of PA were associated with better HRQL (p < .001). The strongest associations (> 4 point differences in HRQL) were found for the bodily pain, physical functioning, general health, social functioning, and vitality SF-38 subscales. Women doing ‘sufficient’ PA, equivalent to 150 minutes/week of moderate PA, had the best HRQL. Associations were attenuated in prospective models, more so for emotional HRQL-related scales than for physical HRQL-related scales. Strong associations (> 4 point differences) were still evident for physical functioning, general health, and vitality. Conclusion: For Australian women in their 70s and 80s with depressive symptoms, PA may improve present and future HRQL. Incorporating PA into depression management in older women may improve their HRQL. Acute Exposure and Exercise in Moderate Altitude Change Spatiotemporal Gait Characteristics in Healthy Community-Dwelling Seniors Donath, Lars1; Drum, Scott2; Faude, Oliver1; Zahner, Lukas1 of Sport, Exercise and Health, University of Basel, Basel, Switzerland; [email protected], [email protected], lukas.zahner@ unibas.ch 2Department of Health and Human Performance, Northern Michigan University, Marquette, USA; [email protected] 1Department

Introduction: Hiking at moderate altitude is a popular outdoor activity in seniors. Previous studies on acute effects of physical exercise on postural control showed that exercise (Donath et al., 2013) led to diminished postural control and changes of muscle activity (Donath et al., 2015). Interestingly, acute exposure to moderate altitude also impaired postural control in young adults (Stadelmann et al., 2015). Thus, the present study examined the combined effects of altitude and walking on static and dynamic balance. Methods: Thirty-six healthy seniors (age: 62 [SD: 4] y; BMI: 25 [5] kg/ m2) were examined on three days. Firstly, walking velocity was determined at 85% of the first ventilatory threshold (VT1). Therefore, a ramp walking test on a treadmill was completed. On day two or three, a 40-minute treadmill walk under sea level or normobaric hypoxia (2,600 m) was randomly double-blindly performed. Balance performance was assessed on a force-plate during single leg stance with eyes open (SLEO, 10 s on a force-plate) before and after walking. Spatiotemporal gait characteristics were collected during walking at 5 min and 35 min. Results: Condition × time interaction effects were found for neither parameter (0.13 < p < 0.60; 0.007 < ηp2 < 0.07). Only time effects were observed for cadence (–1.5%, p < 0.001, ηp2 = 0.29), stride time (+2.3%, p = 0.007, ηp2 = 0.28), and temporal gait variability (+22.6%, p = 0.01, ηp2 = 0.16). A moderate time × condition effect was observed for postural sway during SLEO (p = 0.04, ηp2 = 0.11). Post-hoc testing revealed difference between hypoxia and normoxia at 35 min (p = .01) and between 5 min and 35 min testing during hypoxia and normoxia (both p < 0.001). Conclusion: Altitude provided an adverse stimulus to walkinginduced changes of standing balance performance. Only a few time-based spatiotemporal gait characteristics changed marginally after 40 min walking. Thus, moderate hypoxia did not provide a meaningful provocation to gait control. Still, longer walking in older seniors at altitude on uneven ground might yield a meaningful threat to balance control with an increased risk of falling. References: Donath, L., Zahner, L., Roth, R., Fricker, L., Cordes, M., Hanssen, H., . . . Faude, O. (2013). Balance and gait performance after maximal and submaximal endurance exercise in seniors: is there a higher fall-risk? Eur J Appl Physiol, 113(3), 661–669. Donath, L., Kurz, E., Roth, R., Hanssen, H., Schmidt-Trucksass, A., Zahner, L., & Faude, O. (2015). Does a single session of high-intensity interval training provoke a transient elevated risk of falling in seniors and adults? Gerontology, 61(1), 15–23. Stadelmann, K., Latshang, T.D., Lo Cascio, C.M., Clark, R.A., Huber, R., Kohler, M., . . . Bloch, K. E. (2015). Impaired postural control in healthy men at moderate altitude (1630 m and 2590 m): data from a randomized trial. PLoS One, 10(2), e0116695. Leg and Trunk Muscle Activity During Standing Balance Tasks with Increasing Difficulty in Young Adults and Seniors Zahner, Lukas; Faude, Oliver; Donath, Lars Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; [email protected], [email protected], lukas.zahner@ unibas.ch JAPA Vol. 24, Suppl., 2016

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Introduction: Ageing changes neuromuscular performance during static and dynamic balance tasks that increase fall risk in seniors (Donath et al., 2015). Comparative studies on muscle activity during various stance conditions on ankle, thigh, and trunk level in young and old adults are lacking. The present study compared neuromuscular performance measures of selected ankle, thigh, and trunk muscles during standing balance tasks with increasing difficulty in both age groups. Methods: Postural sway, relative muscle activity (%MVC), amplitude ratios (AR), and co-activity indices (CAI) were collected during different upright standing tasks for 30 s (1: double limb stance, eyes opened on a foam surface; 2: double limb stance, closed eyes on firm ground; 3: double limb stance eyes opened, feet in step position on a foam surface; 4: double limb stance eyes closed, feet in step position on firm ground; 5: single limb stance, opened eyes on firm ground) in 20 healthy young adults (24 ± 2 y) and 20 seniors (73 ± 6 y). Surface electromyography (SEMG) was applied (SENIAM guidelines) to ankle (tibialis anterior, soleus, medial gastrocnemius, peroneus longus) and thigh (vastus lateralis, vastus medialis, biceps femoris, semitendinosus) muscles (non-dominant leg). Electrodes over trunk (multifidus and internal oblique) muscles were applied bilaterally. Results: Postural sway was higher in seniors for all tasks (p < 0.001). Two- to six-fold higher relative muscle activity was found in seniors for ankle (0.0002 < p < 0.001), thigh (0.0008 < p < 0.075), and trunk (0.001 < p < 0.036) muscles. Co-activation was elevated in young adults for the trunk (0.001 < p < 0.031) and in seniors for the ankle (0.009 < p < 0.03). With higher tibialis and multifidus muscle activity contribution on ankle and trunk level in seniors, respectively, percentage muscle coordination patterns differed for all stance condition at ankle (0.06 < ηp2 < 0.28) and trunk (0.14 < ηp2 < 0.23) level, but hardly on thigh level. Conclusion: Seniors spent higher relative electrophysiological costs for all stance conditions. Muscle coordination showed inverse activity patterns at ankle and trunk level. Whereas young adults seem to stiffen the trunk, seniors tend to stiffen the ankle for postural adjustment during upright standing. Optimal balance and strength training programs may take age-specific ankle and trunk muscle activity alterations into account to improve intervention outcomes (Donath et al., 2015). References: Donath, L., van Dieen, J.H., & Faude, O. (2015). Exercisebased fall prevention in the elderly: What about agility? Sports Med. In press. Donath, L., Kurz, E., Roth, R., Zahner, L., & Faude, O. (2015). Different ankle muscle coordination patterns and co-activation during quiet stance between young adults and seniors do not change after a bout of high intensity training. BMC Geriatr, 15(1), 19. The Relationship Between Physical Activity and Mental Health in Australian Seniors Jongenelis, Michelle1; Pettigrew, Simone1; Newton, Robert2; Jackson, Ben3; Warburton, Jennifer4 University, Perth, Australia; [email protected], [email protected] Cowan University, Perth, Australia; [email protected] 3The University of Western Australia, Perth, Australia; ben.jackson@uw 4La Trobe University, Melbourne, Australia; a.edu.au [email protected]

1Curtin 2Edith

Introduction: The significant effects of ageing on physical health, and the sheer number of people entering older age groups, have made the promotion of health and well-being amongst older people an important and urgent task. Although engagement in physical activity has the potential to result in significant physical and mental health benefits, older people tend to engage in lower levels of physical activity than other populations. The objective of the present study was to explore how engagement in physical activity may differ according to selected demographic factors, and the relationship between physical and mental well-being in older Australians. Methods: Over 400 Australian seniors aged 60+ completed a battery of measures that assessed psychological well-being (quality of life, depression, mental well-being, satisfaction with life, satisfaction with health, self-reported health) and engagement in moderate to vigorous physical activity. The study participants were recruited via a broad range of methods including newspaper and radio advertisements, flyers distributed to retirement villages and community senior centers, and a social research agency. Results: Males and those who were married reported engaging in significantly more moderate to vigorous physical activity than females and those who were separated, divorced, or widowed. Similarly, those who lived with a spouse or partner reported engaging in significantly more moderate to vigorous physical activity than those who lived alone or lived with others. Engagement in moderate to vigorous physical activity was significantly associated with higher self-reported quality of life and mental well-being, lower levels of depression, more favourable ratings of health, greater satisfaction with health, and greater satisfaction with life. Conclusion: Given the likelihood of a reciprocal relationship between physical activity and mental health, efforts should be made to promote physical activity in seniors and to increase awareness of the current guidelines in this population segment. Efforts should also be made to target those seniors who are less likely to engage in physical activity, such as those who do not have a part. Provision of Standard and Fortified ‘Meals-on-Wheels’ Meals to Improve Nutrition, Functional Status, Quality of Life, and Hospitalizations of Community-Dwelling Nutritionally At-Risk Elderly Arjuna, Tony1,2; Chapman, Ian1; Soenen, Stijn1; Miller, Michelle3; Visvanathan, Renuka1,4; Ueno, Tomoko3; Luscombe-Marsh, Natalie1,5 of Adelaide, Adelaide, Australia; [email protected], [email protected], [email protected], renuka. [email protected] 2University Gadjah Mada, Yogyakarta, Indonesia 3Flinders University, Adelaide, Australia; [email protected], [email protected] 4Central Northern Adelaide Health Services, Queen Elizabeth Hospital, Adelaide, Australia 5CSIRO Food, Nutrition and Bio-based products, Adelaide, Australia; [email protected]

1University

Introduction: Under-nutrition is prevalent among the elderly and is associated with many health consequences. The aim of this study was to explore whether provision of standard (2.3 MJ and 30 g protein; 33% of recommended daily intake requirements) Vs. protein and energy enriched MOW meals (4.6 MJ and 60 g protein; 66% of recommended daily intake requirements) could improve nutritional and functional status, quality of life, and hospitalizations of community-dwelling nutritionally at-risk elderly adults. Methods: Forty-two nutritionally at-risk individuals participated in a 12-week randomized, single-blinded, controlled study where they were allocated to receive one of three meal types: (1) fortified meals on ≥ 3 days/week + dietetic counselling (HEHP), (2) standard meals on ≥ 3 days/week + dietetic counselling (STD), (3) dietetic counselling but no meals (CON). Nutritional status was measured by weight change, calf circumference, arm circumference, triceps skinfold, BMI, and Mini Nutritional Assessment (MNA). Functional status was measured by handgrip strength and 3-meter-walk test, and quality of life was measured using the Hawthorne Quality of Life questionnaire JAPA Vol. 24, Suppl., 2016

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(AQoL) and Geriatric Depression Scale (GDS). The number of hospital admissions and length of hospital stays (LOS) three months prior to the study and during the study were also recorded. Assessments were made at baseline and 12 weeks and changes in each outcome was analyzed using mixed model ANOVA. Results: A total of 13 men and 16 women, aged 83 ± 5.8 years completed the study (HEHP = 12, STD =7, CON = 10). MNA score increased by 4 points with HEHP compared to 2.79 points for STD and 2.4 points for CON (treatment effect; P < .05). LOS in HEHP and STD was reduced by –5.4 ± 2.8 days and –5 ± 3.2 days compared with CON, which experienced no reduction in LOS (treatment effect; P < .01). Changes in the other health parameters were not significantly different between the groups. Conclusion: For the community-dwelling nutritionally at-risk elderly population, the provision of fortified and standard MOW meals resulted in small improvements in nutritional and functional status, quality of life, and hospitalization, although the majority of improvements were not significantly greater than were observed for the elderly adults receiving dietetic counselling alone. The Effect of Exercise on Muscle Mass in Older People: A Systematic Review and Meta-Analysis of Randomised Controlled Trials Fairhall, Nicola1; Tavares, Graziela1,2; Tiedemann, Anne1; Sherrington, Catherine1 George Institute for Global Health, Sydney, Australia; [email protected], [email protected], csherrington@ georgeinstitute.org.au 2Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil;[email protected]

1The

Introduction: Sarcopenia is a major problem for older people, and intervention to prevent or reverse sarcopenia has the potential to improve quality of life and reduce health care costs. The effect of exercise on muscle mass in older people is unclear. This systematic review and meta-analysis aimed to determine the impact of exercise on muscle mass in older people. Secondary objectives were to establish the impact of exercise on muscle strength and mobility, and evaluate whether the type of exercise influenced the effect on muscle mass. Methods: Systematic review with meta-analysis of randomised trials investigating the effect of exercise in people aged 60 years and older. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Lilacs, SportDiscus and the Physiotherapy Evidence Database (PEDro) from inception to October 2014. Exercise was delivered alone or as a component of a multi-faceted intervention. We extracted data on muscle mass and the secondary outcomes of strength and mobility. Standardised mean differences and 95% confidence intervals were calculated using a random effects model. Results: Thirty-eight trials involving 2,194 older adults were included in the meta-analysis of the effect of exercise on muscle mass (48 comparisons, as 10 trials had more than one intervention group). There was a small beneficial effect of exercise (Hedges’ g = 0.09, 95% CI 0.004 to 0.18, p = .04), with muscle mass improving by 0.65 kg following an average of 25 weeks of exercise. There was a bigger effect on muscle mass in programs that contained a resistance-training component, but this difference was not statistically significant (effect of strength in meta-regression, p = .47). Exercise had a moderate effect on strength (Hedges’ g 0.77, 95% CI 0.51 to 1.04, p < .001) and mobility (Hedges’ g = 0.74, 95% CI 0.4 to 1.09, p < .001). Conclusion: Exercise produced small, significant increases in muscle mass in older people, and moderate improvements in strength and mobility. Ongoing research is required to determine the optimal exercise program to increase muscle mass and function in older people. Note: PROSPERO Systematic review registration number CRD42014014513 Effectiveness of a Community Group and Home Based Exercise Intervention on the Maintenance of Vertebral Body Height and Prevention of Vertebral Compression Fractures in Older Adults: The ProAct65+ Bone Study Duckham, Rachel L1,6; Masud, Tahir2; Taylor, Rachael2; Kendrick, Denise3; Carpenter, Hannah3; Skelton, Dawn A5; Dinan-Young, Susie4; Iliffe, Steve4; Ladd, Hayley1; Brooke-Wavell, Katherine1 of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK; [email protected] for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK 3Department of Medicine, University of Nottingham, Nottingham, UK 4Department of Primary Care & Population Health, University College London, London, UK 5School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK 6Present Address: Centre for Physical Activity and Nutrition Research, Deakin University 1School

2Healthcare

Introduction: Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture, causing significant physical limitations, pain, and morbidity, and yet two-thirds of fractures go undiagnosed. Targeted exercise may provide an effective non-pharmacological intervention against age-associated declines in vertebral bone architecture, helping to prevent VCFs. This study investigated the effectiveness of a six-month communitybased group (FAME) and home-based (OEP) exercise intervention to maintain vertebra (T8-L4) height and prevent VCFs. Methods: Participants were 319 men and women, aged (mean + SD) 72 + 5 years recruited through primary care and randomised by practice to FaME, OEP, or a usual care group. Lateral vertebral morphometry was assessed using dual-energy x-ray absorptiometry (DXA) (GE-Lunar Prodigy) prior to randomisation and following the 24-week intervention. Dual-energy vertebral assessment (DVA) was used to calculate the anterior, middle, and posterior heights of T8–L4 vertebral bodies, and detect the type (wedge, biconcave, or crush) and severity (mild, moderate, or severe) of vertebral deformities. Repeated measures general linear model (GLM), adjusted for gender and age was used to assess anterior, middle and posterior dimensions of T8–L4 vertebrae over time. Alpha level was set at P < .05. Results: A total of 268 participants (FaME n = 95; OEP n = 74; usual care n = 99) with sufficient vertebral morphometry data were included in the final analysis. Four new deformities (OEP: 1, FAME: 2, and usual care: 1) were detected over the six-month intervention. Changes in mean vertebral heights were small (ranging from –0.1 to 0.2 mm), there was no significant main effect of time (p = .69), and changes over time did not differ between groups (time × group interaction p = .49). Conclusion: Exercise interventions, including strength exercise specifically targeted at preventing falls, did not result in clinically significant changes in vertebral height or prevent VCFs. The number of incident vertebral deformities was not enough to detect differences in incidence and a trial period of six months seemed insufficient to detect changes in vertebral height. There is a need for longer term studies to examine the potential role of exercise in preventing vertebral deformity. Evaluating the Impact of the Use of the Functional Fitness MOT Tool by Active Ageing Professionals Laventure, Bob1; Skelton, Dawn2 1BHF

National Centre for Physical Activity and Health, Loughborough University, England, UK; [email protected] JAPA Vol. 24, Suppl., 2016

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Caledonian University, Scotland, UK; [email protected]

Introduction: The Functional Fitness MOT tool was designed in 2011 to disseminate the UK CMO Guidelines on Physical Activity for Older Adults (65+) (Department of Health, 2011) to Active Ageing professionals, raising awareness of the importance of functional fitness (Rikkli & Jones, 2002) and providing a tool for professionals to design activities to engage older adults in community-based physical activity. The tool contains nine individual assessments based upon the functional fitness normative scores for community-residing older adults, ages 60–94 (Rikkli & Jones, 1999). Methods: From 2013 to 2015, a series of 34 one-day educational events throughout the United Kingdom included dissemination of the components of functional fitness, participating in the Functional Fitness MOT tool, information on guiding participants toward taking up physical activity, and guidance on planning MOT events to engage older adults. Participating professionals were provided with materials to support future activities. The programme was evaluated by questionnaire during the training events (93%) and through an on-line follow up survey at four months (38%). Results: 669 participants from different professional backgrounds attended the educational events. 93% shared the information learned during the day in meetings with other colleagues (52%) and during informal conversations (48%). 63% reported sharing the information on the UK CMO guidelines. 14% used the information to inform design and content of promotional materials, 57% used the information to change content of local programmes or interventions, and 32% included the information in educational activities with other professionals. 27% indicated they had organised a Functional Fitness MOT event since attending the training day. Of those who had not organised an event, 81% were still considering this as an option. Conclusions: There is a lack of awareness of the UK CMO guidelines for physical activity for older adults, even amongst exercise and fitness professionals. The Functional Fitness MOT can be employed in a number of community settings and scaled to size to meet different professional functions. Further educational programmes are required to support Active Ageing professionals without qualifications in physical activity and ageing. There is a need for an adapted version of the tool for use in residential supported living settings. References: Department for Health. (2011). UK CMO physical activity guidelines for older adults (65+ years). Department of Health, London. Rikkli, R., & Jones, J. (1999) Functional fitness normative scores for community residing older adults ages 60-94. Journal of Aging and Physical Activity, 7, 129–161. Rikkli, R., & Jones, J. (2002) Measuring functional fitness of older adults. The Journal on Active Aging, March–April 2002. Fracture Incidence and Prediction in Māori and Non-Māori Octogenarians Kerse, Ngaire1; Rolleston, Anna2; Teh, Ruth1; Wham, Carol3; Bacon, Catherine1 of Population Health, University of Auckland, New Zealand; [email protected], [email protected], [email protected] Clinic, Tauranga, New Zealand; [email protected] 3School of Food and Nutrition, Massey University, Auckland, New Zealand; [email protected] 1School

2Cardiac

Introduction: Fractures are at highest prevalence in those over 80 years of age and cause undue disability. Methods: LiLACS NZ is a cohort study of 421 Māori aged 80–90 years and 517 non-Māori aged 85 years (56% and 59% participation rate respectively). Fracture risk factors were ascertained at baseline in 2010. Fractures were ascertained from (1) self-report yearly and (2) the hospital discharge dataset over 48 months follow-up available on 498 non-Māori and 379 Māori. Results: Fewer Māori (4.1%) than non-Māori (9.9%) reported fractures (p < .001). More women (9.2%) self-reported fracture than men (4.8%) (p .007). Considering hospitalization for fracture, the five-year fracture incidence prior to enrolment was 2.4% and 5.6% for Māori and non-Māori, respectively, and four-year post enrollment was 8.5% and 8.8% for Māori and non-Māori, respectively. During the four-year follow-up, women (11.9%) had more fractures than men (3.6% p = .023). Using multiple logistic regression for Māori, significant predictors of selfreported fracture included falls per amount of activity (p .047), with those having low activity and falling being at higher risk of fracture, controlling for age and sex. For non-Māori, significant predictors of self-reported fractures were female gender and falls per activity level. Predictors of four-year hospitalizations from fracture were falls per amount of activity (p .039) and taking calcium (p .02), with those taking calcium having higher risk; comorbidity, prior fracture, weight, and BMI were not related to fracture in advanced age. Conclusion: Fracture prevalence was high in octogenarians. Falls in those with low activity significantly predicted fracture. Risk factors varied between Māori and non-Māori, suggesting ethnic-specific strategies for prevention may be needed. When is a Change in Sedentary Behaviour a Real Change? Dontje, Manon L; Dall, Philippa M; Skelton, Dawn A; Chastin, Sebastien FM—on behalf of the Seniors USP Team Glasgow Caledonian University, Glasgow, UK; [email protected], [email protected], [email protected], Sebastien.Chastin@ gcu.ac.uk Introduction: To examine the effectiveness of interventions at reducing sedentary behaviour (SB), accurate measurements are paramount. Measurement tools need to be valid and reliable, but, more importantly, sensitive to change. When researchers find a decrease in SB, they often assume that their intervention worked. However, there is a risk that the difference in SB is a result of measurement error, which includes typical day-to-day variability. To determine whether a change is real or within the measurement error, information about the minimal detectable change (MDC) of the measurement tool is needed. The MDC is the minimum amount of change that is larger than the measurement error. The purpose of this study was to assess the MDC of two subjective methods to measure SB in older adults. Methods: Sedentary behaviour of 22 older adults (aged 73 ± 6 years, BMI 26.1 ± 3.9 kg/m2, 68% male) was assessed with a previous day recall questionnaire (7 times; days 5–11) and an average day in the previous week recall questionnaire (2 times; day 8 and 15). MDC scores for total sitting time are based on the standard error of measurement (SEM), which is derived from the square root of the mean square error term in the repeated measures ANOVA (MDC = SEM × 1.96 × √2). Results: The mean (± SD) time spent sedentary was 495 (± 101) minutes per day. For total sedentary time, the MDC of the previous day recall was 296.6 minutes, and the average day recall was 244.8 minutes. This represents approximately a 60% and a 50% change relative to total sitting. Conclusion: Previous day recall questionnaires have generally been found to be more valid and accurate than average day recall; however, they seem to be less sensitive to change, probably because they capture day-today variability better. To be considered as a real change, the difference in total daily sitting time should be more than approximately five hours when using a previous day recall questionnaire, and more than approximately four hours when using an average day recall questionnaire. This implies that self-report is unlikely to be a suitable measurement tool for intervention studies. JAPA Vol. 24, Suppl., 2016

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Functional Capacity and Falls Research in the Context of Aging in India Johnson, Shanthi University of Regina, Regina, Canada; [email protected] Introduction: Falls are a major threat to the health of older adults. In addition, many older adults have compromised functional capacities marked by indicators such as mobility limitations associated with increased rates of falls. While it has been estimated that 70% of the world’s older adults are and will be in developing countries/low or middle income countries (LMICs), most of the research on functional capacity and falls emerge from developed countries. As a result, a co nsiderable research gap exists in the context of LMICs. The present study examined the level of functional capacity, frailty, and falls among elderly in Chennai, India. Methods: The sample included 207 elderly adults (91 males and 116 females), and the participants ranged in age from 60 to 106 years, with a mean age of 71 years. Physical tests were carried out to assess mobility (Timed Up and Go), balance and flexibility (Functional Reach), lower extremity strength (Sit to Stand), and functional endurance (6-minute walk). Frailty was assessed using the Brief Frailty Scale. Incidences of falls within the last year were recorded using a single-item question. Results: The mobility scores ranged from 6 to 105 seconds with an average of 19 seconds. Men in the study had lower mobility compared to women. Functional reach scores also differed based on gender, with men having greater functional reach, compared to women. The lower extremity strength scores assessed using sit to stand (5 repetitions) ranged from 9 to 85 seconds with an average time of 22 seconds. In the present study, one-third of the participants were unable to complete the 6-minute walk test, which measures functional endurance. Also, approximately half of participants recorded ever having had a fall (100 out of 207): 69 fell only once while 31 fell multiple times. Conclusion: The results showed a significant relationship of the functional indicators and falls contributing to frailty. The findings have implications for the development of physical activity and falls prevention programs for seniors in low income countries. This presentation will highlight several conceptual and methodological challenges and opportunities for injury prevention research from the context of LMICs. Health Information for Tracking and Preventing Falls in Canadian Long-term Care Facilities Johnson, Shanthi1; Johnson, Ernest2 1Faculty 2Faculty

of Kinesiology and Health Studies, University of Regina, Regina, Canada; [email protected] of Business Administration, University of Regina, Regina, Canada; [email protected]

Introduction: Falls are a major threat to the health of older adults. Compared to older adults who live in the community, residents of long-term care (LTC) facilities fall two to four times more often, and are twice as likely to injure themselves. While many LTC facilities are located in rural areas, falls and injury prevention literature is predominantly urban-centric. As such, the purpose of the study was to examine the rural-urban differences in the falls tracking and falls prevention strategies in place in LTC. Methods: The study included 79 LTC facilities (of a possible 118 facilities) in Saskatchewan and used key informant telephone interviews with the director of care or alternate. In addition, the incident reporting information system/form was reviewed. This process elicited facility information, profiles of interviewees, and fall-tracking and falls intervention strategies currently in place in the facilities. Results: Approximately 65% of the participating facilities were located in rural areas, while the remaining facilities were in urban locations (approximately 35%); the size of the facilities ranged from four to 270 residents (avg = 54). The majority of interviewees were female (90%) and had a nursing background (67%). The facilities were generally similar except for statistically significant differences in the size of the facility (avg = 35 beds in rural vs. 90 in urban areas) and length of operation (avg = 29 years in rural vs. 36 urban). In total, 84% of all facilities surveyed stated that falling was a concern and there were no statistically significant regional differences. Several falls prevention strategies were adopted by the facilities with the use of assistive devices, environmental modification, medication review, and clinical assessments being the most common. Exercise as a falls prevention intervention showed the greatest rural-urban differences. However, there were no statistically significant regional differences in the falls prevention strategies in place in LTC facilities. Conclusion: The study highlights the need to promote promising and effective falls prevention strategies in rural as well as urban contexts. On Your Feet—A Multidisciplinary Approach to Falls Macpherson, Sharon; Bate, Laura Older Persons and Rehabilitation, Waikato Hospital, New Zealand; [email protected], [email protected] Introduction: On Your Feet is an multi-disciplinary programme, that is designed to reduce falls risk for community-dwelling persons who live at home and want to remain safely on their feet, by providing education and information about falls, fall prevention, and a functionally-based exercise programme. Methods: All patients referred into the older persons and rehabilitation outpatient service with reported balance, mobility, or falls are triaged and reviewed in the balance and falls assessment clinic. In this clinic patients are assessed by a clinical nurse specialist, occupational therapist, and physiotherapist, who discuss with a geriatrician. Patients are assessed holistically and are onward referred to the most appropriate pathway, one being the On Your Feet programme. On Your Feet is a six-week programme in a group setting of 8–10 participates. Each week a new topic is discussed and strength, cardiovascular, and balance exercises are completed over a 90-minute session. At the completion of the programme outcome measures are re-reviewed to monitor progress. Results: The average BERG balance improvement following the On Your Feet programme was 4.7, which is clinically significant. The Timed Up and Go clinical tool also indicated patients were less likely to fall, with the average Timed Up and Go improving to 13.43 seconds. Patient confidence also improved with an average increase of 15 points when self-scoring confidence in the Modified Falls Efficacy Scale. On Your Feet is a cost effective programme, as 100 patients can complete the programme for the cost of one fractured neck or femur. Socialisation for patients has been a positive outcome, with many patients continuing with community-based exercises together at the completion of the programme. 128 patients have completed the programme over the past two years with only one patient sustaining a fractured neck or femur. Conclusion: The On Your Feet programme showcases the gold standard of multi-disciplinary collaboration for the health of our older population. After two years, this programme continues to deliver positive results for patients and reduces risk of falling. The On Your Feet programme has recently won the sustaining excellence in patient safety award at Waikato Hospital. It is aimed to expand the clinic and programme in 2016 so more patients within Waikato District Health Board can benefit. JAPA Vol. 24, Suppl., 2016

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Older Australians’ Awareness of and Motivation to Engage in Preventive Cognitive Activity Pettigrew, Simone1; Jongenelis, Michelle1; Biagioni, Nicole1; Talati, Zenobia1; Newton, Rob2; Warburton, Jeni3; Jackson, Ben4; Worrall, Caitlin1 University, Perth, Australia; [email protected], [email protected], [email protected], zenobia. [email protected], [email protected] 2Edith Cowan University, Perth, Australia; [email protected] 3LaTrobe University, Adelaide, Australia; [email protected] 4University of Western Australia, Perth, Australia; [email protected] 1Curtin

Introduction: The risk of cognitive decline increases with age, making it important for seniors to engage in protective behaviours to enhance cognitive function in their later years. Such behaviours include stimulating cognitive activity and physical activity. The aim of the present study was to assess older Australians’ beliefs and behaviours relating to the types of activities that are beneficial in the prevention of cognitive decline. The findings can inform future efforts to encourage appropriate preventive behaviours among older people. Methods: This study was undertaken as part of a larger research project on healthy ageing. Interviews were conducted with 242 Western Australians who were 60 years of age and older. Just over half the sample (n = 135) was female. A range of topics was covered in the interviews, including current participation in activities perceived to be protective of cognitive health. The interviews were audio recorded and the transcriptions were subsequently imported into NVivo10 for coding and analysis. Discussions relating to cognitive health were coded to a range of conceptual nodes, including specific activities undertaken, general beliefs about the effects of ageing on cognitive health, and any concerns about their own cognitive performance. Results: The interviewees had favourable views about cognitive decline prevention. Many reported intentionally engaging in activities they hoped would protect them from deterioration. These activities typically involved playing games (such as crosswords, Sudoku, solitaire, and bridge), reading, and/or staying abreast of current affairs. Participation in these activities was not perceived as onerous or tiresome, and instead they were considered entertaining and engaging. There was little appreciation of the cognitive benefits associated with undertaking new cognitive activities or engaging in moderate to vigorous physical activity. Conclusion: Older Australians appear to have a general understanding of the need to deliberately engage in activities to maintain their cognitive health, but their awareness of the range of activities that can be beneficial is somewhat limited and could be improved with appropriate health promotion communications. In particular, there appears to be great potential to increase knowledge relating to the cognitive benefits of physical activity, which could have positive physical and cognitive outcomes. What Works for a Person with Dementia? How to Make Resources and the Web Accessible so People with Dementia Stay Active and Engaged! Hennessy, Sophie; Reilly, Ann Alzheimer’s Australia Vic, Melbourne, Australia; [email protected], [email protected] Introduction: Staying engaged and active with dementia can be beneficial. While there are extensive print and web-based resources about living with dementia for healthy adults, carers, and health professionals, there is a distinct lack of health promotion resources designed for and accessible to people living with dementia. Over recent years, computer use has become more common among people of all ages, including older people. Research also suggests that people living with dementia or cognitive impairment will have different needs and capabilities in accessing such resources (Savitch & Zaphiris, 2006). In preparing to develop resources, including a website, accessible to people with dementia, existing online (WCAG 2.0 [W3C, 2008]) and print accessibility guidelines were referenced, however these do not cater to dementia and other cognitive impairments. Methods: Taking a consumer-driven approach and based on best available evidence, Alzheimer’s Australia developed health promotion resources titled Engage, Enable, Empower, which provide accessible information and recommendations so people with dementia can remain engaged and active. The development of these resources was guided by existing accessibility principles, however consumer consultation and reference to local and global research added to these principles by including specific information on accessibility for people with dementia. Specific methods included a literature review, focus groups, and consultation with consumer groups, related industry bodies, and medical professionals. For online information, sophisticated measures of usability in the development of a website included analytics, heat mapping, and screen recording. Results: The resources produced for people with dementia include a booklet, education materials, and a website. These resources all contain information focusing on making the most of life with dementia. Further adding to this accessibility, principles for people with dementia have been collated. These principles provide specific information in consideration of design, font, colour, readability, and navigation. Conclusion: In producing these resources, the importance of staying engaged and active has been highlighted in an accessible format for people with dementia. The dementia-specific accessibility knowledge collected in creating these resources has value in adding to current online and print-based accessibility principles. There are practice implications for increasing accessibility for people with dementia. References: Savitch, N., & Zaphiris, P. (2006). Accessible Websites for People with Dementia: A Preliminary Investigation into Information Architecture. In K. Meisenberger, J. Klaus, W.L. Zagler, & A.I. Karshmer. Computers Helping People with Special Needs (pp. 144­–151). Berlin: Springer Berlin Heidelberg. W3C. (2008). Web Content Accessibility Guidelines (WCAG) 2.0. Retrieved February 05, 2015, from http://www.w3.org/TR/2008/REC-WCAG20-20081211/ Living Longer Living Stronger™ 15 Years and Still Going Strong! Hendy, Sue COTA Victoria, Melbourne, Victoria, Australia; [email protected] Introduction: The Living Longer Living Stronger™ (LLLS) program was established 15 years ago and remains a ground breaking program in attracting people over 50 to undertake strength training. Methods: Progressive resistance strength training benefits older people by increasing their strength and muscle mass, improving their health profile, and dealing with many health problems, which results in prevention of many falls, being more mobile, and the ability to do daily chores. LLLS is a partnership between COTA and strength training providers within community and health centres, who offer this program in their downtime, keep fees to a minimum, and build up their membership/income. The partners are endorsed to provide the LLLS program under guidelines. Participants are assessed by instructors before they join the program and where needed seek approval from their doctor. Each person has an individual program designed for him or her and an instructor is present at all times. Results: LLLS is a well-known sustainable program in over 110 venues, including gyms, leisure centres, hospitals, community health services, community centres, retirement villages, and by personal trainers. JAPA Vol. 24, Suppl., 2016

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There are over 15,000 participants in the program across Victoria. The program has spread to South and Western Australia. The success stories for older participants are significant, measureable, and result in a healthier, stronger older population. Conclusion: The LLLS program brought together the best knowledge and research in the science, medicine, and health arenas and developed into an effective community-based intervention. References: Dr. Elizabeth Cyarto, National Ageing Research Institute, Melbourne, Australia; Dr. Miriam Nelson, Director, John Hancock Research Centre, Tufts University, Medford/Somerville, Massachusetts, USA; Peter Burns, CEO, YMCA Victoria, Melbourne, Australia. Sarcopenic Characteristics of a Faller: Can We Capture Fallers with a Few Simple Questions? Rantalainen, Timo; Duckham, Rachel L; Tait, Jamie L; Brownell, Sarah M; Daly, Robin M Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne; [email protected] Introduction: Falls are recognized as a common consequence of sarcopenia, which is characterized by low muscle mass, strength, and/or impaired function. Currently the clinical assessment of sarcopenia is based upon objective measures, including appendicular muscle mass, grip strength, and gait speed. Recently it was shown that a simple five-item questionnaire, termed SARC-F, has excellent specificity when identifying people with sarcopenia (Woo et al., 2015), but whether such simple questions can also predict falls risk remains uncertain. The aim of this study was to investigate whether both SARC-F and objective measures of sarcopenia were associated with a history of falls. Methods: 122 adults (92 women) aged 56–89 (mean 72 years) residing in retirement villages in metropolitan Melbourne completed the SARC-F questionnaire: Q1 difficulty lifting and carrying 10-pounds (4.5 kg); Q2 difficulty walking across a room; Q3 difficulty transferring from a chair or bed; Q4 difficulty climbing a flight of 10 stairs; and Q5 number of falls in the past year. Objective measures of muscle mass (appendicular fat free mass [FFM]; bioelectrical impedance, Tanita), gait (Timed Up-and-Go [TUG]), and muscle strength (grip and knee extension strength [KES]) were assessed. For this study, falls history was the primary outcome while the sum of the other four SARC-F questions were treated as the independent variable. Logistic regression was used to assess associations between falls history, SARC-F, and the objective measures of sarcopenia. Results: Overall 30 individuals reported having at least one fall over the past 12 months. Age, height, weight, and number of chronic diseases were no different between those with and without a history of falls. When all objective measures were entered into the model, only TUG was predictive of falls history (OR 1.26 [95%CI: 1.03–1.54]). In contrast, the sum of the four SARC-F questions was not significantly predictive of falls history (OR 1.19 [95% CI: 0.93–1.53]). Conclusion: In this study of older adults residing in retirement communities, the simple TUG test, and not sarcopenia-specific questions nor objective measures of muscle strength or mass, was associated with a history of falling. References: Woo, J., Leung, J., Morley, J.E. (2014). Validating the SARC-F: a suitable community screening tool for sarcopenia? J Am Med Dir Assoc. 15(9):630–634. Sports Clubs as an Important Stakeholder in Dementia Care: Interim Results of the Study “Sport for People with Dementia” Wolter, Veronique; Reichert, Monika TU Dortmund University, Dortmund, Germany; [email protected], [email protected] Introduction: Different studies prove the benefit of physical activity for people with dementia. Especially, the preventive character of an integral health approach, consisting of a “movement, cognition and social friendly environment”, is an important part of effective strategies. Feasibility and sustainability are more problematic and often not considered when implementing physical activities for the target group, particularly for community-dwelling residents. The project (2014–2016) evaluates 73 selected local initiatives of tandems between sports clubs and care service providers of dementia care in North Rhine-Westphalia, Germany. The main aims of the project are (1) to identify important framework conditions for a successful implementation of sports classes, (2) to analyse the effects participation has on the life satisfaction and wellbeing of the users and their informal carers, and (3) to analyse the role of sports clubs as a “life accompanying partner”. Methods: The scientific evaluation is based on a multi-method approach: (a) focus groups to analyse the needs and expectations of the different partners involved at three times during the project, (b) qualitative interviews with the users and their carers to examine the effects of participation in physical activity, and (c) analysis of the user statistics. Results: Participants of the focus groups confirm the importance of a local network and a sustainable finance model to ensure long-term feasibility. People with dementia and their carers emphasize that the experience of social support, joy, and relief in their daily life is the most relevant aspect for taking part in sports classes. In general, there are no boundaries with regard to time, place, and content for being active, but it has to fit into the user’s and carer’s life concept. Conclusion: People with dementia, their informal carers, sports clubs, and care service providers are different stakeholders, but also experts in their own special way. The key factor for the successful implementation of more physical activity for the target group is—besides favourable framework conditions—a local community network, which has to “act in concert”, i.e., they have to complement each other. In turn, the willingness for communication and cooperation is the basis. Perception of Functional Activity Through Social Comparison Across Older Age Among Community-Dwelling Older People Rodgers, Vivien Massey University, Palmerston North, New Zealand; [email protected] Introduction: As New Zealand and global populations rapidly grey, it is important that functional ability/activity be maintained into late old age. Many intervention programmes have been initiated to promote maximum activity across older age. The interplay between physiological and psychological factors is a possible facilitator for enhancing the effectiveness of these programmes. Self-evaluation by social comparison is a psychological mechanism used to maintain a positive perception of self in the face of physical decline. The use of social comparison as an adaptive/protective psychological mechanism in the perception of functional ability across older age has not been investigated previously in New Zealand. Methods: A cross-sectional survey of 542 community-dwelling people aged 65+ measured functional ability activity, satisfaction with functional ability, and two social comparison dimensions (direction and frequency). Participants were randomly selected from the general electoral role of the Manawatu region of New Zealand. The Groningen Activity Restriction Scale (GARS) measured functional ability; satisfaction with function was determined with a single item, and the Iowa-Netherland Comparison Orientation Measure (INCOM) assessed social comparison. Additional demographic information was collected and age groups (65–74; 75–84; 85+) were compared. Results: A marked difference was found in satisfaction with activity before and after 85 years of age that was not explained JAPA Vol. 24, Suppl., 2016

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by functional ability scores, demographic factors, or comparison frequency. The oldest participants (aged 85+) consistently reported the highest levels of satisfaction with functional activity. This same group reported predominantly making downward social comparisons. Conclusion: Important agedependent links were found between satisfaction with functional activity and making downward social comparisons. While there was little difference between the young- and middle-old groups in any of the variables studied, the oldest participants reported the highest levels of satisfaction with activity, the poorest functional ability, and the greatest use of downward social comparisons. Better understanding of comparison drivers across older age will progress discussion on beneficial utilisation of social comparison to enhance functional activity interventions with the oldest members of our populations. What Matters for Successful Ageing: Satisfaction with Health, Function, and Life Through Social Comparison After 65 Rodgers, Vivien Massey University, Palmerston North, New Zealand; [email protected] Introduction: In a rapidly greying world, successful ageing is an important concept and goal. While this remains poorly-defined in the literature, there is wide agreement that satisfaction with health, function, and life overall are major contributors. It has been suggested that the perception of satisfaction in these areas might be affected by social comparison, but little is known about these relationships, particularly among older people. To examine the associations among these variables, this study investigated the impact of social comparison variables on the perception of health, function, and satisfaction with life at various stages of old age. Methods: Health, functional ability, satisfaction with life, and two social comparison dimensions (direction and frequency) were measured with a cross-sectional survey of 542 community-dwelling people aged 65+. Participants were randomly selected from the general electoral role of the Manawatu region of New Zealand. Health was measured with the SF-12. The Groningen Activity Restriction Scale (GARS) measured functional ability and satisfaction with life was assessed with the Satisfaction With Life Scale. The Iowa-Netherland Comparison Orientation Measure (INCOM) assessed social comparison. Additional demographic information was collected and age groups (65–74; 75–84; 85+) were compared. Results: Little variation was found between participants 65–84, but a marked difference was found in satisfaction with life before and after 85 years that was not explained by health or functional ability, demographic factors, or comparison frequency. The oldest participants (85+) consistently reported the highest levels of life satisfaction despite declining health and function. This same group reported predominantly making downward social comparisons. Conclusion: Important age-dependent links were found between life satisfaction and making downward social comparisons. Better understanding of comparison drivers across older age will progress discussion on beneficial utilisation of social comparison to enhance satisfaction with ageing. The Role of Vitamin D and Exercises in Correction of Age-Related Skeletal Muscle Changes in Postmenopausal Women Povoroznyuk, Vladyslav; Dzerovych, Nataliia; Povoroznyuk, Roksolana D.F. Chebotarev Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine; [email protected] Introduction: The aim of the study was to evaluate the role of vitamin D and exercises in correction of age-related skeletal muscle changes in postmenopausal women. Methods: 38 postmenopausal women aged 53–82 years (mean age: 67.00 ± 7.08 years) were examined. The women were divided into the following groups: A—control group (n = 10), B—women who took an individually-targeted vitamin D therapy (n = 11), C—women who took an individually-targeted vitamin D therapy and OTAGO Exercise Programme (http://www.hfwcny.org/Tools/BroadCaster/Upload/Project13/Docs/ Otago_Exercise_Programme.pdf) during 12 months. We used the following questionnaires: SARC-F, IADL-questionnaire, frailty scale, Desmond fall risk questionnaire. For evaluation of skeletal muscle function and strength, we assessed the usual gait speed and used hand dynamometry. 25(OH)D total and iPTH levels were measured by electrochemiluminescent method, i.e., Elecsys 2010 analytical system (Roche Diagnostics, Germany) and test-systems cobas. The lean mass was measured by the DXA method (Prodigy, GEHC Lunar, Madison, WI, USA). Results: At the baseline, the groups of examined women did not differ in their age, anthropometric characteristics, 25(OH)D values, data of skeletal muscle mass, strength, and function. In women of the control group, the mean 25(OH)D level significantly increased after nine months of observation (р = .03), purportedly due to the seasonal factors. In women of the second and third groups, the 25(OH)D level significantly increased after three, six, nine, and 12 months of observations (р < .05). In the third group, the SARC-F data significantly decreased after 12 months (р = .02), while the IADL data significantly increased after nine (р = .04) and 12 months (р = .05). The muscle strength significantly increased after nine months (р = 0.01) in women of the third group, while women of the first and second groups did not change in this parameter. The usual gait speed and lean mass assessed by DXA did not change in all groups during 12 months. The fall frequency in women of the first group significantly increased after 12 months, while women of the second group did not change and women of the third group saw the fall frequency significantly decreased. Conclusion: Using individually-targeted vitamin D therapy and the OTAGO Exercise Programme during 12 months significantly improves daily activity and muscle strength and decreases the fall frequency in postmenopausal women. It’s Personal and Professional: Women Baby-Boomers ‘Working Out’ with a Personal Trainer Sweet, Wendy University of Waikato (Te Whare Wananga o Waikato), Hamilton, New Zealand; [email protected] Introduction: Baby-boomers have witnessed numerous initiatives intended to activate a greater proportion of the population. One initiative has been the growth in personal trainers who typically view ‘working out’ as a means to an objectified end goal where they mediate between one’s exercise behavior and everyday life. Little is known about the meanings and value those involved with a personal trainer attribute to the experience. For baby-boomer women, who are at a stage in life when the thought of ‘getting old’ connotes a multitude of thoughts (Codina et al., 2013), this warrants exploration. Informed by social constructionism, this study endeavors to get inside the motives and experiences baby-boomer women attribute to ‘working out’ with personal trainers (Phoenix & Grant, 2009). It explores the meanings they form about ageing along with their beliefs and experiences about the place of physical activity in their lives. It also considers the benefits or otherwise of using a personal trainer, especially in the context of their ‘older age’ in the years ahead. Methods: A purposeful sample of 18 women aged 50–65 years who ‘employed’ a personal trainer participated in two 50–60-minute interviews that focused on their beliefs and experiences related to ageing and physical activity. From a thematic analysis, three themes were identified: (i) habits of a lifetime, (ii) working-out: the professional is personal, and (iii) it’s the attitude that counts. Results: Beliefs and attitudes about prevailing dependency JAPA Vol. 24, Suppl., 2016

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discourses of ageing, interacted with social and historical influences, gave participants a renewed perspective on the value and meaning of exercise as they aged. These meanings differed from prior experiences. Conceptualising their future ‘successful older age’ as being able to remain ‘fit, functional, healthy and independent’ added to the agentic decision to invest in an exercise intermediary. Conclusion: In this study, personal trainers were potential mediators in the participants’ constructs of how they envisioned their functional and healthy ‘older self’. This has relevance to the fitness industry and others supporting lifestyle change in readiness for later life. It also supports Betts Adams and colleagues’ (2011) call for the increased consideration of the meaning of activity to strengthen successful ageing paradigms. References: Betts Adams, K., Leibrandt, S., & Moon, H. (2011). A critical review of the literature on social and leisure activity and wellbeing in later life. Ageing & Society, 31, 683–712. Codina, N., Pestana, J., & Armadans, I. (2013). Physical activity among middle-aged women: Initial and current influences and patterns of participation. Journal of Women and Aging, 25(3), 260–272. http://dx.doi.org/10.1080/08952841.2013.791605. Phoenix, C., & Grant, B. (2009). Expanding the research agenda on the physically active aging body. Journal of Aging and Physical Activity, 17, 362–380.

Posters Comparison of Knowledge, Attitudes, and Practices of Healthy Lifestyles in the Active Elderly and Inactive Goodarzi, Abolfazl1; Bahrami, Leyla2 1Faculty 2PhD

member of PNU (University of Payam Noor)

student in sport management

Introduction: Aging is a global phenomenon and will be the most prominent challenge for countries (1). It has been estimated that the Iranian elder population will increase up to 25% in 2050 (2). That means, in the future, Iran will be an ‘old’ country. When considering the elderly lifestyle, attention should be paid to different factors such as social, economic, welfare, and incursion (3). Previous internal research disclosed that, despite some improvement, the social condition of elders was low (4,5,6). In other research, the condition of elders’ knowledge was in the middle level, and their attitude and performance were reported well (7). Previous studies showed lower levels of physical activity among Iranian elders compared to Swedes (6). Moreover, much research focuses on the influence of the role of exercise on the quality of life. This study compares elders’ knowledge, attitudes, and performance regarding a healthy lifestyle in old age among elder people who regularly take part in daily exercise (active elder) and inactive elders in Isfahan city. Methodology: In this descriptive survey, 470 elders (240 active and 230 inactive) took part voluntarily. Active persons are those who take part in physical activities in the parks in Isfahan city for at least one year, three times a week, one hour each time, and inactive elders do not participate in sport at all. A WHO questionnaire consisting of 14 questions for knowledge, 7 questions for attitude, and 10 questions for performance was used. Descriptive statistics and ANOVA were two methods used in this analysis. Results and Discussion: 52% of samples were from men and 48% of them were women, whose average age was 72 ± 2.32. All data were normal. In general, the levels of knowledge, attitudes, and performance of samples were in a favorable level and a significant difference was seen between the two groups of active and inactive elders (P ≤ .01). The findings indicated growing social conditions among elders due to possibly increasing membership in social networks and improvement of social relations and life quality. Considering the positive effects of exercise, it is suggested that healthcare administrators take into consideration the improvement and development of sport activities, specifically among elders. References: (1) Saber, M. Nosratabadi, M. (2014). Social support and health-related quality of life in elderly people covered by the Welfare organization of Kerman city. Journal of Health & Development, 3(3):189–199. (In Persian). (2) Statistical Center of Iran. www.amar.org.ir. (3) Goldsmith, T.C. (2004). Aging as an evolved characteristic- Weismann theory reconsidered. Med Hypotheses, 62(2):304–308. (4) Saberian, M., Hajiaghajani, S., Ghorbani, R. (2003). Survey of health, social and economic conditions of the elderly and their leisure time. koomesh: J of Semnan Univ of Med Sci, 4(3):25–32. (In Persian). (5) Samadi, S., Bayat, A., Taheri, M., Joneid, B.S., Roozbahani, N. (2007). Attitude and practice of elderly towards lifestyle during aging. J of Qazvin Univ of Med Sci, 11(1):83–84. (In Persian). (6) Maddah, B.S. (2008). The status of social and leisure time activities in the elderly resising in Iran and Sweden. Salmand, Iranian Journal of Ageing, 3(8):597–606. (In Persian). (7) Ramezankhani, A. Mohammadi, G. Akrami, F. Zeinali, M. (2013). Knowledge, attitude and practice of the elder residents of Tehran city about healthy lifestyle. Journal of Health in the Field, 1(1):1–5. (In Persian) Are Supervised, Group-Oriented, and Machine-Based Resistance Programs as Effective as Standard Group Exercise Classes in a Residential Aged Care Facility? Cook, Andrew; Atkinson, Jake; Waide, James Sir Moses Montefiore Jewish Home, Sydney, Australia; [email protected], [email protected], jwaide@montefiorehome. com.au Introduction: Sir Moses Montefiore Jewish Home (Montefiore), in conjunction with HUR Australia, wanted to investigate the effectiveness of a supervised, group-orientated, and machine-based resistance program compared against Montefiore’s standard group exercise classes. This project was completed to improve the quality and standard of exercise service delivery within Montefiore. Methods: Eight pneumatic resistance machines and one electronic balance platform from HUR were used for a three-month period. Twenty residents from the Montefiore Randwick (treatment group) and nine residents from the Montefiore Hunters Hill (control group) campuses participated in the study. Participants all volunteered and were accepted after receiving a signed approval form from their treating doctor. The treatment group completed a supervised, 12-week, twice-weekly, machine-based progressive resistance group exercise program plus balance exercises. The control group completed a supervised, 12-week, twice-weekly, free weight and resistance band group exercise program plus balance exercises. These programs involved a pre and post assessment of eight predetermined objective measures taken by a physiotherapist. Results: Nine residents (2 female, 7 male, average age: 87) completed the treatment program and seven residents (4 female, 3 male, average age: 85) completed the control program. The treatment group achieved an average 8.8 second (225%) increase in tandem stance time, compared with an average 7.2 second (139%) increase for the control group. Functional tests like the Timed Up and Go (1.24 s or 8.2% increase) and one-minute Sit to Stand test (2.5 repetition or 7.8% increase) improved in the treatment group compared with control group (0.2 s or 3.2% decrease and no change respectively). The average increase in isometric strength across both legs for knee flexion, extension, and ankle dorsiflexion was 1.42 kg for the treatment and 1.45 kg for the control group. There was no improvement in six-minute walk test distances or Icon Falls Efficacy Scale score for either JAPA Vol. 24, Suppl., 2016

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group. Conclusion: Montefiore assessed the machine-based equipment to be effective in improving residents’ overall well-being. Further studies into the use of such equipment should be encouraged to maximise the effectiveness of exercise delivery within the aged care industry. Development of a Product to Minimize Fall Injuries in Older Adults Wollesen, Bettina1; Sankowski, Olga2; Köhler, Berit1; Krause, Dieter2; Mattes, Klaus1 1University of Hamburg, Department of Human Movement Science, Hamburg, Germany; [email protected] (corresponding author), [email protected], [email protected] 2Hamburg-Harburg University of Technology, Department of Product Development and Construction Technology, Hamburg, Germany; o.sankowski@ tuhh.de, [email protected]

Introduction: Falling is one of the leading causes of serious health declines in older adults. Resulting injuries have a major impact on quality of life, entailing fear of falling and further reduction of mobility (Chan et al., 2007). Incidents of falls have been well researched (e.g., reduced strength, cognitive decline). Further, studies have presented fall detection devices in order to rapidly alarm medical services (Noury et al., 2007). Based on angular correlation of body segments it is even possible to detect falls prior to impact (Nyan, Tay, & Mah, 2008). Nevertheless, only a few studies evaluated the underlying kinematic and biomechanical principles to identify fall directions. Considering the serious effect of falls, it would be a substantial improvement to reduce the severity and occurrence of post fall injuries. The study aim is to develop a device that predicts falls and their directions and protects older adults from injuries accordingly through an airbag system. Methods: Following an interdisciplinary approach, we evaluate (1) ways to predict falls and fall directions using kinematic and biomechanical parameters and (2) analyze existing products which aim at detecting falls and avoiding fall-related injuries. The research findings of human movement science and the results of the product analysis will be transferred into the product development process of an airbag system to prevent fall-related injuries in the elderly. Results: By merging the research findings of both integrated disciplines, this paper will show the gap between the needs and the existing products, resulting from the high diversity of users and situations and the limited possibilities for customization. One final result of this paper will be an approach for a personalized design of an airbag system. A first model will be presented at the conference. Discussion: The demographic change leads to a growing need for products which help to maintain the autonomy and mobility of the elderly. Technical devices are used to reduce the risk of falling (e.g., walking aids) or to detect falls. The presented findings will be a first step towards an interdisciplinary approach for a personalized design of an airbag system for the prevention of fall-related injuries. References: Chan, B.K., Marshall, L.M., Winters, K.M., Faulkner, K.A., Schwartz, A.V., & Orwoll, E.S. (2007). Incident fall risk and physical activity and physical performance among older men: the osteoporotic fractures in men study. American Journal of Epidemiology, 165(6), 696–703. Noury, N., Fleury, A., Rumeau, P., Bourke, A.K., Laighin, G.Ó., Rialle, V. & Lundy, J.E. (2007). Fall detection – Principles and Methods. Proceedings of the 29th Annual International Conference of the IEEE EMBS, 1663–1666. Nyan, M.N., Tay, F.E., & Mah, M.Z. (2008). Application of motion analysis system in pre-impact fall detection. Journal of Biomechanics, 41(10), 2297–2304. Examining the Appropriateness of Equipment Length and Center of Mass for Wielding Action: Manipulation of the Development and Experience Yang, Chih-Mei; Huang, Chia-Sheng; Shih, Chang-Chih; Tang, Ming-Yuan National Taiwan University, Taipei, Taiwan; [email protected] Introduction: Implement manipulation skill can be observed in only part of primates. Implements can be considered an extension of the body. Racket players perform various skills through long-time training. Previous studies showed that people can perceive the physical property and act appropriately while the center of mass of the objects were manipulated. This study is based on the learning perspective in ecological psychology: experience makes a new organism know better, rather than makes an old organism possess more knowledge. The aim of this study is to find out the interaction effects among participants with different development levels, experiences, and the appropriateness of implements. Methods: Three groups were recruited: middle-late childhood (10–12 years), young adults (20–30 years), and old adults (60–70 years) (three participants for each group, one expert in each following sport: tennis, badminton, and table tennis). The length and inertia of the rod will be manipulated. Participants were asked to perform the max power and the accurate wielding tasks. Data were recorded by Cortex V4 (Motion Analysis Corp.). The dependent variables include the wielding accuracy and max wielding power. Mix-designed three-way ANOVAs, 2 (experience) × 3 (rod length) × 3 (position of the weight), and 3 (age level) × 3 (rod length) × 3 (position of the weight) were used for statistical analysis. Additionally, 3 (rod length) × 3 (position of the weight) repeated-measured two-way ANOVAs were used for the analysis of the preference rating of the rod. The significance level was set at α = .05. Results: The results showed that the wielding accuracy performance was better while the short rod was used (compared with the long rod). The experience factor (of long-time racket-sport training) plays a role in the selection of rod preference. Conclusion: The conclusions of the current study are that: (1) Developmental level makes a difference neither in max-power wielding and accurate wielding performance nor in rod-using preference. (2) The past experience in racket-sport training does not influence the wielding power and the wielding accuracy. However, in accurate wielding conditions, racket-sport experts demonstrate an opposite trend of rod preference against the other groups. (3) No interaction was found between the developmental level and racket-sport training experience in any of the three dependent variables (wielding power, wielding accuracy, and rod preference). Life Exercise–A Progressive Exercise and Education Program to Improve Physical Function in Older Adults Flavel, Chris ACH Group, Adelaide, Australia; and Port Adelaide Football Club, Adelaide, Australia; [email protected] Introduction: Physical inactivity is a leading cause of preventable death and morbidity in developed countries. The most susceptible population at risk are adults 60 years and older. An appropriate strength and conditioning program can improve muscle mass and strength and endurance, and improve walking mechanics, self-reported sleep quality and cognitive function, flexibility, and functional capacity. The physical and cognitive abilities of older adults decline with age. Various practices have been used to fight against physical and cognitive declination. Methods: The purpose of this study is to evaluate the effectiveness of an appropriately prescribed resistance and aerobic training and education program on older adults aged between 60 and 93 years, focusing on lower and upper limb muscular strength, aerobic endurance, and flexibility in older adults, utilizing appropriate and recognized JAPA Vol. 24, Suppl., 2016

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testing to determine functional outcomes. The program consisted of 10 weeks, twice-per-week of resistance, aerobic exercise, and flexibility. A followup was also completed at six months post program. Results: It was found this study had statistical significance, with all test results finding p values of < .001. The sit to stand test rendered a 58% improvement from week 0 to week 34. The arm curl test delivered results with an average improvement of 30%. The six-minute walk test showed marked improvements overall, with participants improving 14% on average. Our oldest participant, 92 years of age, improved in all results: 139%, 50%, and 47% for the sit to stand, arm curl, and six-minute walk test, respectively. Conclusion: These results, in conjunction with evidence-based education, could result in reduced blood pressure, cardiac related illness, and other lifestyle risk factors. The ‘Life Exercise’ program promotes good lives for older people, with appropriate exercise prescription and education. Results indicate the ‘Life Exercise’ program is a very effective education and exercise program for improving fitness components in older adults. References: Anderson-Hanley, C., Nimon, J.P., Westen, S.C. (2010). Cognitive health benefits of strengthening exercise for community-dwelling older adults. Journal of Clinical and Experimental Neuropsychology, 32:996–1001. Dionigi, R.A., Baker, J., Horton, S. (2011). Older athletes’ perceived benefits of competition. International Journal of Sport & Society, 2:17. Wahl, H.W., Schmitt, M., Danner, D., Coppin, A. (2010). Is the emergence of functional ability decline in early old age related to change in speed of cognitive processing and also to change in personality? Journal of Aging and Health, 22:691–712. Effect of Balance and Body-Weight Squat Training in Physically Frail Older Adults Fujita, Eiji1; Takeshima, Nobuo1; Narita, Makoto2; Kato, Yoshiji3; Koizum, Daisuke3; Taaffe, Dennis4 Institute of Fitness and Sports in KANOYA, Japan; [email protected], [email protected] University of Medical Science, Japan; [email protected] 3Active Aging Association, Japan; [email protected], [email protected] 4University of Wollongong, Australia; [email protected] 1National 2Suzuka

Introduction: Falls represent a major public health problem for older adults, and loss of balance ability is one of the primary causes of falls. Previous studies have shown muscle weakness to be a common risk factor for falls. However, less evidence is available for the beneficial effect of various exercise modalities in the frail elderly who are most at risk. The objective of this study was to determine the effect of a relatively inexpensive short-term program of body-weight squat and balance training in physically frail community-dwelling older adults. Methods: Twenty-eight older adults (77.5 ± 6.3 years, 11 males and 17 females) who required assistance performing ADL participated in the study. Participants were assigned to either squat training (ST, n = 16) or squat and balance training (SBT, n =12), with training undertaken twice weekly for 12 weeks. ST performed squat exercises using body-weight as resistance (48 reps/day, 2 days/week), while SBT performed body-weight squat training as well as balance training under supervision. Knee extension torque (KET), static balance (eyes open and closed on firm and foam surface), and dynamic balance (reaction time, movement velocity, endpoint excursion, maximum excursion) by a Balance Master Platform System (NeuroCom International) were measured before and after the intervention. Results: Two participants (one ST and one SBT) dropped out during the intervention period. Following training, KET significantly increased (p < .05) in both groups (ST 9.8%; SBT 15.2%) with no significant difference between groups. Changes in balance for the ST group were generally modest with effect sizes (ES) of 0.10–0.51 for static balance and 0.00–0.57 for dynamic balance. For SBT, ES ranged from 0.35–0.60 for static balance and 0.02–0.86 for dynamic balance, with enhancement in maximum excursion being significantly greater (p < .05) with combined strength and balance training. Conclusion: The addition of balance exercises to a relatively short-term lower-body strength training program has a modest beneficial effect on enhancing balance ability in physically frail older adults. Although multicomponent programs appear to be most beneficial, further work needs to be undertaken to establish evidence-based dose–response relationships in this population. One Session of High-Intensity Interval Training (HIIT) Every Five Days Improves Muscle Power in Lifelong Sedentary Ageing Men: A Randomized Controlled Trial (RCT) Herbert, Peter1; Grace, Fergal2; Sculthorpe, Nicholas3 of Wales Trinity St David, Wales, UK; [email protected] University, Victoria, Australia; [email protected] 3University of the West of Scotland, Hamilton, UK; [email protected]

1University

2Federation

Introduction: Declining muscle power during advancing age predicts falls and loss of independence. High-intensity interval training (HIIT) may improve muscle power but remains largely unstudied in ageing participants. This study investigated the efficacy of a low-frequency HIIT intervention on muscle power, body composition, and balance in lifelong sedentary but otherwise healthy males. Methods: Thirty-two lifelong sedentary ageing men were randomly assigned to either intervention (INT; n = 22 age 62.3 ± 4.1) or control (CON; n = 11 age 61.6 ± 5.0) conditions and were assessed at baseline (Phase A), following six weeks of conditioning exercise in INT (Phase B), and following six weeks of HIIT once every five days in INT (Phase C). CON maintained their normal sedentary lifestyle. Data were analysed using SPSS version 20.0. Q-Q plots were employed to confirm normal distribution of data. Training effects were compared using a 2 × 3 (group × time) mixed design ANOVA. Significant interactions were further investigated using pairwise comparisons both within and between group simple main effects using a Bonferroni correction. P ≤ .05 was used to indicate statistical significance. Data are presented as mean ± standard deviation (S.D). Results: Although balance remained unaffected, both absolute and relative peak power output were not different between groups at Phases A or B but was greater in INT following HIIT (P < .01). Lean body mass displayed a significant interaction (P < .01) due to an increase in INT between Phase B and Phase C (P < .05). Conclusion: In conclusion, the novel findings of the present study are that HIIT is both feasible and effective as a training modality to increase lower limb muscle power, reduce body fat, and increase lean tissue mass in lifelong sedentary ageing men. References: Herbert, P., Grace, F.M., & Sculthorpe, N.F. (2015). Exercising caution: prolonged recovery from a single session of high-intensity interval training in older men. Journal of the American Geriatrics Society, 63(4), 817–818. Herbert, P., Sculthorpe, N., Baker, J., & Grace, F. M. (2015). Validation of a six second cycle test for the determination of peak power output. Research in Sports Medicine, 1–11. A Comparison of Three Frailty Assessment Tools: Are They Consistently Reporting Frailty Phenotype? Jones, GR1; Neubauer, NA1; O’Connor, B2; Jakobi, JM1 JAPA Vol. 24, Suppl., 2016

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of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada; [email protected] K. Barber School of Arts & Sciences Unit 4, University of British Columbia, Kelowna, Canada

1School 2Irving

Introduction: Frailty is a leading cause of age-related morbidity and mortality in older adults. Estimates suggest one in four older adults (≥ 65 years) is frail. Frailty progresses across a spectrum of defined stages described as non-frail, pre-frail, and frail phenotypes. However, frailty, although easy to recognize, remains difficult to define. In this study we use three known frailty assessment tools: (1) Cardiovascular Health Study Frailty Index (CHSfi) (Fried et al., 2001); (2) Modified Frailty Index (Mod-fi) (Rockwood et al., 2005); and (3) gait speed (Montero-Odasso et al., 2005). No study has applied all three measurements to examine differences in frailty identification. Methods: Forty-nine non-frail, 20 pre-frail, and seven frail older adult males and females aged 65–94 years participated in this study. Exclusion criteria: unable to ambulate independently, those < 65 years or those > 95 years of age, current or previous neurological disorders, engaged in physical activity greater than two times per week. Bivariate analysis was used to identify the strength of association between Mod-fi, CHS-fi, and Gait speed scores (95% confidence interval [CI] and P ≤ .05). Results: Participants were classified differently with each assessment tool (CHS-fi: 52 non-frail, 22 pre-frail, 2 frail; Mod-fi: 43 non-frail, 26 pre-frail, 7 frail; gait speed: 51 non-frail, 18 pre-frail, 7 frail). This study demonstrates that CHS-fi, Mod-fi, and gait speed report frailty phenotype slightly differently. This may be the result of different components being assessed with each frailty tool to determine frailty phenotype. These differences make it challenging to compare frailty phenotypes across research studies, contributing to the difficulty of establishing a clear definition of frailty. Conclusion: These frailty assessment tools do not consistently report frailty phenotype. Researchers and clinicians should be aware that frailty assessment may under or over-estimate the appropriate frailty phenotype. However, a gait speed of < 0.1 m/s and a Mod-fi score ≥ 0.21 were indicative of frailty phenotype. References: Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., . . . McBurnie, M. (2001). Frailty in older adults: evidence for a phenotype. J of Gerontol: Med Sci, 56A(3):M146–M156. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. CMAJ, 173(5):489–495. Montero-Odasso, M., Schapira, M., Soriano, E.R., Varela, M., Kaplan, R., Camera, L.A., Mayorga, L.M. (2005). Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol Med Sci, 60A(10): 1304–1309. Age Differences in Effects of Information Processing Loadings on Reaction Time Jwo, Hank; Wu, Elyse; Chen, Amber; Kuo, Joan; Wang, John National Taiwan Normal University, Taipei, Taiwan; [email protected] Introduction: From the information processing view perspective, reaction time (RT) has often been adopted as a dependent variable in the research for stimulus-response processes of human behavior so as to infer indices of nerve transmission speed and time for information processing. However, based on developmental view point, RT changes as a function of aging in a progression and regression trends. Purposes: This study was designed to examine age differences in RT under various information processing loading. RT variability and error rate were also investigated. Methods: A crosssectional approach was used to call upon 450 participants from 5–75-year-old age groups, with 30 participants in each 5-year age group (15 males and 15 females). Independent variables were age and information processing loadings from SRT, CRT, and DRT. Dependent variables were time measures, variability, and error rate from SRT, CRT, and DRT. Results: Two-way mixed design ANOVA 15 (age) × 3 (information loading), with last factor as repeated measure found: (1) RT: age (F[14, 435] = 22.96, p < .05, ES = 0.26, power = 1.0) and information loading (F[2, 870] = 738.75, p < .05, ES = 0.23, power = 1.0 ) were found to have significant differences, and significant interaction was also found (F[28, 870] = 7.31, p < .05, ES = 0.03, power = 1.0 ); (2) RT variability: age (F[14, 435] = 29.08, p < .05, ES = 0.27, power = 1.0) and information processing loading (F[2, 870] = 104.44, p < .05, ES = 0.08, power = 1.0 ) were found to have significant differences, and significant interaction was also found (F(28, 870) = 1.77, p = .01, ES = .02, power = .98 ); and (3) error rate: age (F[14, 435] = 17.20, p < .05, ES = 0.11, power = 1.0) and information loading (F[2, 870] = 107.92, p < .05, ES = 0.11, power = 1.0 ) were found to have significant differences, and significant interaction was also found (F[28, 870] = 5.18, p < .05, ES = .07, power = 1.0 ). Conclusion: Age differences exist in the time consumption, variability, and error rate for information processing to reduce uncertainty. References: Salthouse, T.A. (2000). Aging and measure of processing speed. Biological Psychology, 54, 35–54. Wilkinson, R.T., & Allison, S. (1989). Age and simple reaction time: Decade differences for 5,325 subjects. Journal of Gerontology: Psychological Sciences, 44, 29–35. The Association Between Advanced Glycation End-Products and Paratonia in Alzheimer’s Disease: The PARAGE Study Drenth, Hans1,2; Zuidema, Sytse3; Krijnen, Wim P1; Bautmans, Ivan4; van der Schans, Cees1; Hobbelen, Hans1 Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; j.s.m.hobbelen@ pl.hanze.nl 2Zuid Oost Zorg, Organisation for Elderly Care. Burg, Drachten, the Netherlands 3Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands 4Frailty in Ageing Research Group and Gerontology Department, Free University of Brussels, Brussels, Belgium

