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Purpose Due to stay-at-home orders during COVID-19, we transitioned supervised, group, in-person resistance training interventions in two clinical trials in cancer survivors to live, online delivery using video-conferencing technology. We describe the feasibility, preliminary efficacy, and safety of live online group training and compare to in-person training. Methods Adherence (% sessions attended), retention (% participants completing intervention), and safety (# adverse events) data of resistance training groups from two randomized controlled trials in cancer survivors that participated before or during the COVID-19 pandemic were collated. Participants were post-treatment breast cancer survivors and their spouses (n = 62) and prostate cancer survivors (n = 32) (age range: 38-82 years). During COVID-19, delivery of supervised, group resistance exercise sessions was delivered live online via video-conference. Preliminary evidence for training efficacy was assessed by chair stand performance over the 6-month intervention. Results Feasibility of online resistance training was better than in-person for both studies (adherence: 86% vs 82% and 91% vs. 81% and retention 95% vs. 80% and 92% vs. 84% for online and in-person classes). Improvements in chair stand time were similar in prostate cancer and spouse groups that trained online vs. in-person, except for breast cancer survivors who improved more with in-person training (7% vs. 14% for online vs. in-person). Safety was similar between formats (12 vs. 11 adverse events for online vs. in-person). Conclusion Supervised, in-person group resistance training can be feasibly adapted for live, online delivery and could help broaden approaches to exercise delivery in cancer survivors, including older adults. Trial registration The studies described in this commentary were registered on ClinicalTrials.gov on August 3, 2018 (NCT03630354) and on October 30, 2018 (NCT03741335).

Fuzhong Li,1 Peter Harmer,2 Jan Voit,3 Li-Shan Chou4 1Oregon Research Institute, Eugene, OR, USA; 2Willamette University, Department of Exercise and Health Science, Salem, OR, USA; 3Voit Better Balance, Seattle, WA, USA; 4Iowa State University, Department of Kinesiology, Ames, IA, USACorrespondence: Fuzhong LiOregon Research Institute 1776 Millrace Dr., Eugene, OR 97403, USAEmail fuzhongl@ori.orgPurpose: This study evaluates the feasibility of delivering a virtual (online) falls prevention intervention for older adults with mild cognitive impairment (MCI).Methods: Community-dwelling older adults with MCI (mean age = 76.2 years, 72% women) were randomized to either a Tai Ji Quan (n = 15) or stretching group (n = 15) and participated in 60-minute virtual exercise sessions, via Zoom, twice weekly for 24 weeks. The primary outcome was the incidence of falls. Secondary outcomes were the number of fallers and changes from baseline in the 4-Stage Balance Test, 30-second chair stands, and Timed Up and Go Test under both single- and dual-task conditions.Results: The intervention was implemented with good fidelity, an overall attendance rate of 79%, and 13% attrition. Compared with stretching, Tai Ji Quan did not reduce falls (incidence rate ratio = 0.58; 95% confidence interval [CI], 0.32 to 1.03) or the number of fallers (relative risk ratio = 0.75; 95% CI, 0.46 to 1.22) at week 24. The Tai Ji Quan group, however, performed consistently better than the stretching group in balance (between-group difference in change from baseline, 0.68 points; 95% CI, 0.12 to 1.24), 30-second chair stands (1.87 stands; 95% CI, 1.15 to 2.58), and Timed Up and Go under single-task (− 1.15 seconds; 95% CI, − 1.85 to − 0.44) and dual-task (− 2.35; 95% CI, − 3.06 to − 1.64) conditions. No serious intervention-related adverse events were observed.Conclusion: Findings from this study suggest the feasibility, with respect to intervention fidelity, compliance, and potential efficacy, of implementing an at-home, virtual, interactive Tai Ji Quan program, delivered in real-time, as a potential balance training and falls prevention intervention for older adults with MCI. The study provides preliminary data to inform future trials.Keywords: cognitive function, dual-task, incidental falls, elderly, exercise, e-health

Influencing factors analysis plays an important role in plant disease identification. This paper explores the key influencing factors and severity recognition of pear diseases using deep learning based on our established pear disease database (PDD2018), which contains 4944 pieces of diseased leaves. Using the deep learning neural networks, including VGG16, Inception V3, ResNet50 and ResNet101, we developed a “DL network + resolution” scheme that can be used in influencing factors analysis and diseases recognition at six different levels. The experimental results demonstrated that the resolution is directly proportional to disease recognition accuracy and training time and the recognition accuracies for pear diseases are up to 99.44%,98.43%, and 97.67% for Septoria piricola (SP), Alternaria alternate (AA), and Gymnosporangium haracannum (GYM), respectively. The results also shown that a forward suggestion on disease sample collection can significantly reduce the false recognition accuracy.

