Search

Tai ji quan, a moderate-intensity mind–body exercise, has been shown to improve cognition in healthy older adults. This study compares the effectiveness of cognitively enhanced tai ji quan with standard tai ji quan and with stretching exercise in improving cognition and task performance in older adults with mild cognitive impairment or self-reported memory concerns. Visual Abstract. Clinical Effectiveness of Cognitively Enhanced Tai Ji Quan Training on Global Cognition and Dual-Task Performance During Walking in Older Adults With Mild Cognitive Impairment or Self-Reported Memory Concerns: Tai ji quan, a moderate-intensity mind–body exercise, has been shown to improve cognition in healthy older adults. This study compares the effectiveness of cognitively enhanced tai ji quan with standard tai ji quan and with stretching exercise in improving cognition and task performance in older adults with mild cognitive impairment or self-reported memory concerns. Background: Mild cognitive impairment (MCI) negatively impacts cognition and dual-task abilities. A physical–cognitive integrated treatment approach could mitigate this risk for dementia. Objective: To compare the effectiveness of cognitively enhanced tai ji quan versus standard tai ji quan or stretching exercise in improving global cognition and reducing dual-task walking costs in older adults with MCI or self-reported memory concerns. Design: 3-group, randomized (1:1:1), superiority trial. (ClinicalTrials.gov: NCT04070703) Setting: Community residential homes. Participants: 318 older adults with self-reported memory decline or concern and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline. Intervention: Cognitively enhanced tai ji quan (n = 105), standard tai ji quan (n = 107), or stretching (n = 106). All groups exercised at home via real-time videoconferencing, 1 hour semiweekly for 24 weeks. Measurements: The co–primary endpoints were change in Montreal Cognitive Assessment (MoCA; range, 0 to 30) and dual-task walking costs (difference between single- and dual-task gait speed, expressed in percentage) from baseline to 24 weeks. Secondary outcomes included CDR–Sum of Boxes (CDR-SB), Trail Making Test B, Digit Span Backward (DSB), and physical performance tests. Outcomes were assessed at 16, 24 (primary endpoint), and 48 weeks (6 months after intervention). Results: A total of 304 participants (96%) completed the 24-week assessment. Cognitively enhanced tai ji quan outperformed standard tai ji quan and stretching with a greater improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] and 2.8 points [CI, 2.1 to 3.6 points], respectively) and in dual-task walking (mean difference, 9.9% [CI, 2.8% to 16.6%] and 22% [CI, 13% to 31%], respectively). The intervention effects persisted at 48-week follow-up. Limitation: There was no nonexercise control group; participants had subjective or mild cognitive impairment. Conclusion: Among community-dwelling older adults with MCI, cognitively enriched tai ji quan therapy was superior to standard tai ji quan and stretching exercise in improving global cognition and reducing dual-task gait interference, with outcomes sustained at 48 weeks. Primary Funding Source: National Institute on Aging. [ABSTRACT FROM AUTHOR]

Objective Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer's disease and related dementias, mild cognitive impairment). Results We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice. PROSPERO Registration number: CRD42020202094. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Purpose: Emerging evidence indicates exercise training improves mobility and cognition and reduces falls in older adults, but underlying mechanisms are not well understood. This study tested the hypothesis that change in dual-task walking capacity mediates the positive effect of Tai Ji Quan and multimodal exercise on physical performance, activity confidence, global cognition, and falls among community-dwelling older adults at high risk of falling. Methods: We conducted a secondary analysis of a 6-month randomized clinical trial comparing Tai Ji Quan: Moving for Better Balance (TJQMBB) and multimodal exercise to stretching exercise in a sample of 670 adults older than 70 yr who had a history of falls or impaired mobility. Distal outcome measures, ascertained at a 12-month follow-up, were the Short Physical Performance Battery, Activities-Specific Balance Confidence, Montreal Cognitive Assessment, and falls. The mediator hypothesized to account for the intervention effects was dual-task cost estimated by calculating changes in gait speed from single-task to dual-task walking from baseline to the end of intervention. Results: At 12 months, compared with stretching exercise, multimodal exercise significantly improved Short Physical Performance Battery and Activities-Specific Balance Confidence outcomes and reduced the number of falls (P < 0.05). However, it did not lower dual-task cost or mediate the intervention effects on distal outcomes. In contrast, TJQMBB significantly reduced dual-task cost relative to multimodal and stretching exercises (P < 0.05) which in turn resulted in improvements in lower-extremity physical performance, activity confidence, global cognitive function, and reductions in falls (P < 0.05) during follow-up. Conclusions: Enhanced dual-task walking capacity as a result of Tai Ji Quan training mediated improvements in physical and cognitive outcomes in older adults at high risk of falling. [ABSTRACT FROM AUTHOR]