1Research

Introduction: Physical activity has been proven to be effective in improving and sustaining physical and cognitive performance in dementia. However the exact physiological pathways of effect are unclear. Paratonia, a distinctive form of hypertonia, is a movement disorder in dementia and is characterized by an active unintentional resistance against passive movement and is associated with a loss in physical performance, severe contractures, and pain (Hobbelen et al., 2006). The pathogenesis of paratonia is not well understood. It has been suggested that advanced glycation end-products (AGEs) may partly be responsible for the development of paratonia (Hobbelen et al., 2011). Regular physical activity has shown to correlate with reduced glycation and AGE formation (Drenth et al., 2016). Methods: A longitudinal, one-year follow-up cohort study with three assessments (baseline, six months, and 12 months) was conducted in 144 community-dwelling early stage Alzheimer’s disease (AD) and Alzheimer’s/vascular disease (AVD) patients. Outcome measures: Paratonia and severity of paratonia (PAI and MAS), the Timed Up and Go (TUG), Quality of life (QOL) and ADL with AGE reader measurements as the explanatory variable. Results: The GLM model shows a significant association of paratonia with the levels of AGEs (OR = 3.48, 95%CI: 1.65–7.34). A linear mixed model shows a significant association with the severity of paratonia and the levels of AGEs (Beta = 0.14, 95% CI: JAPA Vol. 24, Suppl., 2016

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CI:0.08–0.22). For the association between the levels of AGEs and quality of life, functional mobility, and ADL, the linear mixed models showed the following results: QOL (Beta = –1.04, 95%CI: –1.85 to –0.21), TUG (Beta = 2.24, 95%CI: 0.09–4.60), GARS (Beta = 0.48, 95%CI: –1.62 to 2.64), and Barthel (Beta = –0.28, 95%CI: –0.86 to 0.39). Conclusion: This is the first study that shows a significant association between AGEs and paratonia. Furthermore, we found that AGEs levels are associated with decline in functional mobility and quality of life in patients and with early stage AD and AVD. Future research should focus on the effect of physical activity programs to postpone the development of paratonia and maintain functional mobility and quality of life in dementia in relation to AGE breakdown. References: Hobbelen, J., Koopmans, R., Verhey, F., Van Peppen, R., de Bie, R. (2006). Paratonia: a Delphi procedure for consensus definition. J Geriatr Phys Ther, 29(2):50–56. Hobbelen, J., Tan, F., Verhey, F., Koopmans, R., de Bie, R. (2011). Prevalence, incidence and risk factors of paratonia in patients with dementia: a one-year follow-up study. Int Psychogeriatr, 23(7):1051–1060. Drenth, H., Zuidema, S., Bunt, S., Bautmans, I., van der Schans, C., Hobbelen, H. (2016). The contribution of advanced glycation end product (AGE) accumulation to the decline in motor function. Eur Rev Aging Phys Act, 4(13):3. Effect of Sport Environment on Athletic Identity, Physical, and Motor Fitness: Seeking a Successful Transition for Former Elite Athletes Hadiyan, Helen1; Sheikh, Mahmoud2 University, Melbourne, Australia; [email protected] University, Tehran, Iran; [email protected]

1Victoria 2Tehran

Introduction: The study on retirement from elite sport is growing recently. Due to changes in social and professional points of reference, the transition from professional sport could initially have negative repercussions, such as the development of an identity crisis (Lavallee, Wylleman, & Sinclair, 2000). Athletic identity tends to decrease with age (Alfermann, Stambulova, & Zemaityte, 2004) and with the duration after sport career termination (Stephan, Torregrosa, & Sanchez, 2007). The purpose of the present survey was to investigate whether sport environment can affect the trend of athletic identity, physical, and motor fitness after termination of a sport career. Methods: Similar to past research, 18 former female elite athletes as well as 18 current female elite athletes are included as samples of this survey. The retired athletes responded to the athletic identity questionnaire twice with views on preand post-retirement of their athletic status. Physical fitness tests (cardiovascular endurance, muscle strength, and muscle endurance) and motor fitness tests (50 yard run, dynamic balance, agility, and medicine-ball pitch) were given to both groups. An independent t-test was conducted to identify the differences between two groups on athletic identity, physical fitness, and motor fitness. A paired sample t-test was used to distinguish the differences in two situations, pre- and post-retirement, within retiring athletes. The significance level was assumed to be p ≤ .05. Results: Athletic identity in retiring athletes in pre- and post-retirement had no significant difference, likely due to their constant presence in the sport environment even after termination of their sport careers. Besides, the retired athletes significantly displayed the same level of physical fitness as elite athletes, whereas in motor fitness tests elite athletes significantly showed better performance. Conclusion: The results of this study recommend that athletes should actively participate in sport environments during their post-retirement, and continuously seek to find a way to transfer their athletic skills in their new careers. By doing so, they can have a successful transition from their professional sport while maintaining their fitness training. As a result, in their post-retirement they can avoid negative repercussions of transition from elite sport, such as developing an identity crisis. References: Alfermann, D., Stambulova, N., & Zemaityte, A. (2004). Reactions to sport career termination: A cross-national comparison of German, Lithuanian, and Russian athletes. Psychology of Sport and Exercise, 5, 61–75. Lavallee, D., Wylleman, P., & Sinclair, D. (2000). Career transitions in sport: An annotated bibliography. In D. Lavallee, & P. Wylleman (Eds.), Career transitions in sport. International perspectives (pp. 207–258). Morgantown, WV: Fitness Information Technology. Stephan, Y., Torregrosa, M., & Sanchez, X. (2007). The body matters: Psychophysical impact of retiring from elite sport. Psychology of Sport and Exercise, 8, 73–83. Prevalence of Elderly Residents with Amnestic Mild Cognitive Impairment in Long-Term Care Facilities in Taiwan Wu, Hua-Shan Associate Professor, Department of Nursing, Asia University Background: Besides physical factors, multiple factors in long-term care facilities may lead to cognitive decline of elderly residents. From normal aging to dementia, elders may go through a transition period called mild cognitive impairment (MCI), involving amnestic and non-amnestic types. Because ~18% of elders per year with amnestic MCI may convert to Alzheimer’s disease dementia, early detection for elderly residents with amnestic MCI in long-term care facilities is important. Objectives: To survey the prevalence of elderly residents with amnestic MCI in Taiwan’s long-term care facilities. Methods: A cross-sectional design was used. The participants were recruited from four large-scale (> 100 beds) long-term care facilities in central Taiwan. A total of 141 eligible residents were screened by the Barthel index, Chinese version verbal learning test (CVVLT), and the chronic care facility adaptation of the Clinical Dementia Rating scale (CDR-CC). The participants who had (1) CDR-CC 0 to 0.5, (2) a score on Barthel index ≥ 90, (3) a score on the CVVLT ≤ 5, and (4) no dementia diagnosis on their charts were defined as “amnestic MCI case”. Demographic characteristics, geriatric depression scale scores, state anxiety inventory scores, and the hours of physical activities were also collected. The chi-square, t-test, and univariate logistic regression were used to analyze these data. Results: The prevalence of residents with amnestic MCI in long-term care facilities was 17.7%. In all possible predictors, the significant difference was only found in the degree of education between residents with and without amnestic MCI. Through univariate logistic regression analysis, it was found that the odds in which amnestic MCI happens of illiterate residents are 0.33 times those of residents with primary education level. Conclusion: About one-sixth of residents in long-term care facilities may be amnestic MCI cases, especially illiterate residents. Therefore, for illiterate residents, staff could plan extra time to nurture literacy in order to reduce the opportunities for which MCI happens. Keywords: amnestic, mild cognitive impairment, resident, long-term care facility, elderly Ultrasound Measures of Knee Extensor Muscle Architecture are Associated with Isometric and Isokinetic Strength in Older Adults Selva Raj, Isaac1; Bird, SR1; Shield, AJ2 1Discipline 2School

of Exercise Sciences, School of Medical Sciences, RMIT University, Melbourne, Australia; [email protected]

of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia JAPA Vol. 24, Suppl., 2016

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Introduction: It is well known that ageing is associated with sarcopenia, which is characterised by decreased skeletal muscle mass, strength, and functional capacity (Doherty, 2003). With an ageing population, time and budget constraints mean that it is important to identify simple and efficient tools that can be used to quantify sarcopenia in the clinical and research settings. The aim of this study was to determine if ultrasound measures of pennation angle (θ), fascicle length (Lf), and thickness of the knee extensor muscles can predict performance in isometric and isokinetic strength tests of the knee extensors in older adults. Methods: Thirty-six healthy older adults (average age 68.2 ± 5.3 years; 20 males, 16 females) undertook isokinetic dynamometry for isometric and isokinetic concentric knee extensor strength (60, 120, 240, and 360º/s). In addition to torque measurements, time to peak torque (TTP) was measured for each concentric contraction speed as a surrogate measure of power. Also, ultrasound images (probe frequency 10 MHz) of the vastus lateralis (VL) and rectus femoris (RF) muscles were obtained at two sites on the thigh with participants seated with knee at 90º flexion. Results: After entering age, sex, and BMI into the multiple regression models, RF thickness was a significant independent contributor to the model predicting isometric and isokinetic knee extensor strength at all contraction speeds (R ≥ .797; P < .05). In addition, VL thickness was a significant independent contributor to the model predicting isokinetic knee extensor strength at 60 and 240º/s (R ≥ .807; P < .05). VL Lf was a significant independent contributor to the model predicting TTP at 60, 120, and 240º/s (R ≥ .482; P ≤ .05). Conclusion: Ultrasound measures of knee extensor muscle thickness can predict the performance of older adults in isokinetic and isometric strength tests. Ultrasound measures of VL fascicle length can also predict time to peak torque at some contraction speeds. Ultrasound is a simple, safe, non-invasive and efficient bedside tool that can be used to monitor sarcopenia. References: Doherty, T.J. (2003). Invited review: Aging and sarcopenia. Journal of Applied Physiology, 95(4), 1717–1727. Effects of Progressive Resistance Training on Cardiovascular Risk Factors in Older Adults: A Meta-Analysis Letton, Meg1; Saliba, Andrew1; Thom, Jeanette1; Fiatarone Singh, Maria2; Parmenter, Belinda1 of Exercise Physiology, Faculty of Medicine, University of NSW, Sydney, Australia; [email protected], andrew.saliba@unsw. edu.au, [email protected], [email protected] 2Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, Australia; maria.fiataronesingh@sydney. edu.au

1Department

Introduction: According to the World Health Organization and the Global Burden of Diseases Study, in 2020 cardiovascular diseases (CVD) will be the leading cause of death and disability in developing countries, as it already is in most developed countries. Ageing increases the risk of developing CVD and thus interventions aiming to prevent CVD in older populations are of major importance globally. The purpose of this systematic review and meta-analysis is to explore the benefits of progressive resistance training (PRT) in reducing CVD risk in older adults free from chronic disease. Methods: Electronic databases (PubMed, Medline, PEDro, Embase, EBSCO) were searched up until August 2015. Studies were included if they were a randomised controlled trial (RCT) examining the effect of a supervised PRT intervention (> 4 weeks) on older adults (> 65 years) free from chronic disease and measured at least one cardiovascular risk factor (including blood pressure, cholesterol, fasting glucose, body mass index and/or body fat, physical activity levels, inflammation, arterial stiffness, or sedentary behaviour). Mean difference (MD) was calculated for each outcome and data was analysed and assessed for heterogeneity and bias using RevMan v5.3. Results: Eleven RCTs studying 490 people (43% male; mean age 70.0 ± 2.4 years) were included. Interventions ranged from 8–104 weeks in duration (mean = 24.6 weeks), were mostly whole-body PRT, 2–3 days per week. PRT significantly reduced fat mass with MD –0.83 kg (–1.11 to –0.55; p ≤ .00001) and body mass index (BMI) MD –0.26 kg/m2 (–0.46 to –0.05; p = .01). Sub-analyses showed that moderate to high intensity PRT was more effective than low intensity for reducing body fat percentage MD –1.12% (–1.57 to –0.68; p ≤ .00001). Conclusion: Few studies reported cardiovascular risk factors. However, those that did found that PRT reduced fat mass, BMI, and body fat percent in older adults free from chronic disease. Furthermore, moderate to high intensity PRT proved more effective than lower intensity PRT for reducing body fat. Other cardiovascular risk factors such as physical activity, blood pressure, and cholesterol levels were seldom reported. More study is needed in this area to identify whether a PRT program reduces other cardiovascular risk factors in otherwise healthy older adults. References: World Health Organization. (2004). The Global Burden of Disease: 2004 update. Geneva, Switzerland: World Health Organization. Formal Volunteering and Depression for Elders: Documented Findings and Future Research Li, Jialu University of California Berkeley, Berkeley, USA; [email protected] Introduction: Formal volunteering provides elders with opportunities to remain socially engaged and is believed to decrease depression levels of elders. Despite considerable improvements in methodology rigor in the past 20 years, existing research gaps may hinder us from developing optimal program and policy interventions for the aging population both in the U.S. and internationally. Hence, the purpose of this manuscript is to briefly review previous empirical findings and discuss possible directions for future research. Methods: The author searched for related articles published in the past 20 years by using different combinations of key words (i.e., “volunteer*” and “depression”, “volunteer*” and “psychological well-being”, and “volunteer*” and “mental health”) within Google Scholar and PubMed. Results: Previous publications usually documented negative associations between formal volunteering and depression in elders. Additionally, some researchers confirmed the non-linear relationship between volunteer hours and depression levels. Findings in the literature also consistently proved that elders with less human, social, and cultural capitals are less likely to consider volunteering and sustain their participation. Apart from the established knowledge base, some areas merit future study. First, it was found that church-related volunteering significantly decreased depression in elders. However, whether different types of secular volunteering have the same effects on depression in elders is seldom investigated. Second, we still do not know clearly the particular obstacles hindering minority and immigrant elders from volunteering in the U.S. Third, scant research has examined the impacts of environmental factors (transportation, access to volunteer recruitment information, etc.) and the interactions between older volunteers and human agencies on volunteer participation and depression levels. Fourth, we know little about the impacts of formal volunteering on disabled elders. Finally, there is little research which enables us to know the role formal volunteering plays on different groups of elders in countries other than the U.S. Conclusion: Publications in the past 20 years have strongly confirmed hypotheses proposed by social gerontologists. Nevertheless, without moving beyond we may find it hard to get more elders (particularly socioeconomically, physically, and mentally disadvantaged elders) involved in volunteering and understand the mechanisms potentially linking formal volunteering with depression in different groups of elders. JAPA Vol. 24, Suppl., 2016

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Falls in Temples Among Elderly Living in the Community Horpibulsuk, Jitwadee, MD1; Chinkulkijniwat, Avirut, PhD2 1School 2School

of Internal Medicine, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand; [email protected] of Civil Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima Thailand

Objective: To estimate the frequency of recent falls and fall-related injuries in temples among adults aged 60 years or older. Design: Cross-sectional descriptive study. Subjects: 750 adults aged 60 years or older living in Nakornrachasima Province who visit temples at least once a week. Methods: We calculated the prevalence of recent falls, near falls, and fall-related injuries in the elderly. Results: About 60.1% of older adults fell in temples at least once in the past year and about 15.2% of them had near falls. The most common fall-related injuries were muscle pain (27.3%) and hematoma (23.9%). About a quarter (25.9%) of older adults who fell were hospitalized. Conclusion: The prevalence of near falls and falls among Thai older adults in temples is quite high and very concerning as both result in adverse health outcomes including decreased quality of life, functional limitations, morbidity, and mortality. Therefore, fall prevention programs are very important. Keywords: elderly, falls, temple Analysis of Dual-Task Performance in Alzheimer’s Disease Patients, Depressed Patients, and Healthy Controls Ferreira, José Vinicius A1; Moraes, Helena1,2; Laks, Jerson1,2; Deslandes, Andrea1,2,3 Laboratory Exercise (Lanex), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; joseviniciusalvesferreira@gmail. com, [email protected] 2Alzheimer’s Disease Center and related disorders (CDA), Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil 3Institute of Physical Education and Sports, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil 1Neuroscience

Introduction: The dual-task (DT) analysis can contribute to the evaluation of independence and functional capacity of the elderly. However, few studies have assessed the DT performance in patients with Alzheimer’s disease (AD) and major depression (MD) (1,2). Objective: Analyze the differences in performance between single-task and dual-task in elderly patients with AD, MD, and healthy elderly controls (HC). Moreover, the study aims to assess which variables can predict the difference in the performance between single-task and dual-task in different groups. Methods: We selected 90 elderly adults, among whom were 30 AD patients (age: 73.90 ± 6.88; Mini Mental State Examination [MMSE]: 21.35 ± 3.67), 17 MD patients (age: 70.46 ± 7.69; MMSE: 28.33 ± 1.79), and 43 HC (age: 70.69 ± 8.04; MMSE: 27.70 ± 2.14). DT was measured by a physical test (8 foot up and Go test) performed together with a cognitive test (verbal fluency test) and the speed difference between single-task and dual-task (Δm/s = single-task speed – dualtask speed) was analyzed. We used a one-way ANOVA and Bonferroni post-hoc test to compare Δm/s among groups. Linear regression statistics were performed to verify the better predictor of Δm/s in the different groups (AD × MD × HC) among dependent variables (sit chair stand [STS], 8 foot up and Go test [8 foot], verbal fluency and Trail Making test part A). Results: The four measures (STS, 8 foot, verbal fluency, and Trail A) explained 31% of the variance in delta on HC group (R2 = .310; p = .000), 29.8% of the variance in delta on DM group (R2 = .298; p = .000), and explained 31.8% of the variance in delta on AD group (R2 = .318; p = .000). Conclusion: Executive functions associated to lower body strength and agility can partially explain the performance in dual-task. The DT can contribute to evaluate the differences among highly prevalent mental disorders in elderly patients. References: (1) Tierney, K.M., Lonie, J. A., Herrmann, L.L., Donaghey, C., O’Carroll, R.E., Lee, A. & Ebmeier, K.P. (2008). Dual task performance in early Alzheimer’s disease, amnestic mild cognitive impairment and depression. Psychological Medicine, 39, 23–31. (2) Kaschel, R., Logie, R.H., Kazén, M., & Sala, S.D. (2009). Alzheimer’s disease, but not ageing or depression, affects dual-tasking. J Neurol, 256,1860–1868. Prediction of Gait Speed by Spatiotemporal Parameters in Residential Aged Care Residents Keogh, Justin1,2,3; Fien, Samantha1; Henwood, Timothy4,1; Climstein, Mike5 University, Australia; [email protected], [email protected] University, Auckland, New Zealand 3University of the Sunshine Coast, Sippy Downs, Australia 4University of Queensland, Brisbane, Australia; [email protected] 5University of Sydney, Australia; [email protected] 1Bond

2AUT

Introduction: The majority of older Australians, especially residential aged care (RAC) adults, have decreased physical activity, leading to poor physical function such as reduced gait speed, strength, and balance (Peel et al., 2013). Specifically, individuals with slower gait speeds are at higher risk of disability, cognitive impairment, institutionalisation, falls, and mortality (Abellan Van Kan et al., 2009). The aim was to describe gait spatiotemporal characteristics and determine if the spatiotemporal gait parameters (e.g., step length, step rate) could predict gait speed in RAC adults. Methods: A total of 100 older RAC adults (85.6 ± 6.7 years, range 66–99 years, 66 females) provided informed consent. Participants completed three trials of their habitual gait speed over the 3.66-m long Gaitmat II pressure mat system. The Gaitmat II allowed calculation of gait speed as well as many spatiotemporal gait parameters including step length, stride length, support base, step time, swing time, stance time, single support time, and double support time. These spatiotemporal parameters were input into univariable and multivariable regression analyses to predict gait speed. Results: The multivariable linear regression involving all independent secondary spatiotemporal outcomes identified the following factors (stride length, support base, and step time) that predicted walking speed (r2 = .89). Stride length was the strongest predictor, with each 0.1 m increase in stride length resulting in an average 0.09 (95% CI 0.06–0.13) m/s faster preferred gait speed. Conclusion: While more research is required, preliminary evidence suggests that three spatiotemporal parameters (stride length, support base, and step time) predict gait speed in RAC residents. Therefore, interventions focusing on improving these three spatiotemporal parameters may increase gait speed in this population. References: Peel, N.M., Kuys, S.S., & Klein, K. (2013). Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. J Gerontol A Biol Sci Med Sci. 68(1):39–46. Abellan Van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., et al. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. JNHA: Clinical Neurosciences. 13:881–889. JAPA Vol. 24, Suppl., 2016

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Age and Practice Effects on Inter-Manual Performance Asymmetry Francis, Karen L1; MacRae, Priscilla G2; Spirduso, Waneen W3; Eakin, Tim3 of San Francisco, San Francisco, CA, United States; [email protected] University, Malibu, CA, United States; [email protected] 3The University of Texas at Austin, Austin, TX, United States; [email protected], [email protected]

1University

2Pepperdine

Introduction: Manual dexterity declines with increasing age, however, the way in which inter-manual asymmetry responds to aging is unclear. Our purpose was to determine the effect of age and practice on inter-manual performance asymmetry in an isometric force pinch line tracing task that varied in difficulty within segments. Methods: Thirty right-handed participants, five males and five females in each of three age groups, young (Y20), young–old (O70), and old-old (O80), practiced anisometric force pinch task for 10 trials with each hand on each of five consecutive days. Inter-manual performance asymmetry of the right and left hands was analyzed with a repeated measures analysis of variance (ANOVA) of asymmetry with age groups, practice, task difficulty, and hand as factors. The within-individual magnitude of asymmetry was also analyzed with repeated measures ANOVA of manual asymmetry calculated as an asymmetry index (AI). Posthoc pair-wise comparisons were performed when significance was found. Results: We observed no inter-manual performance asymmetry on this isometric tracing task among any of the age groups, either in the hand performance differences or in the magnitude of the AI. Age and practice interacted in terms of manual performance: the Y20 and O70 group improved accuracy and task time across the five days of practice but the O80 group did not. However, practice did not differentially affect the AI for accuracy or task time for any group. Accuracy of performance of the two hands was differentially affected by practice. All age groups exhibited poorer performance and larger AIs on the most difficult segments of the task (3 and 6) and this did not change with practice. Conclusion: In conclusion, knowledge about isometric motor control in neurologically intact older adults is relevant to rehabilitation specialists such as physical therapists and occupational therapists who work with neuromuscularly-impaired adults. Isometric tasks that can be performed by either hand and require very low levels of force are especially important tools for therapists working with patients attempting to recover from unilateral impairments in brain connectivity, such as stroke, fall-related concussions, or accidents. Preventing Neurocognitive Decline Through Daily Physical Activity: A Two-Year Intervention Study Kimura, Ken1; Yasunaga, Akitomo2; Hamada, Masatoshi1; Tanaka, Keita1 1Tokyo 2Bunka

Denki University, Tokyo Japan; [email protected], [email protected], [email protected] Gakuen University, Tokyo Japan; [email protected]

Introduction: It has been reported that daily physical activity (PA) plays an important role in maintaining cognitive health of the elderly. The present study conducted a two-year intervention study to reveal the effects of daily PA on cognitive executive function with a focus on neurocognitive mechanisms. Method: More than 120 people aged 65 or older participated in this study. They wore an electronic accelerometer throughout their waking hours for two years to assess the amount and intensity of their individual daily PA. The accelerometer recorded the number of steps they walked and the duration of PA per day as either low (< 3 METs) or moderate (≥ 3 METs) activity. Participants were randomly divided into three groups: low active (LA), moderate active (MA), and control (Co) groups. The LA group was instructed to spend more time walking daily than they had done previously before the study. The MA group was instructed to increase their amount of time engaging in moderate PA, i.e., walking at a brisk pace on a daily basis. The cognitive executive function was tested by using a task-switching test. fMRI assessments were conducted to record neuronal activity of the executive performances. Baseline testing took place in August 2013 and follow-up testing took place two years later in August 2015. Result: The study analyzed 72 elderly people who met the study’s criteria as follows: accepting fMRI assessments, providing informed consent, and attending all examinations during both the baseline and two-year follow-up periods. According to the results of the executive cognitive performance tests, there was no indication of age-related decline among the MA and LA groups. Moreover, the fMRI assessments demonstrated that the neural activity during the task was accentuated in the left prefrontal cortex and lateral anterior cingulate cortex, showing the task-related activation in MA and LA groups. Discussion: It was noteworthy that the activity groups were able to restore their neutral networks and maintain appropriate resource allocation for the cognitive tasks. Furthermore, the present study demonstrated that cognitive executive performance of the elderly people was maintained due to the effects of increasing daily physical activity over the long-term (e.g., two years). Lower Extremity Circumferences in Relation to Lower Limb Muscular Strength and Mobility in the Middle-Aged and Elderly Chen, Lee-hwa; Shih, Shan; Chien, Kuei-Yu National Taiwan Sport University, Taoyuan, Taiwan; [email protected] Introduction: Sarcopenia has been a major contributor to the development of functional limitations and disability for older adults. Recent studies showed that dynapenia might precede sarcopenia and become an important indicator of muscle quality for the ageing population. Lower limb circumferences, an easily accessible anthropometric measurement, have been shown as good markers of health for older adults. However, the relationship between the lower extremity circumferences (including: thigh and calf circumference), lower limb muscular strength, and functional mobility for the middleaged and elderly has not been well-established. Methods: Seventy participants over the age of 50 were recruited. Measurements of circumferences of their thigh and calf were conducted, along with their lower limb strengths, including knee extensor/flexor and ankle dorsiflexor/plantar flexor by the MicroFET3 handheld dynamometer, and mobility, including 6-meter usual walk (UW) and fast-paced walk (FW), 8-ft up-and-go (TUG), and 6-minute walk. Pearson product-moment correlation and partial correlation (adjusted for age) were performed to identify the association between lower extremity circumferences and lower limb muscular strength and mobility. Significance level was set at α = .05. Results: After adjustment for age, thigh circumferences were significantly and positively related to knee extension strength (p = .006), but not to any other lower limb muscular strength and mobility parameters. Calf circumference was significantly and positively correlated with all lower limb muscular strength parameters (knee extensor: p = .000, knee flexor: p = .0001, ankle dorsiflexor: p = .0001, ankle plantar flexor: p = .001), and with FW in mobility (p = .036). Conclusion: Calf circumference may be used to predict lower limb muscular strength and straight-line walking ability for the middle-aged and older JAPA Vol. 24, Suppl., 2016

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adults. However, for a longer duration and distance and a more complex mobility performance, it may not be well predicted by using a single lower extremity circumference. References: Clark, B.C., & Manini, T.M. (2008). Sarcopenia≠ dynapenia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(8), 829–834. Clark, B.C., & Manini, T.M. (2010). Functional consequences of sarcopenia and dynapenia in the elderly. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 13(3), 271–276. Landi, F., Onder, G., Russo, A., Liperoti, R., Tosato, M., Martone, A.M., . . . Bernabei, R. (2014). Calf circumference, frailty and physical performance among older adults living in the community. Clinical Nutrition (Edinburgh, Scotland), 33(3), 539–544. Exergames to Improve Postural Balance in Older People with Dementia Majed, Lina1; Hansen, Clint2 1Sport

Science Program, College of Arts and Science, Qatar University, Doha, Qatar; [email protected] Orthopaedic and Sports Medicine Hospital, Doha, Qatar; [email protected]

2Aspetar

Introduction: The focus of the study concerns the well-documented increased risk of falling in older adults that can lead sometimes to fatal consequences. Improving posture and motor skills is central to preventing falls. Further investigations targeting specific older people such as those suffering from cognitive impairment or dementia are still needed for fall prevention (Shaw, 2003). New technology-based methods, such as digital motion-sensitive games or exergames, appear promising for improving balance (Lamoth, Stins, Pont, Kerckhoff, & Beek, 2008; Lamoth, Caljouw, & Postema, 2011). The present pilot study was aimed to analyze the feasibility and effectiveness of digital balance exergame training in elderly people with dementia. Methods: The postural sway is a common measurement when evaluating the standing posture stability of a person. This study was conducted with four subjects (88.8 ± 6.4 years) suffering from dementia and living in a retirement home. The participants completed a six-week (two sessions per week of 60 minutes) training program using the Wii Fit system (Nintendo). Pre- and post-tests were done to collect the center of pressure (CoP) fluctuations using a force plate (Kistler Type 9260a). The posturographic analyses included the standard deviation in the anterior-posterior (A/P) and medio-lateral (M/L) directions, the mean velocity, the path lengths, and the 95% confidence ellipse. Nonparametric Kruskal-Wallis test (Statsoft, Statistica) was used to examine the effects of training on the selected parameters with a significance level of p < .05. Results: Although the six-week intervention did not bring significant changes to the tested parameters, clear trends were identified. Results showed an increase of 12.48% in the mean CoP velocity, an improvement of 18.89% for the 95% confidence ellipse and a clear extension of the CoP path. Conclusion: Even though no significant pre–post changes were noted, a trend toward better stability was shown and considered a promising result. Exergames could offer a safe and motivating option to improve postural parameters in older people with dementia. However, further investigations with a larger sample would be needed to bring further insights on the effectiveness of this method. References: Lamoth, C.J.C., Caljouw, S.R., & Postema, K. (2011). Active video gaming to improve balance in the elderly. Annual Review of CyberTherapy and Telemedicine, 167, 130–133. Lamoth, C.J., Stins, J.F., Pont, M., Kerckhoff, F., & Beek, P. J. (2008). Effects of attention on the control of locomotion in individuals with chronic low back pain. J Neuroeng Rehabil, 5, 13. http://doi.org/10.1186/1743-0003-5-13 Shaw, F.E. (2003). Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ, 326(7380), 73–73. http://doi.org/10.1136/bmj.326.7380.73 Muscle Thickness and Concentric Strength in Community-Dwelling Older Women Gallo, Luiza Herminia1; Rodrigues, Elisangela Valevein1; Melo Filho, Jarbas1; Silva, Carla Tissiane de Souza2; Gomes, Anna Raquel Silveira3 student, Federal University of Paraná, Curitiba, Paraná, Brazil; [email protected] student, Federal University of Paraná, Curitiba, Paraná, Brazil 3PhD, Physiotherapy Department, Masters and Doctoral Programs in Physical Education, Federal University of Paraná, Curitiba, Paraná, Brazil; [email protected]

1PhD

2Master

Introduction: Among all the changes in the aging musculoskeletal system, there is sarcopenia, defined as the loss in muscle mass and strength (1). Muscle strength is important to perform activity of daily living and it can be related to muscle mass (2). Thus, the purpose of this study was to verify the relation between muscle strength and thickness in older community-dwelling women. Methods: A cross-sectional design study was performed with community-dwelling older women from Parana, Brazil. The study was approved by the Research Ethics Committee of Federal University of Paraná (UFPR, number 36003814.2.0000.0102). The sample consisted of 25 elderly women (69.7 ± 4.1 years, 63.5 ± 10.2 kg, 1.5 ± 0.1 m, 27.5 ± 3.6 kg/m2). Muscle thickness of the medial gastrocnemius (MG) was measured at 20%, 30%, and 40% between the lateral tibia condyle and lateral fibula malleolus, using a B-mode ultrasonography (US) imaging device (Logiq Book XP, General Eletric®) with a linear-array probe (50 mm, 11 MHz, General Eletric®). Muscle thickness (MT) was defined as the mean distance between deep and superficial aponeuroses, measured at five places along the ultrasound image. All US images analyses were performed using ImageJ software (Version 1.46r, National Institutes of Health, Bethesda, MD, USA). The isokinetic concentric peak torque (PT) of ankle plantiflexors was evaluated through an Isokinetic Dynamometer (System 4, Biodex Medical Systems, Shirley, New York). Two sets of three repetitions each were performed at 60º/s, with two-minute intervals between each set, but only the second one was adopted. For statistical analysis, the Pearson correlation test was used to verify the association between variables (p < .05). Results: Correlation between MT and PT was observed only when evaluated at 30% (r = .47, p = .018) or when the mean value was calculated between the three percentiles (r = .44, p = .028). No other relation was observed at 20% (r = .328, p = .110) or 40% (r = .38, p = .061). Conclusion: It can be concluded that in order to find a relationship between muscle strength and thickness, the best portion to evaluate GM thickness is at 30% of the distance between the lateral malleolus of the fibula and the lateral condyle of the tibia. References: (1) Cruz-Jentoft, A.J., Baeyens, J.P., Bauer, J.M., et al. (2010). Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 39(4):412–423. (2) Frontera, W.R., Reid, K.F., Phillips, E.M., et al. (2008). Muscle fiber size and function in elderly humans: a longitudinal study. J Appl Physiol (1985). 105(2):637–642. Factorial Analysis of Get Up and Go Test Modified Version in Active Elderly Women Margareth, Alfonso M Universidad de La Sabana, Bogotá, Colombia; [email protected] JAPA Vol. 24, Suppl., 2016

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Introduction: The recent modification of the Get Up and Go Test (TGUGVM) suggests that it is a tool that quantifies the risk of falls integrally in the elderly. In its implementation, different motor tasks are performed simultaneously, imitating motor control mechanisms that adults use in activities of daily living (Giné-Garriga et al., 2009, 2010). Methods: A cross-sectional study was carried out with 202 women. Their ages ranged from 55–75 years old and they all belonged to a program of physical activity in their towns. We took sociodemographic data from the participants, and conducted an initial interview to recognize exclusion criteria; TGUGVM was applied by using a qualitative scale and taking 12 points as the cutoff point to determine the falling risk. We quantified the time of TGUGVM in each phase: time 1, get up; time 2, kick the ball; time 3, pass behind the cone with a cognitive task in parallel; time 4, sit back; total time, sum of all time. Results: The factorial analysis was built with an extraction method with components and varimax rotation based on the time of the tests. This factor analysis suggests the existence of two factors, which are known as get up (GU) and gait with dual-task (GDT). Based on the coefficients of the equations to calculate the weighting factor for each time score, two indicators were created for GU and GDT, respectively. Derived from the breakpoints indicators, a stratification was built based on the Dalenius-Hodges model, where less than 9.45 seconds GDT indicator is considered a quick execution, 9.46–12.58 seconds is a moderate execution, and 12.59 seconds or longer is considered a slow execution. For the GU indicator, less than 1.10 seconds is considered a quick execution, 1.11–1.46 seconds is a moderate execution, and 1.47 seconds or more is a slow execution. Conclusion: The TGUGVM has two dimensions which are grouped into GDT and GU. According to the stratification, those indicators can be described as fast, moderate, or slow. This explains the execution of the physical test and each dimension measures different physical qualities of the movement in elderly active woman. References: Giné-Garriga, M., Guerra, M., Marí-Dell’Olmo, M., Martin, C., & Unnithan, V. B. (2009). Sensitivity of a modified version of the ‘timed get up and go’ test to predict fall risk in the elderly: a pilot study. Archives of Gerontology and Geriatrics, 49(1), e60–e66. Giné-Garriga, M., Guerra, M., Manini, T.M., Marí-Dell’Olmo, M., Pagès, E., & Unnithan, V. B. (2010). Measuring balance, lower extremity strength and gait in the elderly: Construct validation of an instrument. Archives of Gerontology and Geriatrics, 51(2), 199–204. GinéGarriga, M., Guerra, M., Pagès, E., Manini, T.M., Jiménez, R., & Unnithan, V.B. (2010). The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. J Aging Phys Act, 18(4), 401–424. Perspectives of Lower Socioeconomic Singaporean Older Adults on Successful Ageing and Physical Activity Tay, Mary Ann1; Hayashi, Mayumi2 Department, Tan Tock Seng Hospital, Singapore; [email protected] of Gerontology, King’s College London, United Kingdom; [email protected]

1Physiotherapy 2Institute

Introduction: With Singapore’s population living longer and growing older, there is an urgent need to explore how to age successfully. Physical activity has been associated with successful ageing, but activity levels remain low. Activity levels are especially low in the lower socioeconomic group, who are also least likely to age successfully (Ng et al., 2009). This study aims to explore the concepts of successful ageing and physical activity among lower socioeconomic older adults, as well as the perceived barriers and motivators to physical activity. Methods: Twelve older adults above the age of 65, living in rented government apartments, are recruited from two senior activity centres. Using a qualitative interpretive approach, concepts of successful ageing and physical activity are explored through semi-structured in-depth interviews. Barriers and motivators to physical activity are also explored using a life-course approach. Interview transcripts are analysed using framework thematic analysis. Results: Participants define successful ageing as maintaining good health and familial relationships. All participants view physical activity positively. Most participants associate physical activity with benefits to health, functional independence, and general wellbeing. Despite this, participants do not engage in sufficient physical activity based on the World Health Organisation recommendations. Physical inactivity may be due to poor awareness, conflicting concepts, and over caution with engaging in higher exercise intensities. Perceived barriers and motivators are mostly congruent with existing literature on older adults. In earlier life, barriers to physical activity include life complexities and the lack of physical education, while motivators include a culture of activity play and exercise enjoyment. In later life, barriers include health impairments, fear of injury, and lack of motivation, while motivators include more time and knowledge of exercise benefits. Two unique barriers raised are the concept of ageing as a stage where activity declines and the lack of accessible long-term community exercise programmes. Conclusion: Physical activity seems a relevant and reasonable means to maintaining health and promoting successful ageing among lower socioeconomic older adults in Singapore. However, physical activity levels remain low. Greater understanding of the barriers and motivators toward physical activity may help improve existing public education and community exercise programmes to promote physical activity and thus facilitate successful ageing. Reference: Ng, T.P., Broekman, B.F., Niti, M., Gwee, X., & Kua, E. H. (2009). Determinants of successful aging using a multidimensional definition among Chinese elderly in Singapore. The American Journal of Geriatric Psychiatry, 17(5), 407–416. Energy Expenditure During Nordic Walking in Community-Dwelling Older Adults Takeda, Masaki1; Hasegawa, Taichi2; Fujita, Eiji3; Islam, Mohammod M4; Rogers, Michael E5; Takeshima, Nobuo3 of Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan; [email protected] School of National Institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima, Japan; [email protected] 3National Institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima, Japan; [email protected], [email protected] 4Department of Rehabilitation, Yonaha General Hospital, Kuwana, Mie, Japan; [email protected] 5Department of Human Performance Studies, Wichita State University, Wichita, KS, USA; [email protected] 1College

2Graduate

Introduction: Nordic walking is an outdoor activity using specially-designed poles for the purpose of activating the upper body while walking. The poles are used to push against the ground with each stride. Previous studies found that although Nordic walking was performed at a slower pace than regular walking without poles, it resulted in a higher heart rate and higher oxygen consumption. Although mechanical and physiological responses during Nordic walking have been studied, no one has yet investigated the energy expenditure during Nordic walking in community-dwelling older adults. The purpose of this study was to determine the energy expenditure of Nordic walking in older adults. Methods: Thirty-five healthy adults (age 81 ± 5 years, 4 males, 31 female) volunteered to participate in the study. All participants performed supervised exercise sessions on two days/week (60 min/day) for nine weeks. They wore an accelerometer (Mediwalk, Terumo Co. Tokyo, Japan) at waist- or chest-level to monitor the number of steps (STEP) and amount of moderate intensity physical activity (MPA; min) performed during exercise. Energy expenditure was calculated based JAPA Vol. 24, Suppl., 2016

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on a formula developed from accelerometer data collected in a laboratory-based study that compared conventional walking and Nordic walking (y = 1.804x + 1.099, x: accelerometer data). Results: Mean STEP and MPA were 7683 ± 105 step and 46 ± 10 min, respectively, during NW for nine weeks. Energy expenditure during NW was 6.2 ± 1.0 (min: 3.2, max: 8.8) kcal/min. Conclusion: Energy expenditure during Nordic walking at 5 km/hr in the current study was found to be similar to that of normal walking at a speed of 6~7 km/hr (the latter based on previously published data). Furthermore, Nordic walking seems to be a suitable exercise mode for middle-aged and older adults as it simultaneously activates the upper body, which is commonly not done in normal walking. Effect of Exercise for Visuospatial Ability in Frail Older Adults Nemoto, Miyuki1,2; Yabushita, Noriko3; Tsuchiya, Keito1; Hotta, Kazushi4; Fujita, Yoshihiko4; Kim, Taeho1; Hamasaki, Ai1; Tsujimoto, Takehiko1; Tanaka, Kiyoji1 1University of Tsukuba, Tsukuba, Japan; [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] 2The Japan Society for the Promotion of Science, Tokyo, Japan 3Up-ten health support, Tsukuba, Japan; [email protected] 4Ibaraki Prefectural University of Health Sciences, Ami, Japan; [email protected], [email protected]

Introduction: Although recent studies have shown that exercise has positive effects on cognition, little is known about the effectiveness of exercise interventions on different domains of cognition (attention, visuospatial ability, etc.) in frail older adults. Visuospatial ability, which is often impaired at the early stage of Alzheimer’s disease, is associated with the risk of fall. As frail older adults are mentally and physically frail, it is worthwhile to prevent them from becoming dementia/dependent. The purpose of this study was to examine the effect of our newly developed exercise which could improve visuospatial ability in frail older adults. Methods: This study included 32 frail older adults (21 women), aged 66–92 years (77.6 ± 8.5 years). We recruited the frail according to the long-term care insurance system in Japan. We assigned participants to a visuospatial ability intervention group or a controlled group. Both groups exercised under the supervision of physiotherapists for 90 min/day, 1 day/week, for three months. The exercises included muscle strength training and walk training. In addition to these two trainings, the intervention group carried out the exercise for improving visuospatial ability. The visuospatial ability program was named “Cube Exercise”. We used colored cubes (30 cm × 30 cm × 30cm), which were colored six patterns. We asked them to “reproduce the same colored pattern as shown by the photo, using a set of colored cubes”. The mini-mental state examination (MMSE), clock drawing test (CDT), and seven physical performance tests were conducted before and after the intervention. We evaluated the CDT by qualitative and quantitative analyses using the Freedman method. Results: The repeated-measures ANOVA revealed that there were group × time interactions not only on the cognitive tests but also on the physical performance tests in frail older adults. The cube exercise group showed significantly better MMSE (p < .05), CDT (p < .05), and physical performance tests (four tests; p < .05) compared to the controlled group. Conclusion: The Cube Exercise for the improvement of visuospatial ability might have a positive effect on visuospatial ability as well as global cognition in frail older adults. Furthermore, our program could improve their physical performance. Predicting Cognitive Function in Community-Dwelling Older Women Using the Four Square Step Test and Walking Speed Naoki, Tomiyama1; Ryuichi, Hasegawa2 1Seijoh 2Chubu

University, Tokai, Japan; [email protected] University, Kasugai, Japan; [email protected]

Introduction: Predicting the earliest stages of cognitive impairment has important implications for initiating treatment and monitoring disease (Buracchio, Dodge, Howieson, Wasserman, & Kaye, 2010). Motor performance requires a range of cognitive abilities is highly correlated with control processes (Ren, Wu, Chan, & Yan, 2013). Previous studies have measured gait ability as an indicator of cognitive deficits. However, the intention of the relationship between cognitive function and gait ability were varied with each study. The Four Square Step Test (FSST) is a dynamic balance test for older adults that is easy and quick to administer and score and requires limited space and no special equipment. Additionally, it has been suggested that the FSST may be useful in evaluating the motor–cognitive interaction (McKee & Hackney, 2014). The purpose of this study was to investigate the predictability of cognitive function by the FSST and gait speed in community-dwelling older women. Methods: Sixty-eight community-dwelling older women (mean age of 72.2 ± 6.1 years) performed the 5-m walking test for fast speed, the FSST as physical performance, and the cognitive function test using Test Your Memory. Multiple linear regression analysis was used to examine whether physical performance can predict cognitive function. Results: The factor selected as the independent variable for multiple regression analysis was FSST score (β = −0.289, P = 0.012). Conclusion: These results suggest that the FSST may be more useful than walking speed in predicting cognitive function in community-dwelling older adults. References: Buracchio, T., Dodge, H.H., Howieson, D., Wasserman, D., & Kaye, J. (2010). The trajectory of gait speed preceding mild cognitive impairment. Archives of Neurology, 67(8), 980–986. McKee, K.E., & Hackney, M.E. (2014). The Four Square Step Test in individuals with Parkinson’s disease: association with executive function and comparison with older adults. NeuroRehabilitation, 35(2), 279–289. Ren, J., Wu, Y.D., Chan, J.S.Y., & Yan, J.H. (2013). Cognitive aging affects motor performance and learning. Geriatrics & Gerontology International, 13(1), 19–27. Friendship with Age Elapsing: A Model of Successful Aging in Iranian Women Javadi Pashaki, Nazila1; Mehrdad, Neda2,3; Mohammadi, Farahnaz4; Jafaraghaee, Fateme1 of Nursing and Midwifery, Guilan University of Medical Sciences (GUMS), Rasht, Iran; [email protected], [email protected] Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; [email protected] 3Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

1School

2Elderly

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Introduction: Nowadays, because of improving life expectancy in the world, focus has shifted to the issue of the quality and nature of life and how to successfully age rather than focusing on physical survival and life span. Successful aging is a multidimensional and relative concept, and a contextdependent process with different paths and outcomes. Therefore, the use of theories and models of a society cannot be built on a model for the elderly in other communities. This study is aimed to provide a theoretical explanation of successful aging in women and the model of fitness for Iran. Method: The present qualitative study was conducted by a grounded theory approach in the years 2013 to 2015. The main population of the study were women aged over 60 years living in the community, with the ability to understand and speak the Persian language and a cognitive health score higher than 7 on AMT (Abbreviated Mental Test) who were willing to participate in the study. At first, sampling was purposeful and then ended with theoretical sampling. Snowball sampling was used to select some participants. In order to verify and supplement the information, and based on formatting the theory, family members, younger, and middle-aged women also participated in this study. Sampling continued until theoretical saturation. Depth and semi-structured interviews were used for data collection. In total, 21 women aged 28 to 96 were interviewed. Data from the interviews, participants’ written narratives, and field notes were analyzed by grounded theory approach (Corbin & Strauss, 2008). Findings: 51 initial category, 15 sub category, and four themes emerged during data conceptualization. “Perception of bitter and sweetness of aging” and “barriers and facilitators of life stream” were referred to in the context. “Accompaniment with life caravan in the shadow of threats and opportunities” and “fuse with life” were referred to in the process that, respectively, were highlights of the strategies used in response to the context and consequences of it. The category, “Friendship with passing of life” was identified as the core category that was associated with other categories and continually emerged in all stages of life in order to successfully age. Conclusion: Successful aging is a dynamic process beginning from exposure to changes over time in the context of barriers and facilitators of life stream and the perception of bitterness and sweetness of aging. It occurs by strategies of prevention and coping of threats, self-control and optimizing of life time, and through friendship with the passing of life. These strategies are used consistent with each other or consecutively until the person is fused with life, despite the changes experienced in the aging process. By understanding the process of successful aging and the factors affecting it, staff members of healthcare systems can play an important role in promoting women’s successful aging by providing comprehensive, supportive, consultative, and caring interventions. As well, organizations and associations supporting women can provide favorable conditions for successful aging, with respect to role of facilitators of life stream in friendship with the passing of life. References: Corbin, J.M., Strauss, AL. (2008). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. California: Sage Publications, Inc. Wakasaki, A., Mutsomoto, K., Kakehashi, C. (2006). A study on successful aging of middle-and advanced- aged people-with major focus on the current status of women in their mature stage living in three districts in Japan. Kawasaki J Med Welf, 12:145–153. Willcox, D.C., Willcox, B.J., Sokolovsky, J., Sakihara, S. (2007). The cultural context of “successful aging” among older women weavers in a Northern Okinawan village: the role of productive activity. J Cross Cult Gerontol, 22:137–165. Development of Objective ADL Assessment Particularly in Frail Older Adults Using a Kinect Sensor Takeshima, Nobuo1; Kohama, Takeshi2; Kusunoki, Masanobu2; Ogayu, Takashi3; Okada, Soichi3; Fujita, Eiji1; Islam, Mohammod M4; Brechue, William F5 1National

Institute of Fitness and Sports in Kanoya, Kanoya, Kagoshima, Japan; [email protected], [email protected]

2Faculty of Biology-Oriented Science and Technology, Kinki University, Kinokawa, Wakayama, Japan; [email protected], [email protected].

ac.jp of Rehabilitation, Ukai Hospital, Nagoya, Japan; [email protected] of Rehabilitation, Yonaha General Hospital, Kuwana, Japan; [email protected] 5Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA; [email protected] 3Department 4Department

Introduction: Much research has focused on assessment of physical function and disability in frail older individuals. Tests, such as the Functional Independence Measure, are widely used and accepted measures of infirmity in inpatient rehabilitation settings. However, reliability of these scales is dependent on the individual conducting the assessment; this is especially problematic when assessing physical- or movement-based tasks. Further, effective and reliable analysis of movement is technically complicated and time intensive. The Microsoft Kinect sensor (Kinect) is potentially a low-cost alternative that may provide a portable device for rapid objective and reliable clinical assessment of human movement. Our purpose was to conduct a preliminary assessment of the utility of Kinect to economically and objectively aid in evaluation of an activity of daily living (ADL) in frail older adults. Methods: Older individuals volunteering for this study were divided into two groups: healthy (HE; n = 10) and frail (FR; n = 15). Inclusion in FR was defined by needing assistance performing ADLs according to long-term care regulations in Japan. All subjects completed the FIM testing protocol and two trials of “standing from a chair” ADL task conducted without assistance from one’s hands. Each trial was recorded with Kinect and the coronal plane angle (determined by a line transecting the subject’s shoulder-center and waist relative to the vertical axis) was analyzed to assess chair stand movement quality. Results: FIM failed to differentiate HE (126 ± 0) from FR (122.3 ± 2.5). Likewise, the time needed to complete the chair stand movement was similar between groups (HE: 0.98 ± 0.20 s vs. FR: 1.15 ± 0.40 s). In contrast, the coronal plane angle was significantly less in HE (21.8 ± 6.2°) compared to FR (28.1 ± 6.3°, p < .05). Conclusion: The greater coronal angle during the chair stand indicates a compensation for weakness in the legs/torso not accounted for by time alone; bending forward reduces head weight, assisting the weaker lower limbs to bear less body weight. Using movement correlates (e.g., coronal angle during standing) determined with Kinect to adapt scoring used by FIM, or similar assessments, may more accurately portray physical frailty and improve specific physical evaluation in older adults. Comparison of Handgrip Strength Performance According to Different Initial Body Positions in Elderly Adults López-Torres, Olga1,2; Pedrero-Chamizo, Raquel1,2; Maroto-Sánchez, Beatríz1; Ara, Ignacio3; González-Gross, Marcela1,2 Research Group; [email protected] of Health and Human Performance, Faculty of Physical Activity and Sport Science, Technical University of Madrid, Spain 3GENUD, Toledo Research Group, University of Castilla La Mancha, Spain 1ImFINE

2Department

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Introduction: Handgrip strength is a commonly used indicator of muscle strength and is linked to premature mortality as well as dependence risk and rise in hospitalization costs, among others (Sugiura et al., 2013). Dynamometer tests are non-invasive, inexpensive, fast, and simple to execute. Elderly adults are often limited to perform the test in standing position. The aim was to compare handgrip tests with dynamometer in standing and sitting positions. Methods: 207 subjects (72 males, 135 females) aged 68 and older performed four different handgrip strength tests (right and left hand, in sitting and standing position) with a Takei 5401 Hand Grip Digital Dynamometer. Scores from the four tests as well as maximal strength in standing (MxSD) and sitting position (MxST) in both hands and summatory of both sides in standing (ΣSD) and sitting position (ΣST) were analyzed. Statistical analysis used Chi-square tests and Pearson correlations to establish the independency and correlation of the different tests. The sample was divided by sex. Significance was set at p < .05. Results: Mean results from the right hand in standing position (RHSD) and right hand in sitting position (RHST) were 24.00 ± 8.47 and 23.46 ± 8.42, respectively. Right and left handgrip tests presented dependent correlation between both standing and sitting positions. Pearson tests showed a positive correlation in men in RHSD with RHST (r = .950), left hand in standing position (LHSD) with left hand in sitting position (LHST) (r = .959), MxSD with MxST (r = .955), and in ΣSD with ΣST (r = .970). In women, a positive Pearson correlation was found in RHSD with RHST (r = .940), LHSD with LHST (r = .923), MxSD with MxST (r = .939), and ΣSD with ΣST (r = .951). The poorest correlation was found in men in RHST with LHSD (r = .826) and in women in RHSD with LHST (r = .830). The strongest correlation appears to be in both sex in ΣSD with ΣST. (p < .000 in all cases) Conclusion: Although maximal scores are obtained in RHSD, the strongest correlation appears in ΣSD with ΣST in both sexes. References: Sugiura, Y., Tanimoto, Y., Watanabe, M., Tsuda, Y., Kimura, M., Kusabiraki, T., Kono, K. (2013). Handgrip strength as a predictor of higher-level competence decline among community-dwelling Japanese elderly in an urban area during a 4-year follow-up. Arch Gerontol Geriatr, 57(3):319–324. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics Freak-Poli, Rosanne, PhD1,2; De Castro Lima, Gustavo, MD1; Direk, Nese, PhD1; Franco, Oscar H, PhD1; Tiemeier, Henning, PhD1,3,4 of Epidemiology, Erasmus Medical Centre, The Netherlands; [email protected] of Epidemiology and Preventive Medicine, Monash University, Australia 3Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, The Netherlands 4Department of Psychiatry, Erasmus Medical Centre, The Netherlands 1Department

2Department

Introduction: There is a common misconception that individuals become asexual as they get older, leading medical professionals to not address sexual health proactively with individuals over the age of 65 years (1,2). Sexual health is a part of healthy ageing and is particularly important now as the population is ageing rapidly and we are physically and mentally capable for longer (2). Furthermore, younger generations of older adults are more extroverted, spending more time out of a marital relationship, engaging in more sexual behaviour that is more varied, and the importance of sexual health is changing (3). We aim to assess the prevalence of and characteristics associated with sexual behaviour, incorporating both sexual activity and physical tenderness, in community-dwelling older adults. Methods: From the Rotterdam Study, 2,374 community-dwelling, dementia free, 65+ year olds were assessed between 2009 and 2012 in the Netherlands. Results were stratified by gender and partner status due to differential effects upon sexual partner availability. Results: The vast majority of partnered participants had experienced physical tenderness in the past six months (male: n = 858, 83.7%; female: n = 724, 82.9%) and nearly half had engaged in sexual activity (49.5%, 40.4%). Very few unpartnered females engaged in either sexual activity (n = 675, 1.3%) or physical tenderness (5.2%), while prevalence rates were slightly higher for unpartnered males (n = 117, 13.7%, 17.1%). Engaging in sexual activity and physical tenderness were generally associated with younger age, better socioeconomic position, healthier lifestyle behaviours, and better physical and psychological health. In contrast, higher glucose and lower high-density lipoprotein cholesterol was associated with sexual behaviour in men. Conclusion: While almost half of partnered older adults engage in sexual activity and over two-thirds engage in physical tenderness, very few unpartnered older adults engage in sexual behaviour. Sexual behavior was extremely low for unpartnered females. In men, the association between sexual behaviour and an unhealthy metabolic profile might be an indicator of healthy survival. Sexual health is an important aspect of healthy ageing and efforts to maintain sexual health should be expanded to older ages. Change in cultural attitude may help to improve the sexual health of older unpartnered females. References: (1) DeLamater, J. (2012). Sexual expression in later life: a review and synthesis. J Sex Res, 49(2-3):125–141. (2) Gott, M., Hinchliff, S., Galena, E. (2004). General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med, 58(11):2093–2103. (3) Beckman, N., Waern, M., Ostling, S., Sundh, V., Skoog, I. (2014). Determinants of sexual activity in four birth cohorts of Swedish 70-year-olds examined 1971-2001. J Sex Med, 11(2):401–410. Cross-Sectional Study on the Association of Knee Pain with Physical Activity and Inactivity in Community-Dwelling Elderly Adults Shinichiro, Sato1,2; Yuta, Nemoto2; Masaki, Takahashi2; Noriko, Takeda3; Munehiro, Matsushita2; Yoshinori, Kitabatake4; Mutsue, Amano5; Kazuhiro, Ishikawa5; Takashi, Arao2 of Human Arts and Sciences, Saitama, Japan; [email protected] University, Tokorozawa, Japan 3Kougakuin University, Hachioji, Japan; [email protected] 4Saitama Prefectural University, Koshigaya, Japan; [email protected] 5Tsuru City Government, Tsuru, Japan; [email protected]

1University 2Waseda

Introduction: The purpose of this study was to examine relationships between knee pain and physical activity or inactivity among community-dwelling elderly adults in a Japanese local community. Methods: A questionnaire survey of 1,133 independently living elderly adults was conducted. Measured variables included demographics, lifestyle, knee pain, physical activity, sitting time, social participation, and health status. Knee pain was evaluated by a 5-point Likert scale. Physical activity and sitting time were assessed by the IPAQ-Short version. With regard to physical activity, subjects were classified into two groups of “non-achieved” or “achieved”, based on the WHO recommendation of 150 minutes per week. With regard to sitting time, subjects were classified into two groups of “long time” or “short time” based on a median value of five hours. With regard to social participation, participants were classified into two groups, with or without participation. Multiple logistic regression analysis was used to examine the association of knee pain JAPA Vol. 24, Suppl., 2016

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with physical activity, sitting time, and social participation. These variables were entered individually as independent variables in separate models. An additional model simultaneously included all three variables as independent predictors. Every model was adjusted for sex, age, and BMI. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results: The number of valid respondents for the analysis was 841 (response rate: 74.2%), including 376 men and 465 women. Among the respondents, 497 (59.1%) were classified as “no pain” in knee pain, 374 (44.5%) as “non-achieved” in physical activity, 346 (41.1%) as “short time” in sitting time, and 373 (44.4%) as “no practice” in social participation. When variables were entered as separate predictors, only physical activity significantly related to knee pain. The OR (95% CI) of physical activity was 0.614 (0.459–0.822). When variables were entered simultaneously, physical activity was also the only factor showing a significant association with knee pain. The OR and 95% CI were 0.621, 0.464–0.832, respectively. Conclusion: This study showed that physical activity is a factor associated with reduced odds ratio of knee pain in the elderly, whereas sitting time and social participation are not relevant factors in knee pain. References: Kamada, M., Kitayuguchi, J., Lee, I.M., Hamano, T., Imamura, F., Inoue, S., Miyachi, M., & Shiwaku, K. (2014). Relationship between physical activity and chronic musculoskeletal pain among community-dwelling Japanese adults. Journal of Epidemiology, 24(6), 474–483. Comparisons of Physical Function and Habitual Exercise Among Japanese and Korean Community-Dwelling Older Adults Jung, Songee1; Okubo, Yoshiro2,3; Osuka, Yosuke2; Seino, Satoshi4; Park, Joonsung5; Nho, Hosung5; Tanaka, Kiyoji1 of Tsukuba, Ibaraki, Japan; [email protected], [email protected] Japan Society for the Promotion of Science, Tokyo, Japan; [email protected], [email protected] 3Neuroscience Research Australia, Sydney, Australia 4Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; [email protected] 5Kyung Hee University, Kyunggi, Korea; [email protected], [email protected] 1University

2The

Introduction: The purpose of this study was to compare the level of physical function (PF) among Japanese and Korean older adults. Methods: A crosssectional study was conducted on 1,069 community-dwelling older Japanese (n = 601, 67.9% women) and Korean adults (n = 468, 63.5% women), aged 65–93 (mean 73.9 ± 5.2) years. The participants were asked to complete a self-reported questionnaire regarding habitual exercise and covariates (sociodemographics; anthropometry; medical and functional conditions). Twelve tests on PF including upper and lower muscle strength, gait, balance, and motor skill were conducted. PF age, a composite measure of PF, derived from the 12 items and a principal component analysis were used for the comparisons. PF age and habitual exercise were compared between the Japanese and Korean adults by using analysis of covariance and multivariable logistic regression analysis adjusted for all the covariates using propensity scores. Results: PF age in older Japanese adults was significantly lower than that in Korean counterparts (70.4 ± 0.4 vs. 74.1 ± 0.4 years, P < .001). Overall, older Japanese adults exercised significantly less frequently (3.8 ± 0.2 vs. 4.6 ± 0.2 day/week) and much less (6.6 ± 0.7 vs. 15.7 ± 0.9 METs×hr/week) than their Korean counterparts did. Regarding the type of exercise, older Japanese adults practiced significantly less brisk walking (20.0% vs. 30.1%), mountain climbing (0.8% vs. 8.8%), and bicycling (1.5% vs. 3.4%), but more rhythmic gymnastics (7.2% vs. 1.5%), resistance training (6.7% vs. 2.8%), stretching (4.3% vs. 2.1%), and exercise classes (10.3% vs. 4.9%) than did their Korean counterparts. Conclusion: The study demonstrated that older Korean adults had lower PF (2.5 years older in PF age) than did their Japanese counterparts. Although the frequency and amount of habitual exercise in older Korean adults were higher than those in their Japanese counterparts, particular types of exercise including resistance training, stretching, rhythmic gymnastics, and participation in structured exercise classes may contribute to better PF among older Japanese adults. Based on these results, older Korean adults may need to be more engaged in some types of habitual exercise that are specifically effective in maintaining PF. Effect of Virtual-Reality Balance Training and Group Exercise on Falls Risk Factors Phu, Steven1,2; Kinsella, Rita2,3; Duque, Gustavo1,2,3 of Melbourne, Melbourne, Australia; [email protected], [email protected] Institute for Musculoskeletal Sciences, Melbourne, Australia 3Western Health, Sunshine Hospital, Melbourne, Australia; [email protected] 1University

2Australian

Introduction: Ageing is often associated with a loss of muscle mass, strength, balance, and mobility, all of which can result in an increased risk for falls. The aim of this study was to evaluate the effects of two different exercise and balance programs in older adults with a falls risk. Methods: Participants included 103 community-dwelling older adults (mean age 77 ± 7 years) who were previous fallers. For the intervention, subjects were assigned to either an exercise group performing individualised strength and balance training based on the Otago protocol (EX, n = 59), or virtual reality balance training using the Balance Rehabilitation Unit (BRU, n = 44). Both groups took part in supervised twice-weekly sessions for six weeks. For outcome measures, falls risk was assessed using validated tests, including the Five Times Sit to Stand (5STS), Timed Up and Go (TUG), Walking Speed (WS), and a posturography assessment. Fear of falling was assessed using the self-report Falls Efficacy Scale. Results: Significant improvements were observed in all physical measures, in particular the 5STS, which improved in both groups by over 20% (p < .05). Posturography results revealed significant gains in the BRU groups limits of stability (+46% ± 8%, p < .05) and ellipse areas for almost all tasks (~ –9%, p < .05), whereas the EX group only significantly improved their ellipse area in the foam eyes closed task (–21% ± 6%, p < .01). Self-reported fear of falling (FES-I) improved in both groups (EX –14% ± 3%, BRU –7% ± 4%, p < .05). No between-group significant mean differences were observed for any of the measures. Conclusion: Both exercise and virtual reality training programs resulted in reductions to falls risk. Virtual reality training was found to achieve a significant improvement in control of static posture. No significant differences were observed between groups. Leisure Participation Among Community-Dwelling Older Adults After Falling Chen, Tuo-Yu DUKE-NUS Medical School, Singapore, Singapore; [email protected] JAPA Vol. 24, Suppl., 2016

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Introduction: Leisure activity is important in later life because it promotes health, associates with life satisfaction, and reduces mortality. Falls are a serious health problem among older adults. Although falls among older adults have been studied extensively, less is known regarding the changes in leisure activity after falling. The purpose of this study was to investigate the effects of falls on leisure activity among community-dwelling older adults aged 65 years and older. Methods: To this end, growth curve modeling was performed using the data from five waves of the Health and Retirement Study (2002–2010) and its supplement survey, the Consumption and Activities Mail Survey (2003–2011). The outcome variables were the total number of formal (e.g., volunteer work, religious attendance), informal (e.g., watch TV, read books), and physical leisure activities (e.g., walk, yard work). Falls were structured as a time-varying variable, and its impact on each type of leisure activity was examined separately adjusting for known risk factors of falling. Results: The results showed that falls over time were a significant factor for the total number of formal (B = –.02, p = .007) and informal leisure activities (B = –.02, p = .002), but not for physical leisure activity (B = –.02, p = .074). Specifically, for older adults who reported one additional fall, their total number of formal and informal leisure activities reduced by .02 every two years. The effects of falls on formal leisure activity (slope) was similar among the older adults, but its effects on informal leisure activity varied significantly across individuals (T11 = .03, p = .021). For physical leisure activity, falls were not a significant factor. Instead, older adults’ total number of mobility difficulty (B = –.06, p < .001; T22 = .02, p = .008) was a more prominent predictor of the changes in physical leisure activities across time. Conclusion: The results of this study have practical implications. Practitioners should especially target formal and informal leisure activities after older adults fall to promote and maintain overall health. Trabecular Bone Score in Geriatrics Povoroznyuk, Vladyslav D.F. Chebotarev Institute of Gerontology NAMS Ukraine, Kyiv, Ukraine; [email protected] Introduction: Trabecular bone score (TBS) is a parameter of bone microarchitecture that is determined by the level analysis of DXA images. TBS is associated with fractures in the preliminary case-control and prospective studies. The aim of this study was to assess the TBS role in geriatrics. Methods: We examined 176 healthy women aged 40–79 years (mean age 53.4 ± 0.6 years) and 117 men aged 40–79 years (mean age 59.8 ± 0.9 years). Bone mineral density (BMD) of whole body, PA lumbar spine, and proximal femur were measured by DXA method (Prodigy, GEHC Lunar, Madison, WI, USA), and PA spine TBS was assessed by TBS iNsight® software package installed on the available DXA machine (Med-Imaps, Pessac, France). Results: We have observed a significant decrease of TBS as a function of age (F = 6.56; p = .0003), whereas PA spine BMD was significantly increasing with age (F = 4.04; p = .008) in the examined women. This contradiction can be traced to spinal osteoarthritis and degenerative diseases progressing with age in elderly patients. TBS was significantly lower in women with duration of PMP over four years (p = .003) in comparison with women without menopause; BMD of spine significantly decreased in women with duration of PMP over 7–9 years (p = .02). So, the TBS can detect changes in the state of bone tissue at an earlier stage than BMD. We have observed a significant decrease of TBS in men with ageing (F = 2.44; p = .05). Overall, TBS values in men are lower than the age-matched TBS values in women. Conclusion: TBS is an independent parameter which has a potential diagnostic value of its own, without taking into account the BMD results. The study concerning patients with osteoporosis and fractures is underway. Are Physical, Psychological, and Family Functions of Community-Residing Older Adults Associated with Risk of Falls? Chan, Wayne1,2; Li, Tim1; Lam, Benny1; Ng, Edwin1; Sit, Virginia1; Wong, Christopher1 1The 2Chi