Fuzhong Li,1 Peter Harmer2 1Oregon Research Institute, Eugene, OR 97403, USA; 2Department of Exercise and Health Science, Willamette University, Salem, OR, 97301, USACorrespondence: Fuzhong LiOregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, USAEmail fuzhongl@ori.orgPurpose: To compare the prevalence of falls, physical performance, and dual-task cost during walking between cognitively healthy and impaired older adults at high risk of falling.Methods: A cross-sectional analysis of 670 community-dwelling older adults who were considered at high risk of falling, operationalized as 1) having fallen at least once in the preceding 12 months and having a health-care practitioner’s referral indicating that the participant was at risk of falls or 2) having impaired mobility as evidenced by a Timed Up and Go (TUG) result ≥ 13.5 s. Participants (mean age = 77.7 years, SD = 5.6) were divided into cognitively healthy (n = 461) or cognitively impaired (n = 209) groups using a cutoff score of < 23 on the Montreal Cognitive Assessment test. Assessment included self-reported number of falls over the previous 12 months, functional reach, TUG, Short Physical Performance Battery (SPPB), and single- and dual-task walk performance. Data were analyzed using Poisson regression to estimate the prevalence ratios of falls and analysis of variance to examine between-group differences on physical performance and dual-task cost during walking performance.Results: In the analysis, 82.3% of older adults with cognitive impairment and 69.4% of unimpaired older adults reported 1 or more falls in the previous 12 months. Compared with cognitively healthy participants, those with cognitive impairment were 2.57 (95% confidence interval [CI] = 2.17 to 3.05) times more likely to have any fall and 2.33 (95% CI = 1.95 to 2.78) times more likely to have multiple falls. Older adults with cognitive impairment performed worse on functional reach (mean difference [MD] = − 2.33 cm, 95% CI = − 3.21 to − 1.46), TUG (MD = 3.05 s, 95% CI = 2.22 to 3.88), and SPPB (MD = − 1.24 points, 95% CI = − 1.55 to − 0.92) and showed increase in dual-task costs (MD = 6.59%, 95% CI = 4.19 to 9.03) compared to those without cognitive impairment.Conclusion: Older adults at high risk for falls and who have cognitive impairment are associated with a greater risk for falls and decrements in physical and dual-task performance.Keywords: cognitive impairment, dual-task, falls, elderly, physical performance

Highlights • The proportion of school-aged children and adolescents in China who engage in recommended levels of physical activity (PA), in or outside of school time, has been declining for decades. • Current PA promotion policies for Chinese schools are primarily “stand-alone” approaches and their efficacy appears limited. • Re-evaluating the problem from a comprehensive social-ecological perspective within a public health model offers greater potential for developing effective and culturally appropriate interventions to increase PA among Chinese youth. • If the goals of Healthy China 2030, including the prevention of the early onset of chronic diseases among Chinese children and adolescents, are to be met by reversing the trend of declining PA, careful consideration of this new paradigm is imperative.

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.