Background: Data on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling.Methods: We conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions-TJQMBB, multimodal exercise, or stretching exercise (control)-each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon.Results: The total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered.Conclusions: Among community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.Trial Registration: Clinicaltrials.gov (NCT02287740). [ABSTRACT FROM AUTHOR]

Assesses the cross-cultural validity of the Task and Ego Orientation in Sport Questionnaire (TEOSQ) using male college students across the United States, Thailand and Taiwan and the factorial equivalence and structured latent mean differences of the TEOSQ in these samples. Relationship between task and ego orientation; Evaluation of the TEOSQ factor structure across countries.

Presents a study designed to assess the factor analysis of the Group Environment Questionnaire, within a hypothesis-testing framework. Method of study; Results; Discussion.

Contends that the failure to provide medical support is a breach of authority's obligation to minimize the risks and maximize the potential for athletes. Author's arguments for the inclusion of medical personnel on representative teams; Author's reply to the arguments against inclusion of medical personnel.

Objectives. To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. Methods. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. Results. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. Conclusions. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIM: To address the unusual phenomenon of unbroken blades causing penetrating hand injuries in sabre fencing by applying the van Mechelen model of the 'sequence of prevention'. METHODS: Cases were collected from three surveillance systems and snowball sampling, and examined for potential aetiological factors. Presumed contributing factors were evaluated against the available evidence to compile a viable list for change. Determining a prevention strategy was guided by the philosophy of developing an approach that was most likely to produce a meaningful reduction in these injuries with the least disruption to the current norms of competitive sabre fencing. RESULTS: Nine factors which contributed, either individually or in some combination, to these injuries were grouped under three headings relating to: (1) the nature of modern sabre fencing, (2) the design of the sabre blade and (3) the vulnerability of the hand. Changes to the design and integrity of sabre gloves were selected as the most feasible option and new standards were introduced as compulsory in international competitions from 1 April 2014. The effect of this change is now being monitored via available surveillance systems. CONCLUSIONS: The van Mechelen model is a useful framework for sports federations to apply to reduce injury risk, even for rare injuries. However, this research model has limitations in guiding the realities of sometimes competing interests among the scientific, political, financial and technical aspects of injury prevention interventions. [ABSTRACT FROM AUTHOR]

Background/aim To address the unusual phenomenon of unbroken blades causing penetrating hand injuries in sabre fencing by applying the van Mechelen model of the 'sequence of prevention'. Methods Cases were collected from three surveillance systems and snowball sampling, and examined for potential aetiological factors. Presumed contributing factors were evaluated against the available evidence to compile a viable list for change. Determining a prevention strategy was guided by the philosophy of developing an approach that was most likely to produce a meaningful reduction in these injuries with the least disruption to the current norms of competitive sabre fencing. Results Nine factors which contributed, either individually or in some combination, to these injuries were grouped under three headings relating to: (1) the nature of modern sabre fencing, (2) the design of the sabre blade and (3) the vulnerability of the hand. Changes to the design and integrity of sabre gloves were selected as the most feasible option and new standards were introduced as compulsory in international competitions from 1 April 2014. The effect of this change is now being monitored via available surveillance systems. Conclusions The van Mechelen model is a useful framework for sports federations to apply to reduce injury risk, even for rare injuries. However, this research model has limitations in guiding the realities of sometimes competing interests among the scientific, political, financial and technical aspects of injury prevention interventions. [ABSTRACT FROM AUTHOR]