Hong Kong Polytechnic University, Hong Kong, Hong Kong; [email protected] Lin Nunnery Elderly Services, Hong Kong, Hong Kong

Introduction: This study aimed at investigating the difference in physical, psychological, and family functions between older adults living in the community who have and do not have fall risk. The association between fall risk and various demographic data and functional outcomes was also explored. Methods: Cross-sectional analyses were conducted on 120 older adults who were living in the community, able to ambulate independently, and had no significant neurological or cognitive dysfunction. The participants were stratified into two groups, with and without risk of falls. Timed Up and Go test (TUG) was used to screen the risk of falls among participants, based on the cut-off point (13.5 seconds) determined for community-dwelling older adults (Shumway-Cook & Brauer, 2000). Upper and lower limb strength, aerobic endurance, balance control, and level of independence in basic activities of daily living (ADL) were used to determine physical function, along with depressive symptoms and family support representing psychological and family functions, respectively. The differences between participants with and without fall risk were compared using one-way ANCOVA, controlled for age, sex, body mass index, and waist–hip ratio. Multivariate logistic regression was used to determine the association between fall risk and multiple demographic and functional outcomes. Results: 30 (25%) participants had a TUG score higher than 13.5 seconds and were identified as having risk of falls. Compared to those without fall risk, participants with risk of falls had significantly poorer upper and lower limb muscle strength, aerobic endurance, balance control, basic ADL, and depressive symptoms. Better lower limb muscle strength and balance control were found to be associated independently with no risk of falls. Conclusion: Community-dwelling older adults with fall risk may have decreased muscle strength, aerobic endurance, balance control, and ADL independence, and increased depression symptoms. Lower limb muscle strength and balance control may be associated with risk of falls. Interventions that include strategies in improving a wide range of physical and psychological functions may be warranted in order to lower risk of falls. References: Shumway-Cook, A., Brauer, S., et al. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy, 80(9):896–903. Does Participation in Physical and Social Activities Protect Against Depressive and Anxiety Symptoms?: The Moderating Influences of Acculturation in US Chinese Older Adults Dong, XinQi1; Simon, Melissa Andrea2 1Rush

Institute for Healthy Aging, Rush University, Chicago, IL, USA; [email protected] University Medical Center, Chicago, IL, USA

2Northwestern

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Introduction: Depression is a significant public health issue that leads to adverse health outcomes. The US Chinese population is one of the fastest growing racial/ethnic groups in the US, however, very few studies have explored the protective factors against depressive symptoms. This study aimed to examine: (1) the association between physical and social activities participation and depressive symptoms and (2) the potential moderating influences of acculturation in these relationships in US Chinese older adults. Method: Guided by the community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the greater Chicago area were interviewed in person from 2011–2013. Independent variables are self-reported physical function of activities of daily living (ADL) and instrumental activities of daily living (IADL) and directly observed physical performance testing and participation in social activities with friends and community. The dependent variable was depressive symptoms as measured by PHQ-9. Acculturation was measured using validation instruments using US Chinese populations. Logistic regression and interaction term analyses were performed using SAS. Result: Of the 3,159 participants, 58.9% were female and the mean age was 72.8 years. After adjusting for age, sex, education, income, family structure, and medical conditions, lower levels of impairment in Katz ADL (OR, 1.20, 95%CI, 1.15–1.30) and IADL (OR, 1.90, 95%CI, 1.80–2.35), and higher levels of directly observed physical performance testing (OR, 2.01 [1.90–2.60]) were associated with lower levels of depressive symptoms. Participation in social activities was associated with lower levels of depressive symptoms (OR, 2.45, 95% CI, 2.25–2.75). Interestingly, interaction terms indicate that levels of acculturation moderated the association between social engagement and depressive symptoms (PE, 0.65, SE, 1.45, p < .001), but neither by self-reported nor directly observed physical performance testing. (PE, 0.10, SE, 0.20, p = .07). Discussion: This study suggests higher levels of physical function and greater engagement in social activities were associated with lower levels of depressive symptoms among US Chinese older adults. Level of acculturation may moderate the association between social engagement and depressive symptoms. Future longitudinal studies should be carried out to understand the temporal association among these factors in Chinese populations. “Daily Home-Based Exercise” Intervention Improves Fall Risks in Community-Dwelling Elderly People Kimura, Yasuo1; Ohki, Kazuko2; Hisatomi, Mamoru1; Nakagawa, Naoki1; Shimada, Mieko3; Mizunuma, Toshimi1 of Fitness & Health Sciences, Tokyo, Japan; [email protected] Jyogakuen University, Aichi, Japan; [email protected] 3Chiba Prefectural University of Health Sciences, Chiba, Japan; [email protected] 1Institute

2Sugiyama

Introduction: Recent research has shown that older people who perform poorly on standardized tests of lower extremity strength and balance are at a higher risk of developing disabilities. Regularly performed physical activity is extremely important for elderly people to maintain their health status. However, falls must be prevented in order to keep independent healthy longevity. The purpose of this study is to investigate the effectiveness of a home-based exercise intervention for falls prevention in community-dwelling elderly people. Methods: Seventy-eight (71 + 6 years, 71.8% women) volunteers examined the circumstances of falls. The subjects were divided into two groups: fallers (n = 28) and non-fallers (n = 50). Fall risks, falls assessment, a 15-item version of the Geriatric Depression Scale (GDS-15), Tokyo Metropolitan Institute of Gerontology Index (TMIGI), grip strength, one-leg standing time with eyes open, sit-to-stand, functional reach (FR), and walking ability were measured and compared. Home-based exercise included stretching, squats (15 reps., two times a day), and balance exercises (1 min for each leg, two times a day), and were performed for six months. Additionally, educational programs, such as mini-lectures, booklets, etc., were tailored for groups. T-tests and Mann-Whitney U-tests were performed. Results: Before the intervention, fallers showed lower TMIGI (11 vs. 12 pts, p < .05) and higher falls assessment (4 vs. 2 pts, p < .05) and GDS-15 (5 vs. 4 pts, p < .05) than non-fallers. After the intervention, fallers improved in the frequency of falls (0.7 + 0.4 to 0.3 + 0.8 times, p < .05), the number of falls assessment (4 + 2 to 3 + 2 #, p < .05), one-leg standing time (25 + 23 to 30 + 19 s, p < .05), FR (26 + 6 to 30 + 7 cm, p < .05), and sit-to-stand (10 + 3 to 8 + 2 s, p < .05). Non-fallers improved in FR (26 + 5 to 31 + 5 cm, p < .05) and sit-to-stand (9 + 3 to 7 + 2 s, p < .05). Conclusion: These findings revealed that the home-based exercise seemed to be effective, along with fall-related information, in falls prevention for community-dwelling elderly people. This study was supported in part by a Grants-in-Aid for Scientific Research C 25350060 (to K. Ohki) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. The Effects of Mind-Body-Spirit Group Interventions on the Quality of Life of Korean Older Cancer Survivors Yoon, Hyunsook; Kim, Yojin; Lim, Yeon Ok; Kim, Woon Jeong; Ham, Hye Jin; Choi, Kyoungwon Hallym University, Chooncheon, Korea; [email protected], [email protected], [email protected], [email protected], loveme420@naver. com, [email protected] Introduction: The purpose of this study is to examine the effects of mind-body-spirit group interventions on the quality of life of Korean older cancer survivors. The mind-body-spirit group intervention takes the WHO’s definition of health as a state of complete physical, mental, and social well-being. It is a holistic approach using various modalities such as physical exercise, nutrition, mindfulness mediation, imagery, and etc. This intervention was found to be effective for healthy Korean older adults (Lee et al., 2012) and breast cancer survivors (Chan et al., 2006). Methods: Fifty-nine older cancer survivors who are 65 years or older are recruited from four university-based hospitals in Korea and assigned to experimental (n = 35) and control (n = 24) groups. The groups compose four groups with 7 to 10 participants and are led by medical social workers. A total of eight sessions are carried out twice a week. Outcomes of health status and health care behavior for body component, positive/negative affect, and self-esteem for mind component, and life satisfaction and forgiveness for spirit component, are gained at pre-and post-sessions and analyzed with Wilcoxon’s signed-ranks test. To capture the overall effects, the quality of life was measured. Results: It was found that cancer survivors who participated in the intervention groups showed improvement in health status evaluation of body component, negative moods and self-esteem (at .10 level) of mind component, and overall quality life. For spiritual component, statistically significant changes were found. However, the scores of life satisfaction and forgiveness increased. Conclusion: The effectiveness of the intervention indicated the importance of incorporating the holistic approach in enhancing the quality of life of older cancer survivors, paying attention not only to the physical component, but also the mind and spiritual aspect. To capture the effectiveness of the intervention, it is suggested to integrate qualitative methods. References: Chan, C.L.W., et al. (2006). A randomized controlled trial of psychosocial interventions using the psychophysiological framework for Chinese breast cancer patients, Journal of Psychosocial Oncology, 24, 3–26. Lee, E.O., et al. (2012). Body-mind-spirit practice for healthy aging, Educational Gerontology, 38, 473–485. JAPA Vol. 24, Suppl., 2016

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Muscular Strength and Physical Function are Improved in Older Korean Women Utilizing a Body-Mass Based, Lower-Body Exercise Training Program Yaginuma, Yu1; Kawanishi, Masashi1; Kim, Seol Hyang2; Kitamura, Takahiro1; Fujita, Eiji1; Brechue, William F3; Takeshima, Nobuo1 Institute of Fitness and Sports in KANOYA, Kanoya, Kagoshima, Japan; [email protected], [email protected], kitamura@nifs-k. ac.jp, [email protected], [email protected] 2University of Seoul, Seoul, Korea; [email protected] 3Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA; [email protected]

1National

Introduction: Simplified but effective exercise strategies are contributing to increased popularity of community- and home-based programs as alternatives to gym-based exercise. One such alternative is our lower-body training program (CHOKIN) which utilizes body mass as the exercise load. Our present purpose was to determine the effect of this short-term lower-body training program on muscular strength and physical function in community-dwelling older Korean women. Methods: Older women (n = 30, 76 ± 5 years) living in Seoul, Korea participated in this study. Participants were instructed to perform the CHOKIN program (series of five lower body exercises) as a home-based exercise program with one supervised training session per week. Training was conducted for 10 minutes/day for an average of 7 days/week over 16 weeks. Body composition (body mass [BM], body mass index [BMI], and %fat), muscular strength (maximal isometric knee extension torque [KEXT] and chair stand [CS; time to complete 10 repetitions]), and physical function (8-m walk at self-selected pace and maximal velocity and 20-s march- in-place test [MIP]) were measured before and after training. Results: All changes reported here were statistically significant with p < .05. Following training, BM (57.2 ± 7.9 vs. 56.8 ± 8.1 kg), BMI (25.1 ± 3.1 vs. 24.9 ± 3.2), and %fat (35.9 ± 5.2 vs. 35.2 ± 5.6 %) decreased. Muscular strength improved as KEXT increased (21.0 ± 5.8 vs. 23.5 ± 5.6 N) and CS time decreased (14.0 ± 4.7 vs. 9.6 ± 1.4 s). Gait improved as self-selected (1.26 ± 0.17 vs. 1.50 ± 0.19 m/s; 123.3 ± 11.1 vs. 134.7 ± 11.9 cm) and maximal (1.48 ± 0.27 vs. 1.78 ± 0.19 m/s; 135.9 ± 12.5 cm vs. 143.1 ± 16.0 cm) velocity and stride length increased, respectively. Dynamic balance improved as indicated by decreased MIP contact time (690 ± 0.11 vs. 640 ± 0.05 ms) and contact time coefficient of variation (8.8 ± 12. vs. 4.7 ± 4.5) and increased (p < .05) single support phase during self-selected (54.7 ± 4.2 vs. 59.5 ± 8.2%) and maximal velocity (59.3 ± 4.0 vs. 63.8 ± 5.9%) gait. Conclusion: The CHOKIN program improved body composition and muscular strength leading to significant increases in dynamic balance and self-selected and maximal gait velocity. Thus, this lower-body exercise program utilizing a body-mass loading strategy appears to be a significant stimulus for changing fitness and physical function in older Korean women. Effects of Tai-Chi Chuan on Balance Ability and Functional Fitness in Japanese Older Adults Kitabayashi, Yukiko1; Kato, Yoshiji2; Koizumi, Daisuke2; Narita, Makoto2; Islam, Mohammod M2; Rogers, Nicole L3; Rogers, Michael E4; Takeshima, Nobuo5 Isen Nursing School, Nagoya, Japan; [email protected] Aging Association, Nagoya, Japan; [email protected], [email protected], [email protected], parumon@ hotmail.com 3Department of Public Health Science, Wichita State University, Wichita, KS, USA; [email protected] 4Department of Human Performance Studies, Wichita State University, Wichita, KS, USA; [email protected] 5Sport and Life Science, National Institute of Fitness and Sports in Kanoya, Kanoya, Japan; [email protected] 1Nagoya 2Active

Introduction: Tai Chi Chuan has been reported to improve health status, physical fitness, mood, and emotional condition in older adults. However, the effect of Tai-Chi Chuan on static and dynamic balance and functional fitness in this population is not well known. The purpose of this study was to determine the effects of Tai-Chi Chuan on static and dynamic balance and functional fitness in older adults. Methods: Fifty-four volunteers were divided into an exercise group (EX: 9 men and 16 women, average age 72 ± 5 years) and control group (13 men and 11 women, average age 73 ± 6 years). The EX participated in a 12-week supervised exercise program (60 min/day, 2 days/week) that consisted of a 10-min warm-up and stretching, 40-min Tai-Chi Chuan exercise, and 10-min cool-down/relaxation exercises. The control group was asked to not change their physical activity habits. Static and dynamic balance (static balance: sway velocity [SV] standing on firm or foam surfaces with eyes open or closed; dynamic balance: limits of stability [LOS]) was measured before and after the intervention. LOS parameters were endpoint excursion (EPE), maximum excursion, reaction time, mean movement velocity, and directional control. Functional fitness measures including body mass, arm curl (AC), chair stand (CS), functional reach, timed up and go, 12-min walk, and back scratch, sit and reach were taken before and after the intervention. Data were analyzed using analysis of variance (ANOVA) with repeated measures for the main effects of group, time, and interaction (group × time). Results: At baseline, significant differences were noted in AC, CS, and DCL between groups, so the influence of the initial level of these parameters was examined using analysis of covariance (ANCOVA). After the 12-week Tai-chi exercise program, there were no improvements in any variable although EPEcomp tended to increase (13.1%, p = .052). Conclusion: These results indicate that this Tai-chi Chuan program has little effect on static and dynamic balance and functional fitness parameters in Japanese older adults. A Cross-Sectional Study on the Relevant Factors of Cognitive Decline in Community-Dwelling Elderly Adults Yuta, Nemoto1; Shinichiro, Sato1,2; Masaki, Takahashi1; Noriko, Takeda3; Munehiro, Matsushita1; Yoshinori, Kitabatake4; Mutsue, Amano5; Kazuhiro, Ishikawa5; Takashi, Arao1 University, Saitama, Japan; [email protected] of Human Arts and Sciences, Saitama, Japan; [email protected] 3Kogakuin University, Tokyo, Japan; [email protected] 4Saitama Prefectural University, Saitama, Japan; [email protected] 5Tsuru City Government, Yamanashi, Japan; [email protected]

1Waseda

2University

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Introduction: The number of patients with dementia has been increasing rapidly and preventive measures are urgently needed in Japan. However, evidence on the related factors of cognitive decline has not been sufficiently accumulated in Japan. This study, therefore, aims to examine the relationships between cognitive decline and physical activity, physical inactivity, and social activity in community-dwelling elderly people. Methods: A total of 1,133 independently living elderly adults in a local Japanese community were recruited for the survey and 929 participants (407 men and 522 women) completed the questionnaire (response rate 72.5%). Multilevel logistic regression analysis was conducted to examine the related factors of cognitive decline using the presence or absence of cognitive decline as the dependent variable, and physical activity, sitting time, and social participation as the independent variables. The covariates included in the analysis were age, educational level, smoking status, drinking status, and depression (Geriatric Depression Scale). The related factors of cognitive decline were examined using three statistical models: no adjustment for OR and 95%CI (Model 1); adjusted for age, education level, smoking status, and drinking status (Model 2); and depression was added to Model 2 (Model 3). Results: The multilevel logistic regression analysis showed that social participation was significantly and positively related to cognitive decline in Model 1 and Model 2 in both men and women (Model 1 : OR = 0.466, 95%CI = 0.302–0.719, OR = 0.597, 95%CI = 0.401–0.887; Model 2: OR = 0.544, 95%CI = 0.347–0.851, OR = 0.600, 95%CI = 0.398–0.904, respectively), but there was no significant association in Model 3 (OR = 0.672, 95%CI = 0.420–1.073, OR = 0.684, 95%CI = 0.445–1.050, respectively). Physical activity and sitting time, however, did not show a significant relationship for both men and women. Conclusion: Participation in social activity may have a protective effect on cognitive decline, as aging and the impact of social participation is stronger in women compared to men. It is important to undertake intervention programs promoting social participation to maintain cognitive function in the community-dwelling elderly.

JAPA Vol. 24, Suppl., 2016

Journal of Aging and Physical Activity, 2016, 24(Suppl.), S48  -88 © 2016 Human Kinetics, Inc.

WCAA ABSTRACTS

Thursday 30th June 2016: Policy Keynote Global Progress on Healthy and Active Ageing John Beard Director of the Ageing and Life Course Programme, World Health Organization Populations around the world are rapidly ageing, particularly in middle income countries. Yet debate on what this might comprise has been limited, political response has often been slow, and policies are frequently based on negative stereotypes of older people. However, the last two years have seen far greater attention being brought to the topic of ageing, with the World Health Organization identifying it as a priority issue in 2014 and releasing the first World report on ageing and health in 2015. 2016 will likely see the agreement of the 194 WHO member states to a Global strategy and action plan on ageing and health. The report and strategy provide a clear public health framework for action on ageing and the political commitment to pursue this in four strategic areas: ensuring everyone has the opportunity to grow older in an age-friendly environment; aligning health systems to older populations; building systems of long-term care; and improving measurement, monitoring, and research. At their core, these instruments are built around a significant reconceptualization of Healthy Ageing that has implications not just for policy makers but for clinicians, caregivers, and researchers. This is built around the concept of functional ability—the attributes that enable people to be and to do what they have reason to value. The World report identifies three factors that can influence trajectories of ability across the life course: the intrinsic capacity of the individual, the environments they inhabit, and the interaction between them. Physical activity is a central mediator in these relationships. This presentation will outline core aspects of the WHO Healthy Ageing approach and explore the implications for policy makers, practitioners, researchers, and each of us as individuals.

Invited Speakers Changing Patterns of Physical Activity and Sitting Time, and Implications for Healthy Ageing in Australian Women Wendy J. Brown Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia Introduction: The Australian Longitudinal Study on Women’s Health (ALSWH) is a prospective study which commenced in 1996 with approximately 40,000 women in three birth cohorts: 1973–1978, 1946–1951, and 1921–1926. This presentation will describe changes in physical activity (PA) in the two older cohorts (and in sitting time [ST] in the mid-age cohort) over nine years, and will examine how physical activity impacts physical and mental health in middle and early old age. Methods: Participants completed self-report surveys at approximately three-year intervals from 1998. PA was measured using an adapted version of the Active Australia Survey, and ST with the IPAQ global sitting item. The SF36 was used to assess physical and mental wellbeing, and the women reported symptoms of illness and doctor-diagnosed conditions. Results: In the mid-age cohort, ST increased slightly over nine years; it was 0.5 hr/day higher in 2010 (age 59–64 years) than in 2001 (age 50–55) (N = 6,973). Over the same period, the prevalence of meeting PA guidelines (‘active’) increased from 45% in 2001 (N = 10,694) to 56% in 2010 (N = 9,328). In contrast, PA prevalence declined markedly in the older cohort, from 37% ‘active’ in 1999 (N = 9,050) to 24% in 2008 (N = 5,117). ALSWH data illustrate clear dose–response relationships between PA and indicators of mental health (vitality and depressive symptoms), the benefits of doing some vigorous activity in mid-age, and the benefits of walking in older age. Maintaining optimal function in early old age appears to be markedly influenced by physical activity in mid-age. Conclusion: Over nine years, on average, mid-age women became more active and slightly more sedentary (2001 to 2010), while the older women became less active and more sedentary (1999 to 2008). Overall, the data demonstrate the importance of maintaining high levels of physical activity throughout mid-age for prolonging the number of ‘healthy’ years in older age. Urban Spaces and Active Ageing: A National and International Agenda Ester Cerin Institute for Health and Ageing, Australian Catholic University Population ageing and urbanization are two major global and national demographic trends. These are important phenomena as there is growing evidence that the urban built environment plays a key role in shaping physical activity behaviour. As a result of this evidence, national and international urban and health policy documents have identified environmental changes as effective strategies to create healthier societies. Although research on environmental influences on physical activity has flourished in the last decade, most studies have focused on youth and general adult populations. This is at odds with the fact that older residents are the segment of the population likely to be most affected by the features of their local environment due to mobility, independence, and social contacts being greatly limited by a poorly-designed community. A common desire of older adults is to age in their own neighbourhood, but this requires community design that supports activity and mobility across the various stages of the ageing process. It is, thus, important to identify key elements of urban environments that promote an active lifestyle in the older, disadvantaged segment of residents with restricted mobility as well as the mid-aged, fully-functional workforce. This knowledge can inform equitable, universal activity-friendly community design suitable to all age S48

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groups. Since the range of environmental exposures within single geographical locations is limited, work in this area needs to be based on an analysis and synthesis of data from a large variety of geographical regions. Accurate effect sizes and dose–response relationships are needed to judge the relative importance of aspects of community design and provide useful guidance to decision makers and designers who can translate research into policy and practice. Hence, the main goals of this presentation are to provide a critical synthesis of the current evidence on aspects of urban design that promote an active lifestyle in mid-aged and older adults across the globe, and to identify key research gaps and priorities in the field.

Symposia Active Ageing Policy, Leisure in Later Life, and Cultural Change Dionigi, Rylee A1; Grant, Bevan2; Miller, Evonne3 Sturt University, Bathurst, Australia; [email protected] University of Waikato, Hamilton, New Zealand; [email protected] 3Queensland University of Technology, Brisbane, Australia; [email protected] 1Charles

2The

Purpose and Goals: The purpose of this symposium is to draw on our research to stimulate debate regarding the role active ageing policy and leisure practice can play in cultural change. It will focus on: the difference between older people’s understandings of and policy definitions of ‘active or healthy ageing’; the experiences of active leisure among older people in various contexts, such as Masters sport, a community initiative encouraging greater levels of physical activity, and residential aged care settings; and the need for cultural adaptation and policy change to address increased longevity and ageing populations. Content Summary: First, Dionigi presents findings from a project called, The meaning of sport in the lives of older people across the physical activity spectrum: Towards policy implications. Second, under the topic of, People, policy and practice: Uncomfortable bedfellows, Grant shares some of the complexities encountered by a community initiative that aims to promote greater levels of physical activity amongst the ‘older’ population. Third, Miller draws on data from the Inside aged care project (an ongoing longitudinal participatory qualitative research study) to show what restricts and facilitates leisure participation for older aged care residents, particularly as their health declines. Next, we discuss cultural and policy changes that warrant greater attention if we are to respond to the world’s changing demographics. Finally, there will be a Q&A session on the topic of Active ageing policy, leisure in later life and cultural change. Implications for Active Ageing: The research in this symposium illustrates that if cultural change is to occur, active ageing policy and related practice must be informed by older people’s experiences. It is imperative that in their later years, people have the social space and opportunity to develop meaningful life phase-specific roles and responsibilities through all forms of leisure, not just those deemed productive or cost-effective to health policy. If future initiatives are to be sustainable for the long-term, however, some rethinking is required about the types of partnerships between various government agencies at a national, state, and local authority level and how these might better interact with organisations delivering the programs and services at the community level. References: Dionigi, R.A., Gard, M., Horton, S, Weir, P. and Baker, J. 2014. Sport as leisure for older adults: Critical reflections and recommendations. Paper presented at the 14th Canadian Congress on Leisure Research: Our New Leisure Society, Halifax Nova Scotia, May 21–23, 2014. Sport, Ageing, and the Physical Activity Spectrum: Implications for Policy Dionigi, Rylee A Charles Sturt University, Bathurst, Australia; [email protected] The promotion of sport to older people has become part of the active ageing policy agenda in Australia in recent years (van Uffelen et al., 2015). Sport participation, it is argued, can help older people maintain their independence and improve their general quality of life. While there are strong biomedical grounds for promoting physical activity in general, we know much less about the pros, cons, and meaning of competitive sport in later life. Our ongoing research seeks to (i) develop a critical and in-depth understanding of the meaning of competitive sport in the lives of older people who do and do not compete in sport and (ii) inform the development of more expansive active ageing policies. While a laudable goal, encouraging sport participation in later life is complex and, if it is not done effectively, this form of active ageing is potentially harmful. At this point in our research, observational and interview data collected from older athletes at sporting events suggests that Masters sport, especially international and national multi-sport events like the World Masters Games, is a burgeoning area of middle class consumption. It is also a social context in which new understandings of the ageing process are emerging, such as older people as strong, independent, and socially engaged. At the same time, our research reveals outcomes of older peoples’ participation in sport that are unspoken in policy-related documents, such as the disparagement of other ways of ageing (e.g., the ‘shaming and blaming’ of those who are not active in later life), something that has the potential to reinforce cultural and individual fears of ill health in old age. In this presentation I will discuss the potential positive and negative implications, with particular focus on the latter, of the promotion and participation of sport and physical activity in later life. Reference: van Uffelen, J.G.Z., Jenkin, C.R., Westerbeek, H.M., Biddle, S.J.H., & Eime, R.M. (2015). Active and healthy ageing through sport. Report prepared for the Australian Sports Commission. Victoria University, Institute of Sport, Exercise and Active Living (ISEAL). People, Policy, and Practice: Uncomfortable Bedfellows Grant, Bevan C University of Waikato, Hamilton, New Zealand; [email protected] There are advantages and disadvantages with growing older and the choices made can have a considerable impact on the way one ages. But choices are influenced by numerous factors, including social and cultural expectations, one’s state of well-being, access to financial resources, and personal beliefs about what one should and should not do at your age. One choice attracting increasing attention is the considerable disengagement from regular physical activity with the passing of years. The evidence, however, is unequivocal that the opposite is preferable. Active living of the physical kind, even at a very mild level is strongly encouraged, for it can enhance life span, but, more importantly, impact health span. No one wants to live a life devoid of JAPA Vol. 24, Suppl., 2016

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‘good’ health. It is therefore not surprising then that in recent times older people are being targeted more and more by a variety of public, not-for-profit, and private organizations encouraging greater numbers of the older population embrace and maintain an active lifestyle. This is proving to be a notable challenge, something highlighted by the chasm between science, policy, and practice. This suggests some rethinking is called for with regard to trying to reverse the physical inactivity trend in later life. Although this is a plausible ideal, it is anything but straightforward. During my presentation, I will illustrate this when sharing some of the intricacies about what happened when a group of enthusiastic and knowledgeable professionals set out to change the ‘face’ of physically active ageing in their community. Beyond Bingo? Understanding Active Ageing and Leisure for Aged Care Residents Miller, Evonne Queensland University of Technology, Brisbane, Australia; [email protected] How do older adults living in residential aged care experience active ageing? What restricts and facilitates participation in leisure activities? This presentation explores these issues, drawing on ongoing semi-longitudinal qualitative research tracking the lived experience of aged care from the perspective of 20 new aged care residents. Utilising three underutilised qualitative approaches—photovoice (photographs of life and leisure in aged care), phenomenographic analysis (variations in ‘ways of experiencing’), and the arts-based approach of poetic transcription (poems are created from interview data)—I explore the meaning of leisure and the strategies residents utilise to maintain participation as their health declines. Interestingly, although most believed the structured leisure activities provided a valued structure for daily living, facilitated social connections, and enhanced health, a significant minority felt nagged and bullied into participation. Thus, this presentation also explores resident disengagement from organised leisure, specifically the challenge of respecting residents’ wishes for autonomy (the essence of person-centre care) against the knowledge that encouraging leisure participation will facilitate active ageing and quality of life. Challenges for Changing Physical Activity and Sedentary Behaviour in Australia and Brazil Biddle, Stuart1; Antonio Florindo, Alex2; Thogersen-Ntoumani, Cecilie3 University, Melbourne, Australia; [email protected] de São Paulo, São Paulo, Brazil; [email protected] 3Curtin University, Perth, Australia; [email protected] 1Victoria

2Universidade

Introduction: Achieving behaviour change for both physical activity (PA) and sedentary behaviour can be challenging. Greater success in the future may depend on learning more about different contexts for behaviour change, such as across countries. Methods: Three perspectives on PA and sedentary behaviour are offered from Australia and Brazil. A panel discussion will take place with the speakers, plus an expert on PA for older adults from the UK. Results: In Brazil, actions are concentrated mainly in primary health care settings. Brazil has major challenges in the next 10 years for increasing PA in older adults. It needs to improve studies about the built environment for creating healthy places in different cities. Other actions are to create a national guide for PA promotion and decrease sedentary behaviour, and to create intersectoral actions for PA promotion in different levels in Brazil (federal government, states, and cities). A new trial is being developed that will evaluate a proof-of-concept, motivationally-embellished, intervention designed to increase walking, reduce sitting, and improve mental health in older adults living in retirement villages in Perth, Australia. The intervention will pioneer the use of motivationally-trained residents who will be the program’s ambassadors, and who will be trained to use principles from contemporary motivation theory to empower participants to adopt and sustain behaviour changes. A better understanding of sedentary behaviour (sitting time) has been developed in the past decade or so, but little is known about the barriers that adults might face in attempting to decrease their sedentary behaviour. Qualitative data is presented on how older adults perceive the barriers to such behavior change, including lack of perceived alternatives and the organizational culture at work. Other themes include excuses, being skeptical, and education. Such data can help plan for behavior change by accounting for perceived barriers. A panel discussion will conclude the symposium with reference to priority issues across and between different countries. Conclusion: Understanding behavior change for older adults across physical activity and sedentary behavior is a priority. Greater learning can be achieved by studying these issues across countries. Barriers to Moving More and Sitting Less: Perceptions of Australian Adults Over 50 Years of Age Biddle, Stuart JH1; Madden, Jhai1; Gillett, Wendy2; Octigan, Jacey2; Vergeer, Ineke1 Melbourne, Australia; [email protected], [email protected], [email protected] Foundation, Melbourne, Australia; [email protected], [email protected]

1VictoriaUniversity, 2Bluearth

Introduction: A better understanding of sedentary behaviour (sitting time) has been developed in the past decade or so, but little is known about the barriers that adults might face in attempting to decrease their sedentary behavior alongside increasing their physical activity. Methods: The ‘Move More Sit Less’ initiative of Bluearth, a national health promotion charity in Australia, is underway. To inform this initiative, Bluearth undertook a survey of adults across Australia aimed at assessing issues concerning the reduction of sitting and the promotion of more movement. One element of the survey was an open-ended question asking participants, “What would it take to get more people to change their sitting habits and move more?” Australian adults (n = 636) provided open-ended responses, of which 22 provided statements on ‘perceptions and barriers to change’ and were over the age of 50 years. Data were analysed by using inductive content analysis, with the coding of qualitative responses performed using NVivo 11 software. Results: For the whole sample, themes included perceived lack of alternatives, organizational culture, and being a skeptic. For older adults, barriers to behavior change for reduced sitting included lack of perceived alternatives (e.g., long drive to work and the belief that some jobs are meant to be done sitting) and the organizational culture at work (e.g., most workplaces do not support being able to get up and move more). Some expressed more skeptical views, such as not believing that apps and reminders will assist them. There was some indication that physical health concerns (e.g., a bad back) prevented more standing. Conclusion: It is clear from this sample that adults over the age of 50 years perceive many barriers to moving more and sitting less, mainly in the workplace. Such data can help plan for behavior change initiatives. JAPA Vol. 24, Suppl., 2016

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Challenges to Promote Physical Activity and Decrease Sedentary Behaviour in Older Adults in Brazil Antonio Florindo, Alex Universidade de São Paulo, São Paulo, Brazil; [email protected] Introduction: Brazil is a middle-income country in South America with more than 205 million inhabitants, with 8% being older adults. This country has improved its life expectancy in the past 50 years. The objective of this paper is to discuss the prevalence, policies, and physical activity (PA) interventions in Brazil for older people in the past 10 years. Methods: We used papers that were published about trends of PA, policies, and community-based interventions for PA promotion. Results: The results of a surveillance system study in Brazil (Mielke et al., 2014) showed that the PA in leisure time (5 days/week for at least 30 min/day) was stable (~12.5%) in the older population. In 2006, the Federal Brazilian Government approved the National Health Promotion Policy, with a highlight for PA promotion (Malta, 2012). In 2011, the Federal Brazilian Government started a community-based intervention in primary health care settings called “Academia da Saúde”. The health system in Brazil is universal and public and has coverage of 75% of the population (Florindo et al., 2013). This intervention is being implemented in more than 2,000 cities in Brazil and includes funds to improve facilities (places to practice PA) and professionals (e.g., fitness professionals) in primary health care units. The actions include PA classes and PA counseling. Conclusion: Brazil has improved PA promotion for older populations, but the effectiveness of such approaches depends on additional actions. For example, is necessary to evaluate the effectiveness of the “Academia da Saúde”. Also, it is necessary to evaluate different types of interventions in different settings (for example, decreased sedentary behaviour). Built environment studies for creating healthy places for PA practice in different cities (open spaces, green areas, recreation centers, bike lanes) are necessary. This action can contribute to policy, policymakers, and new urbanism. The National Guideline for PA promotion and decreasing sedentary behavior is also important, and can improve intersectoral actions (for example, education, transportation, urban planners, environment, health, and sports) for PA promotion at different levels in Brazil (federal government, states, and cities). References: Florindo, A.A., Mielke, G.I., Gomes, G.A.O., Ramos, L.R., Bracco, M.M., Parra, D.C., Simoes, E., Lobelo, F., Hallal, P.C. (2013). Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors. BMC Public Health, 13:794. http://www.biomedcentral.com/14712458/13/794. Malta, D.C. (2012). Policies to promote physical activity in Brazil. The Lancet. 18, http://dx.doi.org/10.1016/S0140-6736(12)61041-1. Mielke, I.G., Hallal, P.C., Malta, D.C., Lee, I.M. (2014). Time trends of physical activity and television viewing time in Brazil: 2006–2012. International Journal of Behavioral Nutrition and Physical Activity, 11:101. http://www.ijbnpa.org/content/11/1/101. The Residents in Action Trial (RIAT): Promoting Walking, Less Sitting, and Better Mental Health in Residents in Retirement Villages Thøgersen-Ntoumani, Cecilie1; Ntoumanis, Nikos1; Burton, Elissa1; Hill, Keith1; Cerin, Ester2; Biddle, Stuart JH3 1Curtin University, Perth, Australia; [email protected],

[email protected], [email protected], [email protected] Catholic University, Melbourne, Australia; [email protected] 3Victoria University, Australia; [email protected] 2Australian

Introduction: Ageing is accompanied by increased risks of chronic disease, declined functioning, and dependency. Physical activity is critical to retaining physical and mental health and independence, but the majority of older people are insufficiently physically active to achieve these benefits. The proposed trial will evaluate a proof-of-concept motivationally-embellished intervention designed to increase walking, reduce sitting, and improve mental health in older adults living in retirement villages in Perth. The intervention will pioneer the use of motivationally-trained residents acting as the program’s ambassadors, who will be trained to use principles from contemporary motivation theory to empower participants to adopt and sustain behavioural changes longer term. Methods: A pilot cluster randomised trial will be conducted in 14 retirement villages (7 per group) located in different environmental settings in Perth, Western Australia. Fifteen residents per village will be recruited for a 16-week intervention. Resident ambassadors (n = 5 per village) in the experimental arm will be trained in applying motivational techniques to empower participants to increase walking and reduce sitting. These increases are expected to improve mental health. Participants in the control group will be encouraged to engage in group- and independently-organised walks, but their resident ambassadors will not be motivationally trained. Walking, sitting, and mental health outcomes will be assessed at baseline, postintervention, and at a six-month follow-up. Feasibility-related outcomes, and mediators (autonomy support and motivation for walking) and moderators (characteristics of the neighbourhood physical environment), of the intervention’s effectiveness will also be explored. Hypotheses: It is hypothesised that increases in walking, reductions in sitting, and improvements in mental health will be greatest in participants assigned to the experimental arm. It is also hypothesised that motivation for walking and autonomy support provided by walk ambassadors will mediate, and the characteristics of the neighbourhood physical environment will moderate, intervention effectiveness. Conclusion: The data will be used to inform the design of a definitive randomised controlled trial. If effective, the intervention can subsequently be rolled out for adoption in many retirement villages in WA and throughout Australia, or it can complement existing programs and inform relevant policy. Acknowledgement: This research is funded by Healthway. Engaging Older People in Physical Activity—Turning Evidence into Practice Smith, Ben1; Nolan, Genevieve2; DeSilva, Renee2; Menzies, David3; Yallop, Sarah4; Thompson, Catherine4 University, Melbourne, Australia; [email protected] and Osteoporosis Victoria, Melbourne, Australia; [email protected], [email protected] 3Fitness Australia, Melbourne, Australia; [email protected] 4Department of Health & Human Services, Melbourne, Australia; [email protected], [email protected]

1Monash

2Arthritis

The Victorian Active Ageing Partnership (VAAP) aims to increase opportunities for participation in physical activity options for older Victorians, especially in areas of socio-economic disadvantage and among isolated, lonely older people currently not involved in physical activity. VAAP has recently conducted a review of the international literature identifying the features of programs, organisations, and organisational settings that act as barriers and facilitators to the engagement of older people in physical activity programs. This literature review has informed the development of an evidence-based best practice framework to guide organisations and the workforce on how to engage and maintain participation of older people in physical activity. JAPA Vol. 24, Suppl., 2016

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This practical, interactive, and developmental symposium will explore how evidence has informed a guide for practice in real-world settings in order to promote and support older people to increase and/or maintain participation in physical activity. The importance of collaborative translation processes, including service providers and policy makers, will be highlighted. Participants will also have an opportunity to use the framework to: (1) review and identify ways to strengthen an existing physical activity program and (2) identify key elements for a ‘self-administered’ organisational audit checklist and the appropriate steps in promoting the development and uptake of such an audit process. Participants will also have the opportunity to share their own experience and learnings as part of this interactive discussion. Environmental Factors Associated with Older Adults’ Active Living: Towards Evidence-Based Policies for Ageing in Place Sugiyama, T1*; Cole, R2; Liao, Y3; van Cauwenberg, J4; Owen, N5** Catholic University, Melbourne, Australia; [email protected] of Sunshine Coast, Sippy Downs, Australia; [email protected] 3National Taiwan Normal University, Taipei, Taiwan; [email protected] 4Ghent University, Ghent, Belgium; [email protected] 5Baker IDI Heart & Diabetes Institute, Melbourne, Australia; [email protected] *Chair, **Discussant 1Australian 2University

Purpose and Goals: A recent report by WHO (2015) emphasised the importance of “ageing in place” as a key policy objective for healthy ageing. As older adults’ daily behaviours can be constrained by contextual factors due to declining physical function, the local environment where they reside is important to help them to remain active and to age in place. Research needs to identify specific environmental factors that encourage older adults’ active living to inform planning and housing policies for achieving ageing in place. This symposium, consisting of four presentations from three research groups in three different countries, will discuss neighbourhood environmental attributes relevant to different aspects of active living. Its goals are to share findings of recent research from environmentally- and culturally-diverse settings and discuss the future research agenda to better inform ageing in place. Content: The presentations in this symposium will address novel aspects of older adults’ active living. Cole et al. will examine differential associations between Walk Score and older adults’ walking by different age groups. Yung et al will identify neighbourhood environmental attributes associated with walking for specific purposes in Japan. Sugiyama et al. will report on environmental attributes (destinations and routes) that might contribute to older adults’ walking maintenance. Van Cauwenberg et al. will explore environmental factors that encourage or deter cycling among Belgian older adults. Implications: Overall, the studies in this symposium will address the relevance of neighbourhood environments for older adults’ active living, and provide more specific evidence on the attributes of neighbourhood environments that can facilitate active living behaviours. The participants will collectively build a case, based on their findings, that older adults living in neighbourhoods with more local destinations and well-connected streets are more likely to walk and to maintain walking. For cycling, attributes of routes (traffic safety, road design, connectivity) seem more relevant. This suggests that building or renovating older adults’ housing in such neighbourhoods may assist older residents to age in place. Discussion will identify key future topics to develop evidence-based policies for ageing in place. Reference: World Health Organization. (2015). World Report on Ageing and Health. Geneva, Switzerland: WHO. Age-Specific Associations of Walk Score with Older Australian Adults’ Home-Based Walking Cole, R1; Hunter, I2; Dunn, P1; Owen, N3; Sugiyama, T4 of Sunshine Coast, Sippy Downs, Australia; [email protected], [email protected] Department of Health, Robina, Australia; [email protected] 3Baker IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected] 4Australian Catholic University, Melbourne, Australia; [email protected] 1University

2Queensland

Introduction: Accessibility to local destinations has been consistently shown to be associated with adults walking. However, less is known about how the availability of local destinations is related to walking by older adults. Walk score is a publicly-available measure of local walkability, determined by the availability of and distance to local destinations. We examined associations of walk score with home-based walking in three older adult age groups: 60 to 64, 65 to 71, and 72 to 84 years. Methods: Data were collected from 5,305 participants aged 60–84 years in the 2009 South East Queensland Household Travel Survey, who reported trips using a 24-hr travel diary. Home-based walking was defined as a walking trip at least five minutes in duration that commenced or ended at home. Walk score was identified for each statistical area in which the participant’s residential address was located. Multilevel logistic regression models examined associations of walk score with home-based walking for each of the three age groups, adjusting for sociodemographic variables and correcting for spatial clustering. Results: On the survey day, 72% of participants reported making a trip of any type and 9.4% reported making a home-based walking trip. Walk score distributions for areas of residence were very walkable (15%), somewhat walkable (34%), car dependent (36%), and very car-dependent ( 15%). For the younger two groups (60–64 and 65–71 years), those living in car-dependent and very car-dependent areas had significantly lower odds of doing home-based walking trips, relative to very walkable areas (OR = 0.49 and 0.39 for 60–64 years, and OR = 0.44 and 0.29 for 65–71 years, respectively). However, for the oldest group (72–84 years), living in somewhat walkable areas was associated with lower odds of walking (OR = 0.44 for somewhat walkable areas, 0.36 for car-dependent areas, and 0.23 for very car-dependent areas). Conclusion: Walk score was generally associated with older adults walking. However, the ‘somewhat’ walkable areas may not be supportive enough for very old adults. Neighbourhoods with more destinations nearby may be important to facilitate older adults’ maintenance of walking and their functional independence. Neighborhood Built Environment and Walking for Specific Purposes Among Japanese Seniors Liao, Yung1,2; Shibata, Ai2,3; Ishii, Kaori2; Oka, Koichiro2 1Department

of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; [email protected] JAPA Vol. 24, Suppl., 2016

Thursday 30th June   S53 2Faculty 3Faculty

of Sport Sciences, Waseda University, Saitama, Japan; [email protected], [email protected] of Health and Sport Sciences, University of Tsukuba, Tokyo, Japan; [email protected]

Introduction: Walking is a specific form of physical activity behavior with known health benefits that could be engaged in easily in daily life (Nelson et al., 2007; Lee & Buchner, 2008). It remains unclear how neighborhood built environments may play important roles in seniors’ walking for different purposes. Thus, this study aimed to examine cross-sectional associations of neighborhood built environments with walking for purposes among Japanese seniors. Methods: Data were collected using a postal survey of 760 Japanese seniors aged 50–69 years in 2010. Adjusted binary logistic regression was used to examine associations of geographic information systems (GIS)-derived built environment attributes (population density, access to destinations, access to public transportation, sidewalk length, and street connectivity) with self-reported walking for purposes (commuting, daily errand, exercise, walking during work). Results: After adjusting for potential confounders, all five GIS-measured attributes were positively associated with walking for commuting. GIS-measured higher population density, better access to destinations, and higher street connectivity were associated with walking for daily errands. No attributes of the neighborhood built environment were associated with walking during work and walking for exercise. Conclusion: Specific attributes of neighborhood built environments should be considered for promoting walking for commuting and daily errands among seniors. Further research using longitudinal design to identify attributes of the neighborhood built environment that influences different purposes of walking among seniors are warranted. References: Nelson, M.E., Rejeski, W.J., Blair, S.N., Duncan, P.W., Judge, J.O., King, A.C., Macera, C.A., Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc, 39(8):1435–1445. Lee, I.M., Buchner, D.M. (2008). The importance of walking to public health. Med Sci Sports Exerc, 40(7):S512–S518. Destination/Route Attributes and Middle- to Older-Aged Adults’ Maintenance of Walking Sugiyama, T1; Mridha, M2; Koohsari, MJ3; Cerin, E4; Owen, N3 Catholic University, Melbourne, Australia; [email protected] University of Technology, Melbourne, Australia; [email protected] 3Baker IDI Heart & Diabetes Institute, Melbourne, Australia; [email protected], [email protected] 4Australian Catholic University, Melbourne, Australia; [email protected] 1Australian

2Swinburne

Introduction: The ability to walk outdoors is fundamental to many aspects of daily living. This ability can decline as people age, but decline can be ameliorated by habitual walking. This study examined how environmental factors—attributes of local destinations and routes—were associated with middle- to older-aged adults’ maintenance of walking for transport (WT) and for recreation (WR). Methods: Participants were 454 adults aged 50–65 years living in Adelaide, Australia. Their walking maintenance was identified through self-reported walking frequency at baseline (2003–2004) and follow-up (2007–2008). Of the 304 participants who walked 2+days/week for transport at baseline, 248 maintained this frequency at follow-up. Of the 314 who walked 1+day/week for recreation at baseline, 237 maintained this frequency at follow-up. Participants were categorised into those who can reach half of the 14 utilitarian destination types and half of the four recreational destination types within 10 min, 11–20 min, and over 21 min by walking (self-report). The two route-related attributes considered were perceived street connectivity and access to walking paths. We examined associations of walking maintenance with the availability of these destinations and route attributes. Results: Maintenance of WT was associated with having more than half of the utilitarian destination types within 10 min of walking (reference: having them beyond 21 min) and higher street connectivity (reference: lower street connectivity). Access to recreational destinations and to walking paths were not related to maintenance of WT. Maintenance of WR was associated with having more than half of recreational destination types within 11–20 min of walking (reference: having them beyond 21 min) and better access to walking paths (reference: poor access to walking paths). Access to utilitarian destinations and street connectivity were not related to maintenance of WR. Conclusion: Having more shops and services nearby (within 10 min of walking) and parks and other recreational destinations in immediate outer areas (11–20 min of walking) seem to be conducive to walking maintenance. A well-connected street network and better access to walking paths also seem to facilitate walking maintenance. Reference: Sugiyama, T., et al. (2012). Destination and route attributes associated with adults’ walking: A review. Med Sci Sports Exerc, 44, 1275–1286. Physical Environmental Influences on Older Adults’ Transportation Cycling Experiences: A Study Using Bike-Along Interviews Van Cauwenberg, Jelle1,2,3; Clarys, Peter2; De Bourdeaudhuij, Ilse4; Ghekiere, Ariane1,2,3; de Geus, Bas5; Owen, Neville6; Deforche, Benedicte1,2 1Department

of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium of Movement and Sports Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium 3Fund for Scientific Research Flanders (FWO), Brussels, Belgium 4Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium 5Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium 6Baker IDI Heart and Diabetes Institute, The University of Queensland, Melbourne University and Monash University, Melbourne, Australia 2Department

Background: Walking and cycling for transport offer opportunities to integrate physical activity into the daily lives of older adults. While walking is a more accessible form of transport, cycling enables greater distances to be covered, increasing older adults’ mobility and action radius. To promote cycling for transport among older adults, physical environments that are supportive for cycling should be provided. However, knowledge about the physical environmental factors influencing older adults’ cycling for transport is limited. The current study used bike-along interviews to obtain in-depth and context-sensitive information about the physical environmental factors that may influence older adults’ cycling for transport. Methods: Purposeful convenience sampling was used to recruit 40 older adults in Flanders, Belgium. The researchers and participants cycled to and back from a destination in the participant’s neighbourhood. During this cycle trip, participants were asked to describe all environmental factors influencing their cycling for JAPA Vol. 24, Suppl., 2016

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transport. The cycle trip was also videotaped to further discuss the encountered environmental factors on arrival at the participant’s home. Inductive content analysis was used to analyse the qualitative data. Results: A model including seven environmental themes emerged from the content analysis: traffic safety, cycling infrastructure, road design, connectivity, aesthetics, hilliness, and weather. Traffic safety appeared to be the participants’ most important concern. Participants felt safer when cycling tracks were well-separated from motorized traffic and when clearly-demarcated crossings were present. Additionally, cycling tracks should be wide, obstacle-free, even, and well-separated from the sidewalk. They expressed preferences for a wellconnected street network since it provided them with different alternative routes to reach their destination. Conclusion: Our findings suggest that traffic safety has a major influence on older adults’ transportation cycling experiences. Consequently, the provision of a well-separated cycling space may be crucial to stimulate older adults’ transportation cycling. Further quantitative (preferably experimental) research is needed to examine the mechanisms proposed in our inductively-derived model. Neighbourhood Environments and Active Ageing: A Sampler of Research Across the Globe Using Different Methods Cerin, Ester1,2,3; Barnett, David1; Barnett, Anthony1; Van Cauwenberg, Jelle4,5,6; Merom, Dafna7 of Health and Ageing, Australian Catholic University, Melbourne, Australia; [email protected], [email protected] University of Hong Kong, Hong Kong, China; [email protected] 3Deakin University, Burwood, Australia 4Ghent University, Ghent, Belgium; [email protected] 5Vrije Universiteit Brussel, Brussel, Belgium 6Research Foundation - Flanders (FWO), Brussel, Belgium 7Western Sydney University, Sydney, Australia; [email protected]

1Institute 2The

Socio-ecological models posit that the neighbourhood environment is an important contributor to residents’ physical activity (PA). This is especially the case for older adults, who are the population segment most vulnerable to environmental challenges. In the last decade, the evidence on aspects of the neighbourhood environment influencing older adults’ PA has been rapidly growing. To draw robust conclusions from such research, data need to be collected and compared across various cultures and geographical locations, and using a variety of research methods and study designs. This symposium will provide an overview of studies that examined the role of the neighbourhood environment in supporting active ageing in diverse cultures and geographical contexts using various methods of investigation spanning from a critical synthesis of the extant literature to well-controlled experimental work. The objectives of this symposium are to: (1) present findings from studies that examined neighbourhood environmental correlates of older adults’ PA in different countries; (2) provide an overview of different study designs and data collection methods in this research field; (3) discuss differences in results between geographical locations and research methods; and (4) discuss implications for future research and translation of findings into practice. This symposium will consist of four presentations and an interactive panel discussion with critical input from the audience. The first speaker (David Barnett) will summarize the findings of a systematic review of studies examining neighbourhood environmental correlates of PA and walking in older adults across the globe. This will be followed by the presentation of findings from an ongoing epidemiological study on Hong Kong Chinese older adults (Anthony Barnett) investigating perceived environmental correlates of non-walking PA, within-neighbourhood walking for transport, and within-neighbourhood walking recreation, and how these differ by chronic disease status. The third presenter (Dafna Merom) will report findings from a randomized control trial on perceived neighbourhood environmental characteristics as moderators of the effectiveness of a walking intervention in sample of Australian older adults. The fourth and final presentation (Jelle Van Cauwenberg) will report on an experimental study investigating the effects of manipulating photographs on micro-scale environmental factors on a street’s appeal for Belgian older adults’ transportation walking. (Presentation abstracts follow.) Built Environmental Correlates of Older Adults’ Overall Physical Activity: An Updated Systematic Review (Presentation 1) Barnett, David1,2; Van Cauwenberg, Jelle3,4; Nathan, Andrea5; Cerin, Ester1,2,6 1Deakin

University, Melbourne, Australia Catholic University, Melbourne, Australia 3Ghent University, Ghent, Belgium 4Vrije Universiteit Brussel, Brussels, Belgium 5Queensland University of Technology, Brisbane, Australia 6The University of Hong Kong, Hong Kong, China 2Australian

Physical activity (PA) is important for healthy ageing. PA is likely influenced by environmental factors. Numerous studies on built environment correlates of older adults’ (OAs) PA in different countries have been conducted since 2010 (most recent systematic review). An updated systematic review of built environmental correlates of OAs’ PA was conducted following PRISMA guidelines and searching for articles in English published from March 2010 to July 2015. Search terms were related to built environmental correlates and overall PA. Sixty-two articles met inclusion criteria. Significant associations were reported. The most influential correlates (positive vs. nil vs. negative results) were: walkability (positive = 9; nil = 12; negative = 1), crime-related safety (positive = 9; nil = 23; negative = 3), access to recreational facilities (positive = 6; nil = 15; negative = 0), and access to amenities/ services (positive = 6; nil = 16; negative = 1). Results suggest that better environmental walkability, safety from crime, and access to amenities/services and recreational facilities may increase OAs’ overall PA. Associations Between the Neighbourhood Environment Characteristics and Physical Activity in Hong Kong Chinese Older Adults with Specific Types of Chronic Disease States (Presentation 2) Barnett, Anthony1; Cerin, Ester1,2,3; Zhang, Casper JP1; Sit, Cindy HP4; Cheung, Martin MC5; Lee, Ruby SY5 1Australian

Catholic University, Melbourne, Australia JAPA Vol. 24, Suppl., 2016

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University of Hong Kong, Hong Kong, China University, Burwood, Australia 4The Chinese University of Hong Kong, Hong Kong, China 5Elderly Health Service, Department of Health, The Government of Hong Kong SAR, Hong Kong, China 3Deakin

Older adults with chronic disease states are less active and possibly more affected by environmental factors than their peers. Understanding neighbourhood barriers and facilitators to physical activity (PA) in this population is currently lacking. Associations between the neighbourhood environment and PA in older adults with and without visual impairment, hearing impairment, musculoskeletal disease, and/or genitourinary disease were assessed. Data were collected in Hong Kong older adults (N = 909) from neighbourhoods stratified by walkability and socioeconomic status. Regression models examined associations of perceived neighbourhood environment characteristics, and moderating effects of having specific chronic diseases, with PA outcomes. Thirteen perceived neighbourhood characteristics were associated with older adults’ PA in the expected direction, irrespective of their health condition. Nine had associations with PA dependent on disease states, typically stronger in participants with a specific chronic disease. Maximizing potential for PA in older adults with chronic diseases requires neighbourhood characteristics specific to these groups. The Performance of Walking Interventions by Older Adults’ Perception of Walkability and Fall-Related Risk Factors: The Results of the “EasyStep-to Health” Randomized Controlled Trial (Presentation 3) Merom, Dafna1; Gebel, Klaus2; Fahey, Paul1; Astel-Burt, Thomas1; Voukelatos, Alexander3; Rissel, Chris4; Sherrington, Catherine4 1Western

Sydney University, Sydney, Australia Cook University, Cairns, Australia 3Health Promotion Unit, Sydney, Australia 4University of Sydney, Sydney, Australia 2James

In older adults, the relationships between perceived neighborhood walkability, walking behavior, and fall-related risk factors are poorly understood. We report on a randomized controlled trial on walking and falls involving 315 community-dwelling inactive adults ≥ 65 years from Sydney. Measures were mobility status, fall history, injurious fall, fear of falling, health status, walking self-efficacy, perceived neighborhood environment, and planned walking ≥ 150 min/week at 12 months. Participants with poorer mobility, fear of falling, and poor health perceived their surroundings as less walkable, but these factors did not prevent increases in walking. Walking at 12 months was significantly greater in “less greenery” (AOR = 3.3, 95%CI: 1.11–9.98) and “high traffic” (AOR = 1.98, 95%CI: 1.00–3.91) neighborhoods, and lower in unsafe neighborhoods. The intervention had greater effects in neighborhoods perceived to have poorer pedestrian infrastructure. There appears to be a greater impact of and need for interventions to encourage walking in environments perceived not to have supportive walking infrastructure. Street Characteristics Preferred for Transportation Walking Among Older Adults: A Choice-Based Conjoint Analysis with Manipulated Photographs (Presentation 4) Van Cauwenberg, Jelle1,2,3; De Bourdeaudhuij, Ilse4; Clarys, Peter2; Nasar, Jack5; Salmon, Jo6; Goubert, Liesbet7; Deforche, Benedicte1,2 1Department

of Public Health, Ghent University, Ghent, Belgium of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium 3Research Foundation - Flanders (FWO), Brussels, Belgium 4Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium 5City and Regional Planning, The Ohio State University, Columbus, OH, USA 6School of Exercise & Nutrition Sciences, Deakin University, Burwood, Victoria, Australia 7Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium 2Department

We investigated the effects of manipulating photographs on micro-scale environmental factors on street appeal for older adults’ transportation walking. Additionally, we aimed to identify subgroups with different environmental preferences for transportation walking. Flemish older adults (n = 1,131) completed a questionnaire including a choice-based conjoint exercise with photographs of a street that was manipulated on nine environmental attributes. In the total sample, sidewalk evenness had by far the greatest appeal for transportation walking. In the two largest subgroups (86% of the sample), sidewalk evenness was the most important environmental attribute. In the two smaller subgroups, traffic volume and speed limit were the most important environmental attributes for one, and the presence of vegetation and a bench for the other. Providing even sidewalks should be a priority in environmental interventions targeting older adults’ transportation walking. Natural experiments are needed to confirm whether our findings generalize to real environments and actual transportation walking. Sedentary Behaviour in Older Men and Women: New Insights and Future Directions Dogra, Shilpa1; Copeland, Jennifer2; Chastin, Sebastien3; Owen, Neville4 of Ontario Institute of Technology, Ontario, Canada; [email protected] of Lethbridge, Alberta, Canada; [email protected] 3University of Glasgow-Caledonia, Glasgow, Scotland; [email protected] 4Baker IDI, Melbourne, Australia; [email protected]

1University 2University

Purpose and Goals: The proposed symposium is intended to provide an update on the most current research available on the topic of sedentary behavior among older men and women. Four speakers will present research findings from their research groups to address age and gender differences, determinants JAPA Vol. 24, Suppl., 2016

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of prolonged sitting, sedentary behavior interventions, and knowledge translation needs. Each of the speakers will be given 18 minutes to present their data, and the remaining 18 minutes will be used for questions and discussion with the audience. Content: Dr. Dogra will do a brief introduction of the speakers and set the stage for the symposium. The order of presentations will be as follows: (1) Dr. Jennifer Copeland; (2) Dr. Sebastien Chastin; (3) Dr. Neville Owen; and (4) Dr. Shilpa Dogra. Each speaker will address new insights and future directions. Of note, the speakers come from three different countries. While they have collaborated on research projects, they also have original data from their own laboratories to present, thus, overlap in content is expected to be minimal. Implications: The symposium will set the stage for a working meeting taking place at the University City Campus on Saturday, July 2. Thus, all researchers, trainees, and knowledge users invited to the working meeting will attend the symposium. Sponsors: Funding for this symposium was provided by the Canadian Institute for Health Research, The Canadian Society for Exercise Physiology, and the Canadian Centre for Active Aging. Consequences of Sedentary Behavior: Do Age and Gender Matter? Copeland, Jennifer University of Lethbridge, Lethbridge, Canada; [email protected] Introduction: Accumulating evidence suggests that prolonged periods of sedentary behaviour are detrimental to the longevity of older adults and may accelerate age-related declines in health and wellbeing. Among older adults, there are known age and gender differences in the risk for developing certain chronic conditions, functional disability, and dependence. What is less clear is whether there are differences between men and women or across ages in the association between sedentary behaviour and health outcomes. Methods: The results of a recently conducted systematic review were used to examine the range of health consequences associated with sedentary behaviour in adults ≥ 60 years. As part of the review process, studies that analyzed age and gender differences were identified, and key findings will be presented. Results: While many of the health outcomes that are influenced by sedentary behaviour in older men and women are similar to those identified for middle-aged and even younger adults, others, such as mortality, loss of physical function, and dependence, are risks that are more specific to an older population. Prolonged and unbroken sedentary time appears to be inversely associated with cardiometabolic health and functional capacity among older adults. Furthermore, studies have identified a stronger relationship between sedentary time, disability, and physical wellbeing among women and the oldest-old compared to men or the younger-old. This finding may be a result of the higher risk for loss of strength and function among women and older individuals. It may also be that the very low levels of physical activity in these subgroups makes them particularly vulnerable to the detrimental effects of sedentary behaviours. The interaction of age and gender as well as the interaction of high sedentary time and low MVPA requires further research, both observational and experimental. Conclusions: Sedentary behaviour may pose a unique problem for older adults by increasing the risk for disability in activities of daily living that ultimately leads to dependence. Strategies to reduce sedentary behaviour in older populations are needed, and limited evidence suggests that women and the oldest-old may be a particularly important target for behavioural interventions that focus on reducing sedentary time. References: Dunlop, D., Song, J., Arntson, E.K., Semanik, P.A., Lee, J., Chang, R.W., & Hootman, J.M. (2015). Sedentary time in U.S. older adults associated with disability in activities of daily living independent of physical activity. J Phys Act Health 12(1):93–101. Gennuso, K.P., Gangnon, R.E., Matthews, C.E., Thraen-Borowski, K.M. & Colbert, L.H. (2013). Sedentary behavior, physical activity, and markers of health in older adults. Med Sci Sports Exerc, 45(8):1493–1500. Martínez-Gómez, D., GuallarCastillón, P., León-Munoz, L.M. & Rodríguez-Artalejo, F. (2014). Household physical activity and mortality in older adults: A national cohort study in Spain. Prev Med, 61:14–19. Context and Determinants of Sedentary Behaviour in Older Adults: State of Evidence, Research Priorities, and System-Based Approach Chastin, Sebastien Institute for Applied Health Research, Glasgow Caledonian University, Scotland, UK; [email protected] Introduction: Older adults are the most sedentary segment of society. It is important to understand the context and determinants of sedentary behaviour in older adults to develop effective interventions to reduce sedentary time in this diverse population. Methods: The European Joint Programme Initiative on Determinants of Diet and Physical Activity (DEDIPAC), which regrouped 46 consortia, research institutes, and groups from 12 EU Member States, conducted systematic reviews and an international consensus process based on concept mapping (hosted as part of ISBNPA 2015) to establish the current evidence base, develop a system-based framework, and set research priorities (Lakerveld et al., 2014). Results: Systematic reviews reveal that 22 studies investigated determinants of sedentary behaviour in older adults (Chastin et al., 2015). Personal factors were the most frequently investigated, with consistent positive associations for age, and negative for retirement, obesity, and health status. Few studies investigated environmental determinants, mediating factors, or more macroscopic factors such as the economy. The consensus process produced a system-based framework made of six interacting clusters of factors influencing sedentary behavior: (1) health and wellbeing, (2) social and cultural context, (3) behaviour and psychology, (4) built and natural environment, (5) institutional and home setting, and (6) politics and economy (Chastin et al., 2016). Cluster 5 ranked highest on research priority. Based on modifiability and potential population scale effect size, the interaction between an individual’s health, the health system, the cultural and social context they live in, the settings of their home and institutions they interact with, the built environment surrounding them, and the economy were deemed as the most important ways to tackle sedentary behaviour in older adults. Conclusions: Current evidence on the context and determinants of sedentary behaviour in older adults is sparse. Future research needs to engage with the complexity of factors influencing sedentary time in older adults and focus on understanding more the role played by the environment, institutional and home settings, social context, and the economy. References: Chastin, S., Craemer, M. Lien, N., Bernaards, C., Buck, C., Oppert, J.-M., … Cardon, G. (2016). The SOS-framework (systems of sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC study. IJBNPA, Submitted. Chastin, S.F.M., Buck, C., Freiberger, E., Murphy, M., Brug, J., Cardon, G., … Oppert, J.-M. (2015). Systematic literature review of determinants of sedentary behaviour in older adults: a DEDIPAC study. The International Journal of Behavioral Nutrition and Physical Activity, 12, 127–138. Lakerveld, J., van der Ploeg, H.P., Kroeze, W., Ahrens, W., Allais, O., Andersen, L.F., … Brug, J. (2014). Towards the integration and development of a cross-European research network and infrastructure: the DEterminants of DIet and Physical ACtivity (DEDIPAC) Knowledge Hub. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 143. JAPA Vol. 24, Suppl., 2016