Background Many prostate cancer survivors are treated with androgen deprivation therapy (ADT), but these therapies may increase frailty, worsen physical functioning, and increase fall risk. While exercise may counter functional declines associated with ADT, no studies have tested whether and which type of exercise may reduce falls and frailty. The purpose of this trial is to compare the relative efficacy of strength training versus tai ji quan training against each other and to a stretching control group on falls, frailty, and physical functioning in men expose to ADT for prostate cancer. Methods Prostate cancer survivors treated with ADT (N = 360) who have fallen in the past year or are at risk of a fall based on validated risk factors will be recruited to participate in this single-blind, parallel group, randomized trial. Participants will be randomized to one of three supervised, group training programs: (i) strength training, (ii) tai ji quan training, or (iii) stretching (control), that train 3×/week for 6 months. Outcomes are assessed at baseline, 3 (mid-intervention), 6 (immediately post-intervention), and 12 (follow-up) months. The primary outcome is falls assessed by monthly self-report. Secondary outcomes include the following: frailty (low lean body mass (by bioelectrical impedance analysis), exhaustion (by SF-36 vitality scale), low activity (by CHAMPS physical activity survey), slowness (by 4 m usual walk speed), and weakness (by chair stand time)); objective and subjective measures of physical function will also be collected. Negative binomial regression models will be used to assess differences in falls between groups, while mixed effects modeling will be used to compare the relative efficacy of training group on secondary outcomes. Discussion Exercise represents a non-pharmacologic approach to mitigate the problem of falls experienced among men treated with ADT. By engaging in appropriate exercise, men may be able to avoid or delay falls, frailty, and disability associated with their cancer treatment. Findings of the trial are expected to inform clinical practice about how exercise could be prescribed as part of cancer care for prostate cancer survivors prescribed ADT. Trial registration ClinicalTrials.gov NCT03741335. Registered on November 18, 2018.

The Internet of Things (IoT) connects increasing number of smart devices, which makes the central authorities or third parties (e.g., cloud, fog, firewall, etc.) based authentication scheme very challenging. In recent, the blockchain shows great promises in IoT to provide secure and flexible authentication schemes. In this work, a blockchain enabled authentication scheme is proposed for IoT devices, which ensures a more secure and easily interoperable alternative to IoT systems. It makes it possible to switch smart devices from an untrust to a trusted data using blockchain.

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.

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation’s youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China’s more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6–17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Inspired by the facts that visual saliency captures more attention and spectral residual (SR) can indicate the saliency of the image, a novel reduced-reference image quality assessment metric is proposed based on the regularity of the SR. The orientation and frequency components of an image are first extracted in wavelet domain. Then SR is obtained to represent the saliency of the component. Next fractal dimension is adopted to encode SR and concatenated as the image features. Finally, the feature differences between reference image and distorted one are pooled as the quality score. The proposed metric is evaluated on four largest image databases (TID2013, TID2008, CSIQ, and LIVE databases), and experimental results confirm that the proposed metric has a good performance.

This follow-up analysis of a randomized clinical trial compares the effectiveness of tai ji quan, multimodal exercises, and stretching exercise interventions for older adults at high risk of falling., Key Points Question Is a therapeutically tailored tai ji quan intervention more effective than stretching exercise or a proven multimodal exercise intervention in decreasing injurious falls among community-dwelling older adults at high risk of falling? Findings In this follow-up analysis of a randomized clinical trial that included 670 older adults with a history of falls or impaired mobility, a therapeutic tai ji quan intervention, Tai Ji Quan: Moving for Better Balance, was significantly more effective for lowering the incidence of both moderate injurious falls compared with stretching exercise and serious injurious falls compared with stretching exercise and multimodal exercise. Meaning The therapeutically tailored tai ji quan training intervention proved to be more safe and effective than stretching or multimodal exercises in reducing the incidence of injurious falls in older adults at high risk of falling., Importance Exercise has been shown to reduce injurious falls in older adults. Evidence, however, is lacking regarding the types of intervention that are most effective in preventing injurious falls among older adults at high risk of falling. Objective To determine the longer-term effectiveness of therapeutic tai ji quan intervention vs multimodal exercise and stretching exercise in decreasing injurious falls among older adults at high risk of falling. Design, Setting, and Participants This trial involves a prespecified analysis with the data analyzed by intent-to-treat. Follow-up analysis of a single-blind randomized trial conducted in community settings of 7 urban and suburban cities in Oregon from February 20, 2015, to September 15, 2018, compared a therapeutic tai ji quan intervention with multimodal exercise and stretching exercise. Eligible participants were community-dwelling adults aged at least 70 years who were considered by a clinician to be at high risk of falling because they had fallen during the preceding year or who had impaired mobility with scores higher than 13.5 seconds on the Timed Up & Go test. Participants were randomized to 1 of the 3 interventions and were assessed monthly after randomization for 12 months, encompassing a 6-month active intervention phase and a 6-month after intervention follow-up phase. Interventions The 3 group-based interventions were therapeutic tai ji quan (Tai Ji Quan: Moving for Better Balance [TJQMBB]), multimodal exercise, and stretching exercise, each implemented twice weekly in 60-minute sessions for 24 weeks. Main Outcomes and Measures Primary outcomes were the incidence of moderate and serious injurious falls at 12 months, measured as incidence rate ratios (IRRs). Results Of the 1147 persons screened, 670 (mean [SD] age, 77.7 [5.6] years; 436 women [65.1%]) were randomly assigned to 1 of 3 intervention groups: 224 persons in TJQMBB, 223 in multimodal exercise, and 223 in stretching exercise. At 12 months, the unadjusted IRR for moderate injurious falls was lower in the TJQMBB (IRR, 0.51; 95% CI, 0.35-0.74; P