Background Falls are the leading cause of injury death in older adults and present a significant public health problem and a major burden to healthcare. Although there is sufficient evidence from randomized controlled trials to indicate that exercise can prevent falls in older people, few effective, evidence-based fall prevention programs exist in community practice. Thus, there is a pressing need to translate and disseminate evidence-based exercise programs to community providers that serve older adults at increased risk of falling. The current study addresses this public health need by disseminating the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program through community senior centers. Methods/Design The study uses a single-group design in which the TJQMBB program is being delivered to community-dwelling older adults through collaboration with senior centers in selected counties in Oregon, USA, for 48 weeks, followed by a 24-week post-intervention follow-up. Study process and outcome measures will be evaluated in accordance with the components of the RE-AIM framework that focus on Reach, Effectiveness, Adoption, Implementation and Maintenance. Discussion This study will determine whether the evidence-based TJQMBB fall prevention program can be disseminated through a broad spectrum of community-based senior centers that often cater to low-income, underserved community-dwelling older adults at risk of falling. If shown to be both practically implementable and sustainable, the TJQMBB program will provide an effective, potentially low-cost, easy-to-implement intervention that could be used by public health practitioners and community-based organizations to address the problem of falls among older adults. Trial registration ClinicalTrials.gov Identifier: NCT01854931 [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated whether Tai Ji Quan: Moving for Better Balance (TJQMBB) could improve global cognitive function in older adults with cognitive impairment. Using a nonrandomized control group pretest–posttest design, participants aged ≥65 years who scored between 20 and 25 on the Mini-Mental State Examination (MMSE) were allocated into either a 14-week TJQMBB program (n =22) or a control group (n =24). The primary outcome was MMSE as a measure of global cognitive function with secondary outcomes of 50-ft speed walk, Timed Up&Go, and Activities-Specific Balance Confidence (ABC) scale. At 14 weeks, Tai Ji Quan participants showed significant improvement on MMSE (mean=2.26, p <0.001) compared to controls (mean=0.63, p =0.08). Similarly, Tai Ji Quan participants performed significantly better compared to the controls in both physical performance and balance efficacy measures (p <0.05). Improvement in cognition as measured by MMSE was related to improved physical performance and balance efficacy. These results provide preliminary evidence of the utility of the TJQMBB program to promote cognitive function in older adults in addition to physical benefits. [Copyright &y& Elsevier]

ABSTRACT A previous randomized, controlled trial of tai chi showed improvements in objectively measured balance and other motor-related outcomes in patients with Parkinson's disease. This study evaluated whether patient-reported outcomes could be improved through exercise interventions and whether improvements were associated with clinical outcomes and exercise adherence. In a secondary analysis of the tai chi trial, patient-reported and clinical outcomes and exercise adherence measures were compared between tai chi and resistance training and between tai chi and stretching exercise. Patient-reported outcome measures were perceptions of health-related benefits resulting from participation, assessed by the Parkinson's Disease Questionnaire (PDQ-8) and Vitality Plus Scale (VPS). Clinical outcome measures included motor symptoms, assessed by a modified Unified Parkinson's Disease Rating Scale-Motor Examination (UPDRS-ME) and a 50-foot speed walk. Information on continuing exercise after the structured interventions were terminated was obtained at a 3-month postintervention follow-up. Tai chi participants reported significantly better improvement in the PDQ-8 (−5.77 points, P = 0.014) than did resistance training participants and in PDQ-8 (−9.56 points, P < 0.001) and VPS (2.80 points, P = 0.003) than did stretching participants. For tai chi, patient-reported improvement in the PDQ-8 and VPS was significantly correlated with their clinical outcomes of UPDRS-ME and a 50-foot walk, but these correlations were not statistically different from those shown for resistance training or stretching. However, patient-reported outcomes from tai chi training were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient-reported outcomes from resistance training or stretching. Tai chi improved patient-reported perceptions of health-related benefits, which were found to be associated with a greater probability of exercise adherence. The findings indicate the potential of patient perceptions to drive exercise behavior after structured exercise programs are completed and the value of strengthening such perceptions in any behavioral intervention. [ABSTRACT FROM AUTHOR]

Objectives To investigate the dissemination potential of a Tai Ji Quan-based program, previously shown to be efficacious for reducing risk of falls in older adults, through outpatient clinical settings. Design A single-group pre/post design in which participants attended a twice-weekly Tai Ji Quan training program for 24 weeks. Setting Communities in Lane County, Oregon. Participants Independently living individuals (N = 379) aged 65 and older. Measurements Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred individuals agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy). Results Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 individuals referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior and community centers with good fidelity, 283 completed the program (75% retention), and 212 of these attended 75% or more of the 48 sessions. Participants reported a reduction in falls, with an incidence rate of 0.13 falls per person-month, and showed significant improvement from baseline in all outcome measures. A 3-month postintervention follow-up indicated encouraging levels of program maintenance among providers, participants, and community centers. Conclusion Healthcare providers successfully implemented a protocol to refer individuals at risk of falling to a Tai Ji Quan-based program. The evidence-based program appears readily scalable and exportable, with potential for substantial clinical and public health effect. [ABSTRACT FROM AUTHOR]