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Influencing Prolonged Sitting Time in Ageing Adults: Which Behaviours? What Interventions? Owen, Neville Baker IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected] Introduction: As evidence accumulates on the health, functional, and other consequences of too much sitting in middle-aged and older adults, there is the need to consider what might be the most helpful and realistic behavioural targets and alternatives to sitting time. Methods: This presentation will address observational study and experimental evidence on the likely benefits of reducing and breaking up sitting time, considering how such evidence can be relevant to changing sedentary behaviour in ageing adults, and what are likely to be the behavioural changes that are—based on recent evidence— most beneficial and feasible. Results: Observational study and experimental evidence now suggests that there will be benefits from both reducing and breaking up prolonged periods of sedentary time. The types of benefits that most usefully can be aimed for will be considered: reducing risk of major chronic diseases and their side effects, particularly in the case of diabetes; improving recovery from disease treatments and adverse events; and maintaining functional capacities and cognitive well-being. The types of sedentary behaviours that might most appropriately be targeted in ageing adults will also be considered, with reference to evidence on: (i) the ways in which sedentary time might best be reduced (increasing standing time, doing more light-intensity activities, identifying alternatives to screen-based recreation) and (ii) how prolonged periods of sitting might most usefully be broken up (simple brief interruptions to time spent sitting involving sit-to-stand transitions, short breaks from sitting time involving aerobic or resistance activities). Conclusion: How such initiatives might be pursued appropriately in different life settings will be considered: occupational and volunteering contexts, transport, the domestic setting, and community and neighbourhood environments. This approach to understanding and influencing older adults’ sedentary behaviour will be informed by the broad logic of the behavioural epidemiology framework. References: Kikuchi, H., Inoue, S., Sugiyama, T., Owen, N., Oka, K., Nakaya, T., Shimomitsu, T. (2014). Distinct associations of different sedentary behaviors with health-related attributes among older adults. Preventive Medicine, 67,335–9. Healy, G.N., Winkler, E.A.H., Owen, N., Anuradha, S., Dunstan, D.W. (2015). Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. European Heart Journal, 36(39):2643–2649. Sardinha, L.B., Santos, D.A., Silva, A.M., Baptista, F, Owen, N. (2014). Breaking-up sedentary time is associated with physical function in older adults. Journal of Gerontology, 70(1):119–124. Knowledge Translation: Understanding the Complete Picture for Public Health Approaches to Sedentary Time in Older Men and Women Dogra, Shilpa University of Ontario Institute of Technology, Ontario, Canada; [email protected] Introduction: There is a need for evidence-based recommendations that can effectively reduce sedentary time in older men and women. In addition to the health-related evidence, it is critical to consider the perspective of older adults to ensure that appropriate messages, tools, and interventions are designed to reduce sedentary time. Methods: Findings from a recently conducted systematic review will be used to identify recommendations and highlight gaps in the requisite evidence. Qualitative data will provide insights into the perceptions, promoters and barriers, and the perceived biopsychosocial outcomes related to sedentary time in older men and women. Population-level data and the processes required for creation of appropriately-targeted evidence-informed approaches in this context will also be presented. Results: While there is a range of evidence available on physical health outcomes of sedentary time, there is still a dearth of data available on the dose–response relationship and age and sex differences in these outcomes. Older men and women do not identify with the term ‘sedentary’, despite spending a large number of their waking hours in sedentary activities. However, some of those sedentary activities can be associated with positive psychosocial outcomes in older men and women. There are also intrinsic and extrinsic promoters of sedentary time in the household, leisure, transport, and occupation domains that will need to be targeted for sedentary time reduction. In order to ensure that future research addresses these translation-related issues, Dogra and colleagues are in the process of creating a consensus statement to identify research priorities for building a broader understanding of older adults’ sedentary habits, perceptions, and preferences. Challenges for integrating more nuanced sedentary time messages with physical activity messages for older adults are also considered. Conclusions: Evidence-informed tools and strategies that are specifically relevant to decreasing sedentary time in older men and women are needed. Knowledge translation tools are currently limited, due to the dearth of relevant evidence currently available. Thus research priorities should align with knowledge translation needs to ensure appropriate public health approaches. References: Mcewan, T., Tam-Seto, L., Dogra, S. Perceptions of sedentary behavior among socially engaged older adults. The Gerontologist. In press. O’Neil, C., Dogra, S. Different types of sedentary activities and their association with perceived health and wellness among middle-aged and older adults: a cross-sectional analysis. American Journal of Health Promotion. In press. Copeland, J.L., Clarke, J., Dogra, S. (2015). Objectively measured and self-reported sedentary time in older Canadians. Preventive Medicine Reports, 232(2):90–95. World of Wellness: Linking Care, Client, and Community in Aged Care Settings to Encourage Successful Active Ageing Barnard, Robert1; Naso, Frank2; Henwood, Tim3; Patchett, Allison4 for Physical Activity in Ageing & Active Ageing Australia, SA, Australia; [email protected] Society of St Hilarion, SA, Australia; [email protected] 3AgeFIT Solutions & The University of Queensland, QLD, Australia; [email protected] 4Uniting Age Well, Melbourne, VIC, Australia; [email protected]

1Centre 2The

“Exercise is Medicine” and “Active Ageing” are global concepts with the aim of providing all with a long life of active, independent, quality living. The 2015 Australian Active Ageing Conference in Sydney sent a clear message about the importance of these concepts by stating “No time to waste: providers need to embed wellness approaches now” (O’Keeffe, 2015). The evidence is clear regarding the multiple benefits of exercise and strength training. From cognitive function to falls prevention, physical exercise can aid in slowing down the ageing process. A recent study published in the Lancet stated that a number of lifestyle factors such as physical activity, diet, vascular risk factors, and brain training can help in slowing down the cognitive decline in older healthy individuals (Ngandu et al., 2015). Furthermore, it has been shown that strength training assisted in slowing down the shrinkage of white matter in brain tissue (Bolandzadeh et al., 2015). The inclusion and use of wellness centres in aged care facilities produces positive effects and has an impact on both residents and carers’ wellbeing and function. With such services now available in all settings—nursing homes, day therapy centres, and JAPA Vol. 24, Suppl., 2016

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retirement villages—people within a wide range of abilities can benefit from the concepts of active ageing. The processes of setting up and running a successful program require knowledge and collaboration from all parts of the care chain: managers with vision, wellness directors with knowledge, clinicians with skills, and all with a passion, mission, and belief. The panelists in this symposium will discuss the evidence and experiences outlining the benefits of implementing wellness and active ageing concepts in a number of organisations. The panelists will discuss the concept from the viewpoint of their expertise: the active ageing phenomenon (Barnard), the wellness concept (Naso), the benefits of strength training in older adults (Henwood), and the decision making and cost-benefit process (Patchett). References: O’Keeffe, D. (2015) No time to waste: providers need to embed wellness approaches now. Australian Ageing Agenda, Retrieved from http://www.australianageingagenda.com.au/2015/10/30/no-time-to-waste-providers-needto-embed-wellness-approaches-now/. Ngandu T., Lehtisalo J., Solomon A., Levälahti E., Ahtiluoto S., Antikainen R., . . . Kivipelto M. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet, 385(9984):2255–2263. Bolandzadeh, N., Tam, R., Handy T.C., Nagamatsu, L.S., Hsu, C.L., Davis, J.C., . . . Liu-Ambrose, T. (2015). Resistance training and white matter lesion progression in older women: exploratory analysis of a 12-month randomized controlled trial. J Am Geriatr Soc, 63(10):2052–2060. The St Hilarion Wellness Approach to Ageing Naso, Frank The Society of St Hilarion Adelaide, Australia; [email protected] Introduction: The purpose of the St Hilarion Wellness Centre is to break down the barriers between the community and the aged care sector by enabling independence of the residents including the suggestions of current literature (Bolandzadeh et al., 2015; Ngandu et al., 2015; O’Keeffe, 2015). The St Hilarion wellness program has a framework that focuses on: (1) the consumers’ capabilities, not deficits; (2) a shared understanding of the consumer’s day-to-day life, their current situation, and the future they desire; and (3) connecting the consumer with the community. This holistic model enables the consumers to continue to experience their chosen lifestyle regardless of their age, conditions, and living arrangements. Methods: In 2013, consumers and family members recognized the need for a holistic wellness model which caters to a diverse range of individuals. A collaborative working party between the consumer representatives and senior management was established to create a novel model of wellness and re-ablement by implementing the following: a wellness team consisting of allied health professionals and lifestyle assistants was established to create a wide range of leisure activities with a rehabilitative approach; The Helsinki University Research (HUR) gym equipment and program was installed to include physical activity and to monitor physical wellbeing; an organic market garden was established to provide organic meals to consumers; a positive psychology program was implemented for senior management, staff, and consumers, as well as family members. Results: The following outcomes were achieved: consumer’s lifestyle satisfaction survey improved from 64% to 98%; consumer challenging behaviours decreased by 89%; reportable staff injuries decreased by 81%; 15 consumers who were unable to bear weight are now mobilizing with assistance; 80 out of 120 consumers utilize the HUR gym equipment; an overall increase of 72% of total body strength was noted. Conclusion: By adopting a co-productive approach in the implementation of consumer wellness programs, the St Hilarion approach has demonstrated that it has the potential to be a blueprint for other aged care providers. By combining leisure activities into a rehabilitative context, a significant impact on consumer’s quality of life can be achieved. References: O’Keeffe, D. (2015). No time to waste: providers need to embed wellness approaches now. Australian Ageing Agenda, Retrieved from http://www.australianageingagenda.com. au/2015/10/30/no-time-to-waste-providers-need-to-embed-wellness-approaches-now/. Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., . . . Kivipelto, M. (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet, 385(9984):2255–2263. Bolandzadeh, N., Tam, R., Handy, T.C., Nagamatsu, L.S., Hsu, C.L., Davis, J.C., . . . Liu-Ambrose, T. (2015). Resistance training and white matter lesion progression in older women: exploratory analysis of a 12-month randomized controlled trial. J Am Geriatr Soc, 63(10):2052–2060. From Community to Aged Care: The Role of Resistance Training in Health and Wellness Henwood, Tim AgeFIT Solutions & The University of Queensland, Brisbane, Australia; [email protected] Evidence is strong that progressive resistance training (PRT) is a powerful tool in the battle against later life disability, and that with participation, older adults, independent of age or health, can prolong community-dwelling status and reduce disease symptoms. Yet even with a breadth of evidence, this potent modality of exercise remains underutilised as a model of care. In line with the “Exercise is Medicine” and “Active Ageing” movement and as guided by Australian aged care reform, “Living longer, living better”, efforts to increase participation and participation opportunity continues to grow through targeted research and direct translation to clinical, community, and care settings. The present talk will draw from a plethora of research across the ageing continuum that demonstrates the value of resistance training and weight bearing exercise. Prescription, delivery, barriers, and enablers will be discussed alongside building program sustainability, client, and organisation benefits (Commonwealth of Australia, 2012; Chodzko-Zajko et al., 2009). Evidence will be given across three settings. Among community-dwelling healthy older adults, data from a long-term, PRT, detraining, retaining study that compared strength and power exercise will be explored. Among community-dwelling adults with aged care needs, outcomes from a 16-week resistance and weight bearing exercise program will be given, as well as the program’s translation to the residential aged care setting explain. Also among the cohort of community-dwelling adults with aged care needs, an ongoing long-term PRT will be explored as a re-ablement service model of care, and preliminary results described. In the residential aged care setting, a long-term PRT program and a water-based program for individuals with dementia will be presented, outcomes discussed, and consideration in delivery in this environment detailed. For well and unwell older adults, PRT has significant benefits, however a number of considerations exist that must be addressed if individuals are to benefit. Equally important is that participation is followed by adherence, and that delivery is appropriate and individualised to participant needs. While complex, the growing memberships of those older than 65 years at exercise clinics and the aged care provider incorporation to a gym style environment are suggestive of an exciting paradigm shift towards this powerful modality of activity. References: Commonwealth of Australia. (2012). Living Longer, Living Better. Canberra: Commonwealth of Australia. Chodzko-Zajko, W.J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., & Skinner, J.S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 41(7):1510–1530. JAPA Vol. 24, Suppl., 2016

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World of Wellness: The Active Ageing Phenomenon—“Wellness” from a Context-Based Perspective Barnard, Robert Centre for Physical Activity in Ageing, Department of Health and Ageing, South Australia; and Active Ageing Australia, South Australia, Australia; [email protected] Introduction: The rapid shift in the community and by aged care service providers to adopt approaches to wellness is now demonstrated by the prominence of both its mention and presence within program and service offerings. This change is linked to the rise of awareness and desire to achieve wellbeing at the individual level and the stimulus of the MyAgedCare (Australian Government, 2016) program. This presentation provides information from a survey of South Australian organizations with specific emphasis on wellness and Active Ageing options for older adults. Further evidence is provided of possible outcomes following physical activity interventions from Centre for Physical Activity in Ageing (CPAA) data. Model physical activity program options are provided by Active Ageing Australia (AAA, 2016). Methods: The survey consisted of: identification of included organizations (based on organization characteristics, age group criteria), the presence of wellness descriptors in organizational information, the nature of wellness offerings (program/activities), and evidence of wellness program outcomes. Information was collated into a table format for comparison. Evidence was gathered from the CPAA rehabilitation database (9,868 individual client cases). Model programs were provided from the AAA website and annual report. Results: Eight NGO aged care organizations and five LG councils were included/surveyed. While all eight aged care organizations mentioned wellness and/ or wellbeing and provided programs, there was a significant difference between those organizations with broadest programs compared to those who appear to have maintained a traditional service model. All councils had some mention of wellness/wellbeing, including links to further information, and provided a range of associated services; however, there was difficulty in accessing information in most cases. The physical benefits expected from participating in exercise have been widely demonstrated by CPAA client pre–post outcome measures. AAA program models exist widely across aged care and community settings. Conclusion: While opportunities for older adults to access wellness programs are widely available across SA, significant differences in offerings suggest that there may be a need to consider the authenticity (Landry, 2015) and outcomes of these programs. Physical activity offers an easily provided and positive contribution towards wellness, and Australia continues to play a leading role in the development of such programs. References: Australian Government: Department of Social Services. (2016). My Aged Care. Available from https://www.dss.gov.au/our-responsibilities/ ageing-and-aged-care/programs-services/my-aged-care. Active Ageing Australia. (2016). www.activeageing.org.au. Landry, R. (2014). Live Long, Die Short: A Guide to Authentic Health and Successful Aging. Austin, TX: Greenleaf Book Group Press. Care, Client, and Community in Aged Care—Why Invest in Active Ageing? Patchett, Allison Uniting Age Well, Melbourne, VIC, Australia; [email protected] Strong evidence of the multiple benefits of exercise and strength training exists. From quality of life to cognitive function and falls prevention, physical exercise can assist in slowing down the ageing process. A number of lifestyle factors such as physical activity, diet, vascular risk factors, and brain training can help in slowing down the cognitive decline in older healthy individuals (Ngandu et al., 2015). The increased number of clients with dementia can be a burden to aged care, therefore it is of interest to encourage active living even in the older frail person. The inclusion of wellness centres in all aged care facilities, nursing homes, day therapy centres, and retirement villages has a positive impact for both residents and carers’ wellbeing and functions. The processes of setting up and running a successful program requires knowledge and collaboration with a strong vision from a management perspective. Uniting AgeWell, a non-for-profit aged care provider in Victoria and Tasmania, has taken a strong active ageing approach. With two installed and fully-functional gyms for both residential and community clients, and more planned, the results show that the investment has been worthwhile financially and ethically. The participants have reported a positive impact on health and wellbeing. All participants state that their strength and fitness had improved since using the HUR gym and the majority also reported that it was easier to perform tasks around the home. The participants reported increased energy levels. Since opening the gym in July 2015, Uniting AgeWell has built a steady client base of 175 clients from the community, with the addition of residential clients also attending. This number, with the interests shown by many in the community, will continue to grow and has brought revenue of $25K to date. The inclusion of active ageing and wellness in the business vision is one of investment in health, independence, wellness, and quality of life. Whilst government support allows for funding on some aspects of care and entrepreneurship to others, it is of interest for all, both staff and clients, to invest in wellness. References: Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., . . ., Kivipelto, M. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet, 385(9984):2255–2263.

Oral Presentations Medical Students’ Perceptions of the Importance of Exercise and their Perceived Competency in Prescribing Exercise Jadczak, Agathe Daria1; Tam, Khai Loon1,2; Yu, Solomon1,2; Visvanathan, Renuka1,2 1Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia; [email protected], [email protected], [email protected] 2Aged

and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia; [email protected]

Introduction: Exercise is beneficial in the prevention of frailty. Medical practitioners have the potential to increase older peoples’ participation in exercise by providing advice or prescribing exercise. Physicians however commonly cite a lack of education as a barrier, but yet there has been little research on how best to address this. The aim of this study was to evaluate the effects of a 4.5-week geriatric medicine course on fifth year medical students’ perceptions of the importance of exercise and their perceived competency in prescribing exercise. Methods: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered at the beginning and end of the course. Scores ranged from 0 (not important or competent) to 4 (important or competent) and 6 (very important or competent). One open-ended question about perceived barriers to exercise prescription was also added. Paired t-test JAPA Vol. 24, Suppl., 2016

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was used to determine change. Data is presented as mean ± standard deviation. Results: 81 students (43 female, 38 male; mean age 23.4 ± 1.5 years) participated. Students’ perceptions of the importance of designing an exercise prescription (4.44 ± 1.29 to 4.76 ± 1.27; P = .038), determining the training heart rate (3.95 ± 1.14 to 4.28 ± 1.04; P = .021), calculating the body mass index (4.74 ± 1.03 to 5.33 ± 0.74; P < .001), referring an older person to an exercise program (4.99 ± 1.01 to 5.33 ± 0.73; P = .001), and identifying age-related limitations (5.05 ± 0.90 to 5.26 ± 0.74; P = .029) improved. Students’ self-perceived competency in prescribing exercise improved significantly across all ten items (P > .001). Post-course scores ranged from 3.27 ± 1.18 to 5.49 ± 0.73 compared to between ± 0.95 and 4.48 ± 0.96 pre-course. Barriers to exercise prescription included lack of knowledge (58.0 %), lack of patient compliance (34.6%), and lack of time (33.3%). Conclusion: We have demonstrated for the first time that a geriatric medicine course for senior medical students contributes to improved student perception of the importance of exercise as well as their perceived competency in prescribing exercise. Nevertheless, there are opportunities for further gains, especially with respect to self-perceived competency scores that will be investigated following course improvement. Post Diagnosis Physical Activity Engagement in Prostate Cancer Survivors: Perceived Motives, Benefits, and Barriers for Physical Activity Patel, Asmita1,2; Schofield, Grant1; Keogh, Justin3 University of Technology, Auckland, New Zealand; [email protected], [email protected] Zealand College of Chinese Medicine, Auckland, New Zealand 3Bond University, Gold Coast, Australia; [email protected] 1Auckland

2New

Introduction: Regular physical activity can result in a number of health-related benefits for prostate cancer patients and survivors (Antonelli et al., 2009). Regular physical activity can also help reduce some of the negative side effects related to androgen deprivation treatment (ADT). The aim of this study was to identify perceived motives, benefits, and barriers for physical activity in prostate cancer survivors. Methods: Sixteen prostate cancer survivors from the Auckland region of New Zealand were individually interviewed. Participants ranged in age from 57 to 88 years of age (71.3 ± 7.4 years). Time since diagnosis ranged from one year to 17 years (6.5 ± 5.6 years). Six men were currently on ADT treatment. Time on ADT treatment ranged between one and 17 years (5.3 ± 5.8 years). The remaining 10 men were in complete remission and were treatment free. Interviews were audio-taped and transcribed. Data were analysed using an inductive thematic approach. Results: Four main themes were identified regarding perceived motives for physical activity post diagnosis: (1) health-related reasons, (2) stress management, (3) social reasons, and (4) past history of physical activity. Three main themes were identified relating to perceived benefits for physical activity post diagnosis: (1) health-related benefits, (2) psychological benefits, and (3) cognitive benefits. Four main themes were identified relating to perceived barriers for physical activity post diagnosis: (1) incontinence and bowel issues, (2) pre-existing chronic health conditions, (3) lack of time, and (4) age-related decline. Conclusion: These findings indicate that some prostate cancer survivors are engaging in regular physical activity for physical health-related benefits, as well as for psychological benefits. If more men with prostate cancer are to benefit from being physically active, alterations in usual care practices and support services may be needed to offset some of their primary barriers and to maximise their motives for physical activity. References: Antonelli, J., Freedland, S.J., & Jones, L.W. (2009). Exercise therapy across the prostate cancer continuum. Prostate Cancer and Prostatic Diseases, 12, 110–115. Influence of Poverty on Mobility and Fall Risks in Older Adults Wollesen, Bettina; Bischoff, Laura; Mattes, Klaus University of Hamburg, Hamburg, Germany; [email protected], [email protected], [email protected] Introduction: Socioeconomic inequalities are associated with reduced health and increasing morbidity with increasing age. There is evidence that a lower income might provoke frailty, morbidity, and institutionalization (Huisman et al., 2013). Moreover, social and economic factors are a risk factor for falls, especially in developing countries (Williams et al., 2015). The present study analyzes whether health characteristics of elderly persons differ due to their income situation in a comparatively wealthy neighborhood. Methods: N = 323 elderly adults were included in a quantitative survey (e.g., SF36, Barthel index, IADLs, general depression scale, fall risk assessment). The analysis considered household, age, gender, and income situation. Age, gender, and socioeconomic influences on falls, morbidity, and mobility were examined by chi2-tests and multifactorial analysis of variance (e.g., gender × factor; status × factor) with IBM SPSS. Results: There were higher values of diseases for lower income than for higher income groups (F[316] = 2.971; p = .008; ηp2 = .053). Lower income groups were more often classified into long-term care level 2 (Chi2 = 25.36; p = . 009; C = 0.283), associated with reduced mobility, less physical and mental wellbeing, and a poorer health status. Falls risks were already cumulated for independent living seniors (> 5 risk factors) and increased for lower income levels (F[316] = 4.988; p = .007; ηp2 = .032). Moreover, there were socioeconomic differences for physical wellbeing (F[225] = 3.4; p =. 034; ηp2 = .029), GD (F[305] = 3.48; p = .032 ηp2 = .022), and IADLs (F[305] = 3.14; p =. 045; ηp2 = .02). Gender differences, with reduced performance for men, were only found for the IADLs. Conclusion: Even in a wealthy neighborhood, socioeconomic inequalities correlate with health risks, where multimorbidity reduced mobility and decreased daily functions. Interestingly, there were already high fall risks for independent living seniors, which increase with lower income. Moreover, we found reduced IADLs for the examined men. These findings lead to the suggestion of individual and setting-specific interventions to improve mobility and to prevent falls. Endeavors should be undertaken to improve prevention strategies to retain independence and quality of life for these older adults. References: Huisman, M., Read, S., Towriss, C.A., Deeg, D.J., & Grundy, E. (2013). Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe Region. Epidemiologic reviews, 35(1), 84–97. Williams, J.S., Kowal, P., Hestekin, H., O’Driscoll, T., Peltzer, K., Yawson, A., ... & Wu, F. (2015). Prevalence, risk factors and disability associated with fall-related injury in older adults in low-and middle-income countries: results from the WHO Study on global AGEing and adult health (SAGE). BMC medicine, 13(1), 1. Why Older Adults Spend Time Sedentary and Break Their Sedentary Behaviour: A Mixed Methods Approach Dontje, Manon L; Leask, Calum F; Harvey, Juliet; Skelton, Dawn A; Chastin, Sebastien FM Glasgow Caledonian University, Glasgow, UK; [email protected], [email protected], [email protected], Dawn.Skelton@gcu. ac.uk, [email protected]

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Introduction: Older adults spend a large part of the day being sedentary, but several national and international health guidelines explicitly recommend that older adults should reduce their sedentary time and break prolonged periods of sitting to promote healthy ageing and well-being. In order to refine the guidelines and develop effective interventions, it is crucial to identify when, why, and how older adults are most likely to be able to change their sitting habits. Therefore, the purpose of this study was to utilise life-logging equipment (objective activity monitor and time-lapse camera) to understand reasons for older people to remain sedentary and to break periods of prolonged sitting. Methods: In this mixed-methods study, 30 older adults (mean [±SD] age 74.0 ± 5.3 years) were asked to recollect their believed reasons for (breaking) sedentary behaviour. In addition, they were presented with a personal storyboard with objective records (1 day activity monitor and time-lapse camera images) of their daily behaviour and asked, during a semi-structured interview, to give their interpretation of their objectively-measured sedentary behaviour and explain their actual reasons for (breaking) their sitting. The interview transcriptions were analysed using inductive thematic analysis. Results: The most frequent reasons that people believed kept them sedentary were television/radio (48.3%), fatigue (34.5%), and health status (31.0%). The factors most often mentioned as actual reasons were eating/drinking (96.6%), television/radio (89.7%), and reading/crosswords (75.9%). Domestic chores (55.2%), walking (37.9%), and socialising (20.7%) were most often mentioned as reasons that people believed made them break their sedentary behaviour. The factors that were most often mentioned as actual reasons were domestic chores (86.2%), food/tea preparation (82.8%), and performing simple tasks (75.9%). Conclusion: This study showed that there is a difference in what older adults believe are reasons for them to remain sedentary or break their sedentary time and what their actual reasons are. This knowledge can be used to develop effective interventions to reduce sedentary behaviour in older adults. Communicating Healthy Ageing Messages to Older Australians: What Do Older People Value? Loton, Carolyn1; Dyson, Claire1; Tiedemann, Anne2; Sherrington, Catherine2 Marketing, Sydney, Australia; [email protected], [email protected] George Institute, Sydney Medical School, University of Sydney, Sydney, Australia; [email protected], csherrington@ georgeinstitute.org.au

1Juntos 2The

Introduction: Older adults who engage in physical activity have a lower risk of disability and mortality, regardless of the presence of other risk factors (Rasinaho et al., 2006), yet 76% of Australians aged 75+ do not meet physical activity guidelines (Australian Health Survey, 2011–2012) and less than 6% of older Australians meet the best practice physical activity recommendations for falls prevention (Merom et al., 2012). The purpose of this qualitative research study was to understand the most effective methods to present key physical activity, fall prevention, and nutrition health promotion materials to older people. Methods: Six focus groups with 36 participants aged from 60 to 85 years old were held across Sydney in August and September 2015. Four of the six groups were recruited from existing community facilities, where participants knew each other. The remaining groups were recruited using existing researcher networks. The groups were facilitated by an experienced qualitative research professional, with an additional observer and/or second researcher present at all groups. Findings were synthesised to identify themes, and commentary was then analysed. Results: Participants were interested in learning more about staying healthy in older age. Improving the amount and type of physical activity was of particular interest. They were motivated by a strong desire to stay mobile, which was seen as vital to living independently. Staying mentally active and being socially connected were also seen as important. Printed materials were valued, particularly those developed using a professional design and layout. Findings include a range of guidelines to maximise readability and adherence to recommendations. Conclusion: Many older people are willing to incorporate changes in their lives to improve mobility and long-term independence. Physical activity and staying mentally and socially connected were identified as key priorities. Approaches to healthy ageing should lead with initiatives that most appeal to people over 60. For many people (particularly > 75 years), messages about falls prevention may be more acceptable when incorporated within a holistic program. References: Australian Bureau of Statistics. (2011–2012). Australian Health Survey: Physical Activity, 2011–12. (ABS cat. no. 4364.0.55.004). Canberra, Australia: ABS. Merom, D., Pye, V., Macniven, R., van der Ploeg, H., Milat, A., Sherrington, C., Lord, S., Bauman, A. (2012). Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults. Preventive Medicine, 55, 613–617. Rasinaho, M., Hirvensalo, M., Leinonen, R., Lintunen, T., Rantanen, T. (2006). Motives for and barriers to physical activity among older adults with mobility limitations. Journal of Aging and Physical Activity, 15, 90–102. Enhancing Physical Activity in Behavior and Lifestyle in Older Persons: The Rome Statement Freiberger, Ellen—on behalf of the EUNAAPA Network Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; [email protected] Introduction: The world, as seen as a complex dynamic system, is constantly changing, and likewise are people and their in- and explicit thoughts and handlings at all levels, from macro to micro. These dynamics find their parallels in our demographics and in our behavior and lifestyle, especially in our physical activity habits. Joint durable action is requested in order to counteract this global process, especially for the elderly. Consequently, the European Network on Action, Aging and Physical Activity (EUNAAPA) and several international, mostly EU partner, organizations concerned with physical activity in the elderly issued recommendations for policymakers, researchers, and professionals in order to advise them how to act in the macro and micro context to provide means to gradually and sustainably increase physical activity for the next elderly generations. These recommendations are collectively known as “The Rome Statement”, and during the presentation the statement is presented and debated in order to improve where possible or even necessary, and to further disseminate towards all relevant settings, institutes, and people involved. Methods: The recommendation is based on discussions on ageing, physical activity, and sedentary behaviour during the “Be Part-expert meeting” (Rome, October 2014) initiated by the European Network Action on Aging and Physical Activity (EUNAAPA) in joined action with the HEPA Working Group on Active Ageing (WG AA) and included several EU-oriented partner-organizations. A specific target of the present recommendation is to increase physical activity at all levels (macro to micro) by changing and addressing dissemination strategies. Conclusion: The final Rome Statement as published in a paper was thereupon officially handed over to the EU for the purpose of further dissemination and submitted for publication.

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Gender and Age Differences in Walking for Transport and Recreation: Are the Relationships the Same in All Neighbourhoods? Ghani, F1; Rachele, J1; Washington, S2; Turrell, G1 1Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia; [email protected], [email protected], Gavin.

[email protected] 2Civil Engineering and the Built Environment, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia; simon. [email protected] Introduction: Walking as regular physical activity (PA) is central to healthy aging, and the neighbourhood environment is an important determinant of an individual’s likelihood of walking. To date, most research has assumed that the neighbourhood environment has a similar influence on the walking patterns of its residents, irrespective of their sociodemographic characteristics. This study examined whether gender and age differences in walking for transport and recreation vary across different neighbourhoods. Methods: 7,866 (72.5%) adults aged 42–68 years living in 200 environmentally-diverse neighbourhoods in Brisbane responded to the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) mail survey in 2009. Minutes per week of walking for transport (WfT) and walking for recreation (WfR) were categorised into: none (0 min), low (1–59 min), moderate (60–149 min), and high (150 min+). Two-level random intercept Markov chain Monte Carlo (MCMC) multinomial logit models were used to estimate fixed effects and between-neighbourhood variation with gender and age as predictors, followed by the specification of random coefficients to test variation across neighbourhoods. These models were repeated incorporating a combined gender/age variable as predictor. Results: No gender differences in average effects were found for WfT, but the odds of WfR were significantly higher for women at moderate and high levels. Older age groups were less likely to do WFT at moderate and high levels and WfR at low and moderated levels, and more likely to do WfR at high levels. Significant random coefficients for gender and age were observed for both WfT and WfR. Conclusion: The observed significant gender/age differences in levels of WfT and WfR across neighbourhoods suggest environments play a role in the likelihood of WfT and WfR. These patterns warrant further exploration through incorporating built and social environmental characteristics. This research could inform the tailoring of multi-level interventions that aim to increase the amount of WfT and WfR among those population groups who are less likely to engage in physical activities, such as women and older adults. Physical Activity Programs for Older Victorians: An Audit and Gap Analysis De Silva, Renee1; Nolan, Genevieve1; Smith, Ben2; Menzies, David3 and Osteoporosis Victoria, Melbourne, Australia; [email protected], [email protected] University, Melbourne, Australia; [email protected] 3Fitness Australia, Melbourne, Australia; [email protected] 1Arthritis

2Monash

Introduction: Australian guidelines recommend that older people (65 years+) should be physically active every day in as many ways as possible (Department of Health, 2013). An audit and gap analysis was undertaken of the physical activity programs available for older people in the state of Victoria and the strategies to increase programs’ accessibility, given environmental factors can present barriers to engagement (Franco et al., 2015). The results will inform the direction of the Victorian Active Ageing Partnership, a three-year Victorian Government initiative to increase physical activity opportunities for older Victorians, especially in areas of socio-economic disadvantage and among isolated, lonely older people not currently involved in physical activity. Methods: Data on physical activity programs promoting fitness, strength, balance, and flexibility offered within Victoria’s 79 local government areas (LGA) was collated via desktop review. Programs offered by local councils, community health centres (CHC), fitness/leisure centres, University of the Third Age (U3A), neighbourhood houses, and other relevant providers were included. Data on cost, frequency, and location, as well as strategies to increase accessibility (e.g., transport assistance, language support, etc.) were gathered. Local council and CHC data were sent to relevant staff for verification and/or completion, while other collated data remained unverified by local sources. Recreation and sporting clubs predominantly frequented by older people (i.e., lawn bowls) were also mapped for each LGA. An analysis examining the availability, diversity, and accessibility of physical activity opportunities in each LGA was undertaken. Results: Preliminary results indicate that few local councils are involved in direct service delivery of physical activity opportunities for older people. Fitness/leisure centres, CHC, U3A, and neighbourhood houses are the principal providers of such activities in each LGA. CHC, U3A, and neighbourhood houses are also more likely than fitness/leisure centres to offer programs at a lower cost and within a social environment. While not involved in direct service delivery, not all local councils act as an information source about available physical activity opportunities. Conclusion: The availability of physical activity opportunities for older Victorians varies, particularly between metropolitan and rural areas. When available, the diversity of programs is generally consistent with current guidelines. Accessibility to many programs could be enhanced. References: Department of Health. (2013) Recommendations on physical activity for health for older Australians. Retrieved from http://www.health.gov. au/internet/main/Publishing.nsf/Content/phd-physical-rec-older-guidelines. Franco, M., Tong, A., Howard, K., Sherrington, C., Ferreira, P., Pinto, R., Ferreira, M. (2015) Older people’s perspectives on participation in physical activity: A systematic review and thematic synthesis of qualitative literature. British Journal of Sports Medicine, 49, 1268–1276. Integrating Potential Health Impact, Trip Generation, and Time-Use Models in an Aging Society for a 20-Minute Metropolis Kayak, Horst (Oz)1; Xu, Jiaming2; Zafar, Fahim3 University of Melbourne, Melbourne, Australia, Town and Country Planning Association (TCPA) Melbourne, Australia; [email protected] University of Melbourne, Melbourne, Australia; [email protected] 3Town and Country Planning Association (TCPA) Melbourne, Australia 1The

2The

Introduction: The presentation summarizes the outcomes of researchers modelling potential health benefits from walking in a 20-min urban environment. The cohort of interest modelled is the 65+ age group. Our research group has used survey data from 1991 to 2016 including VATS, VISTA, ABS, and community feedback to calibrate the model in the ABS-defined Melbourne Statistical Division (MSD) covering the jurisdictions of 31 local government areas (LGAs). For background purposes, VATS and VISTA leads are referenced below. The baseline spatial data infrastructure (SDI) uses VATS and VISTA, which were developed involving DoT (state government departments and agencies in their various manifestations over the last 25 years) JAPA Vol. 24, Suppl., 2016

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and Melbourne and RMIT Universities. Methods: The available out-of-home time use survey data is used to separate physical activity (PA) quintiles by LGA for the MSD, for the 65+ cohort. The Melbourne local government area (MCC) is defined as unique and does not form part of the quintile aggregation. The average PA quintiles of LGAs are compared to the average walk scores for the same LGAs. Approximations are discussed to compare potential health benefits in an ageing society by the morphology in the 30 LGAs using 20-min catchments to meet primary accessibility needs of the 65+ population. Results: Over the years 1991 to 2016, the actual time allocated to walking by the 65+ cohort is used as a gap indicator to potentially benefit personal health. Walking time allocation by quintile across the MSD showed significant variation by aggregation of LGAs. Various age groupings result in different time use patterns. Our aggregated survey data shows that several LGAs have multiple higher physical activity (based on walking time) than others. Conclusion: Existing differences in out-of-home PA by quintile in the MSD indicates that opportunities exist to modify urban morphology, using policy and planning to benefit health in an ageing society for the future. Research and modelling is required to modify legislation and infrastructure to ensure in 2051 the urban aged society is sustainably provided for. Twenty-minute urban environment models for the 65+ cohort combined with 10,000 step scenarios and walk scores need to be tested as suggested by Kayak (2016). References: Kayak, H. (2016). http://oz4lca.com/urban-health-index/. VATS: Some survey details are accessible through http://www.abs.gov.au/AUSSTATS/[email protected]/bb8db737e2af84b8ca2571780015701e/20bf0654e a3581d2ca2571c4007adb46!OpenDocument. VISTA: Some survey details are accessible through http://economicdevelopment.vic.gov.au/transport/ research-and-data/statistics/vista#overview. Urban Design Supporting Active Ageing: Role of Street Layout Koohsari, Javad1; Owen, Neville1; Cole, Rachel2; Hunter, Ian3; Oka, Koichiro4; Sugiyama, Takemi5 IDI Heart & Diabetes, Melbourne, Australia; [email protected], [email protected] of the Sunshine Coast, Sippy Downs, Queensland, Australia; [email protected] 3Queensland Department of Health, Robina, Queensland, Australia; [email protected] 4Faculty of Sport Sciences, Waseda University, Saitama, Japan; [email protected] 5Australian Catholic University, Melbourne, Australia; [email protected]

1Baker

2University

Introduction: The street network is one built environment attribute consistently associated with active travel, especially walking for transport (WT). Within active living and health research, the street network typically is operationalized as intersection density. Space syntax is an alternative way of characterizing the street network, focusing on relationships between streets (Hillier & Hanson, 1984). Koohsari et al. (2016) found that street integration, a space syntax measure, is associated with adults’ WT. However, research has not yet examined how space syntax measures can predict older adults’ travel behaviours. This study examined associations of street integration with older adults’ WT and prolonged car use. Methods: Using travel behaviour data from older adults (aged 60–84 years, N = 3,797) collected via the 2009 South-East Queensland Household Travel Survey, three outcomes were examined: any home-based WT; accumulating over 30 min of home-based WT; accumulating over 60 min of car use. Street integration was calculated for each statistical area using geographic information systems. Street integration scores were ranked into deciles. Multilevel logistic regression models examined associations of street integration with the three travel behaviour outcomes, adjusting for socio- demographic variables and correcting for spatial clustering. Results: About 13% of participants reported any WT, 5% reported 30 min or more of WT, and 24% reported 60 min or more of car use. There were significant associations of street integration with WT and car use. Each one unit increment of street integration was associated with a 14% (95%CI: 1.10, 1.19) and 10% (95%CI: 1.03, 1.17) higher odds of any WT and over 30 min of WT, respectively. It was also associated with 4% (95%CI: 0.93, 0.98) lower odds of using a car for over 60 min. Conclusion: Higher street integration was associated with more walking and less prolonged car use among older adults. This study suggests that space syntax can help in further understanding relationships between urban form and older adults’ travel behaviours. This knowledge will assist urban designers and policy makers to identify locations that would support or hinder older residents’ physically-active travel. References: Hillier, B., & Hanson, J. (1984). The social logic of space. Cambridge: Cambridge University Press. Koohsari, M.J., Sugiyama, T., Mavoa, S., Villanueva, K., Badland, H., Giles-Corti, B., & Owen, N. (2016). Street network measures and adults’ walking for transport: Application of space syntax. Health & Place. How is it to Grow Old in Jordan? Muhaidat, Jennifer1; Al-Yahya, Emad1,2; Mohammad, Maha1; Qutishat, Dania1; Okasheh, Rasha1; Al- Khlaifat, Lara1 of Physiotherapy, Faculty of Rehabilitation Sciences, the University of Jordan, Amman, Jordan; [email protected] Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK

1Department 2Movement

Introduction: Older adults constitute 5.2% of the Jordanian population. The functional status of Jordanian older adults has not been thoroughly investigated. The aim of this study was to investigate the performance of community-dwelling Jordanian older adults on motor and cognitive function measures. Methods: Community-dwelling older adults were included in this study. The following tests and questionnaires were used to investigate performance: 10-meter walking test in single-task (ST) and dual-task (DT) conditions, Timed Up and Go (TUG) test in ST and DT conditions, Mini-Mental State Examination (MMSE), the CLOX test for executive function, and physical activity using the Arabic version of the Global Physical Activity Questionnaire (GPAQ). Results: Ninety-six participants, with an average age of 67.7 ± 5.9 years, height 163.5 ± 9.4 cm, and weight 78.3 ± 15.5 kg, participated in the study. 59% of the sample were females. 32% reported falling in the previous year. The median score for MMSE was 27 IQR 4, for CLOX1 11 IQR 4, and CLOX2 13 IQR 2. Participants needed longer to complete the 10-meter DT cognitive walking test (12.97 ± 4.65 s) than the ST test (10.5 ± 2.6 s) and the DT motor test (10.9 ± 2.8 s) (p < .05). They also needed longer to complete the TUG DT cognitive (16.62 ± 7.89 s) and TUG DT motor (14.3 ± 4.1 s) tests than the TUG ST test (12.0 ± 3.5 s) (p < .05). The average vigorous and moderate PA per week were 32.8 ± 198 min and 189.7 ± 505.1 min, respectively. Sedentary time was 345.5 ± 508.1 min per day. Conclusion: Cognitive function and mobility are important for healthy and successful ageing. Jordanian older adults seem to have slower performance on the 10-meter ST walking test when compared to age-matched values (Bohannon, 1997). The participants did not achieve the recommended time spent in vigorous PA per week for older adults (75 minutes), and they were not able to successfully divide attention between cognitive and motor tasks. References: Bohannon, R.W. (1997). Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age & Ageing, 26(1), 15–19. JAPA Vol. 24, Suppl., 2016

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The Physical Activity Promotion Practices, Beliefs, and Barriers Among Australasian Cancer Nurses Keogh, Justin1,2,3; Pühringer, Petra4; Olsen, Alicia1; Climstein, Michael5; Sargeant, Sally1; Jones, Lynnette6 University, Australia; [email protected], [email protected], [email protected] University, Auckland, New Zealand 3University of the Sunshine Coast, Sippy Downs, Australia 4Department of Neurology, LKH Bruck a.d. Mur, Austria; [email protected] 5University of Sydney, Sydney, Australia; [email protected] 6University of Otago, Dunedin, New Zealand; [email protected] 1Bond

2AUT

Introduction: As many cancer patients and survivors do not meet physical activity guidelines, greater levels of physical activity could have considerable benefits for these individuals. While considerable research has investigated the cancer patients’ perspectives on physical activity, relatively little research has been conducted on the role their health professionals may play in this process. Cancer nurses may be ideally placed to promote physical activity to their patients. However, relatively little is known about cancer nurses’ physical activity promotion practices, beliefs, and barriers in Australia and New Zealand. Methods: An online survey that was informed by the theory of planned behaviour and social cognitive theory (Puhringer et al., 2015) was used to investigate cancer nurses’ current healthy eating promotion practices, beliefs, and barriers. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (< 25 or ≥ 25 years) using ANOVA and chi square analysis for continuous and categorical data, respectively. Results: 119 cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of physical activity advice to their patients (43.7%), compared to physiotherapists (16%), oncologists (3.4%), and exercise physiologists (1.7%). The majority of cancer nurses promoted physical activity prior (56.3%), during (70.6%), and post-treatment (67.2%). The three most commonly cited benefits of physical activity for their patients were improved quality of life (89.9 %), mental health (89.1%), and activities of daily living (89.1%). Lack of time (27.2%), adequate support structures (19.5%) and risk to patient (13.4%) were the three most common barriers to physical activity promotion. Betweengroup analyses indicated relatively few significant differences in the cancer nurses’ physical activity promotion practices, beliefs, and barriers based on their hospital location or years of experience. Conclusion: In spite of numerous barriers, Australasian cancer nurses wish to promote physical activity to their cancer patients across multiple treatment stages as they believe such activity is beneficial for their patients. Hospitals may need to consider how cancer nurses may work with physiotherapists and exercise physiologists in promoting physical activity to their patients, with the ultimate aim to be improved patient outcomes. Reference: Puhringer, P.G., Olsen, A., Climstein, M., Sargeant, S., Jones, L.M., & Keogh, J.W.L. (2015). Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand. Peer J, 3, e1396. Sit Less, Move More—Shaping Health-Promoting Residential Care Services Kameniar, Kate Southern Cross Care; [email protected] Introduction: The global movement towards healthy ageing is defined by the World Health Organisation as the process of developing and maintaining the functional ability that enables well-being in older age. Research shows that sedentary lifestyles promoted by traditional care approaches are the biggest contributor to frailty and decline in older people (World Health Organisation, 2015). Physical activity is well established as the key to combating sedentary lifestyles and improving functional capacity and quality of life. Best practice recommendations for older people are 30 min of exercise on most days and resistance training twice a week (Australian Government Department of Health, 2014). Methods: As part of Southern Cross Care’s strategic commitment to health for all, six health & wellness centres were established within residential care homes in South Australia. The process included refurbishing existing spaces to accommodate equipment selected through consultation with suppliers, allied health, fitness instructors, and external partners. Existing lifestyle and care workers were supported to undertake certificate III in fitness to develop the skills and confidence to coordinate tailored exercise programs to improve fitness, strength, balance, and functional ability. Further education and training was provided to staff to empower residents to set meaningful goals to better manage their health and optimise wellbeing. Results: The response has been overwhelmingly positive, with more than 200 residents utilising the equipment within the first three months. Residents have improved strength, range of motion, and the ability to perform tasks they had not been able to achieve previously, such as getting into the car with their family. Some now require less staff assistance to transfer out of bed and chairs. Additional benefits include improved mood and increased socialisation. Fitness instructors report a sense of achievement, a boost in morale, new energy, and commitment to their work. They outline a strong sense of fulfilment at being part of aspirational change they previously would not have thought possible. Conclusion: Healthy ageing approaches in residential care can have positive impacts on physical and mental wellbeing of both residents and staff. This presentation will discuss case studies from residents and staff in the health and wellness facilities. References: World Health Organisation (2015). World Report on Ageing and Health. Geneva, Switzerland. WHO Press. Australian Government Department of Health (2014). Australia’s Physical Activity and Sedentary Behaviour Guidelines: Physical Activity Recommendations for Older Australians (65 years and older). Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#chba Sedentary Behavior and Cardiometabolic Risk Markers Among Participants in a Multicomponent Exercise Program for Older Adults Fisher, Koren; Parckys, Regina; Wong, Karen; Rose, Debra; Rubin, Daniela Center for Successful Aging, California State University, Fullerton, USA; [email protected], [email protected], karenwong0902@csu. fullerton.edu, [email protected], [email protected] Introduction: Sedentary behavior (SB) has been associated with increased cardiometabolic risk, independent of individuals’ physical activity (PA) participation; however, few studies have examined this relationship among older adults (Ryan et al., 2015). The purpose of this study was to examine patterns of PA and SB and their association with markers of cardiometabolic health in a group of older adults who regularly participate in a multicomponent exercise program. Methods: Markers of risk of cardiometabolic disease (blood pressure, waist circumference, fasting blood glucose, cholesterol, metabolic JAPA Vol. 24, Suppl., 2016

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syndrome) were assessed in community-dwelling participants in a university-based multicomponent exercise program specifically designed for older adults. SB (defined as < 100 counts per min) and PA (light, moderate, and vigorous, as defined by Troiano et al., 2008) were assessed via accelerometry over seven consecutive days. Generalized linear models were used to examine associations between daily sedentary time, sedentary breaks, sedentary bouts, light PA, MVPA, and cardiometabolic risk markers. Results: A total of 23 program participants were included in this study (73.0 ± 6.7 years; 74% female). Valid accelerometer data were obtained from 21/23 participants. The majority of participants (82.6%) had at least one cardiometabolic risk factor and 30% met the International Diabetes Federation (IDF) criteria for metabolic syndrome (Eckel et al., 2010). Time spent (min/day; mean ± SD) in sedentary, light, and MVPA was 202.8 ± 113.9, 207.8 ± 88.1, and 28.9 ± 26.3, respectively. Daily sedentary time was positively associated with the number of cardiometabolic risk indicators, independent of time spent in light and MVPA (β = 0.006; p < .05). No other significant associations were found. Conclusion: These preliminary results suggest that greater time spent in sedentary behaviors is associated with increased cardiometabolic risk in older adults, independent of time spent in PA. This study adds support to an emerging area of research supporting the need not only to increase physical activity participation in this population group but also to decrease the time older adults spend in sedentary behaviors throughout the day. References: Ryan, D.J., Stebbings, G.K., & Onambele, G.L. (2015). The emergence of sedentary behavior physiology and its effects on the cardiometabolic profile in younger and older adults. Age, 37(5), 89. Troiano, R.P., Berrigan, D., Dodd, K.W., Masse, L.C, Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise, 40(1), 181–188. Eckel, R.H., Alberti, K.G.M.M., Grundy, S.M., & Zimmet, P.Z. (2010). The metabolic syndrome. The Lancet, 375(9710), 181–183. Application of a Healthy Ageing Phenotype in the Population-Based Rotterdam Study: A Gender-Based Perspective Jaspers, Loes1; Schoufour, Josje1; Erler, Nicole2; Darweesh, Sirwan1; Portegies, Marileen1; Sedaghat, Sanaz1; Lahousse, Lies1; Stricker, Bruno1; Tiemeier, Henning1; Ikram, Arfan1; Hofman, Albert1,3; Laven, Joop4; Franco, Oscar1*; Kavousi, Maryam1* *These authors contributed equally. of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands; [email protected] of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands 3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 4Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands 1Department 2Department

Introduction: Given the increasing life expectancy and transition from infectious to chronic diseases, healthy ageing is a growing public health challenge. A consensus definition of healthy ageing is absent. Therefore, we aimed to define and apply a healthy ageing phenotype scale (HAPs) in the population-based Rotterdam Study, to assess age and gender differences, and to evaluate the association and discriminative ability of the HAPs with survival. Methods: We included seven domains: chronic diseases, mental health, cognitive function, physical function, pain, social wellbeing, and quality of life. The HAPs consisted of being alive, and a score of 0, 1, or 2 on each domain. A total score (range 0–14) was constructed, and it was assessed continuously and in tertiles (0–10: poor score, 11–12: intermediate score, 13–14: ideal score). Gender-specific decline in mean HAP was computed for the age categories 65–69, 70–74, 75–79, 80–84, and 85 years and older. The association between HAP and mortality was assessed with age and fully-adjusted (age, smoking, education, physical activity, and waist–hip ratio) Cox models. Discriminative accuracy was determined using the area under the curve (AUC). Results: 1,405 men and 2,122 women, aged 75.9 years (SD 6.4), with a mean follow-up of 8.6 years (SD 3.4) were included. The mean HAP was 11.1 (SD 2.2) in men and 10.7 (SD 2.3) in women. The β for decline in mean HAP across the five age categories was –0.55 (95%CI –0.65; –0.45) in men and –0.65 (95%CI –0.73; –0.57) in women. The fully adjusted hazard ratios for the intermediate and ideal score, compared to the poor score, in association with mortality, were 0.65 (95%CI 0.55–0.78) and 0.46 (95%CI 0.37–0.58) for men, and 0.73 (95%CI 0.62–0.86) and 0.46 (95%CI 0.38–0.57) for women, respectively. The AUC was 0.68. Conclusion: The HAPs was strongly associated with mortality and differed across age categories and gender. A better understanding of population healthy ageing could facilitate preventative and treatment strategies for sustainable healthcare. Promoting Physical Activity in Australian Seniors Jongenelis, Michelle1; Pettigrew, Simone1; Newton, Robert2 University, Perth, Australia; [email protected], [email protected] Cowan University, Perth, Australia; [email protected]

1Curtin 2Edith

Introduction: Despite the known physical and mental health benefits associated with physical activity, few individuals meet the recommended guidelines for engagement in physical activity. This is particularly the case among older people who, compared to other population segments, engage in lower levels of physical activity. Given the effects of ageing on physical health, and the significant increases in people entering older age groups, the promotion of physical activity is an important task. The objective of the present study was to explore the effectiveness of messages aimed at motivating seniors to be physically active. Methods: Over 200 Australian seniors aged 60+ years were presented with 14 brief messages promoting physical activity. The messages varied according to the dimensions of length (ranging from 3 to 13 words) and focus (promotion of physical activity alone versus promotion of physical activity plus a statement relating to the potential benefits that can accrue from being more physically active). Participants were asked to rate the extent to which they liked each message and considered it effective on the following scales: 1 (do not like the message at all) to 5 (like the message very much) and 1 (not effective at all) to 5 (very effective). Results: The study participants agreed that the promotion of physical activity among older people is a worthwhile objective. Although the majority reported liking each message and they generally considered all of them to be potentially effective, messages that provided information on the potential benefits of physical activity were considered significantly more likeable and effective compared to those that only promoted physical activity. Shorter messages were also considered significantly more likeable and effective than longer messages. Conclusion: In combination, the results indicate a preference for succinct but informative messages. This suggests that evidence-based messages that provide information on the potential benefits of physical activity represent a potential means of increasing physical activity in seniors. Further research is needed to investigate the most effective means of promoting these messages to seniors to optimise exposure and willingness to comply. JAPA Vol. 24, Suppl., 2016

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“It’s More about the Talking than the Walking”—Heart Foundation Walking (HFW) Encouraging Older Australians to Be Active and Social Wilson, Michelle Heart Foundation Walking Program, Health Outcomes Team, National Heart Foundation of Australia, Adelaide, Australia; michelle.wilson@ heartfoundation.org.au Introduction: Less than 40% of older Australians undertake sufficient active to receive a health benefit (ABS, 2013). People least likely to be active are older, female, live alone, have low incomes, and are overweight or obese. Walking is the most preferred physical activity option and is an appropriate, adaptable activity for older Australians including people with dementia (ABS, 2013). HFW is Australia’s largest free walking network and aims to increase physical activity participation by partnering with local governments and health organisations to facilitate community groups and provide a community of virtual walkers who track activity online. The program model and resources have been adapted for a variety of settings and population groups including aged care settings and people with dementia. Host organisations are supported to recruit and train volunteers to lead groups via a train-the-trainer model supported by an online database, evaluation system, and marketing tools tailored for local community needs. HFW provides volunteer insurance, a walker recognition scheme to provide participant motivation and goal-setting, a regular newsletter, and local walking events. Methods: Demographic data was collected from 24,219 participants at registration, and monthly activity was recorded. Survey data was collected from 11,891 participants to evaluate physical activity levels and effectiveness of training, resourcing, and supporting communities to deliver HFW. Pilot sites (15) were also recruited to trial resources developed to support people with dementia to be more active. Results: HFW engages those least likely to be active, including people who are female (77%), over 60 years (59%), overweight or obese (61%), low income (42%), or live alone (26%). Over 80% of participants undertake sufficient physical activity levels to obtain health benefits. Volunteers demonstrated increased confidence and capacity to support people with dementia to participate in HFW. HFW participants have outstanding retention rates (6 months = 88%; 12 months = 75%). High retention is linked to community partnerships, group ownership, quality training and resources, and social engagement strategies. Conclusion: HFW provides a sustainable framework for engaging and supporting communities to develop long-term walking behaviours in population groups least likely to be active. This presentation discusses key successes and challenges in a national approach to increasing walking. References: Australian Bureau of Statistics (ABS). Australian health survey: physical activity, 2011-12. Cat. No. 4364.0.55.004. Canberra; ABS, 2013. Australian Bureau of Statistics. Participation in sport and physical recreation, Australia 2011-12. Cat. No. 4177.0. Canberra; ABS, 2013. Author Bio: Michelle Wilson has a Bachelor of Science (Health Promotion) from Curtin University in Western Australia. She has been at the Heart Foundation for 12 years in various active living and walking positions. She is currently the National Manager of Walking and Community Engagement overseeing Heart Foundation Walking and Local Government Awards. Her previous experience includes working as a regional health promotion officer, Indigenous health, and as a personal trainer. Association of TV Viewing Time Trajectories Over 12 Years with Timed Up and Go in Australian Adults Reid, Natasha1; Healy, Genevieve1,3,4,9; Baker, Peter1; Eakin, Elizabeth1; Dunstan, David1,4,6,7,8,10; Owen, Neville1,4,5,6; Gardiner, Paul2,11 1School of Public Health, The University of Queensland, Brisbane, Australia; [email protected], [email protected], [email protected], e.eakin@ sph.uq.edu.au 2Mater Research Institute, The University of Queensland, South Brisbane, Australia 3School of Physiotherapy, Curtin University, Perth, Australia 4Baker IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected], [email protected] 5Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia 6Department of Medicine, Alfred Hospital, Monash University, Melbourne, Australia 7School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia 8School of Sport Science, Exercise and Health, The University of Western Australia, Perth Australia 9Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, Australia 10School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia 11School of Medicine, The University of Queensland, Brisbane, Australia; [email protected]

Introduction: Too much sitting is a common risk behaviour detrimentally linked to several health outcomes. However, the relationship of time spent in sedentary behaviours with physical function is less clear, with much of the evidence from cross-sectional studies. The aims of this study were to identify patterns of television viewing (TV) time (a common sedentary behaviour) over 12 years in community-dwelling older Australians and to examine their associations with the Timed Up and Go (TUG) test (a common measure of physical function). Notably, patterns were determined using a data-driven method (rather than pre-determined categories), an approach that has not previously been used in relation to longitudinal data on sedentary behavior. Methods: Data from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study were used. At each assessment (1999/2000; 2004/2005; 2011/2012), data on TV time (hours/week) and socio-demographic factors were collected. The TUG test (seconds) was used as an objective measure of physical function at the 2011/2012 assessment. Patterns of TV time were determined using group-based trajectory modeling. Data from participants aged at least 60 years in the 2011/2012 assessment were included. Regression analyses examined the associations of the identified trajectories with time to complete the TUG in both unadjusted and adjusted (for age, sex, education, urban/rural living, and BMI) models. Results: A total of 2,174 participants with complete data were included in the analyses. Five clusters of people representing different TV time trajectories were identified: those with stable low (10.7%), low increasing (25.8%), moderate increasing (35.6%; reference), moderate decreasing (13.8%), and stable high (14.2%) TV time. In unadjusted models, TUG time was different in the stable low, stable high, and the low increasing group, compared to the moderate increasing group, with participants in the stable high trajectory taking the longest to complete the TUG. However, age attenuated these differences between trajectory groups to the null. Conclusion: Group-based trajectory modeling was successful in identifying patterns of TV viewing over 12 years in older adults and may be suitable to explore longitudinal relationships with health outcomes. After adjusting for age, no statistically significant associations were found between TV time trajectories and time to complete the TUG. JAPA Vol. 24, Suppl., 2016

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Monitoring Physical Activity in Hospitalized Older Patients: Can Upright Time Reduce Risk of Mortality? Theou, Olga1,2; Mallery, Kayla2; MacLean, Mark2; Blodgett, Joanna2; Rockwood, Kenneth1,2 1Geriatric

Medicine, Dalhousie University, Halifax, NS Canada; [email protected], [email protected]

2Geriatric Medicine, Nova Scotia Health Authority, Halifax, NS, Canada; [email protected], [email protected], joannablodgett@

gmail.com Introduction: Hospitals routinely encourage sedentary behaviours and this could put patients’ post-hospital health and independence at risk. The purpose of this study was to examine whether time spent upright could reduce the risk of mortality among hospitalized older patients. Methods: Currently 120 patients (82 ± 8 years, range 63–99 years, 57% women) are recruited within 48 hours of admission to the QEII Health Sciences Centre in Halifax, NS, Canada; 57 patients were admitted to the Geriatric Assessment Unit (16 directly and 41 via the Emergency Department) and 63 were admitted to nongeriatric units via the Emergency Department. The average length of stay among participants was 17.3 ± 18 days. At admission, 35 patients could walk independently. ActivPAL inclinometers were used to monitor how long patients spend upright (standing or walking) up to two weeks or until hospital discharge. Results: Upright time was calculated for 104 patients, and 14 patients died during hospitalization. On average, patients were upright for 80 ± 89 min per day and upright time was similar across all days of the week. Those who could walk independently at admission were upright 108 ± 97 min per day. Upright time gradually increased during hospitalization among patients who got discharged from the hospital, especially during the first three days, whereas it remained stable among those who died during hospitalization. Upright time was significantly associated with reduced risk of mortality (HR per 1 min 0.93 [CI 0.88–0.99]) even after controlling for age, sex, frailty, and mobility status at admission. Conclusion: Monitoring upright time during hospitalization can predict risk of mortality among older patients. Factors Associated with Physical Activity Promotion Amongst Non-Medical Health Professionals Crisford, Paul1; Winzenberg, Tania1,2; Venn, Alison1; Schultz, Martin1; Aitken, Dawn1; Cleland, Verity1 Institute for Medical Research, University of Tasmania; [email protected], [email protected], [email protected]. au, [email protected], [email protected], [email protected] 2Faculty of Health, University of Tasmania

1Menzies

Introduction: A low level of physical activity (PA) is a leading risk factor for morbidity and mortality. All health professionals have the opportunity and are encouraged to promote PA to their patients. However, little is known about PA promotion behaviours outside general medical practice. This systematic review aimed to identify the factors associated with PA promotion behaviour by non-medical health professionals. Methods: A systematic search of five electronic databases was performed for relevant published English-language peer-reviewed articles examining factors associated with the PA promotion behaviour of health professionals. Studies were included if: participants were practicing health professionals (excluding medical doctors); PA promotion behaviour measures were reported; and a statistical test of association between potential factors and PA promotion behaviour was performed. Two reviewers independently completed study selection, data extraction, and quality assessment. Results: Twenty-three studies involving 5,673 dental hygienists, dieticians, health care support workers, nurses, occupational therapists, physiotherapists, psychologists, and practice assistants were included. The factors and PA promotion behaviours measured varied considerably between studies. While results were inconsistent, there was evidence suggesting that self-efficacy in PA promotion, positive beliefs in the benefits of PA, personal PA behaviour, assessing patient’s PA, PA promotion training, and beliefs in the efficacy of PA promotion were associated with PA promotion. Lack of time or remuneration were not clear barriers to the promotion of PA. Common limitations of studies were a lack of non-responder data, collection by survey only, cross-sectional study designs, and limited reliability or validity testing of measurements. Conclusion: The factors identified in this review are useful in guiding the development of strategies to encourage greater PA promotion by the non-medical health professions. Future strategies should consider incorporating improving health professionals’ self-efficacy, their belief in the benefits of PA, PA assessment skills, and increasing their own PA behaviours, but may not need to address lack of time or remuneration. The absence of studies from a number of non-medical health professions and the lack of standardised measures and clear definitions of PA promotion highlight the need for further research, which will enable a more comprehensive understanding of health professionals’ PA promotion behaviours. Agelessness, Can You Choose It? Throssell, Paul University of Tasmania The increasing ageing demographic throughout many countries in the world is often viewed as a global problem with deep social and economic implications. It needs to be focused upon differently by individuals and by governments. This paper discusses how we can develop characteristics of agelessness. It focuses on the importance of our response to change and adversity, and further emphasises the impact of epiphanies and turning points in our lives in choosing agelessness. With people living longer than in past generations, governments have been forced to respond to the challenges that have arisen. However, ageing stereotypes restrict and limit ageing individuals, and narrow governments’ responses to ageing problems with interventions often having a short-term reactive focus based on age as a deficit. Though medical and social advances (in particular) have increased longevity throughout the world, cultural stereotypical perceptions may limit the quality of this extension to life. Cultural perceptions about age, which are often based on ageist stereotypes, can perpetuate attitudes, behaviours, and values following the myths and misconceptions engendered. Limitations on the way our lives are conducted can also have important implications for the role of learning during the whole of our life. Furthermore, influences, such as epiphanies or turning points (Denzin, 2001), may contribute to an agelessness mind-set. Insights into these processes, and their linkage to lifelong learning, may assist in encouraging and facilitating individuals of any chronological age in adapting to change and choosing to improve their wellbeing by understanding and restricting negative age-related influences. A person of any age, who is perceived to have agelessness qualities, conducts their life in ways that are not chronologically age stereotypical in relation to the culture they live in, and would appear to resist being culture-bound (Throssell, 2005). Agelessness is a powerful force for change. It will assist individuals and decision makers to challenge and change the deficit basis of restrictive stereotypical JAPA Vol. 24, Suppl., 2016

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ageing. Agelessness can enable ageing individuals to increase their ageing autonomy by conducting their lives in ways that are not age-stereotypical thus providing considerable benefits to individuals and society. Trending to Living Alone Among Older People in New Zealand and the Implications Koopman-Boyden, Peggy; Moosa, Sheena University of Waikato, Hamilton, New Zealand; [email protected], [email protected] Introduction: Recent international historical and meta-analysis research has shown the increasing incidence of living alone as an alternative to family or collective living, especially among older people. With little information on the topic in New Zealand, this research aimed to establish who among older people were more likely to live alone; to characterise the advantages/disadvantages of living alone in older years; and to consider how future policies could ensure that future older people living alone received appropriate care and support. Methods: The data are drawn from the 2001–2013 New Zealand Censuses and the 2014 New Zealand General Social Survey (Statistics New Zealand), along with qualitative interviews with 45 community-based older people (65+ years) living alone. Results: The findings establish the increasing trend of living alone among older people and middle-aged New Zealanders. A larger proportion of older women continue to live alone, although the trend is changing associated with a smaller longevity gap between men and women. While the proportion of those in the major ethnic groups (European/New Zealander, Maori, Polynesian, Chinese) has varied over the years, recently there has been a consistent increase in non-Europeans living alone, although not to the extent of European older people. Among all ethnic groups, a higher proportion of older people live in the regions of the largest cities. The current older people identified aspects of living alone which were liberating and enabled them to maintain a high level of wellbeing. However in almost all cases, social isolation and loneliness were seen as a major disadvantage. Conclusion: The New Zealand data have established a gradual trend towards living alone, which will broaden as the current middle age cohort ages. The research establishes both macro and micro policy and personal implications (many arising from the older people interviewed): housing policies encouraging smaller houses especially accessible for those with limited mobility; city plans which include facilities for mobility scooters; the importance of personal daily routines; commercial food packaging for single person households with limited storage; along with the implications for health status, care outcomes, the ageing-in-place policy and the involvement of families. References: Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., & Stephenson, D. (2015) Loneliness and social isolation as risk factors for mortality: A meta-analytic review, Perspectives on Psychological Science, 10(2): 227–237. Klineberg, E. (2012). Going solo: The extraordinary rise and surprising appeal of living alone, New York, NY: Penguin Press. Koopman-Boyden, P. (2014). A meaningful life for older people who live alone, in Koopman-Boyden, P., Cameron, M.J., Davey, J., Richardson, M .(2014). Making Active Ageing a Reality: Maximising Participation and Contribution by Older People. The University of Waikato, Hamilton, New Zealand. www.waikato/NIDEA/makingactiveageingareality Older Adults’ Use of Public Transport: Prevalence and Association with Walking Cole, Rachel1; Hunter, Ian2; Owen, Neville3; Sugiyama, Takemi4 of Sunshine Coast, Sippy Downs, Australia; [email protected] Department of Health, Robina, Australia; [email protected] 3Baker IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected] 4Australian Catholic University, Melbourne, Australia; [email protected] 1University

2Queensland

Introduction: Studies have shown that public transport use is associated with higher physical activity levels (Saelens et al., 2014) and higher likelihood of meeting physical activity recommendations (Freeland et al., 2013) among general adults. However, little is known to what extent public transport use contributes to older adults’ physical activity. Methods: Data from the South-East Queensland Household Travel Survey conducted in 2009, in which participants reported travel behaviours using a 24-hr travel diary, were used. The study sample consisted of those who were aged between 60 and 84 years, and reported one or more trips on the survey day. We examined prevalence of public transport use and mean total distance and duration of walking on the survey day for those who used public transport (PT users), those who reported walking trips but not public transport use or car use (walking only), and those who used a car but not public transport (car users). Results: Of the study sample (n = 3,797), 169 reported trips using public transport (4.5%), and 611 reported walking trips only (16%). The mean walking distance (SD) was 2.9 (4.1), 2.2 (2.9), and 0.2 (1.2) km for PT users, walking only, and car users, respectively. The mean walking duration (SD) was 33 (23), 28 (25), and 3 (12) minutes for PT users, walking only, and car users, respectively. PT users walked 1.6 km or for 24 min on average to get to/from public transport stops. Conclusion: In this sample of older adults living in South-East Queensland, prevalence of public transport use was quite low. However, those who used public transport were the most active, and walking trips to/from public transport stops contributed to the majority of their walking. The findings suggest that the use of public transport can be encouraged to increase older adults’ physical activity. However, at the same time, public transport users had to walk a substantial distance to get to public transport stops, which may have contributed to low prevalence of public transport use. More accessible public transport services may be needed to facilitate more older adults to engage in active travel. References: Freeland, A.L., Banerjee, S.N., Dannenberg, A.L., & Wendel, A.M. (2013). Walking associated with public transit: moving toward increased physical activity in the United States. American Journal of Public Health, 103(3), 536–542. Saelens, B.E., Vernez Moudon, A., Kang, B., Hurvitz, P.M., & Zhou, C. (2014). Relation between higher physical activity and public transit use. American Journal of Public Health, 104(5), 854–859. Socio-Demographic, Clinical, and Functional Characteristics of Patients Admitted into a Multi-Professional Home Medical Care Service from 2000 to 2009: A Descriptive and Trend Study Mittal, Rakhi1; Young, Ming Ee2; Tan, Chuen Seng1; Chen, Cynthia1; Tham, Weng Yew3; Seong, Lydia1; Tan, Thai Lian4; Koh, Gerald1 1Saw

Swee Hock School of Public Health / National University of Singapore for Integrated Care, Singapore 3CODE 4 Private Limited, Singapore 2Agency

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Tock Seng Hospital, Singapore

Introduction: Home medical services provide long-term community-based healthcare to frail and homebound older persons with multiple medical or nursing needs through regular domiciliary visits. Code 4 Medical Service is one of the home medical services in Singapore. The main aim of this study is to present the socio-demographic, clinical, and functional characteristics of home medical care patients admitted into this service over a 10-year period. Methods: Data was manually retrospectively extracted from the non-computerized medical records of all patients admitted into Code 4 Home Medical Service from 1 January 2000 to 31 December 2009. Records of 1,069 patients were examined. For annual trends, linear regression was used to calculate beta coefficient and 95% coefficient intervals. Results: The majority were Chinese (77.8%) and female (64.7%). Over the 10-year period, there was an increasing proportion of patients greater than 70 years (B [95%CI], 1.08 [0.43–1.73]) living with their children (B [95%CI], 3.80 [2.53–5.06]), with dependence on a foreign domestic worker as primary caregiver almost tripling from 31.4% in 2000 to 80.0% in 2009 (B [95%CI], 4.65 [3.71–5.58]). Patients with dementia (B [95%CI], 1.84 [0.02–3.66]) and hypertension (B [95%CI], 1.25 [0.17–2.34]) also increased during the 10-year period. Cognitive impairment and functional dependency of the patients increased over the years, as assessed using the abbreviated mental test (AMT) < 7 (B [95%CI], 1.73 (0.71–2.76)] and Barthel Index (BI) = 0 (B [95% CI], 4.32 [2.74–5.91]). Conclusion: There were significant changes in socio-demographic, clinical, and functional characteristics of the patients across time. Knowledge about these trends may be helpful to project future demands for home medical care in Singapore. Sport as Social Policy Across the Lifespan Dionigi, Rylee A1; Gard, Michael2; Horton, Sean3; Baker, Joseph4; Weir, Patricia3 Sturt University, Bathurst, Australia; [email protected] University of Queensland, Brisbane, Australia 3University of Windsor, Windsor, Canada 4York University, Toronto, Canada

1Charles 2The

Introduction: Sport as social policy has reached a peculiar and somewhat paradoxical crossroads. Historically, sport has generally been seen as healthy for young people but ill-advised for older people. However, in the context of the twenty-first century’s “obesity epidemic”, the rising “risk” of lifestyle diseases, and ageing populations, some scholars suggest that competitive and vigorous sports may not be the right kind of physical activity for young people because, they argue, it is not something they will be able to keep doing in later life (e.g., Trost 2006). As a result, they argue that young people should be introduced to moderate intensity “lifestyle” activities like walking and going to the gym, which will hopefully improve their health and protect them from weight gain and ill health as they age. At the same time, enthusiasm for sport participation as a policy setting to help older people maintain their independence and improve their general quality of life is growing (van Uffelen et al., 2015). Sport participation also appears to be on the rise amongst older people and, as our research suggests, is becoming understood as a more “normal” part of the ageing process in Western countries (Dionigi et al., 2014). In this paper we offer examples of these rhetorical shifts and argue that, as ever, sport emerges as an endlessly flexible discursive policy resource. Methods: We conducted a critical analysis of sport, physical activity, and active ageing policy-related documents from 2002–2015, with particular focus on the Australian policy context. Results: Three intersecting and contradictory trends were identified in the relationship between sport policy and public health regarding younger people and older people: the focus on moderate–vigorous “life-long” physical activities for young people, the increase in public money promoting sport in schools, and the growing emphasis on sport for older people. Conclusion: Organised sport, and the idea that it could be put to premeditated social policy ends, were both born at a particular point in Western history. References: Dionigi, R.A., Gard, M., Horton, S, Weir, P., & Baker, J. (2014). Sport as leisure for older adults: Critical reflections and recommendations. Paper presented at the 14th Canadian Congress on Leisure Research: Our New Leisure Society, Halifax Nova Scotia, May 21–23, 2014. Trost, S. (2006). Public health and physical education. In D. Kirk, D. Macdonald & M. O’Sullivan, (Eds.), Handbook of physical education (163–187). London: Sage. van Uffelen, J.G.Z., Jenkin, C.R., Westerbeek, H.M., Biddle, S.J.H., & Eime, R.M. (2015). Active and healthy ageing through sport. Report prepared for the Australian Sports Commission. Victoria University, Institute of Sport, Exercise and Active Living (ISEAL). Solely Sold on Stepping: The Challenge of Expanding Seniors’ Physical Activity Horizons Pettigrew, Simone1; Jongenelis, Michelle1; Biagioni, Nicole1; Talati, Zenobia1; Newton, Rob2; Jackson, Ben3; Warburton, Jeni4; Worrall, Caitlin1 University, Perth, Australia; [email protected], [email protected], [email protected], zenobia. [email protected], [email protected] 2Edith Cowan University, Perth, Australia; [email protected] 3University of Western Australia, Perth, Australia; [email protected] 4LaTrobe University, Adelaide, Australia; [email protected] 1Curtin

Introduction: Physical activity is a critical element of healthy ageing. In Australia, there are separate physical activity guidelines for children, adults, and seniors. These guidelines are stated as minimum recommendations. However, to date, there has been limited communication of these guidelines to the general public and compliance levels are low. Seniors in particular have not been a target audience for physical activity promotion messages and have lower levels of participation than other age groups. The aim of the present study was to assess seniors’ beliefs and behaviours relating to physical activity to inform future health promotion communications to this group. Methods: As part of a larger study on healthy ageing, interviews were conducted with 242 Western Australians aged 60+ years (135 female). The participants were encouraged to describe their current physical activity patterns, including the type and intensity of activity undertaken. The interviews were audio recorded and the transcriptions were subsequently imported into NVivo10 for coding and analysis. A thematic approach to analysis was used to explore the issues relating to seniors’ engagement in different types and different intensities of physical activity. Results: Physical activity was generally viewed as a necessary evil, albeit one that was often avoided. This neglect appeared to be the result of numerous factors, including the prioritisation of most other facets of life and avoidance due to pain or illness. Walking was assumed to be the most appropriate form of exercise for older people and was by far the most commonly enacted form of deliberate physical activity. There was almost a JAPA Vol. 24, Suppl., 2016

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complete lack of awareness of government guidelines and little understanding of the need to exercise at moderate levels of intensity. The ‘10,000 steps per day’ rule of thumb had more salience, although very few were able to achieve this goal. Engagement in physical activity was only infrequently (if ever) discussed with friends, family, or medical practitioners. Conclusion: Older Australians need tailored and targeted health communications about the benefits of physical activity and the range of exercise forms that can promote healthy ageing. Such communications need to overcome current low levels of awareness of existing guidelines. How Far Do Older Adults Walk? A Study on Household Travel Survey Sugiyama, Takemi1; Cole, Rachel2; Hunter, Ian3; Owen, Neville4 1Australian

Catholic University, Melbourne, Australia; [email protected]

2University

of Sunshine Coast, Sippy Downs, Australia; [email protected]

3Queensland 4Baker

Department of Health, Robina, Australia; [email protected]

IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected]

Introduction: Maintaining outdoor mobility (the ability walk outdoors) is a key to healthy, active ageing. Considering older adults’ declining physical function, supportive neighbourhood environments are needed to facilitate older adults to walk more often. Access to local destinations is one factor that is likely to influence older adults’ walking behaviours. However, little is known about how far older adults walk to get to local destinations. Such information is important to characterise neighbourhood environments that would support active ageing. Methods: Data from the South East Queensland Household Travel Survey conducted in 2009, in which participants reported their travel behaviours using a 24-hr travel diary, were used. The study sample consisted of those who were aged between 60 and 84 years, and reported one or more trips on the survey day. This study calculated the distance of home-based utilitarian walking and car trips, and examined how they differed between different age groups. Results: Of the study sample (n = 3,797), 540 reported home-based walking trips (14%). The median distance (25th, 75th percentile) of home-based walking and car trips was 0.8 (0.4, 1.6) and 4.2 (1.7, 9.7) km in one way, respectively. There was an age-related gradient in the distance of walking and car trips. The median distance of home-based walking trips was 1.1, 0.9, 0.7 km for those aged 60–64 (n = 1,410), (n = 1,289), and 72–84 years (n = 1,098), respectively. The median home-based car trip distance for these age groups was 4.9, 4.3, and 3.4 km. Conclusion: Most of the older participants in this travel survey used a car and did not walk for their daily trips. Among those who reported walking, the majority of the walk trips were less than 1 km. A trip distance of 1.6 km may be a threshold beyond which older adults tend to use a car. The walking distance was shorter for the oldest group, suggesting that ‘activity space’ may shrink as people age. This study suggests that areas where there are destinations nearby (ideally within 0.8 km, which can be walked in 10 min) may assist older residents to maintain active living.