12075 Background: Women treated for cancer are more likely to fall than women without a cancer history. Exercise is a fall prevention strategy for older adults that we are testing in the GET FIT trial as a fall prevention approach in women cancer survivors. Increasing physical activity, though, could acutely increase the risk of falls in inactive survivors with known fall risk related to treatment. Knowing who might be at risk prior to beginning an exercise program would inform additional safety precautions during exercise. Methods: We conducted a secondary analysis of baseline data from the GET FIT trial that enrolled inactive, older women who had completed chemotherapy for cancer. Women completed objective (muscle strength, static postural control, range of motion, physical functioning) and self-report (fall history, comorbidities, presence of neuropathy symptoms, pain severity, depressive symptoms, cognitive functioning, perceptions of lower extremity functioning, disability, fear of falling, demographic, and clinical characteristics) measures at baseline. Falls were prospectively collected during the 6 month intervention using monthly self report. Potential predictors of falls were included if univariate tests revealed significant differences between fallers and non-fallers. To identify the strongest predictors of falls, we used an automated model selection and multimodel inference approach to perform an exhaustive model search. Results: Baseline data were available for 415 participants with known faller status at the end of the intervention, of whom 31.3% (n = 130) reported at least one fall. The average age of the sample was 62.1±6.4 years and consisted mostly of non-Hispanic white, married, highly educated, overweight or obese women treated for breast cancer. Fallers (1+ falls) and non-fallers significantly differed on measures of fall history, comorbidities, pain, neuropathy, fear of falling, disability, perceived lower extremity functioning, cognitive functioning, depression, and postural control. The best model of faller status (per BIC) included postural control (p = 0.004), perceived lower extremity functioning (p = 0.072), and fear of falling (p = 0.030). Odds of ≥1 fall during the intervention increased by 1.72 (95% CI: 1.05-2.83) times for a 0.1-point decrease in postural control, 1.11 (1.04-1.19) times for a 0.1-point increase in fear of falling, and 1.02 (1.00-1.03) times for a 1-point decrease in perceived lower extremity functioning. Conclusions: Women cancer survivors with poor balance, poor self-rated functioning, and a fear of falling may need to take additional fall precautions when starting an exercise program. Clinical trial information: NCT01635413.