Background: Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. Methods: We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. Results: The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. Conclusions: Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.) [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Few studies have examined interaction effects between person and environment, especially for cardiovascular disease (CVD) risk. The purpose of this study was to examine built environment characteristics and resident health behaviors as they relate to change in blood pressure, an important component of CVD. Methods: Participants (N =1145, aged 50–75 at baseline) were recruited from 120 neighborhoods in Portland, Oregon. Using a longitudinal design, we assessed changes in participants'' systolic and diastolic blood pressure from baseline to 1-year follow-up (2006–2007 to 2007–2008). Independent variables included baseline neighborhood-level measures of GIS-constructed neighborhood walkability and density of fast-food restaurants, and resident-level measures of meeting physical activity recommendations and eating fruits and vegetables. Results: There was a small but significant resident-level increase in both systolic and diastolic blood pressure (P <0.001) over the 1-year observation period. A similar trend was also observed at the neighborhood level (P <0.001). Significant differences in change in blood pressure, by neighborhood walkability, were observed, with decreases in systolic and diastolic blood pressure for those living in high walkable neighborhoods (P <0.001). Neighborhoods of low walkability but with a high density of fast-food outlets and residents making visits to fast-food restaurants were significantly associated with increases in blood pressure measures over time. The negative effect of fast-food restaurants on blood pressure was diminished among high-walkable neighborhoods, with benefits observed among residents meeting guidelines for physical activity and eating fruits and vegetables. Conclusions: Neighborhoods with high walkability may ameliorate the risk of hypertension at the community level and promotion of neighborhood walkability could play a significant role in improving population health and reducing CVD risk. [Copyright &y& Elsevier]

Purpose. Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial and sociodemographic characteristics. Design. Cross-sectional and multilevel design. Setting. Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon. Subjects. A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate). Measures. A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity. Analyses. Multilevel logistic regression analyses. Results. Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI ≥ 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705- 38.086) for non-Hispanic black residents. Conclusion. Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the built environment and its association with health—especially excess adiposity—and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship. Methods: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50–75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI ≥25), three walking activities, and physical activity. Data were collected in 2006–2007 and analyzed in 2007. Results: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics. Conclusions: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population. [Copyright &y& Elsevier]

Tai Chi — Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings. [ABSTRACT FROM AUTHOR]

The article discusses the results of a five-year study from 2002 to 2007 that estimated the incidence of time-loss injuries in competitive fencing in U.S. national championships and characterized the injuries based on type and location. The researchers found that the rate of time-loss injury in competitive fencing is low and that the predominant characteristics of sprain and strain in the lower extremities such as the knees and ankles are similar to other sports with ballistic action in stop-start and rapid change-of-direction activities.

Background. The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. Methods. This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. Results. At the end of the 6-month intervention, significantly fewer falls (n = 38 vs 73; p = .007), lower proportions of fallers (28% vs 46%; p = .01), and fewer injurious falls (7% vs 18%; p = .03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio, .45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p < .001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. Conclusions. A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive... [ABSTRACT FROM AUTHOR]

Determines whether a six-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy, physically inactive older individuals. Improvement across all functional status measures by study participants; Number of limited responses on physical functioning at baseline and termination; Percentage of improvement at termination.

Presents a study which conducted an additional validation analysis on the Task and Ego Orientation in Sport Questionnaire (TEOSQ), with an investigation of its measurement model with cross-validation. What is required to carry out the process of cross-validation; Indications that the findings of the study supports the construct validity of the TEOSQ as a measure of achievement and goal achievement; Methods employed in the study.

Tests the simplex structure underlying the sport motivation scale via structural equation modeling. Score correlations; Calculations for reliability; Measures and parameters of goodness-of-fit model; Estimates and variances for model; Evidence of simplex structure.

Examines the construct validity of achievement goal orientation in sport in a sample of male and female college students. Use of structural equation modeling procedures in testing measurement invariance and latent mean structure of the Task & Ego Orientation in Sport Questionnaire (TEOSQ); Factor structure of the TEOSQ.