Posters Palliative Care: Where There is No Doctor Manna, Aditya Caregiver, Narikeldaha Prayas, India Aim: As in any developing country, the state of West Bengal in India has the huge burden of cancer patients in advanced stages coming from rural areas where awareness regarding the usefulness of palliative care is rather poor. This pilot study will explore whether communication by mobile phone can lessen this burden. Method: Initially a plan was generated regarding management of an advanced cancer patient in a nodal centre at a district headquarter. Subsequently, every two weeks a trained social worker attached to the nodal centre will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient families were also encouraged to communicate with the team by phone in case of fresh complaints and urgency in between calls. Results: Since initiation in January 2013, 193 cancer patients were contacted by mobile phone every two weeks to inquire about their difficulties. In 76% of the situations, trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover patients’ families were really overwhelmed by the emotional support offered by the team over the phone. Only 24% of cancer patients had to attend the nodal centre for expert advice from palliative care specialists. Conclusion: This novel approach helped: (1) in providing regular physical and emotional support to the patients and their families; (2) in significantly reducing the financial and manpower problems of carrying patients to the nodal units; (3) in improving the quality of life of patients by continuous guidance. More and more team members can take up this new strategy for better communication and uninterrupted care. Association Between Objectively-Measured Sedentary Behavior and Skeletal Muscle Mass Shibata, Ai1; Oka, Koichiro2; Ishii, Kaori2 1Faculty 2Faculty

of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan; [email protected] of Sport Sciences, Waseda University, Saitama, Japan

Introduction: After accounting for the influence of moderate-to-vigorous physical activity (MVPA), sedentary behaviour (SB) has been shown to be associated with adverse health outcomes, including for older adults. However, little is known about how sedentary behavior would be associated with skeletal muscle mass. Methods: The present study sample was 287 who participated in both a population-based cross-sectional postal survey and visiting assessment and had no missing values for relevant variables and insufficient valid accelerometer data (61.7% men, 74.5 ± 5.2 years). The accelerometer (Active Style Pro, Omron) was worn on the left hip during waking hours for seven days. Non-wear time was defined as intervals of at least 60 consecutive minutes of 0 counts, without allowance for up to 2 min of observations of some limited movement within these periods. Bioimpedance analysis (TANITA, MC-980A) was utilized to estimate total skeletal muscle mass (kg/m2).Confounding variables were age, educational attainment, marital status,

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living status, income level, alcohol intake, smoking, chronic disease status, bodily pain, percentage body fat, and MVPA. Linear regression analyses, stratified by sex, were performed to examine the association of total SB (hour/day), total sedentary time lasting 20 min or more (prolonged SB; hour/day), and number of prolonged SB (times /day) with total skeletal muscle mass. Results: On average, total SB, prolonged SB, and number of prolonged SB were 9.16 ± 1.94 hr, 5.51 ± 2.14 hr, and 7.91 ± 2.43 time per day for men, and 8.08 ± 1.54 hr, 4.26 ± 1.82 hr, and 6.36 ± 2.14 time per day for women, respectively. Mean total skeletal muscle mass was 16.8 ± 2.3 kg/m2 for men and 14.5 ± 1.6 kg/m2 for women. Even after adjustment for covariates, total SB had significant negative association with total skeletal muscle mass for both men (R2 = .35, β= –0.19; p = .029) and women (R2 = .51, β= –0.21; p = .012). Only for women, prolonged SB (R2 = .50, β= –0.19; p = .019) and number of prolonged SB (R2 = .50, β= –0.17; p = .036) were also significantly and negatively associated with total skeletal muscle mass. Conclusion: The present study first revealed higher levels of SB in a sample of Japanese older adults were associated with reduced muscle mass, independent of MVPA and well-known confounding factors. Associations of Objectively Measured Sedentary Behavior and Physical Activity with Health-Related Quality of Life in Older Japanese Adults: An Isotemporal Substitution Analysis Yasunaga, Akitomo1; Shibata, Ai2; Ishii, Kaori3; Oka, Koichiro3 Gakuen University, Tokyo, Japan; [email protected] of Tsukuba, Ibaraki, Japan; [email protected] 3Waseda University, Saitama, Japan; [email protected], [email protected] 1Bunka

2University

Introduction: Recent physical activity (PA) guidelines for health promotion indicated the importance of reducing sedentary behavior (SB) as well as increasing PA for promoting better health. However, there is little evidence discussing the potential health benefits with increasing PA time associated with reducing SB time. The purpose of this study was to use the isotemporal substitution (IS) model to examine the cross-sectional relationship between objectively measured SB and PA with health-related quality of life (HRQOL) when replacing one activity with a different activity in older Japanese adults. Methods: The participants were a sample of 288 Japanese older people, aged 65 to 85 years. We measured SB (≤1.5 METs) and different intensities of PA time (low-low intensity PA [1.6–1.9 METs], high-low intensity PA [2.0–2.9 METs], and moderate-to-vigorous PA [≥ 3.0 METs]) using an accelerometer (Active style Pro, Omron Healthcare). HRQOL was assessed by the Japanese language version SF-8. The relationship between SB and four different PA times and HRQOL was analyzed using the IS model. The IS model is designed to simultaneously model the specific activity being performed and the specific activity being displaced in an equal time exchange manner. In this study, we chose to use 10-min units of activity variables. Results: Replacing 10 min/day from SB to moderate-to-vigorous intensity PA was significantly and favorably associated with HRQOL. Likewise, replacing 10 min/day from low-low intensity PA with moderate-to-vigorous intensity PA and replacing highlow intensity PA with moderate-to-vigorous intensity PA also showed significant and positive effects in HRQOL. In contrast, replacing 10 min/day of the moderate-to-vigorous intensity PA with SB, low-low intensity PA, and low-low intensity PA showed significant and negative associations in HRQOL. Conclusion: Our results suggested the potential health benefits with increasing PA, especially moderate-to-vigorous PA time, associated with reducing SB time in older Japanese adults. References: Mekary, R.A., Willett, W.C., Hu, F.B., & Ding, E.L. (2009). Isotemporal substitution paradigm for physical activity epidemiology and weight change. Am J Epidemiol, 170(4), 519–527. Owen, N., Healy, G.N., Matthews, C.E., & Dunstan, D.W. (2010). Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev, 38(3), 105–113. Local and Digital Neighbourhood Networks—Supporting Participation and Self-Organisation Processes of (and for) Older People Krön, Annette; Rüßler, Harald Fachhochschule Dortmund, Dortmund, Germany; [email protected], [email protected] Introduction: For many people, their neighbourhood becomes more important with age. Reasons for this are that more time is spent at home and that the mobility range tends to decrease. Furthermore, many older people want to see their own interests considered within their residential environment. The neighbourhood stands thus for opportunities of communication, interaction, and participation. Methods: Community participation of older people is one of the topics of the research project “QuartiersNETZ” (“Neighbourhood NET”). While the project includes the development and testing of senior-focused interaction and communication media and technical assistance systems, this paper concentrates on the development of local participation structures and the potential role of a digital platform to support local participation. Research methods include participant observation, a resident survey, and semi-structured interviews. Four neighbourhood networks have been created and participation structures implemented. This paper presents and assesses the implemented methods and the challenges of participative neighbourhood development. Furthermore, a first assessment of the acceptance of and requirements for the digital platform will be made. Results: First results show that the different points of departure strongly influence the content and structure of the participation processes. The differences can partly be explained by population structure, location, and urban structure. Other reasons are the difference in process structures, existing networks, how community development relates to those existing structures, and the composition and objectives of local actors. With regard to the platform, there is a cautious acceptance of its potential to reach further people and to support networks. Some residents embrace the idea. Others are more skeptical, but believe it will become “necessary” at some point. Conclusion: There is no one-sizefits-all approach. The steps taken always depend on the community and their ideas. It crystallises that some of the developed ideas are age-specific while others are not. This shows the need to incorporate age-specific ideas into overall community development and vice versa. At the same time, policies to improve the inclusion and participation of older people and different participation formats are necessary. This means that workshops and conferences are as desirable as working bee events and street parties. References: Krön, A., & Rüßler, H. (2015). Participation structures to support the inclusion of older people on the neighbouhood level. In M. Macoun & K. Maier (Eds), Book of Proceedings AESOP Prague Annual Congress 2015 – Definite Space – Fuzzy Responsibility (pp. 506–517), Prague, Czech Republic. Schelisch, L. (2016) Technisch unterstütztes Wohnen im Stadtquartier – Potentiale, Akzeptanz und Nutzung eines Assistenzsystems für ältere Menschen. Wiesbaden: Springer VS. Van Rießen, A., Bleck, C., & Knopp, R. (Eds.) (2015). Sozialer Raum und Alter(n). Wiesbaden: Springer VS.

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What are Essential Factors to Support Patients’ and Families’ Decision-Making in Acute Care Hospitals? Seike, Aya1,2; Mekaru, Shoko2; Sumie, Hiromi2; Takeda, Akinori2; Endo, Hidetoshi2; Washimi, Yukihiko2; Sakurai, Takashi2; Toba, Kenji2; Yoshikawa, Sakiko1 1Kokoro

Research Center, Kyoto University, Uehiro Kokoro Studies, Kyoto, Japan; [email protected] Center for Geriatrics and Gerontology, Ohbu, Japan; [email protected]

2National

Introduction: In Japan, the prevalence of heart disease, cerebrovascular disease, cancer, and dementia continue to increase. In the characteristics of these diseases, patients have the risk of not being able to express their wills suddenly or soon. Nurses and social workers would like to respect patients’ wills and thinking as much as possible. However, they have time limits and tend to respect the thinking of the families. The study objective was the investigation of essential factors to support patients’ and families’ decision-making in acute care hospitals. Methods: The research subjects were 90 patients (their post-discharge care place did not meet the patient’s wishes) discharged from a critical care hospital from April 2013 to December 2014. We extracted statistically analyzed data of patients’ and families’ expression of wishes for place to live after discharge, support required for decision making. Results: 73.4% of patients were non-cancer and 26.6% of patients were cancer patients; 45.4 % of non-cancer patients and 62.1% of cancer patients wished to be discharged to home. In the end, 63.6% and 65.5% (non-cancer, cancer) of patients were discharged to a place other than home or died, and they could not be discharged from the hospital to the same location as they wished. In both groups of patients, high degrees of necessary care and shortage of care attributed to elderly couples were related to the cause. In non-cancer, there were significantly more cases in which prognosis was not notified and dementia (83.3%) was present in comparison to cancer cases (15.9%). In cancer cases, there was significantly more need for continued medical support such as pain relief with opioids (63.3%) than in the non-cancer cases (37.9%). To support decision-making, more than 50.0% of both patients and their families were explained options for care facilities. In non-cancer, support of coordination within the family was offered more than cancer patients. Conclusion: A lot of decision-making support was provided, such as information provision on care location options. This result leads to lack of preparation in thinking about the remainder of life. We suggest the need for awareness activities to discuss how to fulfill wishes of their own life in advance. An Australian Unique Way of Addressing the Research—Selling Health and Wellness to the Over 60s with Active Life Weekends Lord, Brian Healthy Lifestyle Health Promotion Services; [email protected] Introduction: Active Life Weekends have been held in many areas of Australia for over 25 years by various Departments of Health and Sport and Recreation with the main aim being to help senior members of the community to engage in meaningful recreation and sporting activities. Active Life Weekends target people over the age of 60 and provide opportunities for participants to involve themselves in a wide range of activities. An important outcome of the weekends is that they take people away from their normal home surroundings and provide an ideal learning environment. Methods: In NSW, Australia, there are 11 Sport and Recreation Centres that can provide comfortable accommodation for these programs. The program, through surveys, identified client needs, so it is well balanced with opportunities for individuals to participate at different levels of skill, depending on their wellbeing. The activities offered are many and varied including: water exercise, archery, kayaking, pole walking, lifeball, Tai Chi, painting, memory training, massage, flying fox, and Indigenous games. By attending the weekend, participants encourage new and existing relationships, nurture feelings of self-worth, encourage self responsibility, and promote a positive attitude towards ageing. Participants are also encouraged to consider being a volunteer instructor in gentle exercise, lifeball, aquafitness, Tai Chi, or relaxation. Results: The concept of healthy residential programs has been evaluated extensively, with the outcomes showing that a large percentage of the participants who attend these holidays gained immediate and long-term benefits, including improved confidence, more positive attitudes to their ageing process, and greater motivation to stay well and to be more active. Conclusion: The Southern Rural Region of Sport and Recreation, Riverina, NSW, Australia is proud to be involved in this worthy project and is keeping the costs of these weekends to a low level to support those people on reduced incomes. The Role of Corporate Culture to Drive Active Ageing in the Workplace Howe, Caroline1; Coombe, Brit2 1ThinkHowe 2QBE

Background: Previous research into the ageing experience tends to focus on the transition to retirement following years of work, but few have looked at the experience of ageing well at work. This study looked at workplace wellbeing, including active ageing and its role on ageing well and how corporations must change to engage workers for longer if they themselves are to remain sustainable and profitable. Objectives: The objective of the study was to ascertain the need for creative solutions for older employer engagement. Method: Using mixed methods Internet-based research methodology, 317 people were recruited with an online survey. Thematic content analysis was utilised to explore trends that emerged from the qualitative analysis. Principle Findings: The principle finding was that employers must rethink how they engage the older worker to ensure that their workforce remains stable. Discussion: Low levels of life satisfaction were linked with being dissatisfied at work. Being at work also decreased the likelihood of social interaction. In contrast, retirement offered freedom from the constraints of work. Employers need to adopt solutions around active workplace design through flexibility, offering choices, and a differentiation of the meaning of the “working day” to this cohort if they are to be successful in retaining older workers in employment. Conclusion: The results are significant because governments, both local and federal, are encouraging an ageing workforce to remain in work longer. Employers, as well as governments, need to consider how they can create greater autonomy, through policy development and workplace change, for older people in the workplace. Effect of an Integrated Exercise Program on Physical Fitness, Functional Ability, and Fasting Blood Glucose in a Community Diabetic Patient Group Tsai, Chin-chueh; Chen, Lee-hwa; Chin, Pei-sung; Tung, Jou-min; Tung, Ya-hsin JAPA Vol. 24, Suppl., 2016

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National Taiwan Sport University, Taoyuan, Taiwan; [email protected], [email protected] Introduction: The purpose of this study was to determine the effects of an eight-week integrated exercise program (IEP) on physical fitness, functional ability, and fasting blood glucose in a community-dwelling diabetic patient group (DPG). Methods: Twenty subjects (18 women, 2 men; aged 60.00 ± 11.03 years) recruited from a community DPG participated in an eight-week exercise program and completed pre and post assessments. The exercise program consisted of a warm-up, line dance, light resistance exercise, and stretching, lasting 2 hr, twice a week. Four hours of exercise and diet education lectures were included. Body mass index (BMI), waist and hip circumference, resting heart rate and blood pressure (BP), fasting blood glucose, muscular function (grip strength, sit-up, and 30-s chair stand), flexibility (sit-and-reach, back scratch), cardiovascular endurance (3-min step test, 2-min step test), static balance (closed-eyes single leg stance), dynamic balance, and agility (8-ft up-and-go) were evaluated before and after the intervention. Paired t-test was used to exam the significance of difference between pre and post tested data. Results: BMI (pre: 25.93 ± 3.95 kg/m2; post: 25.65 ± 3.88 kg/m2, p < .05) and diastolic BP (pre: 81.65 ± 11.22 mmHg; post: 75.75 ± 10.65 mmHg, p < .05) were reduced significantly after IEP. Change of glucose level (pre: 153.06 ± 41.76 mg/dL; post: 145.65 ± 29.61 mg/dL, p > .05) did not show significance after intervention. Significant differences were found in sit-up, 30-s chair stand, flexibility of back scratch, sit-and-reach, and 2-min step test activities (p < .05). Conclusion: The results indicate eight weeks of IEP combined with educational lectures is an effective intervention for diabetic patients in improving some parameters of physical fitness and functional ability. However, effective intervention for lowing blood glucose level need further studies to clarify. (Supported by the Public Health Bureau, New Taipei City, Taiwan.) Who’s Maintaining the Health of Australia’s Grey Nomads? Abigail, Wendy; McCloud, Christine; de Bellis, Anita; Hagger, Christina; Clark, Robyn Flinders University, Adelaide Australia; [email protected], [email protected], [email protected], christina. [email protected], [email protected] Introduction: Australians are living longer, healthier, and wealthier lives than at any previous time, and many choose to explore Australia with a caravan in tow, and are colloquially known as “Grey nomads” (ABS, 2011; Davies, 2011). Grey nomads frequently travel to remote rural areas where access to health services is significantly limited, often at an age when the chance of developing health issues is high (Tate, Mein, Freeman, & Maguire, 2006). Anecdotal reports suggest that recommended health screenings of grey nomads are often not undertaken due to remote location and nomadic status. There have been no studies exploring the specific health issues, screening, and health care experiences in this population, or the experiences of health professionals. Methods: Two ethically approved focus groups will explore the health issues and experiences of grey nomads which will inform the development of a questionnaire aimed at health professionals working in rural and remote locations. The focus group discussions will be audio-recorded and thematically analyzed. Results: This study is currently in the data collection phase, with preliminary results expected in early May 2016. Conclusion: This presentation will discuss the project to date, including the benefits such as providing up-to-date evidence-based information that may impact rural and remote health care clinical practice, as well as service delivery for an increasing grey nomad population. This research also aims to add to the body of knowledge about healthy ageing. Furthermore, the results may identify issues that have policy implications and service delivery ramifications. References: ABS. (2011). General Social Survey: Summary Results, Australia, 2010 (4159.0). Canberra: Australian Bureau of Statistics. Davies, A. (2011). On constructing ageing rural populations: ‘Capturing’ the grey nomad. Journal of Rural Studies, 27, 191–199. Tate, J., Mein, J., Freeman, H., & Maguire, G. (2006). Grey Nomad: Health and health preparation of older travellers in remote Australia. Australian Family Physician, 35(1/2), 70–72. Good Health Transitions Project—Use of Technology to Enhance the Customer Experience Barnard, Elizabeth; Wood, Carolyn ACH Group, Adelaide, Australia; [email protected]; [email protected] Over a two-year period, ACH Group aims to develop, trial, and evaluate a new service delivery model structure, aimed at providing re-ablement to older adults living in Metropolitan Adelaide. The project, titled Good Health Transitions Project (GHTP), has received grant funding to support this process, through the Department of Health, healthy ageing, and aged care service improvement funding. GHTP identifies older people who are at risk of or are already experiencing frailty symptoms. The GHTP aims to target older people at critical transition points in their level of services required and reduce risk of further decline. Through thorough assessment by skilled allied health professionals utilising a coaching model unique to the GHTP, individualised goal-setting and subsequent intervention can be provided. Interventions are tailored to build capacity and improve resilience, reverse the frailty trajectory, and reduce the need for higher level needs of care. In keeping with current contemporary healthcare trends, the GHTP has a key focus regarding the use of technology to assist in individualised interventions, thereby enhancing the coaching experience. Partnering with a large technology solutions provider, the GHTP team aim to provide a platform to support customers to manage their chronic conditions, increase their independence with monitoring their health indicators, increase the uptake of interventions, and enhance customer engagement with health services. Parallel to meeting customer needs, the platform will provide health professionals with improved efficiency in delivering interventions and reduce administration time, to therefore globally improve the customer facing experience. The use of technology as a service delivery tool to enhance other behaviour change strategies to reverse the frailty trajectory is combined with the capacity building of staff critical thinking and clinical skills to ensure customers are best equipped for desired uptake of agreed goals and actions. The findings from the GHTP project will influence future service delivery directions both within the ACH Group and in the wider health community. Six Weeks of Low-Frequency High-Intensity Interval Training (HIIT) Improves Resting Cardiac Function in Lifelong Sedentary Ageing Men Sculthorpe, Nicholas1; Grace, Fergal2; Herbert, Peter3 of the West of Scotland, Hamilton, UK; [email protected] University, Victoria, Australia; [email protected] 3University of Wales Trinity St David, Wales, UK; [email protected] 1University

2Federation

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Introduction: This study examined the effects of high-intensity interval training on cardiac structure function in lifelong sedentary ageing men (SED) compared with a control group of age-matched masters athletes (LEX). Methods: 39 aging male participants (SED; n = 22, aged 62.7 ± 5.2 years) (LEX; n = 17, aged = 61.1 ± 5.4 years) were recruited to a study consisting of three assessment phases: upon enrolment to the study (Phase A), following six weeks of cardiovascular conditioning exercise in SED (Phase B), and following six weeks of HIIT performed once every five days by both groups (Phase C). Echocardiographic measurements were obtained in a laboratory setting using standard techniques. Data were analyzed using SPSS version 20.0. Q-Q plots were employed to confirm normal distribution of data. Training effects were compared using a 2 × 3 (group × time) mixed design ANOVA with pairwise comparisons of within- and between-group simple main effects including a Bonferroni correction. An alpha value of P ≤ .05 was used to indicate statistical significance. Data are presented as mean ± standard deviation (SD). Results: In combination, HIIT and conditioning exercise improved resting systolic and mean arterial blood pressure (both P < .01) and lowered rate pressure product (P < .01), whilst increasing heart rate reserve (P < .01) in SED only. Conclusion: The present findings indicate that HIIT subsequent to cardiovascular conditioning exercise can lower cardiovascular risk by lowering blood pressure and improving cardiovascular efficiency at rest in lifelong sedentary ageing men. References: Herbert, P., Grace, F. M., & Sculthorpe, N. F. (2015). Exercising caution: prolonged recovery from a single session of high-intensity interval training in older men. Journal of the American Geriatrics Society, 63(4), 817–818. Herbert, P., Sculthorpe, N., Baker, J., & Grace, F. M. (2015). Validation of a six second cycle test for the determination of peak power output. Research in Sports Medicine, 1–11. One Session of High-Intensity Interval Training (HIIT) Every Five Days Improves Maximal Cardiorespiratory Function in Both Lifelong Sedentary and Lifelong Active Ageing Men Grace, Fergal1; Herbert, Peter2; Sculthorpe, Nicholas3 University, Victoria, Australia; [email protected] of Wales Trinity St David, Wales, UK; [email protected] 3University of the West of Scotland, Hamilton, UK; [email protected] 1Federation 2University

Introduction: Epidemiological studies consistently identify older adults as the least physically active demographic, with few achieving a sufficient volume of recommended exercise to accrue health benefits. This study examined the effects of high-intensity interval training on maximal cardiorespiratory function in lifelong sedentary ageing men (SED) compared with a control group of age-matched masters athletes (LEX). Methods: 39 aging male participants (SED; n = 22, aged 62.7 ± 5.2 years) (LEX; n = 17, aged 61.1 ± 5.4 years) were recruited to a study consisting of three assessment phases: upon enrolment to the study (Phase A), following six weeks of cardiovascular conditioning exercise in SED (Phase B), and following six weeks of HIIT performed once every five days by both groups (Phase C). All measurements were obtained in a laboratory setting using standard techniques. Data were analyzed using SPSS version 20.0. Q-Q plots were employed to confirm normal distribution of data. Training effects were compared using a 2 × 3 (group × time) mixed design ANOVA with pairwise comparisons of within and between group simple main effects including a Bonferroni correction. An alpha value of P ≤ .05 was used to indicate statistical significance. Data are presented as mean ± standard deviation (SD). Results: Compared with conditioning exercise, HIIT improved VO2Max (P < .01), VEMax (P < .01), O2 Pulse (P < .05), and MET capacity (P < .01) in both SED and LEX. Conclusion: In conclusion, the present findings indicate that HIIT subsequent to cardiovascular conditioning exercise improves components of maximal respiratory function in both SED and LEX. HIIT should be considered when prescribing exercise to aging cohorts, irrespective of initial fitness level. References: Herbert, P., Grace, F.M., & Sculthorpe, N.F. (2015). Exercising caution: prolonged recovery from a single session of high-intensity interval training in older men. Journal of the American Geriatrics Society, 63(4), 817–818. Herbert, P., Sculthorpe, N., Baker, J., & Grace, F. M. (2015). Validation of a six second cycle test for the determination of peak power output. Research in Sports Medicine, 1–11. The Effect of an Exercise Intervention Program on Postmenopausal Women Living in North Queensland Barnett, Fiona; Sealey, Rebecca; Simmons, Lisa James Cook University, Australia; [email protected] Introduction: Sedentary postmenopausal women living in North Queensland have lower levels of cardiorespiratory fitness, and higher resting blood pressure, body mass index, and waist-to-hip ratios (Barnett, 2009), which are all risk factors for cardiovascular disease. In addition, 3.3% of Australians have osteoporosis, with the condition more common in females (5.3%) compared to males (1.2%) (ABS, 2012). Postmenopausal bone loss is a risk factor for osteoporosis and hip fracture. Exercise has been suggested as an effective intervention strategy for the reduction in the rate of bone loss for postmenopausal women and for the attenuation of cardiovascular disease risk factors. Previous research has found that sedentary postmenopausal women of North Queensland perceive a number of barriers to exercise, however when given the opportunity to exercise they perceive it as a positive experience (Barnett, 2013). The aim of this study was to determine whether an eight-week aerobic and resistance group-based exercise intervention had an effect on the health status and QoL of postmenopausal women living in North Queensland. Methods: Thirty-three women volunteered to take part in the intervention consisting of a 60-min group-based circuit style session undertaken three times per week. The circuit included a combination of aerobic and resistance exercises to music. Pre- and post-intervention measures were taken. Primary outcome measures included anthropometric profiles, blood lipids, peripheral bone density, cardiorespiratory fitness, and upper and lower body strength. Secondary measures included exercise self-efficacy and menopausal quality of life. Results: Twenty-six women completed the eight-week program. Significant increases were found in cardiorespiratory fitness (p = .00), upper body strength (p = .00), lower body strength (p = .00), exercise self-efficacy (p = .00), and the Menopause Quality of Life psychosocial (p = .01), physical (p = .00), and sexual (p = .01) domains. Waist girth (p = .01) and triglycerides (p = .02) significantly decreased. A downward trend was also found in cholesterol (p = .07). No difference was found for bone density. Conclusion: Results of this study suggest that an eight-week aerobic and resistance group-based exercise intervention can improve the health status and QoL of postmenopausal women living in North Queensland. It is suggested that a longer duration may be required for positive changes in bone density to be seen. References: Barnett, F. (2009). Do physical activity levels influence the cardiovascular-related physiological characteristics of postmenopausal women? Australasian Journal on Ageing, 28(4), 216–218. Australian Bureau of Statistics. (2012). Australian Health Survey: Health Service Usage and health Related Actions, 2011-12. Barnett, F. (2013). The effect of exercise on affective and self-efficacy responses in older and younger women. Journal of Physical Activity and Health, 10(1), 97–105. JAPA Vol. 24, Suppl., 2016

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The Efficacy of an Eight-Week Exercise and Self-Management Education Program for People with Parkinson’s Disease De Hollander, Catherine; Barnett, Fiona James Cook University, Townsville, Australia; [email protected], [email protected] Introduction: Parkinson’s disease (PD) is a chronic progressive condition which requires long-term management. Exercise is one non-medical therapy which has resulted in numerous physical, psychological, and social benefits in people with PD. In addition to the recommendation of exercise for PD, Europe has also implemented a national self-management education program called the Patient Education Parkinson’s Program (PEPP). To our knowledge, no study has yet to combine these two management methods into one program for people with PD. Methods: Five participants with PD completed the intervention. Weeks 1–4 included 2 × 1 hr weekly exercise sessions with an exercise physiologist (EP). Weeks 5–8 included 1 × 1 hr exercise session with an EP and 1 × 1 hr supervised independent exercise session weekly. Participants attended weekly group PEPP sessions. Assessments included Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS), Stanford Self-Efficacy for Managing Chronic Disease Scale, physical activity level, sit-to-stand test, grip strength, Berg Balance Scale, 2-Minute Walk Test (2MWT), and 10-m gait parameters of walking. Upon completion of the program, a focus group explored the self-perceived effects, strengths, and weaknesses of the program. Results: All participants improved motor aspects and motor examination scores (MDS-UPDRS), activity level, and 2MWT, while four participants improved their balance score. Strengths of the program included: perceived improvements in symptoms, exercising with an EP, socialising, shared identity, and cost-effectiveness. Perceived weaknesses were increases in pain, stiffness, and fatigue, independent exercise sessions, and travel. Conclusion: Exercise and self-management education is beneficial for improving physical and psychosocial wellness in people with PD. The Impact of Exercise Training on Promoting Safety and Healthy Ageing Mokhtari, Iman1; Kamalifard, Mozhgan2; Rezaei, Mohammad3 sport organization, Municipality of Tehran, Iran; [email protected] Medicine Specialist, Occupational Health Research Center, Tehran, Iran 3Sport organization, Municipality of Tehran, Iran 1Physiatrist,

2Occupational

Introduction: Unintentional injuries are a major health problem for older people. While injury in the elderly is related to a combination of factors including those resulting from the aging process, the home environment and product design are important, and often modifiable, contributors. Also, preventive health screenings, lifestyle changes, and environmental modifications are methods that are effective. Appropriate physical activity constitutes one of the major components of a healthy lifestyle. The purpose of this randomized controlled trial (RCT) study was to investigate the impact of a three-month physical activity program on different aspects of health-related quality of life and establish the role of consumer products in injuries to older persons. Also, the biological, behavioral, environmental, and socio-economic factors are reviewed. Methods: Among 60 subjects between the ages of 55–65, participants were randomized to either the control group (n = 30, mass = 71 ± 2/2) or physical activity group (n = 30, mass =70 ± 2/6). All in the latter group were given a training session and received daily exercise. The subjects did the exercises while supervised three times per week during three months. The control group did not receive any activity. All subjects were given an SF-36 scale to fulfill pretest and posttest. Results: At the end of the program, in a between-group comparison, the results of independent sample t-test analysis showed significant changes in physical functioning, general health, physical component summary, and total scores of the SF-36 scale (P < .001). Physical functioning—Control: P = .75 (nonsignificant); Experimental: P = .01 (significant). Role limitation, physical—Control: P = .22 (nonsignificant); Experimental: P < .001 (significant). General health—Control: P = .43 (nonsignificant); Experimental: P = .01 (significant). Vitality—Control: P = .74 (nonsignificant); Experimental: P = .9 (significant). Social functioning—Control: P = .21 (nonsignificant); Experimental: P = .27 (nonsignificant). Conclusions: Regular supervised integrated sport programs are safe and effective in elderly persons. Physical activity is important for healthy ageing and improving and maintaining quality of life and independence as people age. Who Trains the Oldest Old? Prevalence and Correlates of Australian Fitness Trainers Who Train Adults 75 Years and Older Bennie, Jason; van Uffelen, J; Banting, L; Biddle, S Active Living Public Health Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Victoria, Australia; jason. [email protected], [email protected], [email protected], [email protected] Introduction: The Australian Public Health Physical Activity Guidelines recommend that older adults aged ≥ 65 years should engage in regular aerobic, strength, balance, and flexibility training (Australian Government Department of Health, 2014). However, it is estimated that only ~6% of Australians aged ≥ 65 years meet the aerobic and strength training guidelines (Bennie et al., 2015). Due to their skills in exercise prescription, fitness trainers (e.g., gym/group instructors) may have a role in promoting exercise among older adults. However, little is known about the prevalence and characteristics of Australian fitness trainers who train older adults. Methods: In 2014, a convenience sample of 9,100 registered Australian fitness trainers were invited to complete an online survey. Participants reported how frequently they trained clients (4-point scale: 1 = ‘never’ to 4 = ‘most of the time’) from five different age groups (range: 1 = ‘children ≤ 12 years’ to 5 = ‘adults ≥ 75 years’). The proportions reporting training adults age ≥ 75 years ‘never’ and ‘most of the time’ were calculated. Associations with selected sociodemographic (e.g., age, sex) and fitness industry-related (e.g., setting, employment status, fitness industry qualification) variables and frequency of training adults aged 75+ years (‘never’ vs. ‘most of the time’) were examined using multiple logistic regression analyses. Results: Out of 1,206 fitness trainers who completed the survey (response rate = 13.7%, mean age = 37.4 ± 10.8 years), 75.2% (95% CI: 69.1–80.2) reported ‘never’ training adults aged ≥ 75 years, and 6.9% (95% CI: 5.5–8.4) reported training adults this age ‘most of the time’. In the adjusted analysis, trainers who were females (OR 5.9, 95% CI: 2.4–14.1), ≥ 61 years (OR 5.4, 95% CI: 2.6–11.6), aged 51–60 years (OR 2.4, 95% CI: 1.4–3.9), and with more than 10 years’ experience within the fitness industry (OR 1.3, 95% CI: 1.7–3.6) were more likely to train clients aged ≥ 75 years ‘most of the time’. Conclusion: Among a large sample of registered Australian Fitness trainers, over three-quarters reported ‘never’ training older adults aged ≥ 75 years. Given that older adults are among the most inactive population groups, policy-driven efforts should be made to support exercise adherence among this age group. Future efforts should also ensure that trainers are provided with adequate professional training to prescribe exercise to older adults. References: Australian Government Department of Health. (2014). Australia’s physical activity and sedentary JAPA Vol. 24, Suppl., 2016

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behaviour guidelines (adults). Canberra, ACT: Australian Government. Bennie, J.A., et al., (2015).The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults: results from the National Nutrition and Physical Activity Survey. BMC Public Health (In press). Developing a Positive Self-Management Training Programme for Positive Ageing for Older Adults and By Older Adults Stock, Jennifer; Docking, Rachael; Schofield, Pat Anglia Ruskin University; [email protected], [email protected], [email protected] Introduction: The aim of this project was to develop a peer education programme for positive ageing in older adults which would be developed and facilitated by older adults. This programme aims to empower and enable older adults to take control of their own health needs thus building upon the models of control, coping, and enhancing well-being whilst reducing the cost to the NHS and social care. Method: We recruited older adults from local community groups and pensioner forums and a university older adult research advisory group. We also involved health care professionals across London and South East England. Workshops were facilitated to capture insights and perceptions of what positive ageing means to older adults and health care professionals. Insight gathered from these workshops was collated and synthesised and used as part of discussions within the research team to develop curriculum and teaching materials. Additionally, we organised a debate between health care professionals who specialise in gerontology and representatives of the older adult pensioner forums. The aim of this debate was to create an interface where attitudes and opinions of all participants could be challenged and deliberated. Results: We have a developed a programme aimed at pre-retirement over six weeks. The sessions will cover: (1) Week One: What is Ageing, What is Positive Ageing?; (2) Week Two: Barriers & Facilitators to Positive Ageing; (3) Week Three: Perspectives on Positive Ageing; (4) Week Four: Societal Attitudes Towards Ageing; (5) Week Five: Resilience to Better Manage Life Transitions—Moving Forward; (6) Week Six: Developing a Toolkit to Manage Later Life Changes. Conclusion: While older adults face a number of challenges and are negatively portrayed by society, their own positive attitudes towards ageing play a key role in how they adapt to these challenges and override negative environmental cues and our expectations of what older people are capable of. A programme like this has the potential to help younger-old people to increase their capacity to cope with changes and play an active role in their community after retirement. Love Your Parents—The Best Solution to Control Chronic Diseases Chen, Jin Jong1; Chang, Tony2; Lai, Michael MC2,3; Yeh, Chin-Chuan2,4 Ming University, Taipei, Taiwan; [email protected] Health Movement Alliance, Taipei, Taiwan 3Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan 4Tsu Chi University, Hualien, Taiwan 1National Yang

2Taiwan

Introduction: Remote wireless wearing devices have been considered to be potential tools of preventive medicine for health promotion and chronic disease control. However, there are few successful strategies and business models of mobile health for the Chinese aged population. Our vision is to connect community hospitals, social resources, parent-child bonding, and ICT (information, communication, and technology) to develop an effective, low-cost solution to improve the chronic disease control problem. Methods: We cooperate with telecom companies and establish a 4G mobile health business model called “Promote Parents’ Health via Children” to provide efficient and effective aged care services. We invite community hospitals supporting this program and encourage young people to purchase blood pressure monitors, body weight scales, pedometers with GPRS dongles, and 4G SIM cards from telecom companies as a gift for their parents in outpatient clinics, then guide the beloved elder ones to regularly track their blood pressure, body weight, and physical activity, and take healthy lifestyle advice over phone conversations. Results: When a measurement is done, the data will be uploaded to Health Cloud and the subscribers can review data, historical trends, and analysis of blood pressure, body weight, and physical activity through APP and/or a computer. The elderly will be most motivated by their offspring to control their chronic diseases. By spending a small fee, the younger generations are less likely to carry a heavy burden by preventing the elder ones from having a stroke and/or suffering from other chronic diseases. The data and analysis will be sent to city governments for further medical care, preventing thousands of people from stroke and related diseases, and saving enormous social funds and resources. The program also provides a great conversational topic between the two generations. Conclusion: Promote Parents’ Health via Children is an effective, low-cost solution to improve the chronic disease control problem for the Chinese aged population. Characteristics of Domain-Specific Sedentary Behavior Among Japanese Older Adults Ishii, Kaori1; Shibata, Ai2; Oka, Koichiro1 1Waseda

University, Saitama, Japan; [email protected] of Tsukuba, Ibaraki, Japan; [email protected]

2University

Introduction: Domain-specific sedentary behavior, such as television viewing and car driving, has been associated with increased risk of weight gain, type 2 diabetes, cardiovascular disease, and mortality. However, no study has assessed the time that Japanese older adults spend undertaking domainspecific sedentary behavior. The present study examined the domain-specific sedentary time and the differences for each sociodemographic variable among Japanese older adults. Methods: A population-based cross-sectional survey was conducted (N = 3,000; 65–85 years; residents of one Japanese city). Self-administered questionnaires comprising questions on sociodemographic variables and sedentary behavior were mailed to participants. Domainspecific sedentary behavior was estimated using five items: (1) traveling via car; (2) using public transport; (3) at work; (4) watching television, videos, DVDs; (5) using a computer, cell phone, tablet outside work hours; and other leisure time (excluding [4]). Sedentary time (hours and minutes) per day (weekday and weekend) and sociodemographic attributes (gender, age, education, employment status, marital status, life circumstance, and body mass index) were assessed. To estimate the proportion of domain-specific sedentary time, weekly total sedentary time and domain-specific sedentary time per day were calculated. Analysis of covariance estimated the differences between the total and domain-specific sedentary time, adjusting for each sociodemographic variable. Results: Valid responses from 334 older adults (205 males) were used. The mean minutes of domain-specific and total sedentary JAPA Vol. 24, Suppl., 2016

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time per day (SD) were: (1) 41.0 (78.0); (2) 15.9 (33.0); (3) 25.4 (76.0); (4) 199.8 (148.9); (5) 37.0 (62.8); (6) 105.3 (79.5). The total was 424.5 (223.7). Males spent less time on public transport compared to females (p = .05); and females spent less time in cars (p = .05) and on computers (p = .01) compared to males. Those with higher education used computers (p = .02) more compared to those with lower education. Employed persons spent less total time sedentary (p < .00) and watching TV (p < .01) compared to unemployed persons. Unmarried persons spent less time in cars (p = .05) compared to those who were married. Those with a higher BMI spent more total time sedentary (p = .01), watching TV (p = .01), and in other leisure time (p = .05). Conclusion: The proportions of domain-specific sedentary behavior among the chosen sample demonstrated patterns that highlight differences according to sociodemographic variables. Video Feedback Motivation Khaing, Kay; Barrett, Tomiko Wyong Hospital, Central Coast Local Health District, NSW, Australia Objective: The purpose of this study was to explore the feasibility and effectiveness of video feedback on increasing internal motivation and, consequently, the positive effect on the outcome of rehabilitation. Methods and Design: The video feedback motivation study is a feasibility pilot study. Patients were selected from the Geriatric Rehabilitation Unit at Wyong Hospital, CCLHD. At the initial assessment, patients were screened for depression, anxiety, and cognitive function by using the Hospital Anxiety and Depression Scale (HADS) and Mini Mental State Examination (MMSE). Baseline functional status was recorded using FIM. Rehabilitation goals were set up for individual patients as per the physiotherapist and occupational therapist. A short video of their functional status was taken. Then they viewed their own video and filled in the short motivation questionnaires. At the next assessment, another video of the same activity was made. Each patient viewed both of their videos then completed the short motivation questionnaires. Patients were assessed weekly until they were discharged or at six months, whichever came first. A nine-item Intrinsic Motivation Inventory Questionnaire was used to assess the intrinsic motivation and the internalization of motivation. The individual items were rated on scales of 1–7. Patients’ spontaneous comments, the physiotherapists’ observations, and the result of the questionnaires were used to evaluate motivation changes. Preliminary Result: This research project will be finished in February 2016. To date, 20 patients were recruited. One patient was discharged in the first week. One patient was too confused to complete the initial questionnaire. One patient died. Three patients were transferred to the acute medical ward due to acute medical conditions. Of the remaining 15 patients, video feedback internalised the motivation and increased the intrinsic motivation scale in nine patients. These were successfully discharged from GRU. The physiotherapist and investigator observed improved motivation and participation in participants during the process of filming and immediately afterwards. Participants enjoyed being filmed. Conclusion: The preliminary result demonstrates that video feedback can improve motivation, therefore it is recommended to consider incorporating this as a standard practice for patients with low motivation. Patterns of Accelerometer-Determined Sedentary Behavior Among Older Japanese Oka, Koichiro1; Shibata, Ai2; Ishii, Kaori1 1Faculty 2Faculty

of Sport Sciences, Waseda University, Saitama, Japan; [email protected] of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan

Introduction: Little is known regarding the patterning and socio-demographic distribution of objectively-measured sedentary behavior among Japanese older adults. Thus, the present study described the pattern of objectively measured sedentary behaviour (SB) among Japanese older adults. Methods: The present study sample was 287 adults aged 65–85 years who participated in both a population-based cross-sectional postal survey and visiting assessment (61.7% men, 74.5 ± 5.2 years). The accelerometer (Active style Pro, Omron) was worn during waking hours for seven days. Non-wear time was defined as intervals of at least 60 consecutive minutes of 0 counts, without allowance for up to 2 min of observations of some limited movement within these periods. Sociodemographic attributes (sex, age, marital status, and educational attainment) were self-reported. BMI was calculated from measured height and weight. Mean percentage of wearing time spent in SB (%), total time spent in SB (hour/day), and number of bout prolonged SB (times/day) were compared across each of the sociodemographic attributes and BMI status. Results: Within accelerometer wear time, 58.2% (8.75 ± 1.87 hr/day) was spent sedentary and 5.5% (0.83 ± 0.54 hr/day) was spent in MVPA, on average. The mean number of bouts of SB and prolonged SB were 63.9 ± 15.2 and 7.3 ± 2.4 times/day, respectively. Adjusting for wear time and other subgroup characteristics, total sedentary time (61.7 ± 11.3% of wear time, 9.16 ± 1.94 hr/day) and number of bout prolonged SB (7.9 ± 1.4 time/day) in men were significantly higher than in women (52.7 ± 10.1% of wear time, p < .001; 8.08 ± 1.54 hr/day; p < .001; 6.4 ± 2.1 times/day, p < .001). Total sedentary time (57.8 ± 11.6% of wear time, 8.68 ± 2.04 hr/day) in those married were significantly lower than in their unmarried counterparts (60.1 ± 12.0% of wear time, p < .038; 9.05 ± 2.04 hr/day; p < .049). Those overweight and obese had significantly higher total sedentary time than those of normal weight (61.9 ± 13.1% of wear time), and those married were significantly lower than in their counterparts (56.6 ± 10.7% of wear time; p = .002). Conclusion: The present study first provides a detailed analysis of SB patterns among a sample of Japanese older adults. Japanese older adults spent more than half of waking time in SB. The patterns of SB behaviour appear to be different by gender, marital status, and obesity. Exercise Testing, Monitoring, and Supervision for Cardiac Rehabilitation Programs: A Review of International Guidelines Price, Kym J1; Gordon, Brett A1,2; Bird, Stephen R1; Benson, Amanda C1 University, Melbourne, Australia; [email protected] Trobe University, Melbourne, Australia

1RMIT 2La

Introduction: Cardiovascular disease (CVD) results in high rates of morbidity and mortality, with approximately 80% of all instances of CVD mortality occurring in individuals aged over 60 years (Mendis, Puska, & Norrving, 2011). Exercise-based cardiac rehabilitation programs are effective at reducing mortality following an acute cardiac event, however safety during exercise needs to be assured due to increased risk of subsequent events. Electrocardiograph (ECG)-monitored exercise testing prior to commencement of cardiac rehabilitation allows peak exercise capacity to be determined, while it is suggested ECG-monitoring during exercise testing provides increased self-confidence for participation and subsequent JAPA Vol. 24, Suppl., 2016

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independent activity (American Association of Cardiovascular and Pulmonary Rehabilitation, 2013). This review sought to understand the type of supervision required and the recommended use of ECG during testing and monitoring of cardiac rehabilitation. Methods: National guidelines, position statements, and policy documents for outpatient cardiac rehabilitation available internationally in the English language were reviewed for exercise testing and monitoring recommendations, and compared to identify differences and/or consensus. Results: ECG-monitored exercise stress tests are recommended for all patients participating in cardiac rehabilitation in the United States (US), Canada, South America, mainland Europe, and Japan. In Australia, New Zealand, and countries of the United Kingdom, ECG-monitored pre-exercise testing is only recommended for highrisk patients or those participating in high-intensity exercise programs, with less intensive functional assessment preferred otherwise. Routine use of ECG during exercise rehabilitation is specified only in the US, Canada, South America, and Ireland, where guidelines incorporate progression from continuous to intermittent ECG monitoring along with a gradual reduction in the level of supervision as patient risk decreases. However, Belgium, France, Germany, the Netherlands, Japan, and the Europe-wide guidelines recommend ECG monitoring only for initial exercise sessions, high-risk patients, or when symptoms are present, instead relying on monitoring heart rate, blood pressure, and rating of perceived exertion. Typically, nations with more stringent exercise testing and monitoring recommendations suggest higher exercise rehabilitation intensities. Conclusion: The recommendations for ECG monitoring of exercise testing and training sessions in cardiac rehabilitation programs differs considerably between nations and tends to be linked to the recommended intensity for exercise rehabilitation. References: American Association of Cardiovascular and Pulmonary Rehabilitation. (2013). Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs (5th ed.). Champaign, IL: Human Kinetics. Mendis, S., Puska, P., & Norrving, B. (2011). Global Atlas on Cardiovascular Disease Prevention and Control. Geneva, Switzerland: World Health Organisation. Predictors of Adherence to Physical Exercise Recommendations in Brazilian Community Elders Hiratsuka, Marcel1,2; Roma, Maria Fernanda Bottino1; Carvalho, Luis Filipe GL1; Sassaki, Carolina1; Ota, Pedro Ivo Nawa2; Ota, Marcus2; Jacob Filho1 Service of Clinics Hospital of University of São Paulo (USP); [email protected] de Desenvolvimento do Envelhecimento Saudável (CEDPES)

1Geriatrics 2Centro

Introduction: The WHO recommends the practice of 150 min/week of physical activities, but there is limited knowledge about exercise adherence in older adults. The purpose of this study was to assess predictors of adherence to physical exercise recommendations after an intervention involving counselling and exercises classes. Methods: This study is a retrospective cohort with older adults (+60 years old) from community and participants of CEDPES, a healthy aging program in São Paulo. All participants had a comprehensive geriatric assessment (CGA), were counselled about healthy habits including physical exercises, and invited to participate in various physical exercise classes at the admission to the program. One year later, the subjects responded to a telephone questionnaire to inform the current physical activity level. Based on the physical exercise time, we divided the sample in two groups: adherent (≥ 150 min/week) and non-adherent (< 150 min/week). Results: There were 216 subjects with an average age of 71.2 ± 6.6 years. One-hundred-ninety (87.96%) were female. One year after the intervention, 91 (42.13%) were adherent and 125 (57.87%) were non-adherent. Logistic regression indicates as independent factors for overall adherence to exercise: prior time of physical activities (OR = 1.01, CI95% = 1.00–1.17, p < .001), Geriatric Depression Scale-15 points (GDS-15) (OR = 0.79, CI95% = 0.68–0.92, p = .02), and school level in years (OR = 1.09, CI95% = 1.01–1.17, p = .02). Among non-adherent subjects at program admission (n = 140), only 43 (30.71%) achieved 150 min/week of exercise after one year. School level in years (OR = 1.09, CI95% = 1.00–1.18, p = .041) and chronic pain intensity measured by FACES Pain Scale (OR = 0.86, CI95% = .75–0.95, p = .017) were factors associated with becoming adherent. Seventy-six subjects initially accomplished the recommendations and 48 (63.1%) persisted adherent after one year. There was a correlation between GDS-15 (OR = 0.57, CI95% = 0.39–0.84, p = .001) and osteoarthritis (OR = 0.26, CI95% = 0.08–0.86, p = .024) with the maintenance of physical activity. Conclusion: Previous practice of physical activities, higher education level, and less depression symptoms were predictors for adherence to the WHO recommendations. Education level and control of chronic pain were associated with non-adherent elders becoming adherents. A minor number of depressive symptoms and absence of osteoarthritis were factors for adherents to maintain the practice of > 150 min/week of physical activities. Healthcare Assistants’ Information Seeking Behaviors in their Practice Setting: A Systematic Literature Review Burrow, Marla School of Nursing, University of Massey, New Zealand; [email protected] Introduction: Healthcare assistants are key professionals in long-term and community settings and there is a growing demand for them within these sectors. The healthcare assistant is often in the best position to encourage and support the wellbeing of the clients in their care (Watt, Carosella, Podgorski, & Klein, 2004). The professional role of healthcare assistant falls outside the boundaries of the regulated workforce, which is often described as having limited clinical training. Due to the complex and variable environment in which they provide care, healthcare assistants are often presented with the need to inform their practice. The aim of this review is to discover how healthcare assistants are informing their practice using information behavior theory as a search framework. The implications of healthcare assistants’ information seeking, access, and use are significant to the wellbeing and success outcomes for those they care for and support. Methods: A systematic review of the literature was conducted. CINAHL Complete, PubMed, and PsycINFO were searched. Informal and unpaid healthcare assistants were excluded. The search dates encompassed the years of 1980 to October 2015 and the search was limited to peer reviewed articles presented in English. Results: Of the 133 articles found to be pertinent, only three articles were focused on the healthcare assistant and their information behavior and sense making. Conclusion: Within the context of information behavior, healthcare assistants are under-represented. A closer look at the sense making and information behaviors of HCAs in their context of care can provide a greater understanding on how to best support these professionals and their clients’ wellbeing. References: Watt, C.A., Carosella, A.M., Podgorski, C., & D.J. Ossip-Klein. (2004). Attitudes toward giving smoking cessation advice among nursing staff at a long-term residential care facility. Psychology of Addictive Behaviours, 18(1):56–63.