12059 Background: Women with cancer are significantly more likely to fall than women without cancer but there are not yet any evidence-based fall prevention strategies that specifically target cancer survivors. The GET FIT trial compares the efficacy of two distinct types of exercise, strength training vs. tai ji quan, to prevent falls in women finished with chemotherapy. Methods: We conducted a 3 group, single-blind, parallel design, randomized controlled trial in older, inactive women cancer survivors treated with chemotherapy. Women were randomly assigned to 1 of 3 intervention groups: 1) strength training, 2) tai ji quan or 3) a placebo control group (stretching) that trained 2x/week for 6 months. Additional follow-up occurred 6 months after formal training stopped. The primary outcome was fall rate across 6-and 12 months; secondary outcomes, reflective of training fidelity, were maximal leg strength (by 1-repetition maximum) and dynamic postural control (by computerized dynamic posturography), collected at 0, 3, and 6 months. Results: 442 women (mean age 62.4 + 6.3 yrs.) were enrolled and randomly assigned to study groups. Over the 6 months prior to enrollment, 21% of the sample (n = 94) reported at least one fall (of which, 37% (n = 35) reported two or more falls)), and 12% (n = 51) reported at least one injurious fall. Retention across the 12 months study period was 88%, while adherence to the study interventions over 6 months averaged 73%, 71%, and 74% for the strength, tai ji quan and stretching (control) groups, respectively. 26% of the sample (n = 99 of 382) reported at least one fall during the intervention and 27% (n = 102) reported falls during follow up. Using regression models, there were no significant differences in the odds of having at least one fall during the intervention period (1-6 months) or across the entire follow-up period (1-12 months) between the control and either the strength or tai ji quan groups. At 6 months, the strength group showed a greater increase from baseline in maximal leg strength (+14.3 kg, 95% CI: 11.4-17.1) than the control group (+7.5 kg, 95% CI: 4.6-10.4, p = 0.002). Whereas, the tai ji quan group showed a greater increase in dynamic postural control (+2.42%, 95% CI: 1.36-3.48) compared to the control group (+0.35%, 95% CI: -0.69-1.38, p = 0.007). Conclusions: Despite evidence for fidelity of strength and tai ji quan training to improve muscle strength and postural control, respectively, neither program significantly lowered fall rates over a placebo control group. It is possible that the dose of exercise was too low and/or the sample was not at high risk of falls. The etiology of fall risk in women cancer survivors needs to be better understood as it may differ from risk factors in older adults. Future trials should consider patient-centered, tailored fall-prevention interventions for cancer survivors based on identified fall risk factors. Clinical trial information: NCT01635413.

Three decades of rapid economic development in China have not only benefited millions of Chinese by improving their living standards but have also dramatically increased the number of people who are part of the country's aging population. However, economic growth has not been accompanied by sufficient attention given to important public health issues, including an increase in the incidence of chronic diseases and a decline in physical activity (PA) that comes with an aging population. The rapid growth in China's older population will soon exert an impact on the nation's economy, population health status, and health behaviors, and will increase stress on its healthcare system. This review article provides a broad perspective on the impact of rapid economic development, industrialization, and urbanization on health-related behaviors, with a specific focus on PA among older adults. Specifically, the article offers an overview of the demographic context, significant public health challenges, evidence on PA and exercise interventions, and knowledge gaps and future directions for research.

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.

To quantify the perceptual quality of the color image, a novel reduced-reference computational model is proposed in this paper. The proposed metric, named regularity of color distribution measure, is designed to measure the difference of the color distribution regularity between the reference image and the distorted one. In particular, three kinds of channels (bright channel, median channel, and dark channel) are first extracted from the color image. Then, a fractal analysis is employed to characterize each channel by fractal dimension. Finally, we make use of fractal dimensions extracted from channels to predict the image quality. The proposed metric is evaluated on three largest color image databases (TID2013, CSIQ, and LIVE databases) and experimental results indicate that our metric achieves excellent performance.

Women with cancer are more likely to fall than women without cancer placing them at high risk of fall-related fractures, other injuries and disabilities. Determining the efficacy of fall prevention programs depends upon reliable self-reporting of falls. The purpose of this paper is to describe the approach used to collect falls as a primary endpoint of a 12-month fall prevention exercise trial in older women cancer survivors. GET FIT (Group Exercise Training for Functional Improvement after Treatment) was a randomized controlled trial of women cancer survivors aged 50–75 years who had completed chemotherapy and were randomized into one of three exercise groups: strength training, tai chi, or seated stretching (control). We captured falls and injurious falls through monthly and quarterly self-report. Women with an e-mail address received surveys electronically via REDCap and women without one completed the survey by phone, postcard, or in exercise class. Out of 442 randomized women, 96% (n=422) reported having an e-mail. Women with an email address were more likely to be white race (p

BackgroundData 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.MethodsWe 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.ResultsThe 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.ConclusionsAmong community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.Trial RegistrationClinicaltrials.gov (NCT02287740).