Examines the approach to testing effects using structural equation modeling methodology (SEM) in interactive relationship. Interactive effect of perceptions of competence and perceptions of autonomy on exercise intrinsic motivation; Analysis of interaction effects with SEM methodology; Implications of the different interactive relationship approach.

A response by F. Li, P. Harmer and R. Glasgow to a letter to the editor about their article "Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program," in the previous issue of the journal is presented.

Background: Falls are the leading cause of injury death in older adults and present a significant public health problem and a major burden to healthcare. Although there is sufficient evidence from randomized controlled trials to indicate that exercise can prevent falls in older people, few effective, evidence-based fall prevention programs exist in community practice. Thus, there is a pressing need to translate and disseminate evidence-based exercise programs to community providers that serve older adults at increased risk of falling. The current study addresses this public health need by disseminating the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program through community senior centers.Methods/design: The study uses a single-group design in which the TJQMBB program is being delivered to community-dwelling older adults through collaboration with senior centers in selected counties in Oregon, USA, for 48 weeks, followed by a 24-week post-intervention follow-up. Study process and outcome measures will be evaluated in accordance with the components of the RE-AIM framework that focus on Reach, Effectiveness, Adoption, Implementation and Maintenance.Discussion: This study will determine whether the evidence-based TJQMBB fall prevention program can be disseminated through a broad spectrum of community-based senior centers that often cater to low-income, underserved community-dwelling older adults at risk of falling. If shown to be both practically implementable and sustainable, the TJQMBB program will provide an effective, potentially low-cost, easy-to-implement intervention that could be used by public health practitioners and community-based organizations to address the problem of falls among older adults.Trial Registration: ClinicalTrials.gov Identifier: NCT01854931. [ABSTRACT FROM AUTHOR]

Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs. [ABSTRACT FROM AUTHOR]

Presents information on a method for multilevel covariane structural modeling for analyzing a standard confirmatory factor analytic model with multilevel data. What the example used to demonstrate this method examines; Findings of the study outlined.

Presents an abstract on determination of cross-cultural validity of the factor structure of the Task and Ego Orientation in Sport Questionnaire for Thai athletes. Psychological measures in sport; Confirmatory factor analysis; Sexual differences in the reliability of the test.

Presents an abstract on the validation of Group Environment Questionnaire construct. Perceptions of group cohesiveness in sport; Four subscales in the multidimensional measures.

Presents an abstract on the effect of slideboard training on agility and cardiovascular efficiency. Movements in slideboard training; Increase of the duration of each set; Training effect in highly trained individuals.

Pedagogical innovations, ideas, and outcomes designed to enhance student learning in physiology courses are encouraged by our professional organizations and are actively discussed at conferences and in Advance in Physiological Education. Here, we report our experiment with freely available internet-based material as a substitute for the textbook for a single chapter on muscle physiology in a sophomore-level Human Physiology course. Student reactions to the textbookless curriculum were registered with the use of a questionnaire. Their responses indicated that they enjoyed the online material (animations, images, reviews, etc.), the emphasis on important concepts, and the variety of resources. Furthermore, students were almost unanimous in their praise for such pedagogical approaches to science education. Yet, students were reluctant to part with their textbooks. We believe that with subsequent iterations of this course we will be more successful at further separating the learning experience from the textbook. Reliance on freely available material may eventually relieve students from the burden of purchasing a costly textbook. [ABSTRACT FROM AUTHOR]

To determine the relative effects of cobblestone mat walking, in comparison with regular walking, on physical function and blood pressure in older adults. Randomized trial with allocation to cobblestone mat walking or conventional walking. General community in Eugene, Oregon. One hundred eight physically inactive community-dwelling adults aged 60 to 92 (mean age±standard deviation=77.5±5.0) free of neurological and mobility-limiting orthopedic conditions. Participants were randomized to a cobblestone mat walking condition (n=54) or regular walking comparison condition (n=54) and participated in 60-minute group exercise sessions three times per week for 16 consecutive weeks. Primary endpoint measures were balance (functional reach, static standing), physical performance (chair stands, 50-foot walk, Up and Go), and blood pressure (systolic, diastolic). Secondary endpoint measures were Short Form-12 physical and mental health scores and perceptions of health-related benefits from exercise. At the 16-week posttest, differences between the two exercise groups were found for balance measures ( P=.01), chair stands ( P<.001), 50-foot walk ( P=.01), and blood pressure ( P=.01) but not for the Up and Go test ( P=.14). Although significant within-group changes were observed in both groups for the secondary outcome measures, there were no differences between intervention groups. Cobblestone mat walking improved physical function and reduced blood pressure to a greater extent than conventional walking in older adults. Additional benefits of this walking program included improved health-related quality of life. This new physical activity may provide a therapeutic and health-enhancing exercise alternative for older adults. [ABSTRACT FROM AUTHOR]