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Sedentary Behaviour, Body Composition, and Inflammation in Older Canadian Couples Chudyk, Anna M1,2; Hoppmann, Christiane A1,2; Gerstorf, Denis3; Madden, Ken M1,2; Ashe, Maureen C1,2 for Hip Health and Mobility, Vancouver, Canada; [email protected] University of British Columbia, Vancouver, Canada 3Humboldt-Universität zu Berlin, Berlin, Germany

1Centre 2The

Introduction: Sedentary behaviour is an independent risk factor for the development of some chronic conditions (Thorp, Owen, Neuhaus, & Dunstan, 2011), possibly resulting from an accumulation of low-grade chronic inflammation (Henson et al., 2013). No previous studies examined the association between sedentary behaviour and inflammation in older adult couples, who may share common environmental and behavioural determinants. Therefore, our objective was to explore the association between minutes of sedentary behaviour in older adult couples and inflammation (C-reactive protein [CRP]). Methods: We report the baseline findings from a prospective study of community-dwelling older Canadian couples aged 65 years+. All participants completed in-person physicals and serum for high sensitivity CRP analyses. Following assessments, participants were fitted with a waist-mounted triaxial accelerometer (ActiGraph GT3X, Pensacola, FL) and requested to wear it for seven days; we analysed data using standardized methods based on a 13-hr day. We provide descriptive data as mean (SD), Pearson’s correlations, and multi-level linear modeling (MLM; HLM V7.01) to examine associations using dyadic data, or multivariable regression as appropriate. Covariates in multivariable analyses included sex, BMI, and MVPA. Results: There were 113 couples (n = 226) who provided valid data in this study: age 71 (6) years; 50% women; years married 41 (12); 4 participants smoked; BMI 26 (5); sedentary min/day 535 (63); MVPA min/day 28 (19); CRP 2.1 (4.1) mg/L. There was a significant correlation between sex and sedentary behaviour (0.253, p < .001), with men engaging in more sitting time (32 min/day p < .001). Sedentary behaviour (0.135, p = .04) and BMI (0.326, p < .001) correlated with CRP. Using MLM to explore CRP determinants accounting for couples, the ICC was 0.07, p = .112; therefore, we used multivariable regression to describe associations between CRP and sedentary behaviour. In the base model, CRP had a very small association with sedentary behaviour (r2 = .024; p = .02), however this was attenuated after adding sex, BMI, and MVPA into the model; only 12.4% of the variance in CRP was explained by BMI (p < .001). Conclusion: Although we noted a difference in sedentary behaviour between men and women, only BMI was significantly associated with inflammation in the final model. This work extends previous findings on the association between activity patterns, body composition, and inflammation. References: Henson, J., Yates, T., Edwardson, C.L., Khunti, K., Talbot, D., Gray, L.J., . . . Davies, M.J. (2013). Sedentary time and markers of chronic low-grade inflammation in a high risk population. PloS One, 8(10), e78350. Thorp, A.A., Owen, N., Neuhaus, M., & Dunstan, D.W. (2011). Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. American Journal of Preventive Medicine, 41(2), 207–215. Capturing How Age-Friendly Communities Produce Positive Health, Social Participation, and Health Equity Levasseur, Mélanie1,2; Dubois, Marie-France1,2; Généreux, Mélissa1,3; Menec, Verena4; Raina, Parminder5; Paris, Mario2; Roy, Mathieu1,3; Gabaude, Catherine6; Couturier, Yves1,2 de Sherbrooke, Sherbrooke, Quebec, Canada; [email protected], [email protected], Melissa. [email protected], [email protected], [email protected] 2Research Centre on Aging, Sherbrooke, Quebec, Canada; [email protected] 3CIUSSS de l’Estrie-CHUS, Sherbrooke, Quebec, Canada 4University of Manitoba, Winnipeg, Manitoba, Canada; [email protected] 5McMaster University, Hamilton, Ontario, Canada; [email protected] 6Institut français des sciences et technologies, Bron, Lyon, France; [email protected] 1Université

Rationale: To address the challenges of the global aging population, the World Health Organization (WHO) promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components, i.e., policies, services, and structures related to the communities’ physical and social environments, should be designed to be age-friendly and help all aging adults to live safely, enjoy good health, and stay involved in their communities (WHO, 2002). Although age-friendly communities are believed to be one of the best ways to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation, and health equity, and how. Objectives: The general objective of this proposal is to better understand which and how key components of age-friendly communities best foster positive health, social participation, and health equity in aging Canadians. Specifically, the research aims to: (1) describe and compare age-friendly key components of communities across Canada; (2) identify key components best associated with positive health, social participation, and health equity of aging adults; (3) explore how these key components foster positive health, social participation, and health equity. Methods: A mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of selected Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include the age-friendly questionnaire (Menec et al., 2015) targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, and communication and information. The CLSA is a large, national, long-term study representative of the Canadian population designed to examine health transitions and trajectories of adults as they age (Kirkland et al., 2015). In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation, and health equity. Expectations: Building on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help age-friendly communities to identify policies, services, and structures which foster positive health, social participation, and health equity at a population level. References: Menec, V.H., Hutton, L., Newall, N., et al. (2015). How ‘age-friendly’ are rural communities and what community characteristics are related to age-friendliness? The case of rural Manitoba, Canada Ageing and Society, 35(1):203–223. Kirkland, S.A., Grifth, L.E., Menec, V., et al. (2015). Mining a unique Canadian resource: The Canadian Longitudinal Study on Aging Can J Aging, 34(3):366–377. World Health Organization. Active Ageing: A Policy Framework. Madrid, Spain. 2002. Funding: Funding was obtained from the Canadian Institutes of Health Research (CIHR; grant #126315),

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which, except for their special call for projects, did not influence the study. Mélanie Levasseur is a Fonds de la recherche du Québec – Santé (FRQS) junior 1 researcher (grant #26815). Longitudinal Associations Between Income and Well-Being in a National Sample of Older People in Taiwan Lee, Miaw-Chwen1; Tzeng, Huei-Jia1,2 1Department 2Department

of Social Welfare, National Chung Cheng University, Chia-Yi, Taiwan; [email protected] of Preventive Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan; [email protected]

Introduction: With the coming of an aged-society, active ageing has become an urgent social policy. Older people have experienced a variety of social risk factors throughout their life courses. These social risk factors might influence health directly and indirectly in their later life. Previous studies have focused on the concurrent relationship between socioeconomic factors and health that have overlooked their longitudinal relationship. The purpose of this study is to analyze the longitudinal and dynamic relationship between income and health among the older people in Taiwan. Methods: This study used the six-wave data of the “Longitudinal Study on Health and Living Status of the Elderly in Taiwan” from 1989 to 2007. Socioeconomic factors were measured by income deciles, while well-being was measured by self-rated health and life satisfaction. A group-based trajectory modeling approach was employed to create trajectories. Cross-lagged longitudinal models were employed to examine the cross-lagged effects of income and well-being, controlling for demographic variables and educational attainment. Results: The final sample comprises 4,393 males and 3,717 females. The results of cross-lagged analysis showed that the autoregressive coefficients of income (0.46–0.56) were greater than that of self-rated heath (0.36–0.43) and life satisfaction (0.27–0.34). The cross lagged coefficients of income on self-rated health (0.09–0.12) and life satisfaction (0.08–0.13) were greater than that of self-rated health (0.03–0.09) and life satisfaction (0.04–0.08) on income, respectively. Conclusion: The results have provided evidence on the several pathways between income and health, including biological, socio-biological, bio-social, and social and accumulation effect. In addition to social causality of income on health, the social selection effect could not be neglected. The majority of the older people (72%) have demonstrated a consistently high pattern of life satisfaction. The strong relationship between income and life satisfaction indicates that policies should not only be targeted on illness or disability among the older people, but also be concentrated on the subjective selfperceived quality of life. This understanding will facilitate allocation for strategies to the appropriate resource designed to improve well-being and overall health of older people, such as active ageing. Hydrotherapy for the Very Old Warburton, Michael Gateway Physiotherapy, Brisbane, Australia; [email protected] Introduction: This case study examines hydrotherapy for a person aged over 90, specifically, a 92-year-old woman who mobilises with a wheeled walker at home and a scooter outdoors. Hydrotherapy may provide a suitable functional exercise environment for the elderly, and especially to the very old. The buoyancy, warmth, pressure, viscosity, and turbulence are elements of hydrotherapy that may offer the very old a unique hydro-therapeutic environment to achieve and maintain mobility, strength, range of movement, balance, and may also enhance mental well-being (Carer et al., 2015). The purpose of this case study was to establish what measurable physical benefits could be achieved from hydrotherapy for the very old. Methods: Hydrotherapy was provided for four weeks, 2 × week, 30-min session duration. Pool temperature was 32.5 degrees centigrade and pool length was 20 meters. Each session consisted of mobility encouragement and supervision, balance activities, and strength exercises. Outcomes were measured by the Goal Attainment Scale (GAS; Kiresuk et al., 1994) and included three activities from the short physical performance battery (SPPB; Guralnik et al., 1994): gait, balance, and leg strength. Results: Balance and strength exceeded baseline expectations. Gait also changed positively from baseline values. Average scale scores were 1.33, with an overall GAS t-score of 68.26. Conclusion: Hydrotherapy can be a measurable physio-therapeutic option for the very old. It provides a relatively safe environment for functional exercise including mobility, balance, and strength. It may also provide an environment for positive mental well-being changes, which are important for the very old population. Physiotherapists should consider hydrotherapy for very old people. Hydrotherapy can offer unique physical properties for the elderly population not available on land. References: Carere, A., et al (2015). Does hydrotherapy improve a patient’s sense of wellbeing to a greater extent than land-based physiotherapy treatment? Submitted for publication. Presented at the Australian Physiotherapy Association National Conference, Gold Coast, 2015. Kiresuk, T.J., et al (1994). Goal attainment scaling: Applications, theory and measurement, Psychology Press. Guralnik, J.M., et al (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94. Changes in Exercise and Driving in the Candrive Longitudinal Study of Older Drivers in Canada Porter, Michelle M1; Gagnon, Sylvain2; Rapoport, Mark3; Naglie, Gary4; Tuokko, Holly5; Vrkljan, Brenda6; Mazer, Barbara7; Bédard, Michel8; Gélinas, Isabelle7; Marshall, Shawn9 of Manitoba, Winnipeg, Canada; [email protected] of Ottawa, Ottawa, Canada; [email protected] 3University of Toronto, Toronto, Canada; [email protected] 4Baycrest Health Sciences, Toronto, Canada; [email protected] 5University of Victoria, Victoria, Canada; [email protected] 6McMaster University, Hamilton, Canada; [email protected] 7McGill University, Montreal, Canada; [email protected], [email protected] 8Lakehead University, Thunder Bay, Canada; [email protected] 9Ottawa Hospital Research Institute, Ottawa, Canada; [email protected]

1University 2University

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Introduction: The purpose of this study was to examine changes in both exercise and driving in older drivers participating in a longitudinal study in Canada (Candrive). Methods: Participants were assessed annually for abilities related to driving and were asked questions about their driving and health-related behaviours. For this analysis, the questions about driving used were: “How regularly do you drive?” and “Please estimate the number of kilometers you have driven in the past year.” The exercise question was: “Do you routinely participate in exercise?” (meaning weekly). At enrollment, 928 drivers were ≥ 70 years and driving at least four trips per week. In these analyses, data from the baseline and the fourth assessments (i.e., end of year 3) were used. At this latter point in time, there were 753 participants (61.1% male) remaining in the study, who ranged in age from 72 to 97 years. Results: At baseline, 82.0% of participants reported that they routinely participate in exercise. Across the three years (35.8 ± 1.3 months), there was no change in self-reported participation in routine exercise in most individuals (84.3%), with only 7.6% reporting no longer routinely participating, and 8.1% newly reporting routine participation. In terms of driving, 67.1% did not report a change in frequency, and 42.6% did not report a change in distance. For driving frequency, 10.1% reported a decrease in frequency, whereas 22.8% increased their frequency. For driving distance, 38.0% reported a decrease and 19.4% reported an increase. Of those who reported a decrease in driving distance, only 7.0% reported that they no longer participate in routine exercise. In those who reported no longer participating in routine exercise, 35.6% reported a decrease in driving distance. Conclusion: This study reveals some interesting patterns in self-reported exercise and driving behaviours. Across the three years of this study, there were relatively few who reported decreases in routine exercise participation and driving frequency. In contrast, a much higher proportion of individuals (3–4 times higher) reported a decrease in their driving distance. Further analyses will explore what factors affect these changes in exercise and driving, as well as the interrelationships between them. Using Critical Social Theory for Investigating Elderly Women’s Healthcare Access in Bangladesh Hamiduzzaman, Mohammad; De Bellis, Anita; Kalaitzidis, Evdokia; Abigail, Wendy Flinders University, Adelaide, Australia; [email protected], [email protected], [email protected], wendy. [email protected] Introduction: Critical social research identifies the meaning of a phenomenon through description of power relations, and it receives recognition in healthcare research (Mosqueda-Díaz, Vílchez-Barboza, Valenzuela-Suazo, & Sanhueza-Alvarado, 2014). This approach was chosen for a qualitative research project focused on examining rural elderly women’s healthcare in Bangladesh. It is used as a reflexive and political mode of inquiry to address the socioeconomic factors and dimensions of inequality in healthcare (Adams, Hollenberg, Lui, & Broom, 2009). Although it has been argued that this theory is not a scientific paradigm, the strengths of using this methodology include the exploration of conditions and structures that limit an individual (Adams et al., 2009), which make it the most suitable methodology for this project. Methods: Ethical approval was granted by the Social and Behavioural Research Ethics Committee at Flinders University, Adelaide, Australia. A qualitative method of data collection was employed which allows the participants to share experiences in their own choice of language and words (Gale, Heath, Cameron, Rashid, & Redwood, 2013). Accordingly, a threestage process was designed to recruit healthcare professionals and elderly women. Stage one consisted of the recruitment of an organisation to avoid subjective bias (Sylhet Civil Surgeon Office). After obtaining a positive response, stage two consisted of a formal meeting with healthcare professionals, occurring with a number expressing interest to participate. Finally, in stage three, the healthcare professionals were requested to assist in organizing community meetings with elderly women. Face-to-face in-depth interviews were then conducted with 11 healthcare professionals and 25 elderly women during June 2015 to September 2015. Results: Data analysis is currently being undertaken, and the results are expected at the end of 2016. Conclusion: Using a critical social methodology will result in the design of a philosophy and a research methodology that assist in understanding power imbalances, marginalization, and exploitation in healthcare. This presentation aims to demonstrate how this theory has been applied to a research project conducted in a developing country. The presentation includes research methods used and problems faced in conducting this research. References: Adams, J., Hollenberg, D., Lui, C.W., & Broom, A. (2009). Contextualizing integration: a critical social science approach to integrative health care. Journal of Manipulative and Physiological Therapeutics, 32(9), 792–798. Gale, N.K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1), 117. Mosqueda-Díaz, A., Vílchez-Barboza, V., Valenzuela-Suazo, S., & Sanhueza-Alvarado, O. (2014). Critical theory and its contribution to the nursing discipline. Investigación y Educación en Enfermería, 32(2), 356–363. Domain-Specific Sedentary Behaviours of Pre-Retirement and Retirement Age Australian Women and Men Loskot, Monika1; Hadgraft, Nyssa1; Owen, Neville1; Dunstan, David1; Koohsari, Javad1; Sugiyama, Takemi2 IDI Heart and Diabetes Institute, Melbourne, Australia; [email protected], [email protected], Neville.Owen@ bakeridi.edu.au, [email protected], [email protected] 2Australian Catholic University, Melbourne, Australia; [email protected] 1Baker

Introduction: TV viewing and other forms of sedentary behaviour are associated with an increased risk of major chronic diseases. While there may be potential for reducing sitting time through settings-based interventions, only limited evidence exists on domain-specific sedentary behaviours across different socio-demographic groups. The aim of this study is to examine domain-specific sedentary time of women and men in the pre-retirement and retirement age groups. Methods: Cross-sectional data from the third wave of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study (n = 4,432, 45% male, mean [SD] age 61 [11] years, range 34–97 years) was used. In an interviewer-administered questionnaire, participants reported weekly sitting time for television viewing, computer use, transport-related sitting, workplace sitting, and other sitting. Logistic regression analyses (comparing highest tertile with middle and lower tertiles) were used to examine domain-specific sedentary time of women and men of pre-retirement (55–64 years) and retirement (65+ years) ages compared to younger adults (34–54 years). Results: TV viewing time was highest in retirement age (mean [SD] 2.3 [1.4] hr/day) than pre-retirement age (mean [SD] 1.8 [1.3] hr/day) and younger adults (mean [SD] 1.6 [1.1] hr/day). Mean sedentary time for computer use, transport-related sitting, and workplace sitting was higher in younger adults and pre-retirement age, whereas mean hours for sitting for other purposes were highest for retirement age (mean [SD] 2.2 [1.5] hr/day) than younger adults (mean [SD] 1.3 [1.1] hr/day). For TV viewing time and other sitting time, the odds of being in the highest tertile were significantly higher for those of retirement age (TV: OR 2.6 95%CI 2.3–3.1, other sitting: OR 3.1 95%CI JAPA Vol. 24, Suppl., 2016

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2.6–3.6), with men having higher odds of watching TV and women having higher odds of sitting for other purposes. For transport-related sitting, work sitting, and computer use, the odds were significantly lower for those of retirement age. Conclusion: While there were lower levels of workplace and transport-related sitting in the older adults, there were higher levels of TV viewing time and other sedentary behaviours. Prior to and during retirement, initiatives to reduce sedentary behaviour may focus on alternatives to television viewing and other passive forms of recreation. Effects of Using the M-E-T-H-O-D Discharge Planning Intervention on Functional Classification of Cardiac Disease and Readmission After Cardiothoracic Surgery Among Elderly Patients Nareeluk Thinpayup; Suphara Aphinyanon; Sunee Suwanpasu Nursing Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand Background: After cardiothoracic surgery, elderly patients are at increased risk for developing complications due to advanced disease, impaired cardiac status, and comorbidities. Purpose: The purpose was to evaluate the results of M-E-T-H-O-D discharge planning and home call follow-up intervention for patients aged ≥ 60 years undergoing coronary artery bypass surgery and heart valve surgery on functional classification (FC) of cardiac disease at the 24-week post discharge follow-up. Design: A quasi-experiment pre–posttest without control group was used. Setting: King Chulalongkorn Memorial Hospital. Materials and Methods: A purposive sampling was used to recruit the subjects with coronary artery bypass surgery and heart valve surgery. The subjects received M-E-T-H-O-D discharge planning and home call follow-up and a routine nursing care. The data were collected using The New York Heart Association (NYHA) Functional Classification (FC), readmission record and demographic data questionnaire. The controlledexperimental instrument consisted of knowledge, attitude, and practice scores after intervention. Statistics used for data analysis were descriptive statistics, t-tests, and chi-square tests. The results of all analyses were deemed significant when P < .05. Results: Thirty subjects aged 63.97 ± 11.07 were enrolled in the study. 66.7% of subjects were males and 33.3 % were females and there was no patient re-hospitalized within six months after discharge. The subjects showed improvement in knowledge, attitudes, and practice towards discharge planning intervention (57.3% vs. 84.6%; 71.6% vs. 81.2%; 47.4% vs. 78.5%, p ≤ .001). In addition, there were significant differences in NYHA FC between before and after intervention six months (2.83 vs. 1.43, p < .001). Furthermore, in FC 1, 71.4% made up the group of high posttest scoring, whereas 28.6% were in the group of low posttest scoring. However, the difference was not statistically significantly. Discussion and Conclusion: The results of the study demonstrated a likely positive impact of the M-E-T-H-O-D discharge planning program for elderly cardiac surgery patients at high risk for readmission and increased functional classification of cardiac disease. Key words: coronary artery bypass surgery, heart valve surgery, discharge planning, NYHA Functional Classification, knowledge, attitude, practice scores Adherence to a Group Exercise Program for Patients with Knee Osteoarthritis in Qatar Carr, Nathan Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; [email protected] Introduction: Patients with knee osteoarthritis have shown significantly greater improvements in function and pain when undertaking supervised group exercise classes as opposed to home-based exercise. This is largely related to adherence, which impacts exercise effectiveness. Therefore, the purpose of this pilot study is to evaluate the uptake, adherence, and dropout rate of a supervised group exercise program for patients with knee osteoarthritis. This will also help to identify areas of further research to aid in the development of the program. Methods: A total of 74 patients with symptomatic knee osteoarthritic were allocated to a female (n = 51) and male (n = 23) group resistance training program for a period of 12 weeks. These training sessions were performed every two non-consecutive days of the week for 45 min each. The patients were recruited from the Exercise is Medicine clinic. The training consisted of mobility, balance, muscular endurance, and isometric exercises. This study was limited to adults between 40 and 60 years of age. Exercise uptake, adherence, and dropout were registered throughout the 12-week period. Patients needed to attend ≥ 60% of classes to be considered compliant. Patients that missed more than two consecutive weeks were considered dropouts. Results: Of the initial sample, 64.86% (n = 48) completed the 12-week course by meeting the specified ≥ 60% adherence criterion, whereas 22.97% (n = 17) failed to meet the adherence criterion even though they had completed the course. 35.13% of participants dropped out of the 12-week course. The male patients’ overall adherence (71.04%) was greater than the female patients’ (63.63%). The male dropout rate (21.73%) was also lower than the female dropout rate (41.17%). Conclusion: The results of this evaluation suggest that women in Qatar are more likely to uptake group exercise than men. However, men are more compliant and experience lower drop-out rates. With OA often a barrier to continued exercise, a 64.86% adherence to the course reflects well on the program, however more research is needed in this area. Further research will be conducted to identify the factors that influence uptake, adherence, and dropout rates to get more in-depth understanding with regard to the effectiveness of the course. References: Harden, S.M., McEwan, D., Sylvester, B.D., Kauliius, M., Ruissen, G., Burke, S.M., Estabrooks, P.A., & Beauchamp, M.R. (2015). Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review. BMC Public Health,15, 958. Beckwée, D. Bautmans, I. Scheerlinck, T. & Vaes, P. (2015) Exercise in knee osteoarthritis - preliminary findings: Exercise-induced pain and health status differs between drop-outs and retainers. Exp Gerontol, 72, 29–37. Rizk, A.K., Wardini, R., Chan-Thim, E., Bacon, S.L., Lavoie, K.L., & Pepin, V. (2015). Acute responses to exercise training and relationship with exercise adherence in moderate chronic obstructive pulmonary disease. Chron Respir Dis, 4, 329–339. Long-Term Care Policy in Thailand: What Needs Solved Urgently? Khongboon, Pattaraporn1,2; Pongpanich, Sathirakorn1 1College 2Prince

of Public Health Science, Chulalongkorn University, Bangkok, Thailand; [email protected]

Mahidol Award Foundation under the Royal Patronage, Bangkok, Thailand

Introduction: As the elderly population is growing rapidly in Thailand, the risk of disability and chronic illness is expected to grow rapidly with increased longevity (Chuakhamfoo & Pannarunothai, 2014; Muangpaisan, Assantachai, Intalapaporn, Richardson, & Brayne, 2011). As the demand for care has JAPA Vol. 24, Suppl., 2016

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increased, it is a challenge for the Thai government to take steps to develop the treatment processes and improve the management of long-term conditions. There are two aims of this study: (1) to identify policies and interventions to improve quality of life of the elderly with long-term conditions; and (2) develop a sustainable and feasible LTC delivery over the next 10 years. Methods: In-depth interviews were conducted with 11 key policy makers regarding the development system of long term care for older persons in Thailand. Eleven participants comprising eight males and three females were interviewed. Transcripts were subjected to NVivo 8 for data analysis. A first set containing thematic codes produced from the transcript subset was created by two independent investigators to enhance reliability. Afterward, the codes were adjusted using an inductive analytical method, and outcomes were arranged based on major themes within the data. Results: The key informants raised six issues that need to be solved urgently, including an imbalance in care services, poor management systems, the need for skill among informal caregivers, a health workforce shortage, problems with regulations, and problems with the information system. These surveys mentioned that in the next 10 years, the long-term care scheme should be family–community based. Conclusion: The quality of life for those elderly individuals suffering from long-term conditions could be improved by providing integration services, consolidating the regulatory system, building a LTC workforce, developing a delivery infrastructure, and investing in elderly health groups. LTC in the next decade must make use of the capabilities of society through a comprehensive policy. Because of these increasing needs, everyone should raise their awareness and be ready. References: Chuakhamfoo, N., & Pannarunothai, S. (2014). Long-term care: what Thailand needs? BMC Public Health, 14(Suppl 1), P6. Muangpaisan, W., Assantachai, P., Intalapaporn, S., Richardson, K., & Brayne, C. (2011). Health expectancies in the older Thai population. Arch Gerontol Geriatr, 53(1), 3–7. Hybrid Robotic Lower Limb Training and Tilt-Table Machine Hastens Recovery for Patients with Severe Stroke Chan, FL1; Chang, MW1; Chan, CC1; Lai, WK1; Fan, FSY2; Hui, E1; Wong, LKS2 1Shatin 2The

Hospital, Hong Kong; [email protected]

Chinese University of Hong Kong, Hong Kong

Introduction: Robotic training for stroke patients is rapidly developing and shows promising results in improving functional outcomes of stroke survivors. The Erigo machine is a novel hybrid design combining robotic lower limb training and tilt-table training, and its effectiveness in improving the neurological recovery of lower limb and functional outcomes for patients with severe middle cerebral artery (MCA) infarct is uncertain. Methods: Stroke patients admitted to the neurology unit for rehabilitation from September 2014 to December 2015 were utilized. Experimental design: A matched-pair controlled experimental design for age, gender, and affected side of stroke for comparison was used. The experimental group underwent ten 30-min sessions of simulated gait training together with traditional stroke rehabilitation training (TSR). The control group completed the TSR program. Procedures: The patient was tilted into vertical position up to 70° and received passive simulated gait pattern training for 10 consecutive sessions. Outcomes: The active range of movement of the affected side including the hip, knee, and ankle, and Modified Rivermead Mobility Index (MRMI) were measured on day 1 and day 10. The number of days to change from Modified Functional Ambulatory Category (MFAC) 1 (Lyer) to Category 2 (Sitter) or Category 2 to Category 3 (Dependent walker) was noted. Results: 18 patients were recruited. The mean number of days required for advancements from MFAC Category 1 to Category 2 and Category 2 to Category 3 was shortened from 14 (control group) to 8 (experimental group) days and from 12 (control group) days to 8 (experimental group) days, respectively. The results of Wilcoxon signed-rank statistic tests for active range of movement (day 1 vs. day 10) for hip (Z = –3.07; p = .002), knee (Z = –2.979; p = .003), and MRMI (day 1 vs. day 10) (Z = –3.064; p = 1.2) were statistically significant. The result for active range of movement for ankle was statistically insignificant. Conclusion: The results demonstrated that the Erigo machine has a promising role in improving the neurological recovery of truncal, lower limb control, and functional outcomes in stroke survivors. The length of stay in the hospital can be reduced due to earlier functional transition from lyer to sitter and sitter to dependent walker. Resilience in the Fracture Orthopaedic Rehabilitation Geriatric Environment Kohler, Sabrina1; Loh, Sze-Ming2 1Dept.

Geriatric Medicine Westmead Hospital, Australia; [email protected]

2Dept.

Geriatric Medicine Westmead Hospital, Clinical Lecturer Sydney Medical School Westmead, Clinical Lead Orthogeriatric Service, Falls & A4A Rehabilitation Ward; [email protected] Introduction: The psychology affecting healthy ageing is increasingly topical in modern medicine (Jeste et al., 2014). Resilience is a growing concept describing one’s ability to bounce back following adversity. The aim of this study was to explore the significance of the relationship between resilience and rehabilitation outcomes (primarily measured by functional independence measure [FIM] gain) in the older orthopaedic population, and determine how this relationship can facilitate future therapy. Methods: Resilience was assessed according to the Connor Davidson Resilience Scale (CD-RISC) (Connor & Davidson, 2003), an extensively validated scale, in face-to-face interviews. Patient outcomes were assessed according to FIM gain (University of Wollongong), length of stay, discharge destination, and mortality. The data was analysed using MedCalc, examining for linear relationships between resilience and functional outcome. Results: A total of 29 patient interviews were used in data analysis. Resilience scores varied from 49–92, with an average of 73. In comparison to other study populations, this shows high overall resilience. Resilience scores as measured by the CD-RISC did not correlate with functional improvements during rehabilitation post fracture. Conclusion: It remains difficult to draw accurate conclusions from this study. Further studies, including patients with a broader range of resilience scores, particularly at the lower end of the spectrum, are required to explore the relationship between resilience and rehabilitation outcomes. It is possible that there are multiple confounding personal, health-related, and environmental factors which were not accounted for that have affected this result. References: Jeste, D.V., Savla, G.N., Thompson, W.K., et al. (2014). Association between older age and more successful ageing: critical role of resilience and depression. Am J Psychiatry, 170:188–196. Connor, K.M., & Davidson, J.R.T. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18:71–82. Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. What is The FIM instrument? University of Wollongong. [Online]. Available https://ahsri.uow.edu.au/aroc/whatisfim/index.html#aust. JAPA Vol. 24, Suppl., 2016

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Healthcare Students Learning Together to Promote the Health of Older People Hunter, Sharyn; Johnston, Catherine; Newstead, Clint; Rasiah, Rohan; Roberts, Elysa; Macdonald-Wicks, Lesley; O’Toole, Gjyn University of Newcastle, Newcastle, Australia; [email protected], [email protected], clint.newstead@newcastle. edu.au, [email protected], [email protected], [email protected], [email protected] Introduction: There is increasing awareness of the importance of maintaining the health of older people (WHO, 2015). Promotion of healthy ageing requires an interprofessional approach (WHO, 2015), yet the majority of the education of Australian health professionals continues in discipline-specific programs, with little evidence of interprofessional education (IPE) or IPE and health promotion of older people (Kent & Keating, 2013). To determine the best way forward to address these issues, a project explored two strategies where IPE was used to engage students from several health professions in health promotion of older people. Methods: This project used a mixed methods approach to evaluate the two strategies. One strategy was conducted in the community and the other in a hospital. Each strategy consisted of two stages. Firstly, nursing students were paired with another student from a different health profession: physiotherapy, nutrition and dietetics, pharmacy, or occupational therapy. The pairs then interviewed an older Australian using a validated tool, the Healthy Ageing Quiz (HAQ) (Cyarto et al., 2012). Afterward, the student pair presented their findings from the interview at an inter-professional case conference (ICC) with other interprofessional student pairs, and educators from the different health professions. A healthy ageing plan of care was developed at the ICC for each older person interviewed. Each strategy’s process, students’ experiences about IPE and healthy ageing, and developed care plans were then evaluated to determine the feasibility of developing the students’ IPE competencies and knowledge about health and older people. Results: Evaluation revealed that recruitment of students and older people, and the organization of the interviews and IPE case conference, were more difficult in the community than the hospital. The student’s attitudes toward older people and their ability to engage in health promotion were improved with both strategies. Conclusion: Healthy ageing IPE activities do develop students’ knowledge and skills about healthy ageing. The hospital strategy was easier to conduct yet still achieved similar outcomes. References: Cyarto, C., Dow, B., Vrantsidis, F., & Meyer, C. (2012). Promoting healthy ageing: development of the Healthy Ageing Quiz. Australasian Journal on Ageing, 32(1), 15–20. Kent, F. & Keating, J. (2013). Patient outcomes from a student-led interprofessional clinic in primary care. Journal of Interprofessional Care, 27(4), 336–338. World Health Organization. (2015). World Report on Ageing and Health. Geneva, Switzerland: World Health Organization. Effects of 9 Weeks of Pole Walking on Functional Fitness in Older Adults Okada, Soichi1; Hasegawa, Taichi2; Fujita, Eiji3; Takeda, Masaki4; Islam, Mohammod M5; Narita, Makoto5; Kato, Yoshiji5; Rogers, Michel E6; Takeshima, Nobuo3 of Rehabilitation, Ukai Hospital, Nagoya, Japan; [email protected] School of National Institute of Fitness and Sports in Kanoya, Kanoya, Japan; [email protected] 3National Institute of Fitness and Sports in Kanoya, Kanoya, Japan; [email protected], [email protected] 4College of Sports Science, Doshisha University, Kyotanabe, Japan; [email protected] 5Active Aging Association, Nagoya, Japan; [email protected], [email protected], [email protected] 6Department of Human Performance Studies, Wichita State University, Wichita, KS, USA; [email protected]

1Department 2Graduate

Introduction: Pole walking using Nordic poles has become popular in Japan. This type of exercise is characterized by the use of poles that strike the ground in front of the body. This exercise may be ideal for frail or sedentary older adults who have difficulty walking, as the Nordic poles can provide extra stability while walking. However, questions remain regarding the effect of the training stimulus on functional fitness in older adults. Methods: Height, body mass, %body fat, functional fitness (arm curl [AC], chair stand [CS], up & go [UG], functional reach [FR], back scratch [BS], sit & reach [SR], and 12-min walk [TW]) were assessed before and after a program in community-dwelling older adults (n = 16; 1 male, 15 females; age = 65 ± 8 years). Supervised training sessions were conducted for 60 min/day and on 2 days/week. Participants also performed unsupervised training near their home for an average of 42 min/week on 1.3 days/week. Results: Following training, AC (24.3 ± 5.2 vs. 29.3 ± 4.4 reps/30 s), CS (20.9 ± 3.2 vs. 33.5 ± 5.5 reps/30 s), SR (9.8 ± 8.2 vs. 17.1 ± 6.1 cm), and TW (1057 ± 114 vs. 1149 ± 114 m) increased (p < .05). Body mass, %fat, UG, FR, and BS did not change with training. Conclusion: A pole walking exercise program appears to improve upper and lower body strength (AC and CS), lower flexibility (SR), endurance (TW), and maximal attainable gait speed in older adults. These changes suggest that pole walking provides a combination of aerobic and resistance exercise. However, dynamic balance and upper body flexibility did not improve. These variables should be addressed in future research. Results of this study indicate that various fitness benefits can be achieved through pole walking, which would exceed the limited scope of specific aerobic benefits associated with conventional walking. Queensland Older Adults’ Physical Activity, Diet, Screen Time, Smoking, Alcohol, and BMI: Trends from 2007–2014 Alley, Stephanie1; Schoeppe, Stephanie1; Duncan, Mitch J2; Vandelanotte, Corneel1 1Physical Activity Research Group, Central Queensland University, Rockhampton, Australia; [email protected], [email protected], c.vandelanotte@ cqu.edu.au 2Priority

Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia; [email protected]

Introduction: Australia’s ageing population is placing a rising burden on the health care system as the prevalence of chronic diseases is 10 times greater in older Australians. Lifestyle factors significantly contribute to chronic disease and mortality in older adults. The aims of the current study were to examine trends in lifestyle factors including obesity, physical activity, screen time, nutrition, alcohol intake, and smoking between 2007 and 2014 in older versus younger adults. Methods: These lifestyle factors were measured by self-report through the annual Queensland Social Survey (2007–2014). Seven logistic regression analyses were conducted to compare older adults (65+ years) to younger adults (18–64 years) on seven health behaviours and the trends of these health behaviours over time. Differences in trends between older and younger adults were also tested. Results: Findings revealed that a low percentage of adults in both younger and older age groups were meeting the health guidelines for BMI (63%), physical activity (47%), and JAPA Vol. 24, Suppl., 2016

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nutrition (12%). Improvements were seen between 2007 and 2014 in the proportion of Queensland adults meeting the health recommendations for fruit and vegetable intake (OR= 1.11, 95%CI = 1.04–1.18), fast food consumption (OR = 1.06, 95%CI = 1.00–1.12), and physical activity (OR = 1.07, 95%CI = 1.02–1.11) when adjusting for demographics. A higher percentage of older adults were meeting fruit and vegetable guidelines (OR = 3.42, 95%CI = 1.81–6.45), were not eating fast food (OR = 4.26, 95% CI = 2.54–7.12), and were nonsmokers (OR= 3.05, 95%CI = 1.63–5.72) compared to younger adults. However, the percentage of older adults meeting fruit and vegetable guidelines dropped between 2009 and 2014 and is now equal to the low levels of younger adults (11%; OR = 0.89, 95%CI = 0.82–0.97). Conclusion: Both older and younger adults’ health behaviours need to be targeted, particularly diet in the older age group, to reverse the trend of a decreasing proportion of older adults meeting the fruit and vegetable guidelines. Health Care of Elderly Adults in Brazilian Emergency Services: An Integrative Review Yonekura, Tatiana1; Quintans, Jena Roza1; Kato, Mayla Youko1; Macedo, Cesar2; Negri Filho, Armando De2 of São Paulo, São Paulo, Brazil; [email protected], [email protected] of the Heart, São Paulo, Brazil

1University 2Hospital

Introduction: An increased use of health services is related to aging due to the higher prevalence of diseases and vulnerability characteristics and health needs. In Brazil, aging has accelerated dramatically, without the provision of adequate health services. Assistance in emergency services has been insufficient to meet the needs of complex care for the elderly. The aim was to analyze the scientific literature on the health care of the elderly in Brazilian emergency services. Methods: An integrative review was conducted, restricted to articles of elderly health in Brazilian emergency services. Quantitative, qualitative, and theoretical studies were included, with no date and language restrictions. We used three databases for data collection. A tool to extract and analyze data from the included studies was developed. Results: The search resulted in the identification of 1,910 citations, from which 97 studies clearly addressed the topic. After the study titles and abstracts were screened, 23 full manuscripts were retrieved for further examination. The application of the selection criteria resulted in 14 studies included. The main objective of the included studies was to characterize the sociodemographic and health profiles of older people through the quantitative approach. The main medical diagnostics and reasons for seeking medical assistance were: circulatory, respiratory, mental and behavioral disorders, neurological, misuse of drugs, injuries, poisoning, violence, trauma, and fall. Recommendations for health care of the elderly in Brazilian emergency services were described. Conclusion: There are still many problems in elderly health care in emergency departments. The provision of health care services based on health needs is important for effective care and in accordance to principles of the health system. Who are the Future Workers of the Aged Care Industry? And How Can We Make Them Ready to Support Active Ageing? Schumacher, Tracy; Hunter, Sharyn; Kewley, Chris; Scott, Judith University of Newcastle, Callaghan, Australia; [email protected], [email protected], [email protected]. au, [email protected] Introduction: The Australian population aged 65 years or over is estimated to reach 22% in 2061 and 25% in 2101 (Australian Bureau of Statistics, 2013). Both industry and government recognize that there will be a shortage of skilled aged care health professionals to provide care for this ageing population and to support active and healthy ageing in all regions of Australia (Productivity Commission, 2011). Three population groups have been identified as future age care workers, with the potential to attain a skill set appropriate to the future of healthy ageing: students undertaking vocational training during secondary education, new Australians who have disadvantaged backgrounds, and mature-age workers looking to upskill their current qualifications or re-enter the workforce. Methods: Collaborations have been established with interested parties from the aged care industry and educators to describe current educational barriers, predicted characteristics, and roles of future aged care workers, such as specific skills and knowledge. Focus groups will be conducted for each targeted population, including: rural and regional career advisors for secondary school students; people holding, or who have previously held, humanitarian visas; and those aged 25 years and above with qualifications no higher than a certificate IV. Each target population will have an individualized semi-structured script to identify issues specific to each group. Focus groups will contain approximately six to eight members and group transcriptions will be analyzed qualitatively using a systematic deductive approach to identify key themes. Results: Preliminary results indicate that funding models such as consumer-directed care will be of significance to the future workforce and that present barriers exist in providing an education specific to those wanting to support healthy ageing in community and residential aged care. Conclusion: This study is unique in attempting to understand opportunities for recruiting workers to the aged care industry and identifying educational barriers faced by specific populations. Better understanding of the challenges faced by these groups may help: inform education structures; improve opportunities and understandings of those not considering the aged care sector as a viable career path; and prepare a high-quality workforce and active supporters of healthy ageing. References: Australian Bureau of Statistics. (2013). Population Projections Australia. 2012 (Base) to 2101. 3222.0. Canberra: Australian Bureau of Statistics. Productivity Commission. (2011). Caring for Older Australians, Report No. 53 Final Inquiry Report. Volume 2. Canberra, Australia. Cumulative Physical Activity as the Mediator Between Neighbourhood Disadvantage and Physical Function Loh, VHY4; Rachele, JN1; Washington, S2,3; Turrell G1 of Health and Ageing, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia; [email protected], gavin. [email protected] 2School of Civil Engineering and Built Environment, Queensland University of Technology, Brisbane Australia; [email protected] 3Science and Engineering Faculty, Centre for Accident Research and Road Safety, Queensland University of Technology, Brisbane, Australia 4Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; [email protected] 1Institute

Introduction: Regular physical activity is associated with better physical function in old age and longevity (DiPietro, 2001). The majority of previous studies examining the association between physical activity and physical function were based on a single measurement of physical activity either earlier in life or at older ages. Cumulative physical activity seems to have increasing benefits on physical function in midlife and old age. Evidence suggests that the neighbourhood setting has the capacity to create a supportive environment for physical activity (Frank, Engelke, & Schmid, 2003). This is the first JAPA Vol. 24, Suppl., 2016

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study that explores the degree to which the effect of neighbourhood disadvantage on physical function could be attributed to a lack of physical activity over time. This research is of great public health relevance as it has the potential to identify a range of new opportunities for neighbourhood design that encourages physical activity and thus improves the functional health of middle-aged to older adults. Methods: Data were obtained from the longitudinal study of How Areas in Brisbane Influence Health and Activity (HABITAT) from 2007 to 2013 in Brisbane, Australia. Descriptive analysis is conducted to examine the relationship between cumulative physical activities across four waves on physical function in 2013. Mediation analysis was then conducted using the decomposition method, in which the total effect is decomposed into a direct and indirect effect. Expected Results: Residents who are always inactive across four time points have a significantly lower physical function score than those who are always sufficiently active. Mediation analysis revealed that living in a more disadvantaged neighbourhood was associated with poorer physical function, and the negative consequences are mediated to a relative lack of physical activity over time. In the case of partial mediation, there is a clear implication that cumulative physical activity explained some mechanisms on how living in a disadvantaged neighbourhood is associated with poorer physical function. However, other indirect effects could be examined and tested. Conclusion: Cumulative physical activity mediates the relationship between neighbourhood disadvantage and physical function. This study will assist urban planners and policy makers in designing neighbourhoods that facilitate residents engaging in sufficient physical activity, according to the National Physical Activity Guideline of 500 MET×min per week. References: DiPietro, L. (2001). Physical activity in aging changes in patterns and their relationship to health and function. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(suppl 2), 13–22. Frank, L., Engelke, P., & Schmid, T. (2003). Health and Community Design: The Impact of the Built Environment on Physical Activity: Island Press. Five Senses Series CiA (Culture in Ageing) Taheny, Shannon Multicultural Aged Care Inc. (MAC), Adelaide, Australia; [email protected] Introduction: Since 2011, Multicultural Aged Care Inc. (MAC) has conducted workshops that provide a combination of theoretical framework and culturally appropriate activities vital in upholding the quality of life of residents from culturally and linguistically diverse (CALD) backgrounds living in aged care facilities. The CiA (Culture in Ageing) workshops aim to: (1) add cultural significance to service delivery; (2) support service providers to develop better understanding of care recipients from CALD backgrounds; (3) equip service providers with the tools to encourage greater participation amongst CALD residents. Methods: Addressing cultural diversity in leisure and recreational activities is essential to maintaining the quality of life for care recipients. Implementing culturally inclusive lifestyle practices encourages self-esteem, re-affirms recognition and respect of care recipients’ cultural values, and builds a sense of purpose and belonging, guiding all involved through the world of multicultural diversity. Results: During the years, MAC has developed a series of five targeted packages discussing CALD perspectives of smell, taste, sound, touch, and sight, and offering sets of activities and scenarios to be included in recipients’ care plans. The framework is based both on the theory of reminiscence, and cultural understandings and interpretations. Conclusion: Collated feedback indicates that service providers have gained knowledge and understanding of culturally appropriate care for CALD older people. They gained access to appropriate and relevant resources through the MAC nationally-recognised library, which broadened and enhanced their personal awareness of various cultures. It resulted in increased provision of a range of culturally appropriate care components that are reflective of, and responsive to, consumer individual needs and understandings of active ageing, quality of life, and wellbeing. Montessori and Living My Cultural Self Johns, Maria Multicultural Aged Care (MAC), Adelaide, Australia; [email protected] Introduction: Multicultural Aged Care conducts an annual survey with South Australian RACFs. The results continuously demonstrate that in many aged care facilities diversity of workforce and residents is increasing. Staff have reported that appropriate communication tools (e.g., familiar subjects, music, appropriate bilingual resources) are imperative in engaging with residents who are ‘socially isolated’, effectively communicating with residents from culturally and linguistically diverse (CALD) backgrounds, improving outcomes for both residents and staff, and in planning, processing, and delivering care. Methods: Applying Montessori principles into lifestyle activities and implementing culturally inclusive practices encourages self-esteem, re-affirms recognition and respect of care recipients’ cultural values, builds a sense of purpose and belonging, and addresses the concepts of the Commonwealth Reablement, Health and Wellbeing aged and community care policies. Resources from the extensive, nationally-available MAC library and mobile library act as a support and valuable resource in the provision of culturally appropriate care. Results: Quality engagement with consumers from CALD backgrounds was achieved while simultaneously addressing diversity and maintaining service delivery and care quality. Aged and community care service providers reported culturally appropriate activities validate one’s cultural identity and have a positive influence on encouraging and increasing consumers’ engagement. Using Montessori principles and acknowledging cultural needs in communication and interactions resulted in implementing strategies that included: (1) changing the conversation about culture from differences to commonalities; (2) sharing the migration stories and experiences, and validating the older person’s cultural identity and experiences; (3) ongoing staff engagement with people from CALD backgrounds. Conclusion: Implementing culturally inclusive practices results in the benefits outlined above. Montessori principles embedded in cultural competency practices for staff in aged care homes needs to be supported with structured training and relevant resources. Evaluating the Effectiveness of a GRN Program for Prevention of Functional Decline in Hospitalized Elderly Adults with Community-Acquired Pneumonia (CAP) Praparpak, Werapattra; Pongpaew, Wanlapa; Suwanpasu, Sunee Nursing Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; [email protected] Background: Community-acquired pneumonia (CAP) and functional decline are an increasing problem among the elderly. Geriatric syndromes, such as delirium and falling, are important to the function of elders and should be addressed in their care. Objectives: To develop and test the effect of the geriatric resource nurse (GRN) program on functional decline among hospitalized elderly patients with CAP. Design: A quasi-experimental design; pre–posttest without control group. Setting: Tertiary hospital. Patients: A total of 23 elderly patients, age 65 or older admitted for CAP from July to JAPA Vol. 24, Suppl., 2016

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December 2014. Intervention: Geriatric nursing care program consists of the unit-based RNs volunteering to become GRNs and the overall geriatric assessment tool (SPICCIES tool). Measurement: The main outcome was change in the number of activities of daily living (ADLs) between one week before admission and on day of discharge. Secondary outcome was staff nurses’ satisfaction. Results: The participants were male (66.7%); with the mean age of 81.30 ± 5.64 years. Performance-based ADL measures did not differ between baseline and discharge date (mean 8.17 ± 7.08 vs. 8.52 ± 6.82; t = 2.01, P = .057). Nursing care to prevent functional decline was more often implemented against sleep disorder (39.1%), problems with eating or feeding (73.9%), incontinence (73.9%), delirium (56.5%), immobility (100%), risk of evidence of fall (78.3%), and skin breakdown (78.3%), as well as caregiver unpreparedness (60.9%). Further, incontinence (r = –594, p = .003), delirium (r = –.554, p .0006), and skin breakdown (r = –.660, p = .001) were associated with functional status significantly. In multiple regression, incontinence (β = –0.437, p = .021) and skin breakdown (β = –0.401, p = –.033) were predictors of functional status (adjusted R2 = .458). After six months of implementation, satisfaction of staff nurses with nursing care program was higher than baseline (P = .001). Conclusion: The geriatric model is effective to reduce functional decline among hospitalized elders through geriatric syndromes management. However, efforts to follow up for longer periods and study using larger populations are needed. Keywords: community-acquired infection, pneumonia, geriatric nursing, aged, activities of daily living What’s in a Name? Changing Attitudes and Priority in Health Delivery and Care Myers, Yaacov; John B Wellspring’s Universal Environment, Melbourne, Australia; [email protected] Introduction: Language and project titles may influence what we do and accept, and whether or not we have capacity for critical analysis to ensure objectivity and accountability in health care and fair decision-making at the level of board and tribunal/judicial decision in regard to professional conduct and health care. Recent changes in legislation have been made. The question is what are the reasons, likely benefits, and impact not only on health services delivery but also on wellbeing and health? Aims: To examine the potential effect that changing the name Aged Care package (ACp) to Individualised Support package (ISp) has on attitude to care provision from the service provider to regulatory medical board decisions and tribunal and judicial points of view. Methods: ACp and ISp are compared and some other options to age care examined, such as “aging well”, “active aging” and “living well”. Results: “aged care” means care that is aged. The term “active aging”, while meant to refer to activity in older persons, actually indicates active aging, as occurs with smoking and inducing high blood pressure on purpose versus passive aging. Aging well focuses on aging, not on health. The term “aged” is stakeholder focused, and leads to elder abuse, lack of accountability, and failure to advocate. Change of name to ISp signals priority and awareness that over and above stakeholder and providers’ needs are the person’s wishes and needs; accountability in spending and service delivery makes fair decision and respect for elders’ rights unavoidable. Living well means making use of the opportunity to optimise enjoyment in life. Conclusion: Name change adds awareness to the growing body of evidence that must now be regarded as undeniable alerts to the medical board, tribunals, and courts that show previous decisions were wrong, as patient support is primary, as is patients’ wishes, which defines best interest. Changing the “Aged Care” Act to “Person Support” Act, and a review of compliance or failure by agencies, boards, and tribunals/courts regarding professional conduct, and of other project names, is required. Objective review encourages attitude change and high standards of practice such as individualised person support. Effect of Exercise Intervention on Frailty, Muscular Function, and Self-Efficacy in Daily Activities of Life for the Elder Population Chen, Ya-Lin; Huang, Chi-Huang; Chang Yu-Shan National Taiwan Sport University, ROC; [email protected] Introduction: This study aimed to assess the influence of whole body vibration (WBV) and low-resistance body-weight bearing exercises (LRE) on levels of frailty, lower limb neuromuscular performance, and self-efficacy in daily activities for the elder population. Methods: Volunteers were 25 elder individuals (aged 60–85 years old) for a 16-week exercise program, and were assigned to: (1) progressive WBV group; or (2) progressive LRE group (“Sit-to-Stand”), after the first stage of eight weeks whole body vibration. The exercise and rest ratio for the WBV and LRE training were to set at 1:1 for 30 s each, and the intensity was incremented by progressive ways based on the progress of the participants. The levels of frailty, muscle volume, neuromuscular performance, and self-efficacy in daily activity were assessed before, during, and after the intervention by the Chinese-Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), dual-energy x-ray absorptiometry (DEXA), electromyography (EMG), and the Up and Go test, respectively. All the data were analyzed by a two-way ANOVA with mixed design of SPSS 17.0 vision. Results: At the first stage of eight weeks of whole body vibration, the muscle activity of the vastus lateralis in both the WBV and LRE groups were significantly decreased (p = .026 and p = .016 ). After that, the LRE group, which achieved higher mobility, was more willing to implement the sit and stand exercise, and also the level of frailty was continuously going down. The rest of the variables were not statistically significantly different. Conclusion: This study found that the whole body vibration could not only raise the neuromuscular performance but also encouraged the participants to be engaged in active physical activities. However, the light intensity of the body weight exercise might be the reason that the benefit was not maintained. Thus, for future studies, the intensity of resistance exercise is recommended to increase. References: Burton, L.A., & Sumukadas, D. (2010). Optimal management of sarcopenia. Clinical Interventions in Aging, 5, 217–228. Borst, S.E. (2004). Interventions for sarcopenia and muscle weakness in older people. Age and Aging, 33(6), 548–555. Delecluse, C., Roelants, M. & Verschueren, S. (2003). Strength increase after whole-body vibration compared with resistance training. Medicine & Science in Sports & Exercise, 35(6), 1033–1041. Depression Trajectory in Older Cancer Patients Undergoing Chemotherapy Lim, Yeon Ok1; Kim, Yojin2; Choi, Kyoungwon2; Kim, Woon Jeong2; Ham, Hye Jin2 1Hallym

University Institute of Aging, Chuncheon, Republic of Korea; [email protected]

2Hallym

University, Chuncheon, Republic of Korea; [email protected], [email protected], [email protected], [email protected]

Introduction: The chance of encountering cancer increases when looking at elder groups above 65 years old. In 2012, 1 out of 12 among this group had been through cancer treatment or was cured. The proportion of cancer survivors in older adult cohorts will continue to expand. Major depressive disorder and depressive symptoms occur frequently in patients with cancer. Thus, older patients with cancer seem to be at risk of depression. Depression is an JAPA Vol. 24, Suppl., 2016

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independent contributor to increased medical morbidity and mortality. It is assumed that patients who decide to take chemotherapy are more vulnerable to depression, because chemotherapy demands longer time periods than surgery or radiation therapy. Thus, this study was interested in investigating the change of depression and its predictors in the older cancer patient over time. Methods: The longitudinal data were collected through a five-wave longitudinal panel survey. In the baseline survey, the sample was selected from 600 persons with cancer aged 55 years or older, using convenient sampling method. They were treated at five sites, the Hallym University Medical Centers, Samsung Medical Center, and Ajou University Hospital. Of these, 269 participants were selected based upon the study criteria: (1) patients who were 65 years or older and (2) patients who were undergoing or just completed chemo treatment. We attempted the HLM program to analyse the change of depression over time and to find predictors. Results: In order to solve the research questions, we applied the cross sequential design from the cancer diagnosis to survival period, using longitudinal data. Depression was detected as a quadratic function model over time. After the detection, the depression level was 17.6 points, and then decreases a little bit (0.07 points) per one month, but at a certain point, starts to develop very slowly again. Effects of optimism and family support bring on the decrease in depression level over time after a cancer diagnosis. Conclusion: These results provide direction to intervention programs and social services on decreasing depression level in older cancer patients undergoing chemo and monitoring after chemo. References: Hodges, K., & Winstanley, S. (2012). Effects of optimism, social support, fighting spirit, cancer worry and internal health locus of control on positive affect in cancer survivors: A path analysis. Stress and Health, 28, 408–415. Cho, J.H., Cho, E.K. Kim, S.O., Shin, D.W., Cho, B. L., Kim, C.H., Koh, D.H., Guallar, E., Bardwell W. & Park, J.H. (2013). Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea. Psycho-Oncology, 22, 2372–2378. Zenger, M., Brix, C., Borowski, J., Stolzenburg, J. & Hinz, A. (2010). The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients. Psycho-Oncology, 19(8), 879–886. Mental Health of Korean Caregivers of Older Cancer Patients: Interaction Effects of Depression Between the Patients and the Caregivers Choi, Kyoungwon; Yoon, Hyunsook; Kim, Yojin; Lim, Yeon Ok; Kim, Woon Jeong; Ham, Hye Jin Hallym University, Chooncheon, Korea; [email protected], [email protected], [email protected], [email protected], dearwoon@ naver.com, [email protected] Introduction: The purpose of this study is to understand depression of primary caregivers of Korean older cancer patients by analyzing the longitudinal and cross-sectional effects between the cancer patients and their caregivers. Cancer is one of the most serious chronic diseases affecting Korean older adults, which has been the leading cause of death among them over the past 10 years. Because cancer is a chronic and serious disease, the mental health of caregivers is closely related with the state of the cancer patients. Therefore, it would be essential to have a clear understanding of the interaction between the two groups. Methods: The data is from Longitudinal and Multidisciplinary Study on the Quality of Life of the Older Cancer Patients project in Korea. As part of the project data—which has five waves of data of the older cancer patients 55 years old and older—at wave 3 and at wave 5, the paired data of primary caregivers (n = 180) was also collected. In addition to depression and changes in depression of the patients and caregivers, symptoms and functions of the patient (QLQ-30), nutrition of the patients, and the optimism of the caregivers are measured to capture the physical and mental factors affecting the depression level of patients and caregivers. Structural equation modeling was used to test the model. Results: It was found that depression of the patients affected caregivers’ depression (at .10 level) and the changes of the depression. Functions of the patients not only affected patients’ depression but also caregivers’ depression (at .10 level). Symptoms and nutrition level of patients indirectly affected caregivers’ depression and changes of depression via patients’ depression. Level of optimism of the caregivers also affected the depression of the caregivers. Conclusion: The findings of the study suggest that the physical and mental health of the patient are essential factors affecting the mental health of caregivers of older cancer patients. This means that to enhance the well-being of caregivers, close attention should be paid to the state of the patients. Effects of Marching in Place and Chair Rise Exercises on Movement Function and ADL over 12 Months in Nursing Home Residents Kato, Yoshiji1,2; Koizumi, Daisuke2; Narita, Makoto2; Rogers, Michael E3; Takeshima, Nobuo1,4 1Trident 2Active

College of Sports, Medical Care and Nursing, Nagoya, Japan; [email protected]

Aging Association, Nagoya, Japan; [email protected], [email protected]

3National

Institute of Fitness and Sports in Kanoya, Kanoya, Japan; [email protected]

4Department

of Human Performance Studies, Wichita State University, Wichita, KS, USA; [email protected]

Introduction: Nursing home residents often have a sedentary lifestyle. We have previously reported that frail older women residing in a nursing home experience a significant progressive loss of muscle mass. In addition, many nursing home residents have limitations in performing active exercises, especially weight-bearing exercises, due to orthopedic conditions, musculoskeletal conditions, excess adiposity, poor balance, and/or age-associated sarcopenia. The purpose of this study was to determine the effects of a 12-month program consisting of marching in place and chair rising exercise on ADL and function in nursing home residents. Methods: Ten male and nine female (n = 19) nursing home residents (age = 78.3 ± 7.3 years; Barthel index [BI] = min 50 to max) participated in the study. Chair stand mean power (CSMP/kg) was determined using a linear displacement transducer; 10-m walk time (10MT), 30-Second Chair Stand Test (CS-30), and ADL via BI were assessed at pre (T1), 3 month (T2), 6 month (T3), and 12 month (T4) periods. An exercise program consisting of marching in place (MR) and chair rising (CR) was conducted for 12 months in a nursing home. CR was performed at a repetition rate of 2–3 s/rep, 15 reps/set, for one set from T1 to T2, and increased to 1–2 s/rep, 15 reps/set, for two sets from T2 to T4. MR was performed at a pace of 1 step/s, 15 steps/set, for one set from T1 to T2 and increased to two sets T2 to T4. Results: Significant improvement was noted in ADL score (79.7 ± 12.4 to 87.6 ± 12.0, +10%), CS-30 (11.4 ± 4.3 to 13.6 ± 3.9 reps, +19%), and CSMP/kg (11.4 ± 4.1 to 13.6 ± 3.9 W/ kg, +19%) between T1 to T2, with no additional improvements at T3 or T4. Changes in 10MT were not observed. Conclusion: Marching in place and chair rising exercises appear to improve performance specific to the exercises performed (i.e., chair rising exercise improves chair rising ability) and appear to improve ADL, but do not improve walking ability, after three months in nursing home residents. However, doubling the exercise volume after three months does not result in further improvements after six and 12 months. Further study is needed to determine if other modifications to the exercise program can improve function over a longer duration. JAPA Vol. 24, Suppl., 2016

Journal of Aging and Physical Activity, 2016, 24(Suppl.), S89  -115 © 2016 Human Kinetics, Inc.

WCAA ABSTRACTS

Friday 1st July 2016: Practice Keynotes Beyond Borders and Boundaries: Promoting Active Ageing in the 21st Century Abby C. King Professor of Health Research and Policy and Medicine at Stanford School of Medicine While technology is a major driver of many of society’s comforts and conveniences, it has also contributed to engineering regular physical activity and a number of other positive health behaviors out of people’s daily lives. As a result, higher-income nations, as well as a growing number of low- to middle-income countries worldwide, are facing unprecedented levels of physical inactivity, particularly as people age. Given this, finding strategies that go beyond person-level approaches through taking into account social and environmental conditions can expand the effectiveness and reach of physical activity interventions for aging adults. Promising behavior change approaches that have the potential for transcending socioeconomic circumstances and constraints will be highlighted. These include state-of-the-art information and communication technologies targeted to the needs of aging adults; social mobilization and peer facilitator approaches that take advantage of older adults’ wisdom and experiences; and “citizen science” perspectives that show that, when armed with the right tools, all residents, regardless of age, education, culture, or locale, can become data gatherers, consensus builders, and, in collaboration with local decision makers, solution generators for realistic local environmental improvements. These improvements can, in turn, foster health, wellbeing, and more equitable communities for all. Moving Beyond “Going for a Walk”: Rethinking Active Ageing Adrian Bauman Sydney University Physical activity promotion for older adults typically promotes regular moderate intensity activity such as walking in order to meet the physical activity guidelines of 150 min/week. This health threshold has become a mantra for health, and the way physical activity is portrayed in the elderly suggests this is the initial and central strategy to achieve good health. New thinking about ‘active ageing’ requires a reconsideration of the forms of activity that are beneficial in older age groups, especially for those in the older age groups beyond 70 and beyond 80 years of age. Whilst cardiometabolic benefits predominate for “younger elderly” (under 70 years), many other significant benefits result from different forms and contexts for active ageing in later years. These benefits include more than preventing heart disease or reducing the risk of diabetes. Newer epidemiological evidence points to neurological benefits on cognition, reducing dementia, and promoting psychosocial wellbeing and social engagement. Further, the promotion of moderate activity, such as walking, is the initial and most frequent portrayal of activity in the elderly, with pictorials depicting older adults walking in groups, playing tennis, and cycling. In order to meet the physical activity guidelines, consideration of maintaining strength is mostly ignored, although > 80% of older adults fail to achieve this. For inactive older adults, the clinical and public health sequence should be rethought, starting with strength and resistance training and accompanied by balance training, as necessary, and protective antecedents to more aerobic moderate intensity activities such as walking group participation. Finally, sedentary behaviour at all ages is considered a new independent risk factor for ill-health; despite the plethora of commentaries and some epidemiological evidence, it may be on a continuum with physical activity, such that among those unwilling or unable to be active, efforts should focus on reducing prolonged sitting. The hazards of sitting and risks of obesity, chronic disease, and reduced quality of life or mental health could be bi-directional, and careful consideration of confounders is needed before physical activity resources are redirected to sitting-reducing interventions. In summary, the single most important therapy for all older adults is being more regularly aerobically active, but greater benefits would accrue from including additional dimensions of activity in the clinical mix, and in planning community programs for older adults. Since this seldom occurs at the population level, rethinking activity is needed to optimise ‘active ageing’.

Symposia Assessment: What Does Technology Add to Practice? Simpson, D1; Callisaya, M1; Schmidt, M2; Smith, S3; Bird, Marie-Louise2; Teo, Wei-Peng4; Muthalib, Makii5; Colier, Willy6; Brickwood, Katie-Jane2; Watson, G2; Smith, S3; Williams, Andrew2 1Menzies

Institute of Medical Research, University of Tasmania, Hobart, Australia of Tasmania, Launceston, Australia 3University of the Sunshine Coast, Maroochydore, Australia 4Centre for Physical Activity and Nutrition Research (CPAN), Deakin University, Melbourne, Australia 5Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia 6Artinis Medical Devices, Netherlands 2University

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Introduction—Purpose and Goals: The feasibility of the use of technology in clinical practice has been well established, however the translation of use of new technology into practice remains a challenge. One way in which uptake of new technology may embed itself into practice is by having a client assessment that provides superior information or ease of use compared to more traditional methods of collecting information about clients. This symposium will discuss several novel projects that aim to demonstrate the benefits to clinicians in using newer technology by developing three separate themes, including: (1) collection of data remotely that would not be possible without technology; (2) accuracy of data collection; (3) ongoing monitoring and storage of data. Methods: Each presenter will have 15 minutes to present their project and provide a demonstration of the use of technology. This will be followed by a 30-minute panel discussion where the audience will be encouraged to participate in discussion of practical implications of technology in assessment of clinical practice. Content: Four different projects will be presented: (1) use of a custom made sensor and cushion combination to record sit-to-stand performance and remote monitoring and clinician feedback using table technology (theme 1); (2) use of Kinect based motion capture system for clinical assessment of function (sit-to-stand and functional reach) (themes 2 and 3); (3) functional near infrared spectroscopy (fNIRS) as a means to measure brain activity during neurorehabilitation (themes 1 and 2); (4) use of commercial physical activity monitors and remote feedback on maintenance of physical activity levels following an exercise intervention (themes 1 and 3). Implications for Active Aging: Older adults in rehabilitation or after hospitalization are at high risk of being inactive. Engagement of clinicians in monitoring and giving feedback to clients can facilitate independent activity to attain functional goals. Use of a Custom Made Sensor and Cushion Combination to Record Sit-to-Stand Performance and Remote Monitoring and Clinician Feedback Using Table Technology Simpson, Dawn1; Callisaya, Michele1; Schmidt, Matthew2; Smith, Stuart3 Institute of Medical Research, University of Tasmania, Hobart, Australia; [email protected], [email protected] of Tasmania, Launceston, Australia; [email protected] 3University of the Sunshine Coast, Maroochydore, Australia; [email protected] 1Menzies

2University

Introduction: Repetitive sit-to-stand (STS) is a common exercise in physical rehabilitation to improve strength and transfers. This presentation will demonstrate how a custom made activity monitor (AM) and motivational app provides feedback and targets to patients, motivating exercise outside of therapy. Methods: This technology can be used at home or in hospital. Weekly STS targets are programmed into the app by a therapist who adjusts targets based on goal achievement. Patients receive feedback on their goal progress via the app. Therapists review results remotely, allowing assessment of participation and progress. Results: Adherence to the therapist-prescribed program can be monitored objectively. The patient has clear motivation targets for therapy, and feels connected to their therapist through regular feedback. Conclusion: This technology has the potential to expand clinician contact with patients in hospital and at home. Therapy delivered remotely increases rehabilitation opportunities for people in rural areas or those unable to travel. Use of Kinect Based Motion Capture System for Clinical Assessment of Function (Sit-to-Stand and Functional Reach) Bird, Marie-Louise University of Tasmania, Launceston, Australia; [email protected] Introduction: Motion capture technology has the capacity for assessing and recording physical function. This project aims to validate two clinical tests: functional reach and sit-to-stand. Methods: Participants attended a university clinic and performed a functional reach traditionally and electronically (using a Kinect camera) in a randomized order, then performed a 30-s sit-to-stand test. Events were counted by the researcher and the technology simultaneously. Bland-Altman analysis was undertaken. Results: 21 adults (29.35 ± 14.2 years, height 170.5 ± 16.8 cm, weight 72 ± 10.6 kg) participated. Functional reach mean values for traditional (43.62 ± 6.63 cm) versus electronic (42.95 ± 6.08 cm) were not different (p = .73), with a small bias (–0.6725). Sitto-stand means of traditional (13.4 ± 2.3) were not different from electronic data collection (13.7 ± 2.6, p=.79), with a small bias (–.0295). Conclusion: Electronic data collection of functional balance and strength measures are valid. The capacity of this system to perform these tests remotely and store the data longer term have implications for clinical practice. Functional Near Infrared Spectroscopy (fNIRS) as a Means to Measure Brain Activity During Neurorehabilitation Teo, Wei-Peng1; Muthalib, Makii2; Colier, Willy3 for Physical Activity and Nutrition Research (CPAN), Deakin University, Melbourne, Australia; [email protected] Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia; [email protected] 3Artinis Medical Devices, Netherlands; [email protected] 1Centre

2Cognitive

Introduction: The use of functional near-infrared spectroscopy (fNIRS) as a neuroimaging tool is gaining interest. FNIRS measures the relative level of oxy- and deoxy-hemoglobin in cortical areas of the brain during cognitive and/or motor tasks, similar to that of functional magnetic resonance imaging (fMRI). Previous studies have shown high validity and reliability between fNIRS and fMRI measures, however fNIRS has a distinct advantage over fMRI as it is relatively portable and inexpensive to operate, and does not require patients to lie still during measures. This means that brain activity can, for the first time, be measured during functional tasks such as sit-to-stand or reaching tasks in people with neurological disorders, brain injury, or stroke. Methods: This presentation aims to demonstrate the versatility of fNIRS during various motor tasks during sitting, standing, and walking conditions. The advantages, limitations, and future application of fNIRS technology in clinical practice will be discussed in this presentation. Results: FNIRS is a relatively inexpensive tool that can be used to determine online brain activation during functionally-relevant tasks. FNIRS will provide both therapists and patients with online information regarding brain activity during training that was previously only achievable using fMRI. Conclusion: The use of fNIRS has the potential to be used as a standalone measure of brain activation during physical/cognitive tasks, or in conjunction with physical therapy/ virtual gaming to provide online biofeedback regarding brain activity. The measure of brain activation during therapy sessions will be essential to inform training intensity and determine if the therapy is targeting brain areas affected by neurological disorders, injury, or stroke. JAPA Vol. 24, Suppl., 2016

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Use of Commercial Physical Activity Monitors and Remote Feedback on Maintenance of Physical Activity Levels Following an Exercise Intervention Brickwood, Katie-Jane1; Watson, Greig1; Smith, Stuart2; Williams, Andrew1 1University 2University

of Tasmania, Launceston, Australia; [email protected], [email protected], [email protected] of the Sunshine Coast, Maroochydore, Australia; [email protected]

Introduction: Commercially available activity monitors combined with remote feedback (RPAM) may improve physical activity adherence. This project compares the effectiveness of RPAM devices with telephone counselling (TC). Methods: 150 participants will be randomized to 12 months of RPAM, TC, or usual care (UC). Participants randomized to RPAM will use an activity tracker and smartphone to monitor compliance to physical activity targets. TC involves follow-up phone calls fortnightly for three months and monthly thereafter. Compliance to physical activity and effects on health measures will be made before and at three, six, and 12 months. Results: Data comparing the effectiveness of RPAM devices, TC, and UC will be presented. Conclusion: Results of this study will help determine the efficacy of RPAM devices on compliance to prescribed activity compared to the current gold standard of TC. If remote monitoring proves effective, it may provide a cost-effective alternative to assisting maintenance of activity levels. Advances in Sedentary Behaviour Intervention in Later Life Chastin, S1; Gardniner, P2; Rosenberg, D3; Harvey, J1; Leask, C1 1Institute

for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University University of Queensland, Brisbane, Australia 3Group Health Research Institute, Seattle, WA 2The

Older adults are the most sedentary segment of society, and too much time spent sedentary is associated with poor physical and mental health outcomes in later life. Sedentary behaviour is ubiquitous through the day, which requires modifying daily routine. This presents specific challenges and requires tailored solutions in later life due to the wide variety of circumstances older adults find themselves in. The aim of the symposium is to discuss the latest innovations in interventions to reduce sedentary behaviour, considering behaviour change theories (Dr. P. Gardiner), technological solutions (J. Harvey), tailoring to specific sub-populations (Dr. D. Rosenberg) and contexts (e.g., sheltered housing and care homes, J. Harvey), and intervention co-creation (C. Leask). Dr. Sebastien Chastin will chair a discussion with the audience about future interventions and how they can be tailored to the widely different contexts people live in during later life. Sedentary Behavior Interventions in Older Adults: Time to Move Beyond Feasibility Studies Gardiner, Paul1; Rosenberg, Dori2; Lewis, Lucy3; Chastin, Sebastien4 University of Queensland, Brisbane, Australia; [email protected] Health Research Institute, Seattle, WA; [email protected] 3University of South Australia, Adelaide, Australia; [email protected] 4Glasgow Caledonian University, Glasgow, UK; [email protected]

1The

2Group

Introduction: Sedentary behaviour is acknowledged as a target for health behaviour change due to compelling observational and experimental evidence on associations of sedentary behaviour with health outcomes and biomarkers. Older adults have the highest levels of sedentary behavior, making them a suitable group to develop programs to reduce sedentary behaviour and assess changes in health outcomes. Two meta-analyses suggest that interventions in adults targeting sedentary behaviour alone are more effective, but they have not included quasi-experimental studies. The aim of this study is to review interventions to reduce sedentary behaviour in older adults (aged 60 years or older). Methods: A structured search of electronic databases was conducted for articles published up to February 2016. Included studies targeted reductions in sedentary behaviour in older adults. Information on study design, intervention features, and behavioural outcomes was extracted and summarized. Results: Of the 12 studies included, six targeted sedentary behaviour alone (SB), and six targeted sedentary behaviour in conjunction with physical activity (SB+PA). All of the SB interventions and one of the SB+PA interventions were characterized as a either a pilot, feasibility, or acceptability study, with five being quasi-experimental studies. All of the SB studies were less than eight weeks in duration, with all of the SB+PA studies of longer duration. No SB and three SB+PA studies assessed maintenance of behaviour change. Four of the SB studies had ≤ 30 participants (maximum N = 59), with only one PA+SB study having ≤ 30 participants (maximum N = 410). All studies reported total change in sedentary time, with five SB studies also reporting transitions from sedentary to non-sedentary time. Despite all of the SB studies reporting significant reductions in sedentary behaviour (range 24–120 min/day), only one assessed health outcomes and reported improvements in depressive symptoms and gait speed. Conclusion: Reductions in sedentary behaviour in older adults are feasible and achievable. It is time to progress beyond feasibility studies. Sufficiently powered randomized trials of longer-term interventions, with follow-up of maintenance, are needed to evaluate intervention effıcacy and assess clinical outcomes. Future interventions should report on patterns of and individual sedentary behaviours, given the differential health outcomes associated with these. The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults Rosenberg, Dori1; Gardiner, Paul2 Health Research Institute, Seattle, WA; [email protected] University of Queensland, Brisbane, Australia

1Group 2The

Introduction: Older adults with obesity have high sedentary time, up to 10 hr per day, and spend very little time being physically active. Interventions to reduce sitting time could promote health in this population. We conducted a series of feasibility studies on reducing sitting time among obese older adults. Methods: We conducted an initial pre–post test study (N = 25) to reduce sitting time (Rosenberg et al., 2015). We then completed a series of single case JAPA Vol. 24, Suppl., 2016

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design (i.e., ABA) studies (N = 10) to test inactivity alerts to interrupt sitting every 15–20 min. Sitting time, standing time, and breaks from sitting were measured with the activPAL thigh-worn inclinometer during waking hours. Paired t-tests and randomization tests were used to analyze the data. Results: In the initial pre–post test study (N = 25, mean age = 71.4; mean BMI = 34), sitting time was reduced by 27 min per day (p < .05), standing time increased by 25 min/day (p < .05), and breaks from sitting increased by two per day (p > .05). The intervention had high satisfaction ratings. In the ABA studies (N = 10, mean age = 68, mean BMI = 35), we observed an increase in breaks from sitting by seven per day (p < .05). Conclusion: Reducing sitting is feasible and appears modestly effective in older adults with obesity. Our next step is to conduct a pilot randomized study of 60 older adults with obesity using lessons learned from the pre-pilot studies described here. References: Rosenberg, D.E., Gell, N.M., Jones, S.M.W., Renz, A., Kerr, J., Gardiner, P., Arterburn, D. (2015). The feasibility of reducing sitting time in overweight and obese older adults. Health Education and Behavior, 42, 669–-676. SOS Study: Stomp Out (Prolonged) Sitting in Frailer Older Adults Pilot Intervention Study: Objective Effects and Perceived Strategies and Effects Harvey, Juliet A; Chastin, Sebastien FM; Skelton, Dawn A Glasgow Caledonian University, Glasgow, Scotland, UK; [email protected], [email protected], [email protected] Introduction: This study aimed to determine the feasibility of using activity monitoring and real-time or follow-up feedback to assist older adults living in sheltered housing complexes to reduce their sedentary behaviour (SB). Outcomes included objective measures of SB and participant perceived effects of the intervention and behaviour change strategies. Methods: Participants were recruited and randomized into two groups. They were monitored continuously over 14 weeks with an activPAL. On weeks 2, 6, and 10, both groups had face-to-face hour-long discussions, including visual feedback, about their SB. One group had the addition of real-time feedback, via a vibrational feedback function (activPAL-VTap), which activated when they sat for a self-selected period of time. The primary outcomes were SB parameters: bout distribution alpha, total SB time, and fragmentation (Chastin & Granat, 2010), and secondary outcomes were physical function (timed up and go [TUG]; 30-s chair rise) and self-reported wellness. Results: 23 participants started the intervention, but only 12 completed the three-month follow-up. Health and family issues led to dropout in this population. The VTap group tended to display more favorable outcomes at baseline and throughout the study. There were significant effects of group and time with SB alpha (p = .041) and TUG (p = .030). The chair rise had an effect over time, but not group (p = .027). The majority of self-reported benefits were physical in nature, but there were also numerous psychological and social benefits. To achieve a reduction in SB, the older adults reported that they made changes to the way they perceived their environment and daily routines. Conclusion: The dropout rate is reflective of the frailty of the older adults recruited. Although there was no change to total SB time, those in the VTap group broke their sitting more readily into shorter bouts. They also improved functional ability, suggesting this intervention had positive effects. The strategies used suggest useful ways of tailoring the interventions to an individual’s circumstance and perceptions. References: Chastin, S.F.M., & Granat, M.H. (2010). Methods for objective measure, quantification and analysis of sedentary behaviour and inactivity. Gait & Posture, 31(1), 82–86. doi:10.1016/j.gaitpost.2009.09.002 Co-Creating a Tailored Intervention to Reduce Sedentary Behaviour in Older Adults Leask, Calum F1; Skelton, Dawn A1; Sandlund, Marlene2; Chastin, Sebastien FM1 Caledonian University, Glasgow, UK; [email protected], [email protected], [email protected] University, Sweden; [email protected]

1Glasgow 2Umea

Introduction: Older adults are the most sedentary segment of society and, recently, reducing sedentary behaviour (SB) has become a public health priority. There are currently few models of interventions aiming to lower SB in this population. As SB is ubiquitous throughout the day, interventions need to modify the daily routine. Therefore, an intervention will need to be tailored to an individuals’ context and circumstances to improve adherence and lead to sustained positive health action. The aim of this study was to explore if co-creation could be an effective strategy to develop a personalised intervention to empower older adults to identify and reduce prolonged SB. Methods: Eleven community-dwelling older adults (5 men, mean age = 73.9 years) were recruited from a database of research volunteers. The process was based on participatory appreciative action research (PAAR) and involved older adults working together through 10 interactive workshops. Each workshop had a specific focus (e.g., awareness raising, feedback, self-monitoring) and between workshops, participants carried out research fieldwork tasks which they presented back to the group. Data was collected using field notes, video recording, and worksheet tasks. Analysis was conducted using a qualitative content analysis approach. Results: Participants developed the “Are you up for it?” manual: an intervention manual interweaved throughout a daily diary. Key elements of the manual included: (1) education of the concept and benefits of interrupting SB; (2) introducing the concept and categorisation of an individuals’ own reasons to interrupt SB (assets); (3) a daily diary with a corresponding table to facilitate identification of prolonged SB and assets; (4) action planning of when and how to reduce recognised prolonged SB; (5) reviewing the effectiveness of increased sedentary interruptions. Characteristics of the tool which are tailorable include: the manual size, frequency of action planning, assets most frequently used, and SB deemed modifiable based on the context. Conclusion: This study presents a novel approach towards developing a tailored intervention to reduce SB in older adults. The manual allows personalisation based on individual preferences and therefore increases the likelihood of observance. This intervention should now be implemented in a similar demographic to assess its effectiveness. References: Chastin, S.F.M., Egerton, T., Leask, C.F., & Stamatakis, E. (2015). Meta-analysis of the relationship between breaks in sedentary behavior and cardiometabolic health. Obesity, 23(9), 1800–1810. http://dx.doi.org/10.1002/oby.21180. Harvey, J.A., Chastin, S.F.M., & Skelton, D.A. (2013). Prevalence of sedentary behavior in older adults: a systematic review. International Journal of Environmental Research and Public Health, 10(12), 6645–6661. http://dx.doi.org/10.3390/ijerph10126645. Leask, C.F., Harvey, J.A., Skelton, D.A., & Chastin, S.F.M. (2015). Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom). European Review of Aging and Physical Activity, 12(4). http://dx.doi.org/10.1186/s11556-015-0146-7 Meeting Exercise Guidelines for Older Adults in an Engaging Way Bird, Marie-Louise1; Almond, Jodi1; Fazackerly, Lewis1; Barker, Anna2; Talevski, Jason2; Brand, Caroline2; Bohensky, Megan3; Cameron, Peter2; Morello, Renata2; Guest, Jen4

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of Tasmania, Launceston, Australia University, Melbourne, Australia 3University of Melbourne, Melbourne, Australia 4Director/Principal Physiotherapist, Polestar Pilates Senior Educator/Examiner 2Monash

Introduction—Purpose and Goals: Exercise guidelines for older adults include recommendations for several different components of fitness including aerobic capacity, strength training, balance, and agility or flexibility. There is high-level evidence that suggests exercise programs that focus on these components enhance independence and health-related quality of life in older adults. However, participation in these components of exercise is low, with less than 40% of older adults meeting the aerobic activity guidelines, only 11% for strength training and only 4% for balance. Pilates is a popular form of exercise that is considered safe by older adults and may have the capacity to engage uptake in participation in exercise that helps them meet their needs. The Pilates repertoire consists of over 100 different exercises that can be performed with a small apparatus or equipment to offer assistance or resistance, and to challenge different parameters of fitness. Because of the range of exercises available and the ability to modify exercises to make them suitable for an older population, this expert panel will provide a valuable forum for discussion. Methods: Each presenter will have 20 min to present their research and provide a demonstration of the exercises within the Pilates repertoire that fit with the theme of the presenter. This will be followed by a 30-min panel discussion where the audience will be encouraged to participate in discussion of practical implications for engaging older adults in relevant physical activity. Content: Three different themes will be explored: (1) aerobic fitness using standing and lying resistance-based Pilates exercises; (2) Pilates exercise to improve balance and decrease fall risk; (3) resistance training and activation of the pelvic floor during Pilates exercises. Implications for Active Aging: Engagement of older adults into relevant activity and exercise is vital to optimise health outcomes and maintain functional independence for this important sector of our population. The Cardiovascular Effects of Equipment-Based Pilates Exercise in Older Adults Bird, Marie-Louise; Fazackerly, Lewis; Almond, Jodi University of Tasmania, Launceston, Australia; [email protected], [email protected], [email protected] Introduction: Cardiovascular responses while using equipment-based Pilates is not known. Methods: Regular Pilates participants over the age of 60 with stable blood pressure participated. After warmup, seven exercises (using reformer, trapeze, wonder chair and core-align) were performed for 5 min each, and averaged HR (Polar HR monitors) and rating of perceived exertion (BORG 6-20) were recorded. Results: Eighteen healthy older adults (70.6 [4] years; resting HR 67 [6.6] bpm) participated. Average exercising HR was 87 (8) bpm for the 35 min of exercise. Participants averaged 13.8 (10.6) min within their training zone. Participants spent longer in their training zone in standing 2.5 (1.7) per 5 min compared to supine, with 1.1 (1.1) min (P = .0001). Overall, perceived exertion was 12.7 (1.6), ranging from 10 (light) to 13 (somewhat hard). Conclusion: Exercises in standing using Pilates equipment has a small cardiovascular training effect in older adults. Potential exists to design Pilates classes to meet the exercise needs of older adults. Is Pilates a Feasible Form of Exercise to Decrease Falls Risk in Older Community-Dwelling People? A Pilot Randomised Controlled Trial Barker, Anna; Talevski, Jason; Brand, Caroline; Bohensky, Megan; Cameron, Peter; Morello, Renata Monash University, Melbourne, Australia; [email protected], [email protected], [email protected], megan. [email protected], [email protected], [email protected], Introduction: Falls are the leading cause of injury among older people (Clark et al., 2012). This pilot RCT assessed the feasibility of a Pilates exercise program. Methods: Fifty-three people ≥ 60 years with high falls risk were randomised to a Pilates (n = 22) or control (n = 31) group. Pilates classes were performed two times per week for 12 weeks. Outcome measures were acceptability of Pilates and efficacy of Pilates (falls, balance, lower-limb strength, flexibility), measured at 12 and 24 weeks. Results: Pilates participants reported high levels of acceptability. Pilates achieved greater improvements for standing balance, lower-limb strength, and flexibility measures compared to the control group (P < .05). The rate of injurious falls was 64% lower in the Pilates group at 24 weeks, however this was not statistically significant (P = .136). Conclusion: A definitive RCT on Pilates in older people would be feasible and is warranted given the acceptability and positive effects on fall injuries and fall risk factors. References: Clark, D.O., Stump, T.E., Tu, W., & Miller, D.K. (2012). A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults. Medical Care, 50(6):534–539. Resistance Training and Activation of the Pelvic Floor Muscles, Specifically in the Older Population Guest, Jen Director/Principal Physiotherapist, Polestar Pilates Senior Educator/Examiner; [email protected] Introduction: Pilates exercise has been shown to be as effective as resistance training in improving leg and abdominal muscle strength (Otto et al., 2004); however, the impact of Pilates on the female pelvic floor has not been investigated. The purpose of this presentation is to discuss the effects of an abdominal Pilates strengthening program on the pelvic floor musculature (PFM) in the older female. Methods: Two female clients (over 65 years) will be presented as case studies. Baseline measures will ascertain the ability, strength, and endurance of PFM (by digital examination) and abdominal muscle contraction (by real-time ultrasound). Measures will be repeated at six and 12 weeks. The intervention is an eight-week abdominal Pilates strengthening program supervised by a qualified instructor (twice a week). Results and Discussion: Changes in PFM function will be described and the specific cuing and instructions to maintain integrity of PFM and maximize function during resistance training will be discussed. Reference: Otto, R., et al. (2004). The effect of twelve weeks of Pilates vs resistance training on trained females. Medicine & Science in Sports & Exercise, 36, S356–S357.

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Sarcopenia and Physical Frailty in Older People: Multi-Component Treatment Strategies (SPRINTT) Freiberger, Ellen1; Landi, Francesco2; Marzetti, Emanuele2 Erlangen-Nürnberg, Germany; [email protected] Cattolica del Sacro Cuore, Rom Italy; [email protected], [email protected]

1Friedrich-Alexander-University, 2Universita

Introduction: Due to the worldwide demographic transition, healthcare systems are facing new demands. Health services—with their approach of mostly single acute conditions—are indeed confronted with an expanding older population characterized by specific medical needs related to multimorbidity and functional impairment. The European research project “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project is specifically designed to overcome existing barriers for efficient public health interventions against frailty, and promote the implementation of successful aging strategies across Europe. In the symposium, methods of the SPRINTT project and first results from the ongoing screening process will be presented. Methods: The SPRINTT randomized clinical trial (RCT) will compare the efficacy of a multicomponent intervention (based on long-term structured physical activity, nutritional counselling, and an information and communication technology intervention) versus a Healthy Aging Lifestyle Education (HALE) program for preventing incident mobility disability in community-dwelling older persons with physical frailty and sarcopenia. For the RCT, 1,500 community-dwellers, aged 70 years and older (750 per treatment arm) will be enrolled. The study population will be comprised of “real life”, non-disabled older persons exposed to increased vulnerability to stressors. The identification of such population will rely on three key elements: (1) low muscle mass, measured by DXA; (2) clinical signs of physical frailty (i.e., weakness, slow walking speed, and poor balance); (3) absence of major mobility disability. The primary outcome will be the incidence of mobility disability (i.e., incident inability to walk 400 meters). Secondary outcomes will include, among others, changes in physical performance and function; ability of selected biomarkers to predict the rate of change in muscle mass; incidence of falls and injurious falls; changes in health economic parameters; changes in quality of life; mortality rate. Conclusion: The SPRINTT RCT will be conducted in 15 study sites located in nine European countries. All study centers were evaluated and local personnel trained with regard to recruitment capabilities, outcome assessment, and intervention administration. The inclusion of a population with special needs will open pathways for future direction in the prevention of physical disability. References: Landi, F., Calvani, R., Cesari, M., et al. (2015). Sarcopenia as the biological substrate of physical frailty. Clin Geriatr Med, 31(3):367–374. Landi, F., Calvani, R., Tosato, M., Martone, A.M., Bernabei, R., Onder, G., Marzetti, E. Impact of physical function impairment and multimorbidity on mortality among community-living older persons with sarcopenia: results from the ilSIRENTE prospective cohort study. BMJ Open. In press. Marzetti, E., Calvani, R., Landi, F., Hoogendijk, E., Fougère, B., Vellas, B., Pahor, M., Bernabei, R., Cesari, M., on behalf of the SPRINTT Consortium. Innovative Medicines Initiative: the SPRINTT project. J Frailty Aging. In press. http://dx.doi.org/10.14283/jfa.2015.69. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) Project Freiberger, Ellen, PhD (chair); Landi, Francesco, MD, PhD (co-chair) Università Cattolica del Sacro Cuore, Rome, Italy; [email protected] Institute for Biomedicine of Aging Friedrich-Alexander-University Erlangen-Nuernberg, Germany; [email protected] The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project has been designed to overcome the existing barriers for an efficient public health intervention against frailty, and promote the implementation of successful aging strategies. To reach such an ambitious goal, the actions of the SPRINTT Consortium have been directed towards the achievement of a consensus among academia, regulators, industry (pharmaceutical and medical devices), and patients representatives over: (1) clear operationalisation of the presently vague concept of frailty; (2) identification of a target population with unmet medical needs; (3) evaluation and validation of methodologies for implementing preventive and therapeutic strategies among frail elders at risk of disability; (4) definition of an experimental setting as a template for regulatory purposes and pharmaceutical investigations; (5) identification of biomarkers and health technology solutions to be implemented into clinical practice. To ensure the successful accomplishment of all SPRINTT goals, a unique and robust Consortium has been established that convenes internationally-recognised leading experts in the field of physical frailty and sarcopenia. The Consortium is organised in multiple interacting work–package teams, reassembling academia, the European Federation of Pharmaceutical Industries and Associations (EFPIA) and two small and medium enterprises (SMEs), each participant supporting with its own specific expertise for the conduction of the SPRINTT work-packages. Each leader/co-leader in “tandem” will coordinate a group of experts in specific domains. The expertise of each partner will thus be valorised, and the Consortium activities conducted in the most informed, shared, and appropriate way. Operationalisation of the Physical Frailty and Sarcopenia Syndrome in SPRINTT Marzetti, Emanuele, MD, PhD Università Cattolica del Sacro Cuore, Rome, Italy; [email protected] Over the years, different operational definitions have been elaborated to identify frail older persons and sarcopenia, but none of them has received unanimous consensus. The most notable consequence of these persisting uncertainties and debate is the lack of effective interventions to prevent the development and impede the progression of the two conditions. To overcome the current limitations in the field, the SPRINTT consortium has elaborated a novel operationalisation of physical frailty (PF), which grounds its roots in the recognition of sarcopenia as its central biological substrate. This conceptualisation is based on the fact that the clinical picture of PF overlaps substantially with that of sarcopenia. The two conditions may therefore be merged into a new clinical entity, the PF and sarcopenia (PF&S) syndrome, in which muscle loss represents both the biological substrate for the development of PF and a major pathway whereby the negative health outcomes of PF occur. It is worth noting that all of the components describing the PF&S model are measurable and quantifiable in an objective manner. The implementation of such a paradigm would therefore allow the accurate operationalisation of PF&S, a clear identification of the affected population, and the rapid translation of research findings to the clinical arena. Such a conceptualisation would also make PF&S comparable to other chronic degenerative conditions of old age (e.g., chronic obstructive pulmonary disease and congestive heart failure), mirroring the paradigm of a biological substratum for a specific set of symptoms/signs determining a measurable decreased JAPA Vol. 24, Suppl., 2016

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function. The PF&S syndrome may thus gain its spotlight among the geriatric “giants”, besides becoming easily acceptable by healthcare professionals, public health authorities, and regulatory bodies. The recognition of a precise biological substratum for PF&S (i.e., skeletal muscle decline) also opens new venues for the development of new preventive and therapeutic interventions. Design and Methodology Tosato, Matteo, MD, PhD; Freiberger, Ellen, PhD Università Cattolica del Sacro Cuore, Rome, Italy; [email protected] Institute for Biomedicine of Aging Friedrich-Alexander-University Erlangen-Nuernberg, Germany; [email protected] Introduction: The sustainability of health and social care systems is threatened by a growing population of older persons with specific needs related to multimorbidity, frailty, and increased risk of functional impairment. Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society, novel strategies should be devised to preserve adequate levels of function and independence in late life. The development of mobility disability, an early event in the disablement process, precedes and predicts more severe forms of inability. Its prevention is therefore critical to impede the transition to overt disability. For this reason, the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) project will conduct a randomised controlled trial (RCT) to test a multicomponent intervention (MCI) specifically designed to prevent mobility disability in high-risk older persons. Methods: SPRINTT is a phase III, multicentre RCT aimed at comparing the efficacy of a MCI, based on long-term structured physical activity, nutritional counseling/dietary intervention, and an information and communication technology intervention, versus a healthy aging lifestyle education program designed to prevent mobility disability in 1,500 older persons with physical frailty and sarcopenia, who will be followed for up to 36 months. The trial will be conducted in 15 clinical centres, located in nine European countries, under the coordination of the Department of Geriatrics of the Catholic University of the Sacred Heart (Rome, Italy). The primary outcome of the SPRINTT RCT is mobility disability, operationalised as the inability to walk for 400 m within 15 min without sitting, the help of another person, or the use of a walker. Secondary outcomes include muscle mass and strength, persistent mobility disability, falls and injurious falls, disability in activities of daily living, nutritional status, cognition, mood, the use of health care resources, quality of life, and mortality rate. Conclusion: SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives. The findings are also projected to pave the way for major investments in the field of disability prevention in old age. New Strategies for Biomarker Discovery in the Field of Physical Frailty and Sarcopenia Calvani, Riccardo, PhD; Marzetti, Emanuele, MD, PhD Università Cattolica del Sacro Cuore, Rome, Italy; [email protected], [email protected] Physical frailty (PF) and sarcopenia are two common and largely overlapping geriatric conditions upstream of the disabling cascade. The lack of a unique operational definition for PF and sarcopenia and the complex underlying pathophysiology make the development of biomarkers for these conditions extremely challenging. Indeed, the current definitional ambiguities of PF and sarcopenia, together with their heterogeneous clinical manifestations, impact the accuracy, specificity, and sensitivity of individual biomarkers proposed so far. As a consequence, the presently available biomarkers for PF and sarcopenia are typically related to specific pathogenic mechanisms and/or phenotypes. As such, they only describe single aspects of the conditions and are weakly associated with clinically relevant outcomes. This scenario suggests that there might not be one single biological marker that reliably tracks the multitude of different contributors and phenotypes of PF and sarcopenia. A shift of paradigm is therefore needed, moving from the quest for a single biomarker to the development of multivariate/multidimensional modelling of a panel of complementary biomarkers (likely within multiple classes: imaging, serum biomarkers, and functional tests). This approach may promote: (1) the early detection of otherwise subclinical conditions, (2) the diagnostic assessment of clinically-manifested PF and sarcopenia, (3) the risk stratification of subjects with a suspected or confirmed diagnosis, (4) the tracking of the conditions over time, (5) the selection of an appropriate therapeutic intervention, and (6) the monitoring of the response to treatment. As opposed to conventional monodimensional approaches, the simultaneous evaluation of multiple parameters belonging to different domains may be better suited to cope with the heterogeneity of complex age-related phenomena, such as PF and sarcopenia. Health Economic Implications of Physical Frailty and Sarcopenia Mariotti, Luca, PMP; Landi, Francesco Università Cattolica del Sacro Cuore, Rome, Italy; [email protected], [email protected] The frailty status represents a global measure of health in older adults and may therefore reflect their medical needs more closely than the multimorbidity burden. However, the existence of multiple and only partially overlapping definitions of frailty has so far impeded the conduct of comprehensive health economic analyses to estimate the impact of this condition on healthcare consumption. However, preliminary health economic studies have shown that the frailty phenotype, as operationalised by Linda Fried, is independently associated with incident disability, increased morbidity, hospitalisations, need for long-term care, and excessive healthcare consumption. These observations highlights the need of identifying frailty at an early stage, in order to put in place adequate interventions to impede the development of its adverse outcomes and related costs. The operationalisation of physical frailty and sarcopenia (PF&S) elaborated by the SPRINTT consortium, being based on objectively measurable parameters, provides a unique opportunity for health economic studies on the subject. The results of the SPRINTT health economic study will serve as the scientific foundation on which to leverage the development on new programmes targeting elderly people with PF&S. Furthermore, the knowledge gained through these studies will be instrumental for the recognition of PF&S as a true nosographic entity by policy-makers and regulators. This, in turn, is an essential requisite for the development of new and cost-effective models of care and health services for the comprehensive management of PF&S. Using Evidence in Practice: The Benefits of Aged Care Resistance-Based Exercise Henwood, Tim1; Boylan, Jo2; Hall, Nathan3; Bending, Martin4 JAPA Vol. 24, Suppl., 2016

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Solutions & The University of Queensland, QLD, Australia; [email protected] Cross Aged Care, SA, Australia; [email protected] 3Uniting, NSW, Australia; [email protected] 4Australian Unity Retirement Living Services, NSW, Australia; [email protected] 1AgeFIT

2Southern

Evidence is strong that progressive resistance and weight bearing exercise can improve muscle mass, muscle strength, and physical performance among old and very old adults. In addition, with training comes reduced falls and disability risk, physical and cognitive disease prevention and treatment, and overall increased functional capacity for older adults. Importantly, these gains are available independent of age, illness, or disability, with the benefits associated with training said to outweigh the risks (1,2). Yet even in the presence of such strong evidence, progressive resistance and weight bearing exercise remains underutilised in the battle against disability, morbidity, and mortality in later life. In the hope of prolonging community-dwelling status among older Australians with aged care packages, the Australian Government have moved towards a reablement and restorative model of care. This symposium will highlight the translation of evidence to practice by exploring a number of successful progressive resistance and weight bearing exercise models of delivery targeting well and unwell community and institutionalised older Australians. Delegates attending this symposium will be given a brief overview of current evidence and the demonstrated value of including progressive resistance and weight bearing exercise as a model of care (Henwood). This will be followed by the exploration of four successful services targeting healthy community-dwelling (Henwood), day therapy (Hall), retirement living (Bending), and residential aged care older adults (Boylan). In addition to the programme benefits for the client, speakers will talk to the motivators, enablers, and barriers to participation, as well as the programme sustainability and social equity. Presentations will be followed by a panel discussion to allow researchers the opportunity to network with services providers of successful programmes, and to encourage providers to establish a similar service into their model of care. Implication for Active Ageing: While progressive resistance and weight bearing exercise remains underutilised in the battle against disability, a number of successful programmes have emerged that have embraced this modality of training with measurable client benefits. This symposium holds important information for stakeholders, policy makers, and researchers passionate about improving the trajectory of health of the old and very old adults. References: (1) Chodzko-Zajko, W.J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., et al. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 41(7):1510–1530. (2) Liu-Ambrose, T.Y., Ashe, M.C., Marra, C. (2010). Independent and inverse association of healthcare utilisation with physical activity in older adults with multiple chronic conditions. Br J Sports Med, 44(14):1024–1028. Using Evidence in Practice: The Role of Resistance Training in Avoiding Aged Care Henwood, Tim AgeFIT Solutions & The University of Queensland, QLD, Australia; [email protected] Progressive resistance training has a plethora of important benefits for older adults. Current evidence not only promises a reduced falls risk and improved muscle physiology and capacity in activities of daily living, but data are emerging demonstrating ongoing and regular participation can significantly decrease all-cause, cancer, and cardiac mortality risk. In addition, it has been shown that with training comes maintenance of muscle mass, which is protective of morbidity and mortality and associated to a reduced risk of post-operative complications. However, while it would appear that the employment of this modality of activity in the exercise regime of older adults would be paramount, and in particular those experiencing some level of disability, participation rates continue to be low. Moreover, of the 7% of adults over 65 years regularly undertaking progressive resistance training, many are doing so at intensities that allow their symptoms of disease and disability to progress (Chodzko-Zajko et al., 2009; Kraschnewski et al., 2016). To counter low participation rates and to ensure individuals are receiving evidence-based guidance when training, a number of excellent programmes are emerging within Australia servicing old and very old adults with and without dependent care needs. This presentation will be the first of four talks to investigate the value of resistance training in preventing, prolonging, and rehabilitating adult health and wellbeing in later life. Specifically, in this presentation, a clinical exercise, membership-based, community-dwelling programme will be examined. The clinic in question has most recently been acknowledged as an industry leader in prescription and delivery of clinical exercise, is housed inside a progressive organisation catering for the wellbeing of a wide membership of 50 years plus adults, and is participating in a large government-funded reablement project. In addition to a breadth of programme delivery, the conceptual design and establishment, population uptake and reach, and sustainability and growth of the clinic will be discussed, supported by participant data and testimonials. Delegates interested in both the value of progressive resistance training for older well and unwell adults and in establishing a similar service model will benefit from attending this presentation and this symposium. Presentations will be followed by a panel discussion to allow delegates the opportunity to network with service providers of successful programmes. References: Chodzko-Zajko, W.J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., & Skinner, J. S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 41(7), 1510–1530. Kraschnewski, J.L., Sciamanna, C.N., Poger, J.M., Rovniak, L.S., Lehman, E.B., Cooper, A.B., . . . Ciccolo, J. T. (2016). Is strength training associated with mortality benefits? A 15year cohort study of US older adults. Prev Med, 87, 121–127. Using Evidence in Practice: The Benefits of Aged Care Resistance Based Exercise: Stories for Uniting’s Seniors Gym Hall, Nathan Uniting, NSW/ACT, Australia; [email protected] Aware of the emerging evidence supporting progressive resistance and weight bearing exercise for later life health and wellbeing (Fiatarone et al., 1994), UnitingCare NSW/ACT (Uniting) created the Centre for Healthy Ageing in 2003 within the Day Therapy Centre model. With funding reform and restructuring, the program is now delivered within the Commonwealth Home Support framework, and has continued to grow with a second service opening in 2005. The aim of the centres is to promote and maintain health, fitness, independence, and quality of life of all people 65 years and older. A membership-based structure, individuals can participate in evidenced-based group and individual exercise programs that focus on strength training and education aimed at staying healthy and improving wellbeing. Exercise programs are developed according to individual needs, and programs are consistently re-evaluated and outcomes reported. Members benefit from the advice and assistance of highly-qualified staff, predominantly exercise physiologists, and programs commonly include strengthening and balance components, but, based on individual needs, may target disease specifics JAPA Vol. 24, Suppl., 2016

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such as cardiovascular or diabetes needs. In addition, programs have extended benefits inclusive or building participant functional confidence and offering social interactions (Chodzko-Zajko et al., 2009). Currently, the Seniors Gyms caters to over 700 clients that attend over 4,000 sessions per month, with an average age of 74 years; the service continues to grow with a waiting list of 130 people. In 2016 the Seniors Gym has extended its reach into Residential Aged Care, delivering intensive strength and balance programs, and will extend its reach to Uniting Home and Community Care clients by offering functional assessments and exercise programs assessed and delivered by exercise physiologists and personal carers, respectively. Uniting is committed to improving the quality of life for older persons by providing services which encourage and empower clients to remain active and continue to live in the community. The Seniors Gym is an innovative model that addresses this by enablement, empowerment, and maximising client independence through health and wellness practices. In addition to the benefits for the client, the presentation will discuss motivators, enablers and barriers to participation, as well as sustainability and social equity. References: Chodzko-Zajko, W. J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., & Skinner, J.S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 41(7), 1510–1530. Fiatarone, M.A., O’Neil, E.A., Ryan, N.D., Clements, K.M., Solares, G.R., Neleson, M.E., Roberts, S.B., Kehaylas, J.J., Lipsitz, L.A., & Evans, W.J. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. The New England Journal of Medicine, 330(25), 1769–1775. Evaluating a Resistance Training Program: What Benefits Matter to an Older Adult? Bending, Martin Australian Unity Independent and Assisted Living, Australia; [email protected] Introduction: Resistance training has been shown to be beneficial in the health and wellbeing of older individuals. Clinical and physical health and quality of life can be positively affected by resistance training, and are equally important as measures in evaluating the effectiveness of participation. Common measures include HbA1c, systolic blood pressure, Timed Up and Go, Time to stand from chair, and the six-minute walk test (Pederson & Saltin, 2015; Liu & Latham, 2009). In clinical practice, evaluating the benefits of resistance training for older adults with complex health needs often goes further than conventional pre and post measures, with consideration extended to goal setting, adherence, and long-term compliance to programs. Methods: A review of the literature and clinical practice will highlight common outcome measures used to evaluate resistance training programs targeted at an older population with complex health care needs. These will be compared to anecdotal and individual clinical practice case studies, across exercise physiology led programs in aged care settings including centres, gyms, and community and residential locations, to generate discussion considerate of validity, applicability, and value. Results: There is variability between common practice and how older participants of resistance training programs appraise participation benefits experienced and achieved. For participants, a focus on their ability to perform relevant activities of daily living (ADL) is important, specifically ADLs that promote quality of life and enjoyment. Conclusion: There are many ways to evaluate the benefits of a resistance training program. It is important that clinicians individualise the assessment and monitoring of the program to include a combination of evidence-based pre and post outcome measures, as well as measures relevant to the client needs and wants that factor in competency in activities of daily living. References: Liu, C.J., Latham, N.K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev, 3:CD002759. Pedersen, B.K., Saltin, B. (2015). Exercise as medicine-evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports, 25(Suppl 3) 1–72. ‘Making Healthy Normal’ in Aged Care Boylan, Josephine Southern Cross Care, Adelaide, Australia; [email protected] Introduction: The concept of active and healthy ageing may seem like a contradiction for people who receive aged care services and are already viewed as frail. Research is suggesting that aged care settings can deliver services for older people with integrated health promoting interventions and structures, and subsequently improve health and quality of life in later years. This presentation will explain how Southern Cross Care is embedding the enablers for active and healthy ageing into residential and community services, and extending this into retirement living. The overall aim of this approach is driven by knowledge that health and wellbeing is possible for the oldest living, and a conviction that this is their human right. Enablers include participating in health promoting activities, such as exercise classes and resistance training, good nutrition, social engagement, and ongoing learning, focused in health literacy. These enablers support active and healthy ageing and compress the stage of decline and disability, even for frail older people. Methods: Guiding with the World Health Organisation (WHO) Five Standards for Health Promotion and underpinned by the healthy settings concept ensures our approach is systematic, interdisciplinary, and integrated. In preparing and implementing our approach in a stepped way, we have developed policies, procedures, systems and processes; established early intervention working groups to address decline and reverse frailty; introduced data collection measures and tools; provided access to gyms and physical health equipment; and coordinated training of care staff and for lifestyle staff to become personal trainers. Our next planned steps are to systematically measure and monitor frailty and quality of life. Results: Early positive results support Southern Cross Care’s reorientation toward services and activities that promote active and healthy ageing, even for frail older people. One positive indicator shows a 54% reduction in overall fractures in the last year across all 15 residential homes. Conclusion: Leadership is needed from the aged care sector to design and implement services that will extend healthy life expectancy, prevent avoidable decline, promote quality of life, and make healthy “normal” in aged care. To do this, healthy ageing must be viewed as an essential human right. References: Harris, N., Grootjans, J. (2012). The application of ecological thinking to better understand the needs of communities of older people. Australian Journal on ageing, 31(1), 17–21. Harris, N., Grootjans, J., Wenham, K. (2008). Ecological aging: the settings approach in aged living and care accommodation. EcoHealth, 5, 196–204. World Health Organization, (2004). Standards for Health Promotion in Hospitals. WHO Regional Office for Europe. Wearable Technology for Increasing Physical Activity and Reducing Sedentary Behaviour in Chronic Disease Populations: Help or Hype? Lynch, Brigid M1,2,3; Lynch, Chris1,4; Rosenberg, Dori5,6; Cadmus-Bertram, Lisa7; Buman, Matthew P8 1Cancer

Council Victoria, Melbourne, Australia; [email protected], [email protected] JAPA Vol. 24, Suppl., 2016

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University of Melbourne, Melbourne, Australia IDI Heart and Diabetes Institute, Melbourne, Australia 4RMIT University, Melbourne, Australia 5Group Health Research Institute, Seattle, USA; [email protected] 6The University of Washington, Seattle, USA 7University of Wisconsin – Madison, Madison, USA; [email protected] 8Arizona State University, Phoenix, USA; [email protected] 3Baker

Introduction: Wearable technologies (‘wearables’) are designed and marketed as tools to help users to increase physical activity, reduce sedentary behavior, and achieve other health-related goals. Consumer uptake of wearables has been remarkable, with reports suggesting that one in 10 Americans now own a device (Internicola, 2014). There is clearly potential to harness the popularity of wearables to facilitate behavior change amongst older adults at risk of, and living with, chronic diseases. However, the capacity of wearables to create sustainable behavioural changes, either alone or as part of a broader intervention approach, remains to be seen (Patel, Asch, & Volpp, 2015). Methods: A variety of methods and study designs have been utilized by researchers in Australia and the United States to determine the feasibility and efficacy of using wearables for research and clinical purposes in chronic disease populations. Results: Original data from ongoing and completed studies will be presented, including: (i) findings from a series of focus groups, conducted with postmenopausal breast cancer survivors, that explored consumer preferences in relation to different models of fitness trackers; (ii) feasibility studies with prostate cancer survivors and older adults with obesity; (iii) a randomised trial testing two different approaches for modifying sedentary time in postmenopausal breast cancer survivors; and (iv) a smartphone-based application targeting behaviors across the 24-hr day (sleep, sedentary behavior, and physical activity) in adults with increased metabolic risk. Conclusion: Wearables provide real-time, passive, objective, and continuous assessment of free-living physical activity/sedentary behaviour. We propose that wearables may be useful for monitoring physical activity/ sedentary behaviour across chronic disease treatment trajectories. Data collected over the course of disease may help to identify specific time points that are particularly crucial for intervention delivery, or to profile patients who are at risk of poor health and physical functioning. Wearables also have great potential to support physical activity/sedentary behaviour interventions; however, it is unlikely that they will produce meaningful, sustained behavioural change on their own. Without clearly defined personal goals, and external motivation and accountability, few individuals will sustain regular use (Patel et al., 2015). References: Internicola, I. (December 22, 2014). Activity trackers get smarter at measuring your fitness. Scientific American. Patel, M.S., Asch, D.A. & Volpp, K.G. (2015). Wearable devices as facilitators, not drivers, of health behavior change. JAMA, 313(5):459–460. Acceptance of Activity Trackers Among Breast Cancer Survivors: A Qualitative Evaluation Lynch, C1,2; Moore, MM3; Reeves, MM4; Rosenberg, D5; Lynch, BM1,6 Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia; [email protected] University, Melbourne, VIC, Australia 3Medical Oncology, St Vincent’s Hospital, Melbourne, VIC, Australia; [email protected] 4The University of Queensland, School of Public Health, Brisbane, QLD, Australia; [email protected] 5Group Health Research Institute, Seattle, WA, USA; [email protected] 6Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia; [email protected] 1Cancer

2RMIT

Introduction: The beneficial effects of physical activity after a breast cancer diagnosis are evident—appropriate physical activity may reduce all-cause mortality by 41% (Ibrahim & Al-Homaidh, 2011). It is recommended that cancer survivors achieve at least 150 min per week of moderate-vigorous physical activity (Rock et al., 2012), yet achieving this goal can be challenging. Wearable technologies, such as activity trackers, hold potential as intervention tools to help cancer survivors become more active. However, the utility and usability of specific features of these trackers are not well understood. Therefore, the aim of this study was to explore these aspects of activity trackers using qualitative methods in order to determine which device(s) would be the most acceptable to, and likely to be adopted by, breast cancer survivors. Methods: A convenience sample of 18 inactive, post-menopausal breast cancer survivors who had completed primary treatment were recruited. Participants were randomly assigned two activity trackers (from a possible seven) to wear for a minimum of two weeks. Focus groups determined preference for, and acceptability of, each activity tracker. Questions about the different activity trackers focused on three topics: acceptability, efficacy, and participant preference. Focus group discussions were transcribed verbatim. Coding lists were developed after several rounds of reviewing, and inductive thematic analysis interpreted patterns in the data. Results: A number of themes emerged from the focus group data: (1) Self-awareness and goal setting: participants reported that the activity trackers increased their awareness of physical activity and sedentary behaviour. Participants preferred trackers that enabled setting constant goals rather than automated activity-adjusted goals. Step count was the preferred metric for goal setting. (2) Need for ambulation to turn off sedentary behavior alerts: participants noted that sedentary behaviour alerts were not responsive to standing and short durations of stepping. Sedentary behaviour alerts were thus perceived as less useful, and often ignored. (3) Comfort with technology: participants unanimously preferred devices with clear displays. Set-up and connection difficulties were cited for device use only, rather than using the device in conjunction with its interface. Conclusion: A key strength of wearable technology is in raising user awareness of their physical activity and sedentary behaviour levels. Step count is the preferred metric for tracking physical activity amongst breast cancer survivors. Devices that provide instantaneous feedback, with a clear display, and that do not rely on a user-interface are preferred by this population. References: Ibrahim, E.M., Al-Homaidh, A. (2011). Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol, 28(3):753–765. Rock, C.L., Doyle, C., Demark-Wahnefried, W., et al. (2012). Nutrition and physical activity guidelines for cancer survivors. Cancer J. Clin, 62(4):242–274. Validation of Consumer-Based Activity Monitors in Older Adults with Varied Ambulatory Abilities Buman, Matthew P1; Floegel, Theresa A1,2; Florez-Pregonero, Alberto1,3; Hekler, Eric B1 1Arizona

State University, Phoenix, AZ, USA; [email protected], [email protected], [email protected] JAPA Vol. 24, Suppl., 2016

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of North Carolina-Chapel Hill, Chapel Hill, NC, USA; [email protected] de Formacion Pontificia Universidad Javeriana, Bogoto, Columbia

3Departmento

Introduction: The use of wearable devices by older adults is increasing, and these tools may be effective to assist older adults in increasing their physical activity. However, the accuracy of step detection in consumer-based wearable activity monitors in older adults with varied ambulatory abilities is not known. Methods: We assessed the validity of one ankle-worn (StepWatchTM), two hip-worn (Fitbit OneTM and Omron HJ-112TM), and two wrist-worn (Fitbit FlexTM and Jawbone UPTM) activity monitors in older adults of varying ambulatory abilities. Non-impaired, impaired (Short Physical Performance Battery Score [SPPB] score < 9), cane-using, or walker-using older adults (62+ years) ambulated at a self-selected pace for 100 m wearing all activity monitors simultaneously. The criterion measure was directly observed steps with continuous videography. Intraclass correlation coefficients (ICC), mean absolute percent error (APE), equivalency, and Bland-Altman plots were used to assess accuracy. Results: Non-impaired adults steps were underestimated by 4.4% for StepWatch (ICC = 0.87), 2.6% for Fitbit One (ICC = 0.80), 4.5% for Omron HJ-112 (ICC = 0.72), 26.9% for Fitbit Flex (ICC = 0.15), and 2.9% for Jawbone UP (ICC = 0.55). Impaired adults’ steps were underestimated by 3.5% for StepWatch (ICC = 0.91), 1.7% for Fitbit One (ICC = 0.96), 3.2% for Omron HJ-112 (ICC = 0.89), 16.3% for Fitbit Flex (ICC = 0.25), and 8.4% for Jawbone UP (ICC = 0.50). Cane-user steps were underestimated by 1.8% for StepWatch (ICC = 0.98) and walker-user steps were underestimated by 1.3% for StepWatch (ICC = 0.99). Cane- and walker-users steps were underestimated by all other monitors by > 11.5% (ICCs < 0.05). Conclusion: StepWatch, Omron HJ-112, Fitbit One, and Jawbone UP appeared accurate at measuring steps in older adults with non-impaired and impaired ambulation during a self-paced walking test. StepWatch was the only monitor that appeared accurate at measuring steps in cane users. Consideration of the older adult’s ambulatory pattern and/or limitation is needed to ensure accurate step detection. Placement of a device at the wrist, hip, or ankle should be investigated based on the older adult’s walking pattern and use of assistive equipment. Randomized Pilot Trial of Sedentary Behavior Modification in Breast Cancer Survivors Cadmus-Bertram, Lisa1; Tevaarwerk, Amye1; Sesto, Mary1; Thraen-Borowski, Keith1; Koltyn, Kelli1; Trentham-Dietz, Amy1; Kerr, Jacqueline2 of Wisconsin – Madison, Madison, WI, USA; [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] 2University of California, San Diego, La Jolla, CA, USA; [email protected]

1University

Introduction: Sedentary behavior, which is physiologically and behaviorally distinct from physical activity, is an emerging area of research of growing interest to the cancer community. Research on the adverse effects of excessive sitting is advancing quickly, with recent data showing that objectivelymeasured sedentary time is associated with increased risk of incident breast cancer. Research is needed to determine whether reducing sitting time could lower breast cancer risk and/or improve survival. No studies have tested strategies for reducing sitting time among breast cancer survivors or the use of wearables to assist with this behavior change. Methods: This three-arm randomized pilot trial will assign 60 breast cancer survivors to: (1) an intervention that uses the Garmin vivofit2 (with idle alert bar), printed materials, and coaching calls to promote standing breaks every 30 minutes; (2) an intervention that uses a standing desk unit, printed materials, and coaching calls to promote an overall 2-hr/day reduction in sedentary time; or (3) a comparison group. Duration and patterning of sedentary behavior is measured by the activPAL inclinometer at baseline, four weeks, and eight weeks; physical activity is assessed by the ActiGraph at baseline and eight weeks. Results: Recruitment is currently underway. As of March 2016, 29 patients have been referred to the study by their oncologist. Of those, eight have been randomized, 10 were ineligible/uninterested, and 11 are in the screening/enrollment phase. The Garmin vivofit2 has been well received by participants in the standing breaks group and all those randomized to this arm thus far have used the device throughout the eight weeks. Conclusions: Wearable sensors may play an important role in healthy cancer survivorship through their ability to assist with activity self-monitoring and prompt individuals to limit their sedentary time. Our results thus far indicate that breast cancer survivors are amenable to the use of wearables to modify sitting time. However, sedentary behavior interventions would be strengthened by the development of wearable trackers with (a) the ability to distinguish sitting vs. standing and (b) customizable features regarding the amount of allowable sedentary time and the number of steps required to register as a standing break. References: Boyle, T., Vallance, J.K., Ransom, E.K., & Lynch, B.M. (2016). How sedentary and physically active are breast cancer survivors, and which population subgroups have higher or lower levels of these behaviors? Supportive Care in Cancer, 24(5), 2181–2190. Lyden, K., Kozey Keadle, S.L., Staudenmayer, J.W., & Freedson, P.S. (2012). Validity of two wearable monitors to estimate breaks from sedentary time. Medicine and Science in Sports and Exercise, 44(11), 2243–2252. Phillips, S.M., Dodd, K.W., Steeves, J., McClain, J., Alfano, C.M., & McAuley, E. (2015). Physical activity and sedentary behavior in breast cancer survivors: New insight into activity patterns and potential intervention targets. Gynecologic Oncology, 138(2), 398–404. Leveraging Citizen Science and Wearable Technologies for Population Physical Activity Promotion King, Abby C, PhD1; Winter, Sandra J, PhD1; Sheats, Jylana L, PhD1; Rosas, Lisa G, PhD1,2; Buman, Matthew P, PhD3; Salvo, Deborah, PhD4; Rodriguez, Nicole M, MS1; Seguin, Rebecca A, PhD5; Moran, Mika, PhD6; Garber, Randi, MPA7; Broderick, Bonnie, MPH, RD8; Zieff, Susan G, PhD9; Sarmiento, Olga Lucia, MD, PhD10; Gonzalez, Silvia A, ND, MSP10; Banchoff, Ann, MSW, MPH1; Rivera Dommarco, Juan, PhD11 University School of Medicine; [email protected], [email protected], [email protected], [email protected] Alto Medical Foundation Research Institute 3Arizona State University; [email protected] 4The University of Texas Health Science Center at Houston; [email protected] 5Cornell University; [email protected] 6University of Haifa; [email protected] 7Eshel–The Association for the Planning and Development of Services for the Aged in Israel; [email protected] 8Santa Clara County Public Health Department; [email protected] 9San Francisco State University; [email protected]

1Stanford 2Palo

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of Medicine Universidad de los Andes; [email protected], [email protected] Nacional de Salud Pública; [email protected]

11Instituto

Introduction: While technology is a major “driver” of many of society’s comforts, conveniences, and advances, it has been responsible, in a significant way, for engineering regular physical activity and a number of other positive health behaviors out of peoples’ daily lives. A key question concerns how to harness wearable technologies (e.g., smartphones) to bring about positive changes in the health promotion field. One potential solution is “communityengaged citizen science” that brings together researchers, public and private organizations, and citizens in harnessing wearable technologies to solve the physical activity promotion challenge. Method: The history of citizen science in the research arena will be described and an evidence-based method that embeds resident-centered citizen science in a multi-level community-based participatory research approach to physical activity promotion will be presented. Results: Several examples of this citizen science-driven community engagement approach for promoting active lifestyles are discussed, including examples from diverse communities around the globe. Future applications of wearable technologies to engage residents in the scientific process will be discussed. Conclusions: The opportunities and challenges involved in leveraging citizen science activities as part of a broader population approach to promoting regular physical activity will be explored. The strategic use of citizen scientists from diverse backgrounds, as both assessment as well as change agents, provides a promising, potentially low-cost strategy for creating more active, healthful, and equitable neighborhoods and communities worldwide.

Oral Presentations Clinical Screening Tools for Obesity in an Aging Population Morgan, Amy L; Ludy, Mary-Jon; Landry-Meyer, Laura; Kelley, Edward Bowling Green State University, Bowling Green, Ohio, USA; [email protected], [email protected], [email protected], [email protected] Introduction: It is well accepted that body fat increases and muscle mass decreases as part of the normal ageing process. Since increased adiposity is of concern for health-related diseases (e.g., diabetes, coronary artery disease), appropriate screening tools are critically important. Depending on the organization, a variety of assessments are recommended for risk identification. Therefore, we compared common proxies of adiposity to determine which is the most accurate for screening purposes. Methods: Sixty men (n = 22) and women (n = 38) over age 50 (59.9 ± 7.9 years) volunteered. Participants underwent three screening measures currently utilized as indicators of weight status and thus, health risk. These were body mass index (BMI: weight [kg]/height [m]2) (WHO), waist circumference at the natural waist (WC-N) (ACSM), and waist circumference at the umbilicus (WC-U) (National Heart, Lung, and Blood Institute). Body composition analysis (%fat) via air displacement plethysmography (BodPod) served as the criterion method. In addition, correlation coefficients were calculated between indicators. Results: For all participants, 43 (71.7%) were accurately categorized utilizing both BMI and WC-N, while 33 (55.0%) were accurately categorized with WC-U. For women, 31 (81.6%) were accurately categorized using BMI and WC-N, while 19 (50.0%) were accurately categorized through WC-U. For men, 12 (54.5%) were accurately categorized using BMI and WC-N, while 14 (63.6%) were accurately categorized via WC-U. There were significant correlations between all measures. Conclusion: There are well-publicized concerns over the use of BMI as an indicator of weight status, particularly with the physiological changes associated with ageing. However, results from this sample suggest that both BMI and WC-N accurately categorize the majority of participants. When divided by sex, our results suggest that BMI and WC-N are the best screening measures for women, while WC-U is the best choice for men. The measure of WC-U captures more abdominal fat than WC-N. Since men tend to carry more fat in the abdominal region, this may provide an explanation for why WC-U is a better indicator of adiposity in males. In conclusion, either BMI, as recommended by the WHO, or WC-N, as recommended by ACSM, provide the best screening tools for adiposity in adults aged 50 and older. References: Chung, J.Y., Kang, H.T., Lee, D.C., Lee, H.R., & Lee, Y.J. (2013). Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. 56(1), 270–278. National Heart, Lung, and Blood Institute. (2000). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Washington, DC: US Department of Health and Human Services Public Health Service, National Institutes of Health. Pescatello, L.S., Arena, R., Riebe, D., & Thompson, P.D. (Eds.). (2014). ACSM’s Guidelines for Exercise Testing and Prescription (9th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams and Wilkins Health. A Novel Approach to Design Wearable Support Systems for the Aging Workforce Argubi-Wollesen, Andreas; Berger, Christine; Karafillidis, Athanasios; Weidner, Robert Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany; [email protected], [email protected], karafillidis@ hsu-hh.de, [email protected] Introduction: Employees in industrial production are at high risk of musculoskeletal disorders (MSD) due to high work load (Neupane et al., 2015). Additionally, demographic change will lead to an aging workforce. Demanding physical labor will increase the incidence of MSDs for older employees. To prevent the aging workforce from MSDs, wearable support systems to reduce musculoskeletal strain or to ensure ergonomic movements might be one solution. General wearable support systems to prevent MSDs are not available yet. Furthermore, a taxonomy of support systems and their different structural characteristics is missing (Weidner & Karafillidis, 2015). Therefore, there is no clear path as to how these systems should be developed and which aspects have to be considered in the design process. This study presents first results of an interdisciplinary novel approach to design such systems. Methods: A qualitative evaluation of acceptance for two different prototypes of technical systems built by the team’s engineers to support tasks in and above head level was combined with an evaluation of its effects on kinematics (N = 24; males) via 3D motion analysis (ViconTM) and muscular activity of the upper body (8 channel surface-EMG) to gain valuable insights with respect to some crucial constraints of designing a support system. Additionally, we devised a classification procedure for developing support systems regarding technical and acceptance issues. Statistical analysis (one-way ANOVA) was done with SPSS 21. Results: The ANOVA showed a significant reduction in muscular activation for M. deltoideus (F[1,23] = 20.7; p = .001; η2 = .474) and M. triceps (F[1,23] = 5.8; p = .006; η2 = .202) for one prototype, which was attributed to the specific force redirection as initiated by the technical support system. Kinematic analysis however showed constraints in shoulder mobility for elevation (F[1,23] = 5.9; p = .005; η2 = .204). Conclusion: The results confirmed the hypothesis that the use of wearable technical support systems shows great potential in reducing musculoskeletal strain. These JAPA Vol. 24, Suppl., 2016

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results are promising, especially for the aging workforce. However, the design and functionality of the systems demands the consideration of the type of support, the acceptance of its diverse target groups, (different users but also work groups or organizations), and its effects on additional biomechanical parameters. References: Neupane, S., Leino-Arjas, P., Nygård, C. H., Miranda, H., Siukola, A., & Virtanen, P. (2015). Does the association between musculoskeletal pain and sickness absence due to musculoskeletal diagnoses depend on biomechanical working conditions? International Archives of Occupational and Environmental Health, 88(3), 273–279. Weidner, R. & Karafillidis, A. (2015). Three General Determinants of Support-Systems. Applied Mechanics and Materials, 794, 555–562. Health Coaching to Enhance Physical Activity and Prevent Falls in Community-Dwelling People Aged 60 Years and Over: Study Protocol for the CHAnGE Cluster Randomised Controlled Trial Tiedemann, Anne1; Rissel, Chris2; Howard, Kirsten2; Tong, Allison2; Merom, Dafna3; Smith, Stuart4; Wickham, James5; Bauman, Adrian2; Lindley, Richard1; Lord, Stephen6; Vogler, Constance7,8; Lester, David1; Sherrington, Catherine1 George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected], [email protected], [email protected], [email protected] 2School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected], kirsten.howard@sydney. edu.au, [email protected], [email protected] 3School of Science and Health, Western Sydney University, Sydney, Australia; [email protected] 4Faculty of Arts and Business, University of Sunshine Coast, Sippy Downs, Australia; [email protected] 5School of Biomedical Sciences, Charles Sturt University, Orange, Australia; [email protected] 6Neuroscience Research Australia, University of New South Wales, Sydney, Australia; [email protected] 7Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected] 8Department of Aged Care, Royal North Shore Hospital, Sydney, Australia 1The

Introduction: Physical inactivity and falls in older age are major public health issues that can substantially impact health and independence. Physical activity has many health benefits, however, promoting physical activity among older people without specific fall prevention advice may actually increase fall rates (Ebrahim et al., 1997; Lawton et al., 2008). The Coaching for Healthy AGEing (CHAnGE) trial primarily aims to establish the impact of a combined physical activity and fall prevention program compared to a healthy eating program on physical activity and falls among people aged 60+ years. Methods: A cluster randomised controlled trial involving 60 groups of community-dwelling people aged 60+ years will be conducted. Participating groups will be randomised to: (a) a physical activity and fall prevention intervention (30 groups), involving an in-person fall risk assessment, tailored fall prevention and physical activity advice, provision of an activity tracker, telephone-based health coaching and written information; or (b) a healthy eating intervention (30 groups) involving telephone-based health coaching and written information. Primary outcomes will be objectively measured physical activity (Actigraph) at 12 months post randomisation and prospectively measured falls over 12 months (monthly calendars). Secondary outcomes will include: the number of fallers, the proportion of people meeting physical activity guidelines, body mass index, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk taking behaviour, mood, wellbeing, self-reported physical activity, disability, eating habits, and health system and community service utilisation. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously-scored primary and secondary outcome measures, Gaussian GEE regression adjusted with their corresponding baseline scores will assess the effect of group allocation. Exchangeable correlation structures will account for correlation between individuals within the clusters. Analyses will be pre-planned, conducted while masked to group allocation and will use an intention-to-treat approach. Conclusion: This trial will address a key gap in evidence regarding physical activity and fall prevention for older people and will evaluate two healthy ageing programs that could be directly implemented within Australian health services. Trial registration: ACTRN 12615001190594. References: Ebrahim, S., Thompson, P.W., Baskaran, V., Evans, K. (1997). Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age and Ageing, 26:253–260. Lawton, B.A., Rose, S.B., Elley, C.R., Dowell, A.C., Fenton, A., Moyes, S.A. (2008). Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial. British Medical Journal, 337:a2509. Promoting Active Ageing in an African Context: Lessons from Lesotho Tsuinyane, Retselisitsoe1; Cuesta-Briand, Beatriz2 1Ministry

of Social Development, Maseru, Lesotho; [email protected] of Western Australia, Perth, Australia; [email protected]

2University

Introduction: Lesotho is a land-locked country situated in Southern Africa, with a population of less than two million. Approximately 8% of the population are aged 60 years and over. Traditionally, the family was the most important source of support for older people; however, family structures and living patterns are changing due to factors including rural-urban migration, poverty, changes in social values, and the devastating effects of the HIV/ AIDS epidemic. The elderly in Lesotho are a vulnerable group at risk of financial, sexual, and physical abuse, and they often face barriers that prevent them from accessing health and social services. Methods: Since 2014, the Ministry of Social Development of Lesotho, through its Department of Elderly Services, has implemented a strategy designed to raise awareness on ageing issues across all sectors. This strategy has included the delivery of capacitybuilding workshops aimed at community groups of older people, and the development and implementation of a train-the-trainer manual on ageing issues for social workers. The manual addresses the health, economic, and social challenges faced by older people in Lesotho, and includes a module on the benefits of physical activity and an overview of the Otago Exercise Programme (Campbell & Roberston, 2003). Results: To date, a total of 108 older people have attended the community workshops, and 27 social workers have received training on ageing issues, including a demonstration of the Otago Programme. In addition, all residents and six staff at the two nursing homes in Lesotho have trialed the Programme. Initial feedback has been positive, and participants have highlighted that the exercises are easy, age-appropriate, and suit a range of mobility levels. More recently, the Department of Elderly Services has adapted the Programme and included it in the community workshops, incorporating components such as traditional dancing and JAPA Vol. 24, Suppl., 2016

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vegetable growing. Conclusion: Our work in Lesotho shows that the Otago Programme can be successfully implemented in environments with limited resources and adapted to suit local cultural contexts. Our experience also highlights that the Programme can be delivered as part of broader community workshops aimed at promoting health and wellbeing, and financial independence among older people. References: Campbell, A.J., & Robertson, M.C. (2003). Otago Exercise Programme to Prevent Falls in Older Adults. Otago, New Zealand: University of Otago. An Australian Unique Way of Addressing the Research—Selling Health and Wellness to the Over 60s with Active Life Weekends Lord, Brian Healthy Lifestyle Health Promotion Services; [email protected] Introduction: Active Life Weekends have been held in many areas of Australia for over 25 years by various Departments of Health and Sport and Recreation, with the main aim being to help senior members of the community to engage in meaningful recreation and sporting activities. Active Life Weekends target people over the age of 60 and provide opportunities for participants to involve themselves in a wide range of activities. An important outcome of the weekends is that they take people away from their normal home surroundings and provide an ideal learning environment. Methods: In NSW, Australia, there are 11 Sport and Recreation Centres that can provide comfortable accommodation for these programs. The program, through surveys, identified client needs, so it is well balanced with opportunities for individuals to participate at different levels of skill, depending on their wellbeing. The activities offered are many and varied including: water exercise, archery, kayaking, pole walking, lifeball, Tai Chi, painting, memory training, massage, flying fox, and Indigenous games. By attending the weekend, participants encourage new and existing relationships, nurture feelings of self-worth, encourage self responsibility, and promote a positive attitude towards ageing. Participants are also encouraged to consider being a Volunteer instructor in gentle exercise, lifeball, aquafitness, Tai Chi, or relaxation. Results: The concept of healthy residential programs has been evaluated extensively, with the outcomes showing that a large percentage of the participants who attend these holidays gained immediate and long-term benefits, including improved confidence, more positive attitudes to their ageing process, and greater motivation to stay well and to be more active. Conclusion: The Southern Rural Region of Sport and Recreation, Riverina, NSW, Australia is proud to be involved in this worthy project and is keeping the costs of these weekends to a low level to support those people on reduced incomes. Use and Perceptions of Activity Monitors and Health Coaching in Community-Dwelling Seniors Kirkham, Catherine; Sherrington, Cathie; Souza, Juliana; Ramsay, Betty; Chamberlain, Kathryn; Tiedemann, Anne The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected], [email protected], [email protected], [email protected], [email protected], atiedemann @georgeinstitute.org.au Introduction: Physical inactivity is a major health issue for seniors internationally. New activity monitoring technologies and health coaching may assist seniors to become more active. This study aimed to evaluate uptake and perceptions of an intervention aimed at increasing physical activity participation and reducing fall risk with health coaching and Fitbit activity monitors in community-dwelling seniors. Methods: Forty-two people aged over 60 years completed a questionnaire reporting their use and perceptions of activity monitors and health coaching as part of an ongoing pilot randomised controlled trial evaluating a physical activity promotion and falls prevention intervention. This study is a sub-analysis of intervention group data. Intervention group participants received a Fitbit activity monitor and fortnightly telephone-based health coaching from a physiotherapist for a period of six months. Results: Of 42 people who completed the questionnaire, 34 (81%) reported that the program was of use to them, and seven (16%) were unsure. One participant stated it was not useful. The Fitbit was worn every day by 29 participants (69%) and on most days by 13 participants (31%). When asked how useful the Fitbit was in motivating them to be active, 27 people (64%) found it to be very useful, 11 (26%) found it somewhat useful, and four (10%) found it only slightly useful or not useful at all. Forty-one participants (98%) reported that they would wear a Fitbit for the following six months. Twenty-eight participants (66%) found the health coaching to be very useful, nine (21%) found it somewhat useful, and five (12%) reported it to be slightly useful. Conclusion: The use of a Fitbit activity monitor and ongoing health coaching was perceived to be useful to most participants. Health and Wellbeing Impacts of Social Inclusion and Exclusion Waldegrave, Charles Family Centre Social Policy Research Unit Introduction: There is a growing body of research that links loneliness and isolation to reduced wellbeing, greater ill-health, and shorter life spans (Holt-Lunstad et. al., 2015). This presentation will provide results from the New Zealand Longitudinal Study of Ageing (NZLSA) that explore the relationships between loneliness, depression, and social support, respectively, and together, with quality of life and wellbeing. Methods: Amartya Sen’s capabilities approach has formed the conceptual basis of the theoretical framework of this research programme (Sen, 1999). An extensive survey of a national random sample of 3,317 older New Zealand citizens aged between 50 to 84 years was carried out in the second half of 2010. The survey questionnaire included scales on loneliness (De Jong Gierveld Loneliness Scale), depression (CES-D-10), and social support (Social Provisions Scale). These variables were tested for statistical associations with wellbeing and quality of life measures, including CASP 12 and WHOQoL 8. Results: The findings demonstrated highly significant relationships between each domain scale and wellbeing. Higher loneliness and depression scores were strongly associated with lower wellbeing scores, whereas higher social support scores were strongly associated with higher levels of wellbeing. We estimated a linear regression of wellbeing and the results showed a highly significant relationship for the whole model. Conclusion: The results demonstrate the important associations these three domains have with wellbeing. Serious problems arise if older people become socially isolated. The results point to the need for practical planning, policy, and service responses to be designed to encourage participation and social inclusion. References: Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2):227–237. Sen, A. (1999). Development as Freedom. Oxford: Oxford University Press. JAPA Vol. 24, Suppl., 2016

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Ageing, Health, and Retirement Choices in a Diverse Workforce: A Case Study of a Large Private Sector Retail Organisation Edge, Clare; Coffey, Margaret; Cook, Penny A University of Salford, Greater Manchester, United Kingdom; [email protected] Introduction: State pension age is due to rise to 68 years in the UK for both men and women by 2046, and the statutory retirement age has been removed. Organisations need to better adapt to the needs of their older employees. Overall, research suggests that a growing number of people want to remain employed past traditional retirement age if the correct conditions are in place, such as flexible working arrangements or measures to improve employees’ enjoyment of their work. Health is a key predictor of retirement, and good health acts as an enabler to extending working life. Methods: The aim of this research is to explore the factors that enable or inhibit people to work for longer, post traditional retirement age, in a large UK-based private sector retail organisation (n = 76,648). The study is based on a multivariate secondary analysis of existing human resource longitudinal data taken over a three-year period (2011–2013), with a focus on workers aged ≥ 50 (n = 19,316). Results: 76% of workers aged ≥ 50 in the study population (n = 14,596) are female. Specific needs associated with the female over-50 workforce are reflected in the rates of mental ill-health, whereby the largest increases in reported sickness absence from 2011 to 2013 were seen in the over 50 female group, with the median time taken per mental health sickness incident being 17.5 days. Although men had fewer instances of time off for mental health issues, their median recovery time was longer (39.0 days). The over 50s represent 25% of employees, but account for 38% of all long-term sickness. Preliminary findings suggest that female employees, those with higher incidences of sickness absence days in 2011, those with higher pay, and those in part-time roles had a higher probability of retirement during two years follow-up. Conclusion: Workers over 50 show gender-specific workplace health needs, and health has been found to be a key predictor of retirement. Ongoing qualitative analyses will aim to increase our understanding of these findings. References: Department for Work and Pensions. (2014). The Pensions Act 2014. Retrieved from: http://www.legislation.gov.uk/ukpga/2014/19/contents. Ilmarinen, J. (2012). Promoting Active Ageing in the Workplace. European Agency for Health and Safety at Work. Retrieved from: https://osha.europa.eu/en/tools-and-publications/publications/articles/ promoting-active-ageing-in-the-workplace. McNair, S., Flynn, M., Owen, L., Humphreys, C. and Woodfield, S. (2004). Changing Work in Later Life: A Study of Job Transitions, University of Surrey: Centre for Research into the Older Workforce. Outrageous Ageing: An Exercise Intervention for LGBTI Elders Kendrick, Damon; Ardzejewska, Kathie Australian College of Physical Education (ACPE), Sydney Australia; [email protected], [email protected] Introduction: The general population of Australia is aging. Consequently, the numbers of elderly persons who identify as lesbian, gay, bisexual, transgendered, and intersex (LGBTI) is rising. Therefore, an improved understanding of the relationship between general long-term care of the elderly and their sexual orientation is vital. Many aged care providers, particularly those owned by religious organisations, are perceived to be homophobic, and LGBTI elders may therefore be reluctant to enter residential aged care facilities. Additionally, elder LGBTI individuals experience higher levels of chronic ill health, including physical disabilities and psychological conditions than their heterosexual counterparts. The physical benefits of regular exercise in the elderly is well documented. Improvements include blood pressure control, reduction of the prevalence of diabetes, improved blood lipid profile, reduction in the severity of osteoarthritis and osteoporosis, and improvements in neurocognitive function. However, due to their personal histories and experience of homophobia, elderly LGBTI have a high attrition rate from organised exercise programs. Can a program of personal training improve health outcomes and consequently aid in maintaining independent living in LGBTI elders? Methods: Final semester Bachelor of Applied Fitness students at ACPE participated in a research project in 2014 and 2015 called the “Outrageous Ageing Project”. In this project, students delivered an eight-week personal training program to elderly volunteers who identified as LGBTI. Pre and post exercise testing was done and students were required to track standardized fitness and health outcomes on the Microfit system and to present the results of one quantitative and one qualitative parameter. Results: Eighteen people who identified as LGBTI and were over the age of 60 were recruited. Additionally, three more people under the age of 60, but who experienced physical deficiencies usually associated with ageing, such as osteoarthrosis, were also recruited. Twelve individuals completed the eightweek training programme. An 18% reduction in systolic blood pressure and a 15% reduction in diastolic blood pressure was seen. An average of 3.4 kg weight loss was also seen. Qualitative measures included an improved perceived wellness, diminished feeling of sadness and depression, and increased independence via less reliance of walking aids. Conclusion: Targeted exercise interventions for LGBTI elders may be an effective tool in improving health outcomes, helping to maintain independent living and conceivably delay entry into aged care facilities. References: Bynum, B. (2002). Discarded diagnoses: homosexuality. The Lancet, 359. Fredriksen-Goldsen, Ki. I., Kim, H. J, Barkan, S. E., Muraco, A. and Hoy-Ellis, C. P. (2012). Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. American Journal of Public Health, 103(10). Fokkema, T. and Kuyper, L. (2009) The relationship between social embeddedness and loneliness in older lesbian gay and bisexual adults in the Netherlands. Archives of Sexual Behaviour, 3:264–275. Richmond, R.L. (2008). The changing face of the Australian population: The growth of centenarians. Medical Journal of Australia, 188(12). van Wagenen, A., Driscoll, J. & Bradford, J. (2013) “I’m still raring to go”: Successful aging among lesbian, gay, bisexual, and transgender older adults. Journal of Aging Studies, 27:1–14. Wallace, S.P., Cochran, S.D., Durazo, E.M., & Ford, C.L. (2011) The Health of Aging Lesbian, Gay and Bisexual Adults in California. Los Angeles, CA. Policy Brief UCLA Center for Health Policy Res. Short-Term Restorative Pilot Program—Warnervale Buckley, Cathie; Davies, Daniel; Hinton, Jenny Auckland University, Auckland, New Zealand; [email protected], [email protected], [email protected] Hunter Medical Research Institute, Newcastle, Australia Introduction: The aim of this study was to determine the effectiveness of using the Towards Achieving Realistic Goals in Elders Tool (TARGET) in a health coaching model to achieve consumer-directed restorative goals. Outcomes were assessed using a battery of objective measurements for physical function using standard physiotherapy assessments, activities of daily living assessments (ADLs), and quality of life (QOL) assessments. Challenges applying ‘goals as outcomes’ in applied research and the interdisciplinary health coaching model for allied health and certificate III community workers JAPA Vol. 24, Suppl., 2016