This study examined the role of falls self-efficacy as a potential mediator of the exercise and fear-of-falling relationship. The study sample involved 256 community-dwelling older adults aged 70-92 years (M = 77.48, SD = 4.95) who were recruited from a local health care system in Portland, Oregon, and participated in either a Tai Chi (n = 125) or a stretching control (n = 131) exercise intervention, three times per week, for 6 consecutive months. Measures of falls self-efficacy and fear of falling were assessed at baseline and at 3-month and 6-month follow-ups. Intention-to-treat analyses were conducted to evaluate the hypothesis of falls self-efficacy as a mediator of change in fear of falling that resulted from the 6-month Tai Chi intervention. Results supported the mediational hypothesis in that Tai Chi participants, who evidenced improvement in falls self-efficacy over the course of the intervention, reported greater reductions in fear of falling, compared with those in the stretching control condition. Results suggest that exercise interventions designed to improve falls self-efficacy are likely to reduce fear of falling in older adults. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. Randomized, controlled trial with allocation to tai chi or exercise control. General community. One hundred eighteen women and men aged 60 to 92. Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) ( P<.01), PSQI global score ( P=.001), and ESS scores ( P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=–28.64 to –7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71–82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals. [ABSTRACT FROM AUTHOR]

Examines heterogeneity in response patterns of the participants of the Survey of Activities and Fear of Falling in the Elderly (SAFFE). relationship between SAFFE Fear of falling and activity level; Presentation of the mean scores and standard deviations for the dependent outcome variables by SAFFE Fear-of-Falling status.

Data collected from longitudinal designs often have correlated observations arising from repeated measurements on the same subject. Conventional statistical methods (e.g., ordinary least squares linear regression, univariate analysis of variance with repeated measures) that assume independence of observations can be inadequate in providing test statistics. Liang and Zeger (1986) proposed a class of generalized estimating equations (GEE) to account for dependence among observations. The article provides a descriptive introduction to GEE and an example illustrating its use in continuous response data with a multivariate normal distribution. A discussion on the utility of the GEE procedure in longitudinal data analysis is provided. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the prevalence of overweight and obesity in older adults in the U.S.

The authors discusses how air pollution problem in China poses a varied health threat to outdoor physical activity. They mention how regular physical activity and exercise is beneficial for mental and physical health which include decreased risk of premature morbidity and mortality. They report on air pollution situation in China which has negative health impact and how involvement in outdoor physical activity highly risky.

Grounded in the conceptual framework of the Sport Commitment Model and previous empirical studies conducted in Western countries, this study was designed to (a) test and validate a Thai version of the Athlete Opinion Survey to assess components of the Sport Commitment Model in Thai youth athletes and (b) examine structural relationships among various constructs of the Sport Commitment Model as assessed by the Thai version of the Athlete Opinion Survey. Survey data were collected from 1,704 Thai youth athletes and analyzed via structural equation modeling methodologies to establish evidence for validity and measurement reliability. Results from various analyses indicated adequate support for the hypothesized factorial structure and acceptable reliability estimates of the Thai version of the Athlete Opinion Survey subscales. Moreover, modeling analyses showed empirical support for the hypothesized structural relationships underlying the Sport Commitment Model in the Thai youth athlete population. The findings from this study have implications for a better understanding of sport commitment in different cultural settings. [ABSTRACT FROM AUTHOR]

Objective: Few studies have examined interaction effects between person and environment, especially for cardiovascular disease (CVD) risk. The purpose of this study was to examine built environment characteristics and resident health behaviors as they relate to change in blood pressure, an important component of CVD.Methods: Participants (N=1145, aged 50-75 at baseline) were recruited from 120 neighborhoods in Portland, Oregon. Using a longitudinal design, we assessed changes in participants' systolic and diastolic blood pressure from baseline to 1-year follow-up (2006-2007 to 2007-2008). Independent variables included baseline neighborhood-level measures of GIS-constructed neighborhood walkability and density of fast-food restaurants, and resident-level measures of meeting physical activity recommendations and eating fruits and vegetables.Results: There was a small but significant resident-level increase in both systolic and diastolic blood pressure (P<0.001) over the 1-year observation period. A similar trend was also observed at the neighborhood level (P<0.001). Significant differences in change in blood pressure, by neighborhood walkability, were observed, with decreases in systolic and diastolic blood pressure for those living in high walkable neighborhoods (P<0.001). Neighborhoods of low walkability but with a high density of fast-food outlets and residents making visits to fast-food restaurants were significantly associated with increases in blood pressure measures over time. The negative effect of fast-food restaurants on blood pressure was diminished among high-walkable neighborhoods, with benefits observed among residents meeting guidelines for physical activity and eating fruits and vegetables.Conclusions: Neighborhoods with high walkability may ameliorate the risk of hypertension at the community level and promotion of neighborhood walkability could play a significant role in improving population health and reducing CVD risk. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the built environment and its association with health-especially excess adiposity-and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship.Methods: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50-75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI>or=25), three walking activities, and physical activity. Data were collected in 2006-2007 and analyzed in 2007.Results: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics.Conclusions: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population. [ABSTRACT FROM AUTHOR]

Background: The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons.Methods: This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up.Results: At the end of the 6-month intervention, significantly fewer falls (n=38 vs 73; p=.007), lower proportions of fallers (28% vs 46%; p=.01), and fewer injurious falls (7% vs 18%; p=.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p<.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group.Conclusions: A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older. [ABSTRACT FROM AUTHOR]

Using a randomized controlled trial, this study examined whether a Tai Chi exercise program enhanced elderly individuals' psychological well-being. Participants either continued their daily routine activities or participated in a Tai Chi exercise class performing slow rhythmic movements. Psychological well-being measures were assessed at baseline, 3 months, and 6 months (termination of the class). Latent growth curve modeling methodology was used to analyze the repeated measures data. Results indicated that individuals who participated in the 6-month Tai Chi exercise program showed higher levels of health perceptions, life satisfaction, positive affect, and well-being and lower levels of depression, negative affect, and psychological distress. The implications of these findings are discussed relative to potential underlying mechanisms associated with the exercise-psychological health relation in older adults. [ABSTRACT FROM AUTHOR]

Data in social science research often have a multilevel structure, with observations on individuals nested within groups. However, such data have been routinely analyzed at the individual level, whereas the group level variation has been ignored. Recent developments in multilevel covariance structure modeling (MCSM; Muthén, 1994) provide a useful statistical tool for analyzing sources of variation due to both within- and between-group influences. The purpose of this study is to illustrate the use of multilevel confirmatory factor analysis (MCFA) via a didactic example of a 2-level (student vs. class) analysis of exercise intrinsic motivation to experience sensations (IM-ES) data. Application of MCFA revealed substantial variation in the IM-ES at both student and class levels. In addition, predictors designed to explain the between-class levels of IM-ES (class size, type of instructor, and type of activity) significantly predicted the class-level variation in the IM-ES. The study demonstrated the merit of using multilevel analytic techniques in substantive research where data have multilevel components. [ABSTRACT FROM AUTHOR]

Nearly all psychosocial survey datasets contain missing data. Recent advances in statistical theory, and implementation of the theory in modeling software, have made it possible to handle various types of missing data with the proviso that data are missing at random. This study presents an application of a confirmatory factor analysis with incomplete data, demonstrating the utility of several maximum likelihood-based missing data estimation procedures: multigroup, single group, and expectation maximization multiple-imputation. The substantive example used to demonstrate these procedures was a 2-factor measurement model of achievement goal orientation in sports with a sample size of 1,002. Of the total sample, 124 participants (12%) had incomplete data in the form of nonresponse. Initial analysis showed that the data missing were completely random. Subsequent modeling of the incomplete data revealed that, across the 3 data estimation procedures, parameter estimates were remarkably similar and standard errors of estimates were small in magnitude, suggesting the consistency of these procedures in analyzing incomplete data. [ABSTRACT FROM AUTHOR]