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is also discussed. Methods: Ten participants, eight of who were ACAT assessed as suitable for a higher level package (L3/4) took part in this eight-week restorative care PILOT. Primary outcome measures included quality of life, activities of daily living, and standardised exercise measures. Applied research methods included a retrospective pre-/post intervention design for review of client-directed goals. Results: Results demonstrate that in this sample of older people receiving predominantly level 2 (two level 4) homecare services, the use of TARGET by health coaches with participants led to improved goal identification and increased the scope of goal attainment. There was greater change in physical function measured by physiotherapy assessments, including TUG, FTST, and four stage balance test. Improvements in ADLs and QOL were measured by the Nottingham EADL and EuroQOL. Conclusion: The current study highlighted the importance of placing older people central to the goal setting process as they often articulated and set goals as desired outcomes. Significant improvements in physical function and ADLs were observed after the eight-week period of restorative home care services. References: Parsons, J.H.M., Sheridan, N., Rouse, P., Robinson, E., and Connolly, M. (2013). A Randomised controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people. Archives of Physical Medicine and Rehabilitation, 94(6):1015–1022. Parsons, J.G.M. & Parsons, M.J.G. (2012). The effect of a designated tool on person-centered goal identification and service planning among older people receiving homecare in New Zealand. Health and Social Care in the Community, 20(6):653–662. Validity of Activity Monitors for Measuring Steps in an Inpatient Rehabilitation Population Treacy, Daniel1,2; Hassett, Leanne1,3; Schurr, Karl2; Chagpar, Sakina1; Sherrington, Catherine1 George Institute for Global Health, The University of Sydney, Sydney, Australia; [email protected] Hospital, SWSLHD, Sydney, Australia 3The Faculty of Health Sciences, The University of Sydney, Sydney, Australia 1The

2Bankstown-Lidcombe

Introduction: While studies have shown activity monitors to be accurate in measuring step counts within healthy populations, several studies have identified the need for further validation studies to be performed in slower walking populations such as expected within an inpatient rehabilitation setting. Our research questions were: (1) What is the criterion validity of various activity monitors in measuring step counts in an in-patient rehabilitation population? (2) What gait parameters influence the accuracy of these activity monitors? Methods: 166 rehabilitation inpatients, with an average (SD, range) age of 80 (11, 26–98) were recruited from the Bankstown General Rehabilitation Unit and Stroke Unit, Australia. Each participant wore 16 activity monitors (six different models) simultaneously while completing a six-minute walk test (6MWT). Garmin vivofit and the Fitbit Charge were worn on both wrists; standard piezoelectric pedometers (G-Sensor Accelerometer) were worn on each hip; Fitbit Ones were worn on both hips and also on both ankles; ActiGraph GT3X+ accelerometers were worn on both hips; ActivPALs were worn on both thighs; StepWatch Activity Monitors were worn on both ankles. A manual step count of the number of steps taken was recorded during the 6MWT. Gait parameters were assessed using the GAITRite portable gait analysis system. Results: The StepWatch (ICC2,1 = 0.98, 95% CI 0.98–0.99), Fitbit One on the ankle (ICC2,1 = 0.92, 95% CI 0.77–0.96), and the ActivPAL (ICC2,1 = 0.78, 95% CI 0.23–0.91) all showed excellent agreement with the manual step count. All other devices showed poor agreement with the manual step count. Percentage agreement was closest for StepWatch steps compared to the manual count (mean 98%, SD 12%). All devices were less accurate at slower gait speeds and shorter strides, but the StepWatch and the Fitbit One used on the ankle maintained the best accuracy overall. Conclusion: The StepWatch showed the highest accuracy and closest agreement with the manual count of all the devices assessed in this study. The Fitbit One used on the ankle showed high agreement with the manual count and provides immediate feedback to the patient. A Qualitative Evaluation of a Pilot Green Exercise Volunteering Program for Older Adults Living in a Socio-Economically Disadvantaged Area of Glasgow, Scotland Archibald, Daryll1; Jepson, Ruth1; Rennie, Alison1; Graham, David2 1Scottish Collaboration for Public Health Research & Policy (SCPHRP), University of Edinburgh, Scotland; [email protected], Ruth.Jepson@

ed.ac.uk, [email protected] Conservation Volunteers (TCV) Scotland; [email protected]

2The

Introduction: The health and well-being benefits of volunteering in later life are well documented. Decreased mortality risk, improved mental well-being, and increased cognitive functioning are all benefits attributed to volunteering post-retirement. However, some studies have found that relatively affluent and healthy older individuals are more likely to volunteer than older individuals from disadvantaged socio-economic backgrounds (Van Bonsdorff & Rantanen, 2011; Cattan et al., 2011). Consequently, developing ways to encourage older adults from such backgrounds to take part in volunteering is an important issue (Mike et al., 2014). This paper reports on the experiences of older adults from a disadvantaged area in Glasgow, Scotland, who joined a pilot green exercise volunteering program. The program allowed participants to ‘work out’ in the open air through local, practical gardening and environmental work. Methods: Semi-structured interviews were conducted with 10 participants to understand (1) what attracted them to the program, (2) their satisfaction with the program, (3) suggestions for improvements to the program, and (4) perceptions of how the programme impacted their health and well-being. Semi-structured interviews were also carried out with two program leaders who delivered the initiative. A thematic analysis was undertaken applying the constant comparison method. Results: Participants were motivated to engage with the program because of key features such as working outdoors, learning to grow food, and a desire to combat isolation and loneliness. Program adherence was facilitated by social support and humor amongst participants and the fact that tasks were matched to the physical ability of participants. Key concerns included a desire for advice and training regarding the long-term sustainability of the program. Increased feelings of confidence and competence were reported as a result of attending the program whilst increased physical strength and a reduction in feelings of isolation were also reported by the majority of participants. Conclusion: This pilot green exercise volunteering program represents an effective means to engage a hard-to-reach older population located within an area experiencing multiple disadvantages. Social and environmental benefits for both participants and the wider community were observed and funding is now being sought to increase the scope of the program. References: Cattan, M., Hogg, E., & Hardill, I (2011). Improving quality of life in ageing populations: What can volunteering do? Maturitas, 70, 328–332. Mike, A., Jackson, J.J., & Oltmanns, T.F. (2014) The conscientious retiree: The relationship between conscientiousness, retirement, and volunteering. Journal of Research in Personality, 52, 68–77. Von Bonsdorff, M.B., & Rantanen, T. (2010). Benefits of formal voluntary work among older people – a review. Aging Clin Exp Res. JAPA Vol. 24, Suppl., 2016

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An Accelerometer Cut-Point for Moderate–Vigorous Intensity Physical Activity in Chinese Older Adults Barnett, David1,2; Barnett, Anthony1,2; Ridgers, Nicola1; Timperio, Anna1; Cerin, Ester1,2,3 University, Melbourne, Australia; [email protected], [email protected], [email protected] Catholic University, Melbourne, Australia; [email protected] 3The University of Hong Kong, Hong Kong, China; [email protected]

1Deakin

2Australian

Introduction: Reliable and valid methods for assessing free-living activity are needed to accurately estimate dose–response relationships between physical activity (PA) and health outcomes and for identifying determinants of this behaviour. Accelerometry is one of the most reliable and valid methods for assessing levels of free-living PA. Previous research among older adults has commonly defined moderate–vigorous intensity PA (MVPA), corresponding to ≥ 3 metabolic equivalents (METs), as any activity yielding ≥ 1,952 accelerometer counts·min–1. This cut-point was derived from data collected on young Caucasian adults with higher resting metabolic rates (RMR) than older adults and Asian-Chinese populations (Freedson, Melanson, & Sirard, 1998; Hall et al., 2013). The use of this cut-point with Chinese older adults is likely to yield biased estimates of PA. In addition, some studies suggest walking 4.0 km·hr–1 (corresponding to moderate-intensity PA) to confer health benefits, which may be inappropriate for this population (Ainsworth et al., 2011). The aims of this study were to establish an accelerometer count cut-point and walking speed for quantifying engagement in MVPA in AsianChinese older adults. Methods: Forty-three Chinese older adults (20 males, 23 females; mean age = 68.7 ± 6.6 years) living in Melbourne who were able to walk unassisted were recruited. Participants were asked to wear an accelerometer (counts·min–1; ActiGraph), a global positioning system (speed [km·h–1]; QStarz), and a portable indirect calorimeter (energy expenditure [RMR-adjusted METs]; Cortex Metamax 3b) for data collection. Participants were fasted throughout protocol requirements: RMR assessment was where participants laid quietly for 20 min, and PA cut-point development was where participants followed an incremental walking speed protocol. To determine MVPA cut-point and walking speed, multilevel linear regression models were used. Results: In this sample, MVPA (i.e., ≥ 3 METs) corresponded to ≥ 801 accelerometer counts·min–1 and ≥ 2.5 km·h–1 ground walking speed. Conclusion: These findings suggest that accelerometer cut-points and/or walking speed recommendations commonly used in studies on older adults are not appropriate for the assessment of Chinese older adults’ MVPA. References: Ainsworth, B.E., Haskell, W.L., Herrmann, S.D., Meckes, N., Bassett Jr, D.R., Tudor-Locke, C., . . . Leon, A.S. (2011). 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc,43:1575–1581. Freedson, P.S., Melanson, E., & Sirard, J. (1998). Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc,30:777–781. Hall, K.S., Howe, C.A., Rana, S.R., Martin, C.L., & Morey, M. C. (2013). METs and accelerometry of walking in older adults: standard versus measured energy cost. Med Sci Sports Exerc, 45:574–582. Good Health Transitions Project—A Contemporary Model of Service Delivery to Reduce the Impact of Frailty Barnard, Elizabeth; Wood, Carolyn ACH Group, Adelaide, Australia; [email protected], [email protected] Over a two-year period, ACH Group aims to develop, trial, and evaluate a new service delivery model structure, aimed at providing reablement to older adults living in Metropolitan Adelaide. The project, titled Good Health Transitions Project (GHTP), has received grant funding to support this process through the Department of Health and healthy ageing and aged care service improvement funding. GHTP identifies older people who are at risk of or are already experiencing frailty symptoms. The GHTP aims to target older people at critical transition points in their level of services required and reduce risk of further decline. Through thorough assessment by skilled allied health professionals utilising a coaching model unique to the GHTP, individualised goal-setting and subsequent intervention can be provided. Interventions are tailored to build capacity and improve resilience, reverse the frailty trajectory and reduce the need for higher level needs of care. In keeping with current contemporary healthcare trends, the GHTP has a key focus regarding the use of technology to assist in individualised interventions, thereby enhancing the coaching experience. The use of technology as a service delivery tool to enhance other behaviour change strategies is combined with the capacity building of staff critical thinking and clinical skills to ensure participants are best equipped for desired uptake of agreed goals and actions. Further directions for the GHTP team have been drawn from the initial phase of the project and include a focus on the use of technology to enhance customer facing service delivery and assistance of behaviour change for identified frailty symptoms. Key partnerships have been established across Metropolitan Adelaide and further dissemination of the project findings at key intervals and flexibility of the project to meet participant needs are underway. These findings will inform and influence the model of service delivery utilised by ACH Group and the wider health community. Active Ageing in the Bush: Older Persons’ Camp Experience Cyarto, Elizabeth1; Bull, Alan2; Smith, Brendan3 Ageing Research Institute, Melbourne, Australia; [email protected] on the Ageing (COTA) Victoria, Melbourne, Australia; [email protected] 3YMCA Victoria, Pendlebury, Australia; [email protected]

1National 2Council

Introduction: Outdoor education is commonly used to support the personal growth of young people. There is little understanding of its role to promote active ageing. Methods: The Council on the Ageing (COTA) Victoria, the YMCA, and the Australian Camps Association conducted a two-day camp in northeastern Victoria, Australia. Participants were recruited from COTA’s volunteer database. Transportation, activities, meals, and dorm-style accommodation were provided to participants at no cost. The program, facilitated by one YMCA leader, comprised activities offered to school/youth groups, including a 2.5-km hike, a high ropes experience, polypong, archery, bush cooking, and evening games. A formative evaluation was conducted on the pilot program. This included pre- and post-camp surveys, field observations, and a focus group on the final night. Focus group questions centered on the ChANGeS framework (Williams, 2009). Originally developed for adolescents, ChANGeS includes five therapeutically-active domains in nature-based health promotion programs: Challenge, Activity, Nature, Guided experience, Social milieu. Results: Twenty-four people (mean age = 66.5 years, range 56–83 years) attended. Most were women (70%). Mandarin was the preferred language for 63% of participants. Only two participants had experienced outdoor education. Engagement was high during the activities. Most participants achieved their goal(s) and felt more physically capable than they JAPA Vol. 24, Suppl., 2016

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thought. The high ropes experience presented the greatest physical challenge. Participants appreciated the novelty of the activities and acknowledged the beautiful natural setting. The facilitation by the camp leader was ‘a big part of a positive experience’. Participants responded positively to the group dynamics, particularly between the Mandarin-speaking and English-speaking groups. Conclusion: The pilot camp program was successful. It is feasible and acceptable to provide an outdoor education program to seniors. Findings challenged the stereotype that camp activities are only for youth. The ChANGeS framework can be used with older people to promote active ageing through positive outdoor experiences. Building on this project, research is underway to help seniors flourish. Using challenging physical and emotional tasks and guided facilitation in a camp setting, participants will discover their abilities in the pursuit of wellbeing goals that will, at first, appear to be beyond their reach. Reference: Williams, I.R. (2009). Depression prevention and promotion of emotional wellbeing in adolescents using a therapeutic outdoor adventure intervention: Development of a best practice model. (Unpublished Doctoral dissertation). University of Melbourne, Melbourne, Victoria, Australia. How to Promote Active Ageing to Older People from Culturally and Linguistically Diverse Backgrounds: The Have A Try (HAT) and Healthy Ageing Quiz (HAQ) Initiative Cyarto, Elizabeth; Vrantsidis, Freda; Batchelor, Frances; Haralambous, Betty; Dow, Briony National Ageing Research Institute, Melbourne, Australia; [email protected], [email protected], [email protected]. edu.au, [email protected], [email protected] Introduction: Over 20% of older Australians were born in a culturally or linguistically diverse (CALD) country. This demographic is ageing faster than Australian-born seniors (Hugo, 2014). By 2026, 25% of people over 80 years will be from a CALD background, yet few resources support their active ageing until now. NARI and the City of Melbourne (CoM) collaborated on a 16-week pilot program for 31 Spanish-speaking older women. A health educator facilitated four group discussions using the Healthy Ageing Quiz topics (HAQ; Cyarto, Dow, Vrantsidis, & Meyer, 2013). A Spanish-speaking instructor taught a weekly Have A Try (HAT) exercise class (Cyarto, Brown, Marshall, & Trost, 2008). After 16 weeks, participants’ upper and lower body strength increased (35% and 26%, respectively). Their balance (34%) and mobility (13%) improved. Participants reported feeling healthier. The HAT-HAQ initiative evaluated this program over 12 months, with other CALD groups in the CoM. Methods: Information sessions generated participants. Bilingual instructors were trained to deliver the HAT program weekly for six months. Participants were encouraged to exercise at home twice weekly. Bilingual health educators led monthly healthy ageing discussions. After six months, peer leaders were trained to sustain the HAT program and focus groups were conducted to obtain participant feedback. Peer leaders were observed three times post-training. Participants’ functional fitness was assessed at baseline and six months. Paired t-tests and ANOVAs were used to examine pre-post and between-group differences in functional performance. Results: Eighty-one members of four sedentary groups (Italian, Slavic, Chinese, and Eritrean) agreed to participate (98% women, mean = 70 years, range 49–90 years); 75 people completed a baseline assessment. Seventeen women joined HAT-HAQ after it had commenced. At six months, participants reported feeling better, stronger, and even younger. These benefits were corroborated by improved fitness. Follow-up testing revealed significant increases in participants’ strength, balance, and mobility (p < .05), however there were no significant differences between CALD groups. Peer leaders were competently instructing the HAT exercises. Conclusion: This program engaged groups of seniors from CALD backgrounds and promoted active ageing by using existing social programs. References: Hugo, G. (2014). The demographic facts of ageing in Australia. Australian Population and Migration Research Centre. The University of Adelaide. Retrieved from https://www.adelaide.edu.au/apmrc/pubs/policy-briefs/APMRC_Policy_Brief_Vol_2_2.pdf. Cyarto, E.V., Dow, B., Vrantsidis, F., & Meyer, C. (2013). Promoting healthy ageing: development of the Healthy Ageing Quiz. Australasian Journal on Ageing, 32(1):15–20. Cyarto, E.V., Brown, W.J., Marshall, A.L. & Trost, S.G. (2008). Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults. American Journal of Health Promotion, 23(1):3–17. Longitudinal Study of Access to Health Information Online Among the Elderly Johnson, Ernest1; Johnson, Shanthi2 1Faculty 2Faculty

of Business Administration, University of Regina, Regina, Canada; [email protected] of Kinesiology & Health Studies, University of Regina, Regina, Canada; [email protected]

Introduction: The Internet has grown at a tremendous rate and has offered consumers unparalleled opportunities. The use of electronic technology for providing care for the elderly has been a policy and program priority at many levels and countries. However, questions remain about access to the Internet among older adults and the proclivity to use this medium in the health promotion arena. This study examined Internet use and access to health information online among older adults from the Canadian Internet Use survey (2000–2012). Methods: Secondary analysis included a sample of 7,631 individuals over 65 years of age. Demographic and Internet use information was elicited using an interviewer-administered questionnaire. Results: In the sample, 61% were men, 51% were in coupled relationships, 57% had less than a high school education, 93% were retired, and 50% had a yearly income of less than or equal to the Statistics Canada’s Low-Income Cut-Off. Among the older adults, only an average of 10% had reported using the Internet. Among the Internet users, 58% used it to access health information online. A negative relationship between age and access of health information online was observed. Male gender, being married or in coupled relationships, higher levels of education and income, access to Internet from multiple locations other than one’s home, and frequent use of the Internet (daily) increased the likelihood of individuals using health information online. This trend has remained the same over time. Conclusion: These results showed that older adults are on the sidelines when it comes to using the Internet and accessing health information online. The study highlights the need for such training and support for older adults before the Internet is used as a medium for health promotion and the findings have implications for health promotion, public policy, and innovative health care delivery in the future. Strategies and Challenges Associated with Recruiting Retirement Communities and Residents into an Exercise Intervention Trial Tait, Jamie L1; Duckham, Rachel L1; Brownell, Sarah M1; Rantalainen, Timo1; Nowson, Caryl A1; Taaffe, Dennis R2; Sanders, Kerrie3; Hill, Keith D4; Daly, Robin M1 1Centre

for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia; [email protected] JAPA Vol. 24, Suppl., 2016

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of Medicine, University of Wollongong, Wollongong, New South Wales, Australia for Health and Ageing, Australian Catholic University, Melbourne, Australia 4School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia 3Institute

Introduction: Randomized controlled trials (RCT) provide the highest level of evidence for health and clinical outcomes, but successful recruitment of participants is critical to ensure the external and internal validity of results. This study describes the strategies, efficacy, pitfalls, and successes associated with recruiting 300 older adults residing in retirement communities into an 18-month RCT designed to evaluate the effects of dual-task exercise training on physical and cognitive function and falls. Methods: Adults aged ≥ 65 years and at increased risk of falling were recruited to participate in this trial. Recruitment occurred within retirement communities throughout Victoria, Australia (village size 60 to 350 residents) in three rolling cohorts (C). A range of different strategies were used: C1 = providing information packets to managers for distribution and on-site information sessions; C2 = on-site information sessions, free 30-min muscle assessments and sending individually-addressed information packets to residents via managers; and C3 = on-site information sessions and hand delivering information packets to residents. Results: Recruitment was conducted from February 2014 to April 2015. A total of 57 retirement communities were approached, of which 27 declined or did not respond and two did not have suitable facilities. Overall, 3,947 individual letters of invitation were sent to residents in 28 interested villages (C1: n = 1,150, C2: n = 1,265, C3: n = 1,532), but only 22 communities were deemed eligible (C1: n = 8, C2: n = 6, C3: n = 8); six villages had an insufficient number of interested residents. A total of 488 (14%) expressions of interest were received from the 22 communities (C1 = 17%; C2 = 14%; C3 = 11%), of which 380 participants were deemed eligible. However, only 300 consented (health and time commitments were the main reasons for non-consent), with the proportion of consented participants progressively increasing with a more individualized approach adopted for later cohorts (C1 = 27%; C2 = 35%; C3 = 38%). Conclusion: Only half of all retirement community operators and 14% of residents were interested in participating in a free exercise intervention, which indicates that implementing research within this setting may be problematic. Furthermore, no single recruitment strategy appeared to be optimal, but greater success was achieved with hand-delivered mail-outs to residents. Funding Source: NHMRC Project Grant (APP1046267) The Impact of Workplace Exercise Interventions on Health, Fitness, and Physical Activity: A Systematic Review Hunter, Jayden R1; Gordon, Brett A2; Bird, Stephen R1; Benson, Amanda C1 University, Bundoora, Australia; [email protected] Trobe University, Bendigo, Australia

1RMIT 2La

Introduction: Physical inactivity and low fitness are lifestyle-related chronic disease risk factors, the prevalence of which increases with age. A significant proportion of adults work, and health promotion initiatives such as workplace exercise programs (World Health Organization, 2008), where on-site facilities and expertise are provided, may alleviate time and equipment barriers to exercise participation (Trost, Owen, Bauman, Sallis, & Brown, 2002). This systematic review sought to determine the effectiveness of workplace exercise programs for improving chronic disease risk and to identify the characteristics of interventions that provide the greatest stimulus for change. Methods: CINAHL, EMBASE, AMED, SCOPUS, and SPORTDiscus databases were searched from inception to November 2015 using the search terms ‘exercise’, ‘physical activity’, ‘aerobic training’, ‘resistance training’, ‘circuit training’, ‘workplace’, ‘worksite’, ‘employee’, and ‘intervention’. Studies that involved adult employees, prescribed exercise in the workplace, and measured at least one physical activity (accelerometer, pedometer, or self-report) or physical fitness (cardiorespiratory fitness or muscular strength) outcome were eligible. Secondary outcomes included anthropometric and metabolic measures. In total, 37 studies (23 RCTs, 7 quasi-experimental CTs, 7 uncontrolled trials) were included. The strength of evidence for each outcome were assessed using the GRADE system (Higgins & Green, 2008). Results: Improvements in muscular strength (10/13 studies; moderate strength of evidence), cardiorespiratory fitness (20/31; moderate), and central body fat (7/10; high) were identified. Changes in body mass (14/23; low), blood lipid profile (9/15; very low), whole body fat (12/21; very low), physical activity (6/11; very low), BMI (7/15; very low), insulin, glucose, or C-reactive protein (4/9; very low), and blood pressure (6/25; low) were not conclusive. High attrition rates (> 60%) were associated with interventions ≥ 6 months. Conclusion: Exercise of at least moderate intensity appears to have the greatest effect on health and fitness outcomes, while interventions ≥ 6 months might be more suitable for changing anthropometric and metabolic measures, although they have higher attrition rates. Exercise intensity and intervention duration are therefore important considerations when aiming to reduce employee chronic disease risk factors in the workplace setting. It is unclear if providing direct exercise supervision can minimise attrition, however, it warrants investigation. References: Higgins, J.P., & Green, S. (2008). Cochrane Handbook for Systematic Reviews of Interventions (Vol. 5): Wiley Online Library. Trost, S.G., Owen, N., Bauman, A.E., Sallis, J.F., & Brown, W. (2002). Correlates of adults’ participation in physical activity: review and update. Medicine and Science in Sports and Exercise, 34(12), 1996–2001. World Health Organization. (2008). Preventing Noncommunicable Diseases in the Workplace Through Diet and Physical Activity: WHO/World Economic Forum Report of a Joint Event. Geneva, Switzerland: WHO Press. A Comparison Between Estimated Physical Activity from an Open-Ended Self-Report Questionnaire and the SenseWear Armband in Older Australians Northey, Joseph1; Rattray, Ben1,2; Pumpa, Kate1,2; Smee, Disa2; Cherbuin, Nicolas3; Anstey, Kaarin3 Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia; [email protected] of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia 3Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia 1UC

2Discipline

Introduction: Differences in self-reported and objective estimates of physical activity (PA) have been reported in the literature (Scheers, Philippaerts, & Lefevre, 2012), however few studies have assessed these differences in adults aged 70 and over. This study compared intensity-specific estimates of self-reported PA and the SenseWear ArmbandTM (SWA) in a sub-group of The Personality and Total Health Through Life project (PATH). Methods: A sub-group (n = 105, 44 females; mean age: 75.3 ± 1.3 years) of the 60–64 year cohort of the PATH study (Anstey et al., 2012) were analysed in this study. Participants were asked in an open-ended format to report the average time per week undertaking PA of light (e.g., walking or housework), moderate (e.g., dancing), and vigorous (e.g., running) intensities (Bielak, Cherbuin, Bunce, & Anstey, 2014). The SWA (BodyMedia, PA, USA) was worn JAPA Vol. 24, Suppl., 2016

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for seven consecutive days, and total time accumulated (SWATotal) and time accumulated in 10-min bouts (SWAG10) were calculated for light (1.5–3.0 METs), moderate (3.0–6.0 METs), and vigorous (> 6 METs) PA. Moderate to vigorous physical activity (MVPA) was calculated by combining the respective domains. Spearman correlations and Bland-Altman were used to test agreement between each estimate. Results: Small significant associations were found between self-reported PA and both the SWAG10 and SWATotal estimates of PA (r = .23–.33). Mean bias and 95% limits of agreement between self-report PA and SWATotal were large, with estimates of PA from self-report lower for light (–821.0 [–2320.2 to 678.2] min·week–1), moderate (–155.0 [–736.7 to 426.1] min·week–1), vigorous (–2.1 [–236.1 to 231.9] min·week–1), and MVPA (–157.5 [–825.6 to 510.7] min·week–1). However, mean bias between self-reported PA and SWAG10 was small for light (–73.7 [–1489.5 to 1341.0] min·week–1), moderate (+39.02 [–475.1 to 553.2] min·week–1), vigorous (+23.9 [–176.5 to 224.2] min·week–1), and MVPA (+16.9 [–576.4 to 610.2] min·week–1). Conclusion: Despite the significant associations between estimates of PA, large absolute differences were found between SWATotal and self-reported estimates of PA. In general, self-reported PA time was lower than SWATotal, but was more comparable to SWAG10. A combination of objective and self-reported measures of PA may provide interesting and novel insights into any link between PA and improved health outcomes. Acknowledgements: This project was funded by the Dementia Collaborative Research Centre – Early Diagnosis and Prevention, as part of an Australian Government Initiative. References: Anstey, K.J., Christensen, H., Butterworth, P., Easteal, S., Mackinnon, A., Jacomb, T., . . . Cherbuin, N. (2012). Cohort Profile: The PATH through life project. Int J Epidemiol, 41(4), 951–960. Bielak, A.A., Cherbuin, N., Bunce, D., & Anstey, K. J. (2014). Preserved differentiation between physical activity and cognitive performance across young, middle, and older adulthood over 8 years. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(4), 523–532. Scheers, T., Philippaerts, R., & Lefevre, J. (2012). Assessment of physical activity and inactivity in multiple domains of daily life: a comparison between a computerized questionnaire and the SenseWear Armband complemented with an electronic diary. Int J Behav Nutr Phys Act, 9(71), 71–79. What is the Effect of Health Coaching on Physical Activity Participation in Older People?: A Systematic Review of Randomised Controlled Trials Oliveira, Juliana1; Sherrington, Catherine1; Amorim, Anita2; Dario, Amabile2; Tiedemann, Anne1 George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia; [email protected], [email protected], [email protected] 2Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; [email protected], adar3900@uni. sydney.edu.au 1The

Introduction: Physical inactivity is particularly common in older age, yet older people have much to gain from being active in terms of disease prevention and maximising independence (Laudani et al., 2013). Health coaching is a low-cost intervention that may increase physical activity in people with chronic conditions (Olsen & Nesbitt, 2010). However, there is a lack of published research summarising the effect of health coaching on physical activity in older people. Therefore, this review investigated the effect of health coaching on physical activity, mobility, quality of life, and mood in people aged 60+ years. Methods: We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, PEDro, SPORTDiscus, Lilacs, and CINAHL for randomised controlled trials evaluating the effect of health coaching on physical activity among older people. The primary outcome was physical activity; secondary outcomes were mobility, quality of life, and mood. Methodological quality of trials was assessed using the 11-item PEDro Scale. We calculated standardised mean differences (SMD, Hedges’ g) with 95% confidence intervals (95%CI) from random effects model meta-analyses. Meta-regression analyses were undertaken to examine sources of between-study heterogeneity. Results: Twenty-one eligible trials were included with 4,814 participants (mean PEDro score = 5.7). Health coaching had a small, significant effect on physical activity (21 studies; SMD = 0.29; 95% CI 0.18 to 0.39; P < .001, I2 =66%). No significant difference in the effect of health coaching on physical activity was found between trials that included participants with clinical conditions (SMD = 0.37; 95% CI 0.19 to 0.54; P < .001, 9 studies) and those that included only healthy participants (SMD = 0.23; 95% CI 0.09 to 0.37; P < .01, 12 studies). There was no evidence that health coaching significantly improved mobility (7 studies; SMD = 0.07; 95% CI –0.07 to 0.20; P = .20; I2 = 30%), quality of life (7 studies; SMD = 0.07; 95% CI –0.10 to 0.23; P < .05; I2= 57%), or mood (4 studies; SMD = 0.01; 95% CI –0.14 to 0.16; P = .70; I2 = 0%). Conclusion: Health coaching is effective in improving physical activity in people aged 60+, although average effects were small. However, no effects on quality of life, mobility, and mood were found. References: Laudani, L. Vannozzi, G., Sawacha, Z., della Croce, U., Cereatti, A.,& Macaluso, A. (2013). Association between physical activity levels and physiological factors underlying mobility in young, middle-aged and older individuals living in a city district. PloS One, 8(9), e74227. Olsen, J.M. & Nesbitt, B.J. (2010). Health coaching to improve healthy lifestyle behaviors: an integrative review. American Journal of Health Promotion, 25(1), e1–e12. Personalized Citizen Assistance for Social Participation (APIC) in Older Adults with Disabilities: A Feasible Intervention to Foster Active Ageing Levasseur, Mélanie1,2; Lefebvre, Hélène3,4; Levert, Marie-Josée3,4; Lacasse-Bédard, Joanie2; Lacerte, Julie1,2; Carbonneau, Hélène4,5; Therriault, Pierre-Yves4,5 de Sherbrooke, Sherbrooke, Canada; [email protected], [email protected] Centre on Aging, Sherbrooke, Canada; [email protected] 3Université de Montréal, Montréal, Canada; [email protected], [email protected] 4Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada 5Université du Québec à Trois-Rivières, Trois-Rivières, Canada; [email protected], [email protected] 1Université

2Research

Introduction: Social participation, a determinant of health in older adults, requires innovative interventions including mobilisation of society. The Personalised Citizen Assistance for Social Participation (APIC; French acronym for Accompagnement Citoyen Personnalisé d´Intégration Communautaire; Lefebvre et al., 2013) involves weekly 3-hr personalised stimulation sessions over a six-month period targeting significant social and leisure activities difficult to accomplish. Developed with individuals having traumatic brain injury, the APIC needed to be adapted for older adults and its feasibility with this population explored. This study aimed to adapt the APIC for older adults with disabilities and explore its feasibility, including facilitators and barriers to accomplishing social and leisure activities. A qualitative clinical research design was used with 19 older adults with disabilities, living at home, and participating in the APIC program. Methods: A qualitative clinical research design (Miller & Crabtree, 2003) was used with 19 older adults with JAPA Vol. 24, Suppl., 2016

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disabilities, living at home, and participating in the APIC program. Data were also collected to explore the impact of the intervention (Levasseur et al., 2016). Results: Over the six-month period, older adults met with their attendant about 20 times, and 16 of them completed the intervention. Reasons for missing meetings were mainly unavailability of attendant and medical reasons. While participating in the intervention, older adults chose to accomplish mostly social activities, but also some physical and intellectual leisure activities. Personal facilitators and barriers to accomplishing social and leisure activities were mainly related to health and sensory and motor or behavioural capabilities, including their psychological and emotional availability. Environmental facilitators were mainly related to proximity of activities, paratransit, and social support including from attendants, while barriers were inaccessibility of the physical environment, bad weather, over-protection by family members, and lack of support in community resources. Conclusion: The APIC is a feasible intervention that can optimise facilitators and diminish barriers to community integration. By offering new opportunities to increase community integration and optimise resources, innovative interventions like the APIC might help address the global ‘ageing well’ priority in efforts to overcome major universal public health challenges, such as increased prevalence of chronic diseases. References: Lefebvre, H., Levert, M.-J., Le Dorze, G., Croteau, C., Gélinas, I., Therriault, P.-Y., Michallet, B. & Samuelson, J. (2013). Un accompagnement citoyen personnalisé en soutien à l’intégration communautaire des personnes ayant subi un traumatisme craniocérébral: vers la résilience ? Recherche en soins infirmiers 4, 107–123. Levasseur, M., Lefebvre, H., Levert, M.-J., Lacasse-Bédard, J., Desrosiers, J., Therriault, P.-Y., Tourigny, A., Couturier, Y. & Carbonneau, H. (2016). Personalized citizen assistance for social participation (APIC) in older adults: a promising intervention to live longer and better? Arch Gerontol Geriatr. Miller, W., & Crabtree, B. (2003). Clinical Research. In: Denzin, N., Linclon, Y. (Eds.), Strategies of Qualitative Inquiry, 2nd ed. Sage Publications Inc: Thousand Oaks, CA, pp. 397–434. Funding: Obtained from the Canadian Institutes of Health Research (CIHR; grant #284179), which, except for their special call for projects, did not influence the study. Free bus tokens were kindly provided by the Sherbrooke Transit Corporation. Mélanie Levasseur is a Fonds de la recherche du Québec – Santé (FRQS) junior 1 researcher (grant #26815). Competition and Camaraderie: Experiences of Older Adults in a Group Physiotherapy Program at a Rehabilitation Hospital Raymond, Melissa1,2; Burge, Angela2,3; Soh, Sze-Ee1,4,5; Jeffs, Kimberley6; Winter, Adele1; Holland, Anne2,6 Department, Caulfield Hospital Alfred Health, Melbourne, Australia; [email protected] of Allied Health, La Trobe University, Melbourne, Australia 3Physiotherapy Department, Alfred Health, Melbourne, Australia 4Department of Physiotherapy, Monash University, Melbourne, Australia 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia 6Northern Health, Melbourne, Australia 1Physiotherapy

2School

Introduction: Physiotherapy delivered in a group setting has been shown to be effective in a variety of populations However, little is known about the attitudes of this population toward participating in group physiotherapy. Description of the patient experience is increasingly being recognised as a crucial element in the delivery of patient-centred care, role development, and performance evaluation of health professionals and services. The purpose of this study was to explore older inpatients’ perceptions and experiences of group physiotherapy to assist with planning and designing future inpatient programs to maximise patient participation, satisfaction, and clinical outcomes. Methods: Twelve hospitalized adults (≥ 65 years) undertook individual semi-structured interviews regarding their experiences in group physiotherapy. Through iterative thematic analysis, descriptive codes were developed, compared, and grouped together to create themes. Results: Analysis revealed six major themes and 10 sub-themes. Major themes included: participation and satisfaction, exercise and physical benefits, qualities of the group instructor, camaraderie and support, self-satisfaction and self-awareness, and motivation and drive for improvement. All participants reported that they were happy to attend group sessions. They also felt that group physiotherapy was a suitable alternative to individual physiotherapy sessions. Participants described physical benefits that increased their motivation, and expressed gratitude and acceptance of their own health and mobility limitations when comparing themselves to those less mobile. Motivation and camaraderie with peers contributed to their enjoyment of group physiotherapy. Conclusion: This study provides new evidence to support group physiotherapy for hospitalized older adults. They enjoyed exercising with their peers and valued the physical and social benefits of group physiotherapy. Group instructors have the potential to influence patient participation and satisfaction with therapy. Education to group instructors on methods to optimise participant motivation to encourage participation, effort, and peer support may improve future delivery of physiotherapy to hospitalized older adults. Future research should investigate the reasons why older inpatients decline group physiotherapy and methods for encouraging participation. Clinicians may wish to consider replacing several individual treatment sessions with group physiotherapy as part of a weekly treatment schedule. The Effect of a High-Intensity Functional Exercise Group on Clinical Outcomes in Hospitalized Older Adults Raymond, Melissa1,2; Jeffs, Kimberley3; Winter, Adele1; Soh, Sze-Ee4,5,6; Hunter, Peter7; Holland, Anne2,7 Department, Caulfield Hospital Alfred Health, Melbourne, Australia; [email protected] of Allied Health, La Trobe University, Melbourne, Australia 3Northern Health, Melbourne, Australia 4Department of Physiotherapy, Monash University, Melbourne, Australia 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 6Alfred Health, Melbourne, Australia 7Physiotherapy Department, Alfred Health, Melbourne, Australia

1Physiotherapy 2School

Introduction: Following an acute illness, many hospitalised older adults are prescribed physiotherapy to optimise mobility and function. The type and intensity of exercise prescribed are important factors in determining outcomes. High-intensity strength training in older adults is feasible (Fiatarone et al., 1990), safe, and may result in significantly greater improvements in lower limb strength and functional performance compared with lesser intensities (Raymond, Bramley-Tzerefos, Jeffs, Winter, & Holland, 2013). Weight-bearing exercise has significantly greater effects on functional performance than JAPA Vol. 24, Suppl., 2016

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non-weight-bearing exercise (Sherrington, Lord, & Herbert, 2004). However, little is known about the efficacy of a high-intensity functional exercise group program in hospitalized older adults. Methods: An assessor-blinded, randomized-controlled trial compared the effects of a high-intensity exercise group with individual physiotherapy sessions on clinical outcomes in hospitalised older adults (≥ 65 years) in a sub-acute rehabilitation hospital (n = 468). Participants who were able to follow instructions and stand unassisted from a chair were randomly assigned to a standing, high-intensity functional strength and balance group three times a week, plus individual physiotherapy sessions twice a week (‘group’) or daily individual physiotherapy sessions (‘control’). The primary outcome measure was the Elderly Mobility Scale. Secondary measures included the Berg Balance Scale, gait speed, therapist efficiency, and discharge destination. Results: Participants’ mean age was 84.3 years (SD = 7.1) and they significantly improved their Elderly Mobility Scale from admission to discharge: median discharge scores 16.0 (IQR 13.0–19.0) and 16.0 (13.0–18.0) for control and group participants respectively, with no difference between groups (p = .483). There was a significant improvement in balance, mobility, and gait speed over time for group and control (p < .001). There was no significant difference between groups for discharge destination, p = .904. Therapists saved 31–205 min/week when treating 2–6 participants in the group and individual combined when compared with individual physiotherapy alone. Conclusion: The results suggest that a high-intensity functional exercise group program combined with individual physiotherapy may improve mobility without compromising on patient outcomes. Therapist time was saved by treating multiple participants in a group setting. A high-intensity exercise group may be an effective and efficient method to provide care to older inpatients. References: Fiatarone, M., Marks, E., Ryan, N., Meredith, C., Lipsitz, L., & Evans, W. (1990). High- intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA, 263, 3029–3034. Raymond, M.J., Bramley-Tzerefos, R.E., Jeffs, K.J., Winter, A., & Holland, A.E. (2013). Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil, 94(8), 1458–1472. Sherrington, C., Lord, S.R., & Herbert, R.D. (2004). A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture1. Arch Phys Med Rehabil, 85(5), 710–716. Effectiveness of a One-Month Pedometer-Based Intervention Challenge on Physical Activity Levels at the Workplace in Qatar: A Cohort Study Van Der Walt, Mercia; Sayegh, Suzan; Al-Kuwari, Mohamed Healthy Lifestyle Program, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar; [email protected], [email protected], [email protected] Introduction: Due to the time adults spend at the workplace, it has been more recognized as a potential setting to reach the adult population through health promotion programs, such as walking interventions to promote physical activity. The aim of this study is to assess the effectiveness of a one-month pedometer-based intervention challenge on physical activity level among adults at the workplace in Qatar. Methods: This cohort study evaluates the effect of challenge on physical activity levels within workplaces three months before, one month during, and three months after the challenge, which took place in January 2015. A total of 328 employees from different work settings were selected from the “Step into Health” web database, a communitybased program that was launched in 2012 as an approach to improve physical activity in Qatar. Internal workplace incentive-driven challenges were organized within each setting, encouraging individuals to accumulate a target of 10,000 steps/day. Their habitual physical activity, including daily and aerobic step counts, was measured through the Omron HJ-324U pedometer (Omron Healthcare Co., Ltd., Japan). Results: Results show that 62.2% of the overall population were males versus 37.8% females. Average age was 40.1 ± 8.9 years, where 57% fell under the age group 31–45 years. The mean body mass index (BMI) was 27.2 ± 5.0. Majority of participants (37.5%) are originally from the Eastern Mediterranean region. Steps ranged from 5,721 to 7,958 steps/day, with a median of 6,839 steps/day. Males were more active, having a median of 8,244 steps/day (IQR 7,126 to 9,362) compared with a median of 6,090 steps/day (IQR 4,830 to 7,350) among females. There was an overall increase in daily step and aerobic step counts per day during the challenge. Based on physical activity level classification, the sedentary group was mostly affected by the challenge. Office workers were less active than those in the field and healthcare sector. Conclusion: The intervention challenge had an overall significant effect on physical activity levels; however, further research should incorporate additional measures. Anthropometric and behavioral changes associated with pedometer-based intervention challenges can be investigated in future studies. Environmental factors within the workplace should also be taken into consideration. References: Abraham, C., & Graham-Rowe, E. (2009). Are worksite interventions effective in increasing physical activity? A systematic review and meta-analysis. Health Psychology Review, 3(1), 108–144. Engbers, L., van Poppel, M., Chin A Paw, M., & van Mechelen, W. (2005). Worksite health promotion programs with environmental changes. American Journal of Preventive Medicine, 29(1), 61–70. My Aged Care—The Changes and the Challenges of Navigating Aged Care Services Araco, Michael; Byrne, Mary Healthdirect Australia The move to the My Aged Care gateway by the Australian government accompanies significant change for aged care services. The vision is to give consumers more choice, more control, and easier access to a full range of services. Execution of this vision has not been easy or without challenges. These changes have generated debate as to the role of online and telephone services such as My Aged Care in health service delivery. The My Aged Care service is jointly managed by the Department of Health and Healthdirect Australia. Healthdirect Australia, jointly funded by the Council of Australian Governments, is responsible for approximately 50 online and telephone-based products and services. Our vision is to be a key part of a quality Australian health system and to provide all Australians with timely access to health information and advice. Since the initial launch in 2013, the My Aged Care contact centre has taken over one million calls and the website has had over two million visits. Both the contact centre and website have helped consumers navigate a complex industry and receive valuable and concise information on aged care services. A second stage, launched on July 1, 2015, saw the contact centre and website become the single entry point for consumers to access and receive a range of aged care services. Healthdirect Australia, the Department of Health, and our service partners continue to address the challenges behind executing the My Aged Care vision. For example, work is underway to reduce call wait times and improve resource allocation, which has been problematic to date in peak periods. The website is being improved and updated with new information as content gaps are identified and addressed. Feedback from consumers, healthcare professionals, and industry providers is evaluated so as to deliver regular service improvements. Despite these challenges, it is clear that the aging population requires new JAPA Vol. 24, Suppl., 2016

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innovative solutions like My Aged Care. Healthdirect Australia is engaged in continuous service monitoring and improvement to ensure the My Aged Care service best meets the current needs of aged care consumers as well as prepares for future demand. This presentation will provide an overview of the My Aged Care service, problems faced with service execution to date, and a summary of ongoing work to address these challenges and meet the growing needs of aged care consumers. Active Ageing: A Novel Dynamic Exercise Initiative for Older People to Improve Health and Well-Being Sales, Myrla1; Polman, Remco2; Hill, Keith D3; Levinger Pazit1 1Institute of Sport, Exercise & Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia; myrla.reissales@

live.vu.edu.au, [email protected] University, Talbot Campus, Fern Barrow, Poole; [email protected] 3School of Physiotherapy and Exercise Science, Curtin University, Perth WA; [email protected] 2Bournemouth

Introduction: A unique purpose-built exercise park was designed to provide a fun but physically challenging environment to support exercise for older adults in a community setting. This study aimed to investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park designed for senior citizens in improving their physical fitness and function. Methods: Sixty-two participants aged between 60 and 90 years old (71.4 ± 6.7 years; 44 females; 18 males) were randomly allocated to either an 18-week exercise park intervention group (EPIG, n = 31) or a control group (CG, n = 31). The Balance Outcome Measure for Elder Rehabilitation (BOOMER) battery test was used as the primary outcome measure. Secondary outcome measures included hand grip strength, two-minute walk test, and lower limb strength test. Participants’ acceptability, adherence, and safety were also assessed. Outcome assessments were conducted at baseline and at 18 weeks after intervention commencement. Multivariate analysis of covariance was used to assess differences between groups over time. Results: Twenty-seven participants from EPIG completed the 18-week intervention (87%), with attendance of 79.6%. Group by time interaction showed significant improvement for the EPIG group on the single leg stance balance test (p = .02), knee strength (p < .01), 2-min walk test (p = .02), and sit to stand functional tests (p = .03), with no differences in the BOOMER battery test (p = .46). No injuries or adverse events were reported. Process evaluation using qualitative methods (semi-structured interviews) showed that participants valued their participation because this exercise mode helped them in performing their daily activities as well as promoted social interaction. Conclusion: The 18-week exercise park program improved physical fitness and function in older people and showed high adherence and participation rates. Participants demonstrated good acceptability of the senior exercise park, and valued and enjoyed the exercise mode and the social aspect provided in the community setting. The exercise park program has been shown to be safe and effective in reducing physiological risk factors of falls, and therefore might enhance exercise uptake and sustain participation in exercise programs for older adults in the community. Perceived Barriers and Facilitators Relating to Volunteer Work Among Australian Seniors Biagioni, Nicole1; Jongenelis, Michelle1; Pettigrew, Simone1; Warburton, Jeni2; Newton, Robert3; Jackson, Ben4 University, Perth, Australia; [email protected], [email protected], [email protected] Trobe University, Melbourne, Australia; [email protected] 3Edith Cowan University, Perth, Australia; [email protected] 4The University of Western Australia, Perth, Australia; [email protected]

1Curtin 2La

Introduction: Being physically, mentally, and socially active is paramount to healthy ageing. Engagement in volunteer work has been recommended as an effective way to achieve these outcomes. Those who choose to commit their time after retirement to contribute to the well-being of others are thought to benefit from this undertaking in many ways, and uptake in such activities should be further encouraged to achieve better health outcomes for the aging population. Methods: As part of a broader randomized control trial examining health and well-being in Australian seniors, 242 participants aged 60 years and older who were not current volunteers were interviewed. They discussed their perceptions of the barriers to and facilitators of involvement in such activities. The interview transcriptions were imported into NVivo10 for coding and analysis. Results: Many perceived barriers to engaging with volunteer work were identified by the participants, such as being time poor, being unable to transport themselves to and from the commitment, and lacking the relevant information and resources to seek volunteer positions. It was also noted that fitting into an organisation’s schedule with their existing lifestyles was often difficult. Various facilitators were also identified that would assist people to become involved in volunteer work. These included such aspects as making information on volunteer positions readily accessible, finding positions that aligned with personal interests, and introducing more flexibility in positions so that the commitment was easier to manage within existing lifestyles. Conclusion: The findings suggest that there are various barriers that prevent seniors from engaging in volunteer work after retirement. Some of these are at a personal level, such as interest and availability, and other barriers are perceived to exist at the organisational level, such as communication and flexibility. Work could be done to further inform seniors of available opportunities for involvement and to motivate them to take advantage of these opportunities. In addition, volunteering organisations could seek to improve accessibility to volunteering positions and increase the ease with which seniors can contact and interact with these organisations. Physical Activity and Sense of Coherence in Older Australians Hill, Robert1; Tinning, Richard1; McCuaig, Louise1; Quennerstedt, Mikael2 1The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia; [email protected], [email protected], [email protected] 2Örebro University, Department of Health and Medicine, Örebro, Sweden; [email protected]

Introduction: Aaron Antonovsky’s focus on the sources of health (‘salutogenesis’) and his related concept of ‘sense of coherence’ (SOC) have been studied and used widely in Scandinavia, North America, England, and some other countries, but not in Australia. Few papers on his ideas and their usefulness for studying older adult health have been published. Guided by Antonovsky’s theories, this study investigated the relationships between JAPA Vol. 24, Suppl., 2016

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‘sense of coherence’ (SOC), physical activity (PA), and health in 36 Australians 65 years of age and older. Methods: Participants were Brisbane residents, aged 65 to 93, who were free of severe memory problems and able to walk without the assistance of another person. They completed the SOC-13, an instrument created by Antonovsky, to measure levels of SOC, and participated in semi-structured interviews that were recorded and transcribed verbatim. Interview questions focused on how they had handled life difficulties during the most recent five-year period and then in their earlier lives. Participants also completed a survey asking for basic demographic information, diagnosis or treatment for chronic diseases, and their assessment of their overall health. Qualitative data were augmented by quantitative data from accelerometers that each participant wore for one week while keeping a diary of PA. Results: Participants with higher scores on the SOC-13 spoke more often and more enthusiastically about PA. They also engaged in more minutes of moderate-to-vigorous PA, averaged more steps per day, and reported fewer chronic disease problems than those with lower SOC scores. Several expectations that had been expressed by Antonovsky seemed to have been borne out by the results of this study. Conclusion: Antonovsky’s ideas and SOC-measurement tools can be useful for the study of health in Australians aged 65 years and over. Our finding that higher SOC levels seem to be related to engagement in positive health maintenance practices by older people supports conclusions of earlier studies. Since one such practice is PA, further research into the role of SOC may offer novel opportunities for interventions aimed at improving the health of this population. A Two-Staged International Feasibility Study of a Health Promotion Program for Older Adults Focusing on Physical Activity, Mental Wellbeing, and Nutrition Dahl, Stefanie1; Golenia, Marion1; Netz, Yael2; Neuber, Nils1; Brach, Michael1 of Sport and Exercise Sciences, University of Muenster, Muenster, Germany; [email protected] Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel; [email protected]

1Institute 2The

Introduction: A course program (Plan50+) aiming at a healthy active lifestyle and linking aspects of physical activity, mental wellbeing, and nutrition together, has been developed in the European funded project, “Active I – Healthy Active Living for Seniors”, to slow down physical and mental decline and enable a long-lasting, independent participation in the society. A two-staged feasibility study with predefined feasibility criteria was performed in four European countries to assess the feasibility of the health promotion program Plan50+ (Thabane et al., 2010). Methods: 129 participants (112 women; mean age 70.5 ± 7.1 years) from Ireland, Italy, Poland, and Spain participated in two course streams of Plan50+. Each course was guided by 2–3 trained instructors and lasted 11 weeks, with one compact course week (20 hours) and 10 course weeks of 2 × 2 hours per week. The course was slightly revised according to the feedback given by instructors and participants after the first stream. Plan50+ connects aspects of health behavior change with a didactical principle (Experience, Reflection, Action) (Neuber & Wentzek, 2005) and includes a variety of offers in physical activity, mental wellbeing, and nutrition. Feasibility criteria covering the topics, including (1) appraisal by the instructor, (2) safety, (3) appraisal by the participants, and (4) attrition rate, have been defined in advance. The data were collected with self-designed questionnaires for instructors and participants. Results: The course proved to be feasible in all predefined criteria: (1) all instructors (missing data, n = 1 of 11) would conduct the course again; (2) no participant had to stop participation for medical reasons caused by the course; (3) all participants (missing data, n = 11 of 124) would participate in the course again; (4) 3.9 % (5 participants) left the course on their own decision. The attendance rate of participants varied between 41% and 100%. Conclusion: The health promotion program Plan50+ is feasible. Both participants and instructors are satisfied with the course, the attrition rate is low, and the course is safe for older adults. The next step will be an efficacy testing of the course Plan 50+. References: Neuber, N. & Wentzek, C. (2005). Lebensstilorientierte Gesundheitsförderung im Jugendalter – ein bewegtes Pilotprojekt mit Auszubildenden. Zeitschrift für Gesundheitsförderung, 28, 22–25. Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L.P., … Goldsmith, C.H. (2010). A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology, 10:1. Wellness in Action: Enhancing Community Connections Johnson, Susan CommunityWest Inc. Active ageing programs aim to optimise opportunities for older Australians to improve their health, participation, and security in order to enhance quality of life as people age. Quality of life is not simply the provision of ‘quality services’; rather it is about enabling older people to be involved in planning their support, to make decisions and take risks, and to feel valued, known, and understood. Consultation with older consumers through the ‘Let’s Talk about Quality,’ report released in December 2015 found that involvement in life and feeling socially connected to the community were also highly valued. Spirituality in terms of identifying and supporting whatever gives each person’s life meaning, purpose, and connectedness in a way that is relevant to the older person were considered integral to experiencing a good quality of life. Unfortunately, many older people, particularly those with a chronic illness, people living with disability, or those experiencing mental health challenges, find it difficult to make and sustain positive social connections. Loneliness and social isolation can have a significant negative influence on people’s health, wellbeing, and satisfaction with life. CommunityWest Inc., based in Western Australia, over the past three years, has worked within a partnership approach with three large local government organisations to plan and implement the Act to Connect Program aimed at connecting people into the community. Act to Connect is underpinned by the Wellness Philosophy, which focuses on thinking and working in a way that maintains and builds a person’s capacity to live as independently as possible for as long as possible. Psychological and spiritual wellbeing and social inclusion are key concepts of the Wellness Philosophy. The ‘Wellness in Action: Enhancing Community Connections’ presentation will outline the key principles and concepts of the Wellness Philosophy. The presentation will show how this whole-person approach to supporting people as they age is empowering, highly effective, and complementary to active ageing. The presentation will also showcase some of the exciting outcomes achieved by the Act to Connect Program through client stories, poetry, and testimonials garnered through the program’s extensive evaluation. References: Australian Aged Care Quality Agency. (2015). Let’s Talk About Quality. Shaping the Future National Consultation Report. Australian Government, Canberra. CommunityWest. (2015). Wellness: Now and for the Future. Promotion & Enhancement of the Wellness Philosophy. CommunityWest, Perth, Western Australia. WHO. What is Active Ageing? http://www.whoint/active-ageing/en/ JAPA Vol. 24, Suppl., 2016

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Influence and Usage of a Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight Employees: An Experimental Pilot Study Kouwenhoven-Pasmooij, Tessa1,2,3; Ling, Sui Wai1; Robroek, Suzan2; Van Rossum, Liesbeth4; Burdorf, Lex2; Hunink, Myriam1 of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; [email protected], [email protected], [email protected] 2Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands; [email protected], [email protected] 3Department of Occupational Health, Erasmus Medical Center, Rotterdam, The Netherlands 4Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; [email protected]

1Department

Introduction: Addressing the obesity epidemic requires the development of effective interventions. Ehealth interventions with the use of accelerometers, elements of gaming, awarding, or social bonding seem promising. The combined approach of these eHealth elements, administered in a blended care approach, has the potential to have people adopt and maintain a physically active lifestyle. The aim of this study was to assess the influence and usage of a blended web-based and real-life played game in overweight employees. Methods: We observed 52 overweight health care employees who voluntarily participated in a 20-week web-based program, supplemented (blended) with non eHealth components. These non eHealth components were an intake session and five multidisciplinary group sessions. The game was played in real life with the use of a 3D accelerometer and with the focus on social interaction and competition. Data were collected in 2014 and 2015. Primary outcome was physical activity (PA) (metabolic equivalent * time). Secondary outcomes were changes in BMI and waist circumference, compliance to the game, and engagement with the game. Measurements were performed at baseline, and after 10 and 23 weeks. The effects on PA were analyzed using linear regression analysis. Linear mixed models were used to evaluate the effect on the outcome measures, with a correction for the eHealth teams. Results: The mean age of participants was 48.1 years, with 82% females. The mean level of PA was above the Dutch guidelines and remained fairly constant during the game. We found that more compliance and engagement were associated with more PA. BMI was reduced by 5.71% and waist circumference by 5.84 cm. Conclusion: This blended web-based gaming intervention was beneficial in having a constant healthy level of PA and a promising effect on BMI/waist circumference was seen. Broader implementation and longterm follow-up will be needed to evaluate the sustainability of PA and weight loss and to provide insights into who benefits the most from this approach. ‘Active Ageing’ Exists in Residential Care Kanakaris, Vicki Multicultural Aged Care Inc. (MAC), Adelaide, Australia; [email protected] Introduction: ‘Active Ageing’, residential facility, Greek residents! Can ‘Active Ageing’ exist within residential facilities? What does this mean? How does it work? Can the three effectively interrelate? Active Ageing can be embedded and implemented within process and procedure frameworks within residential facilities! Lifestyle coordinators have the ‘power’ to infiltrate the taboo area of ‘quality of life’. Health and wellbeing is paramount and can be achieved through cultural knowledge, cultural competency training, and the provision of tangible, culturally applicable lifestyle activities. Methods: A Greek-specific pilot project involving 39 residential facilities in South Australia, a varied workforce in terms of vocational and diverse backgrounds and many Greek residents and their families, allowed a playing field for research (quantitative and qualitative), data collation, analysis, and conclusions. The foundational cultural awareness training model, developed by Multicultural Aged Care (4 As Model), directed the cultural competency education delivered. Without exception, all participants reported their increased knowledge and awareness of culture for an individual, how it influences beliefs and behaviours, and consequently adjusting their own individual practices as well as organisational practices. Results: Some of the major results for both staff and residents included: changes to processes, procedures, and program delivery and increase in requests for repeated and extended cultural awareness sessions according to their individual needs; increased participation of residents in numerous physical activities such as dance, singing, gardening, cooking, religious celebrations, reminiscing, board games, lively interactive discussions, storytelling, outings, and craft activities. ‘Real’ evidence-based examples have predicated real beneficial outcomes for both residents and the diverse workforce: developing and offering new strategies, developing and maintaining trusting rapport, celebrating individual identity, sharing of knowledge, participation in multicultural activities, engagement in physical and social activities, identifying culturally and linguistically diverse (CALD) specific nutritional options, increasing understanding of behaviours and beliefs of CALD residents, implementing targeted and responsive practises. Conclusion: This labyrinth of elements can assemble to provide a platform for active ageing, resulting in positively influencing the quality of life of residents and the workforce. Let’s Meet at Café 94 Chudecka, Agnieszka Multicultural Aged Care (MAC), Adelaide, Australia; [email protected] Introduction: What happens when you bring together Montessori principles, cultural activities, MAC’s 4 As cultural competence model, and active, older people from diverse cultures in a safe, stimulating environment? A quiet revolution occurs, and it’s called, Café 94. Café 94 utilises a collaborative, multicultural service delivery approach; meets the social needs of older people from culturally and linguistically (CALD) backgrounds; combines opportunities to maintain and enjoy one’s own cultural heritage, with that of other cultures; perhaps shapes community aged care service provision into the future. Methods: The Café 94 model (a collaboration between South Australian CALD community groups, generalist organisations, and MAC), is based on the vision that all older people from CALD backgrounds will lead the lifestyle of their choice, in keeping with the Commonwealth Reablement, Health and Wellbeing aged and community care policies. Culturally-targeted, responsive, consumer-driven activities are but a few of the secret ingredients that are featured in every session. Consumer-directed care, reablement, health and wellbeing concepts, Montessori principles in aged care, and a cultural competency framework were combined and embedded in the planning and delivery of the program. Creating a culturally meaningful environment supports the participants’ confidence and freedom to engage at their own pace while doing activities that recognise individual cultural identities. Results: All activities were devised in consultation with participants. Responsive and targeted cultural activities created a sense of belonging and mutual support, overcoming a sense of social isolation. The music program provided health and wellbeing through body movement and dance. In JAPA Vol. 24, Suppl., 2016

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response to the requests from the participants, a band playing live music was also introduced. Conclusion: We have developed a trusting relationship with all the culturally diverse participants attending Café 94 and participants have socially connected with each other. References: Commonwealth of Australia (Department of Social Services). (2015). National Ageing and Aged Care Strategy for People from Culturally and Linguistically Diverse (CALD) Backgrounds. Canberra, Australia: Commonwealth of Australia. What Matters Most for Satisfaction with Active Ageing in Residential Care: Resident, Family, and Staff Perceptions Yeung, Polly; Rodgers, Vivien; Dale, Michael Massey University, Palmerston North, New Zealand; [email protected], [email protected] Introduction: A rapidly ageing population and increased life expectancy have led to an escalating need for residential aged care services in New Zealand. While successive governments have encouraged ageing in place, the complex health needs of the oldest-old require greater levels of care/support than can be safely provided at home. Provision of opportunities for active ageing is a major quality indicator for aged care services; however, little is known about its relative importance to stakeholders. Differing perceptions may lead to dissonance between levels of satisfaction with care provision. The Eden Alternative is a model aimed at promoting autonomy, self-determination, and wellbeing as attainable goals in aged care. This study compared how different stakeholders (residents, family, staff) in a facility instituting Eden principles perceive the factors that matter most to active ageing in residential care. Methods: A cross-sectional survey design was used to distribute Eden Warmth Surveys (EWS) to semi-dependent aged-care residents (EWS-R), residents’ family members (EWS-F), and staff (EWS-S) of a large residential facility in New Zealand. Results were analysed independently and then compared across groups using analysis of variance and multiple regressions methods. Results: Each of the stakeholder groups reported different factors as being important to their satisfaction with opportunities for active ageing in the facility. Residents were most concerned with their relationships with staff, while family members considered involvement in organized activities the priority. Staff reported time and resources as being the most important factors in providing opportunities for active ageing. Conclusion: Perception of the importance of active ageing in residential care varies across stakeholder groups. For effective, ongoing change to occur in the quality of active ageing opportunities available to residents, the shape and importance of this to the older people themselves must be the initial indicator. The emphasis on resident–staff relationships cannot be ignored. Development and Feasibility of the Nutrition and Functionality Assessment (NFA) Among Japanese Community-Dwelling Older Adults Okubo, Yoshiro1,2,3; Nemoto, Miyuki1,2; Osuka, Yosuke1,2; Jung, Songee1; Seino, Satoshi4; Figueroa, Rafael1; Vinyes, Gerard5; Offord, Elizabeth6; Shevlyakova, Maya6; Arigoni, Fabrizio7; Breuille, Denis6; Tanaka, Kiyoji1 1University of Tsukuba, Tsukuba, Japan; [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] 2The Japan Society for the Promotion of Science, Tokyo, Japan 3Neuroscience Research Australia, Sydney, Australia 4Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; [email protected] 5Nestle Research Center, Beijing, China; [email protected] 6Nestle Research Center, Lausanne, Switzerland; [email protected], [email protected], denis.breuille@rdls. nestle.com 7Nestle

Research Center, Singapore; [email protected]

Introduction: The Nutrition and Functionality Assessment (NFA) is a new screening tool designed to identify older adults who would benefit from a personalized nutrition and exercise program to comprehensively improve their nutritional and functional status. The purpose of the study was to evaluate the feasibility of the NFA among Japanese older adults and to determine the cut-off values used to classify them into three levels in each tri-dimension (nutrition, strength, and endurance). Methods: A total of 301 Japanese community-dwelling older adults aged 65–90 years participated in this crosssectional study. Gait speed was used as an initial screen to identify the target population who could respond to functional stimulation and exclude the very frail and very fit individuals. The Mini Nutrition Assessment short-form (MNA-SF), protein intake assessment, 6-min walk, sit-to-stand, and hand-grip strength tests were conducted as main parts of the NFA, which was followed by a week of physical activity monitoring using a three-axis accelerometer. The cut-off points to classify the target population into three levels were determined as tertiles (33 and 66 percentiles) of each value obtained. Results: Out of 301 participants enrolled, 267 subjects (89%) did the gait speed test. 185 of them (61%) had gait speed between 0.6–1.5 m/s, and classified as the target population for NFA. Nutrition (0–7, 8–11, and 12–14 points for MNA; < 0.8 g/kg, 0.8–1.5 g/kg, and > 1.5 g/kg for protein intake), strength (number of chair rises is ≤ 17, 18–21, and ≥ 22; hand-grip strength ≤ 33, 34–36, and ≥ 37 kg for men and ≤ 21, 22–23, and ≥ 24 kg for women), and endurance (6-minute walk: ≤ 571, 572–618, and ≥ 619 m for men and ≤ 520, 521–587, and ≥ 588 m for women) were stratified into three levels. The physical assessment of the NFA was completed, on average, in 14.8 ± 2.1 min, with no direct adverse events reported in the following week. Conclusion: The current study suggests a good feasibility of the NFA to identify a suitable, responsive population for targeted improvement of nutritional and functional status among community-dwelling older adults in Japan. Further investigation is needed to explore the utility of the NFA and a subsequent personalized nutrition and exercise program. Effects of Exercise Interventions Targeting Older Married Couples on Exercise Adherence: A One-Year Follow-Up Study Osuka, Yosuke1; Jung, Songee2; Kim, Taeho2; Okubo, Yoshiro1; Kim, Eunbi2; Tanaka, Kiyoji2 1The

Japan Society for the Promotion of Science, Tokyo, Japan; [email protected], [email protected] of Tsukuba, Ibaraki, Japan; [email protected], [email protected], [email protected], [email protected]

2University

Introduction: Previous studies have suggested that spousal support could promote a husband’s or a wife’s adherence to exercise (Gellert et al., 2011; Pettee et al., 2006). We have also reported that exercise interventions targeting older married couples may be useful for maintaining higher exercise JAPA Vol. 24, Suppl., 2016

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adherence over supervised periods (Osuka et al., 2015). However, it remains unclear whether the exercise intervention would have similar effects on exercise adherence in the long term or over non-supervised periods. We aimed to examine the effects of an exercise intervention on the exercise adherence of older married couples over a one-year follow-up period. Methods: Thirty-six older married couples and 61 older adults participated in this study as couple and noncouple groups (NCG). We provided an eight-week supervised program and followed up with all participants for one year, during which exercise adherence was measured using a habitual exercise diary and was assessed as practice rates of walking (2 days/week) and strength exercises (6 items for 2 days/week). Multivariable logistic regression analyses, which were adjusted for age and sex, were conducted to obtain odds ratios and 95% confidence intervals of the CG for walking and strength exercise practices during the one-year follow-up. The results of the NCG were used as comparative values. Results: Although the practice rates of walking and strength exercises in the CG tended to be higher than those in the NCG (walking: 44.1% NCG vs. 55.9% CG; strength exercise: 67.8% NCG vs. 76.5% CG), there were no significant differences in the practice rates of walking and strength exercises between the two groups (walking: P = .184; strength exercise: P = .275). Multivariable logistic regression analyses showed that odds ratios for walking and strength exercises did not significantly differ between the two groups (walking: 1.61 [0.74–3.51]; strength exercise: 1.34 [0.56–3.20]). Conclusion: These results suggest that exercise interventions targeting older married couples is useful for maintaining higher exercise adherence over supervised periods; however, the effects may not differ between participation for couple and non-couple participants over non-supervised periods. A blinded randomized controlled trial is needed to confirm this conclusion. References: Gellert, P., Ziegelmann, J.P., Warner, L.M., & Schwarzer, R. (2011). Physical activity intervention in older adults: does a participating partner make a difference? European Journal of Ageing, 8, 211–219. Pettee, K.K., Brach, J.S., Kriska, A.M., Boudreau, R., Richardson, C.R., Colbert, L.H., & Newman, A.B. (2006). Influence of marital status on physical activity levels among older adults. Medicine & Science in Sports & Exercise, 38, 541–546. Osuka, Y., Jung, S., Kim, T., Okubo, Y., Kim, E., & Tanaka, K. (2015). Effects of exercise for older married couples on exercise adherence and physical fitness. The Japanese Journal of Physical Fitness and Sports Medicine, 64, 407–418.

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