We appreciate Rabinowitz's comments on our work1 and the important issue he raises related to understanding individual physical, psychological, and social needs underlying tai chi participation. Growing research-based evidence has made it clear that tai chi provides a wide array of health benefits,2,3 from the physical (e.g., improved postural stability, functional balance, lower-extremity strength), to the physiological (e.g., improved sleep quality, reduced blood pressure), to the psychological (e.g., reduced fear of falling or stress, improved overall sense of well-being). The alternating weight-bearing, rhythm-controlled, and meditative nature of tai chi movements has made it a unique, low-impact exercise well suited for all age groups, particularly older adults. Additional practical and programmatic advantages of tai chi, including low cost and easy implementation, have elevated its profile as a health promotion initiative. It was interesting to note that all of the preceding features were important motivators in Rabinowitz's survey. With the impending unprecedented impact of the retiring Baby Boomer generation4 on health care spending,5 maintaining or improving function and well-being in the general population has become a major public health promotion mission.6 Thus, how to attract and retain those who would benefit from tai chi, but who for a variety of reasons are either not aware of or not motivated to join classes, is emerging as a very salient issue. Therefore, understanding what motivates people to do tai chi (as Rabinowitz has attempted to do) and what discourages them from doing so is the first step toward increasing participation. The fact that less than 20% of those polled by Rabinowitz were participating in tai chi classes at the suggestion of their physician or in support of a friend or relative indicates the need to improve outreach in primary care settings and promotion through social networking. However, this effort must be in concert with more randomized controlled trials being fully translated into community practice protocols. In 2005, a group of researchers, health professionals, and tai chi practitioners and teachers created a national consensus report7 that addresses numerous issues related to tai chi program implementation, including program and course content, teacher training (including lay leaders), instruction for individuals with special needs, and overcoming barriers to program dissemination. With a better understanding of the barriers to participation in tai chi—both real and perceived—the implementation of programs such as the one we developed and the recommendations of the consensus report can result in substantial numbers of at-risk individuals delaying functional declines.

While outdoor physical activity has been shown to promote health and well-being,1 ,2 exercising in environments with high levels of air pollution can increase the risk of health problems ranging from asthma attacks to heart or lung pathologies.3 ,4 The interaction of these two phenomena is of specific significance in China, where outdoor physical activity has been a traditional practice but where rapid industrialisation has led to major degradation of the environment. This situation raises the spectre of an emergent major public health crisis in the most populous country in the world. There is clear and compelling evidence that regular physical activity produces substantial physical and mental health benefits, including improved health-related quality of life and decreased risk of premature morbidity and mortality.1 ,5 ,6 However, it is important to note that in contrast to the commodification of exercise in many western industrialised nations, where exercise for health is often carried out in indoor facilities such as fitness centres, the physical and mental health benefits of physical activity can be achieved outdoors in settings such as community green spaces, parks and trails.1 ,2 Therefore, public health policies designed to encourage participation in physical activity should focus on outdoor settings for promoting public health and improving overall quality of life,5–8 because outdoors settings can accommodate a much larger scale population involvement at substantially lower costs than can physical activity in indoor facilities. In China, cultural norms, history and public policy have presaged this logistical reality, with a significant portion of the population, especially in the older demographic, exercising daily in outdoor settings such as parks, village squares and along streets, through leisure walking, jogging, dancing, bicycling or Tai Ji Quan.9–11 Studies in China have shown a positive association between traditional …

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

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. Language: en

Using a multilevel latent growth curve modeling (LGCM) approach, this study examined longitudinal change in levels of physical fitness performance over time (i.e. four years) in young adolescents aged from 12–13 years. The sample consisted of 6622 students from 138 secondary schools in Singapore. Initial analyses found between-school variation on fitness test scores with intra-class correlations ranging from 0.02–0.19. Subsequent multilevel growth curve analyses revealed a quadratic trend of the longitudinal data across five stations of performance tests, with significant within-school student variability in change over time. The result of the multilevel LGCM showed that there were strong school effects on all of the physical fitness performances, in addition to inter- and intra-individual differences.

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.

Use of structural equation modeling (SEM) methodology to study interactive relationships among latent variables began with the work of Kenny and Judd (1984) who developed a method of testing interactions involving continuous latent variables by forming products of multiple indicator variables. Until recently, there has been considerable difficulty implementing the method in SEM programs. This article reviews a single indicator approach (Joreskog & Yang, 1996) and multiple indicator approaches (Jaccard & Wan, 1995; Ping, 1996) that simplify Kenny and Judd's method. An illustrative application using an empirical example examining the interactive effect of perceptions of competence and perceptions of autonomy on exercise intrinsic motivation is presented. Practical issues surrounding the use of these different approaches are discussed.

The GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is the first randomized controlled trial to test the efficacy of two specific and separate types of exercise training, tai chi and strength training, to reduce falls in older female cancer survivors. The purpose of the present study is to: 1) report on the feasibility of recruitment into the trial and 2) report on retention and adherence to the exercise trial. Women were recruited through cancer registries, clinician referral, letters to past research participants, self-referral and screening of electronic health records (EHR). Interested and eligible women were consented and randomized to participate in a strength training, tai chi, or flexibility (placebo control) exercise class two times a week for 6 months. Out of 1490 screened women, 442 began the study intervention and 52 withdrew before the 6 month intervention was complete resulting in an 88% retention rate. Women who withdrew from the study reported more worry about falls compared to those who did not withdraw (p

Importance Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective To determine the effectiveness of a therapeutically tailoredtai ji quanintervention,Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept oftai ji(also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures The primary measure at 6 months was incidence of falls. Results Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56;P Conclusions and Relevance Among community-dwelling older adults at high risk for falls, a therapeutically tailoredtai ji quanbalance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. Trial Registration ClinicalTrials.gov identifier:NCT02287740

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.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.There was a small but significant resident-level increase in both systolic and diastolic blood pressure (P0.001) over the 1-year observation period. A similar trend was also observed at the neighborhood level (P0.001). 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 (P0.001). 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.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.

This study examined neighborhood built environment characteristics (fast-food restaurant density, walkability) and individual eating-out and physical activity behaviors in relation to 1-year change in body weight among adults 50–75 years of age at baseline. The authors surveyed 1,145 residents recruited from 120 neighborhoods in Portland, Oregon. During the 1-year follow-up (2006–2007 to 2007–2008), mean weight increased by 1.72 kg (standard deviation, 4.3) and mean waist circumference increased by 1.76 cm (standard deviation, 5.6). Multilevel analyses revealed that neighborhoods with a high density of fast-food outlets were associated with increases of 1.40 kg in weight (P < 0.05) and 2.04 cm in waist circumference (P < 0.05) among residents who visited fast-food restaurants frequently. In contrast, high-walkability neighborhoods were associated with decreases of 1.2 kg in weight (P < 0.05) and 1.57 cm in waist circumference (P < 0.05) among residents who increased their levels of vigorous physical activity during the 1-year assessment period. Findings point to the negative influences of the availability of neighborhood fast-food outlets and individual unhealthy eating behaviors that jointly affect weight gain; however, better neighborhood walkability and increased levels of physical activity are likely to be associated with maintaining a healthy weight over time.

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.

INTRODUCTION: Exercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease. METHODS: We used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses. RESULTS: Tai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. RESULTS from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered. CONCLUSION: Tai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation. Language: en

OBJECTIVES: To determine the relative effects of cobblestone mat walking, in comparison with regular walking, on physical function and blood pressure in older adults. DESIGN: Randomized trial with allocation to cobblestone mat walking or conventional walking. SETTING: General community in Eugene, Oregon. PARTICIPANTS: One hundred eight physically inactive community-dwelling adults aged 60 to 92 (mean age � standard deviation 577.5 � 5.0) free of neurological and mobility-limiting orthopedic conditions. INTERVENTION: Participants were randomized to a cobblestone mat walking condition (n 554) or regular walking comparison condition (n 554) and participated in 60-minute group exercise sessions three times per week for 16 consecutive weeks. MEASUREMENTS: 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. RESULTS: At the 16-week posttest, differences between the two exercise groups were found for balance measures (P 5.01), chair stands (Po.001), 50-foot walk (P 5.01), and blood pressure (P 5.01) but not for the Up and Go test (P 5.14). Although significant within-group changes were observed in both groups for the secondary outcome measures, there were no differences between intervention groups. CONCLUSION: 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. J Am Geriatr Soc 2005.

Objective: To examine the relation between built environment factors (representing several dimensions of urban form of neighbourhoods) and walking activity at both the neighbourhood level and the resident level, in an older adult sample. Design, setting, participants: A cross sectional, multilevel design with neighbourhoods as the primary sampling unit and senior residents as the secondary unit. Five hundred and seventy seven residents (mean age = 74 years, SD = 6.3 years) participated in the survey, which was conducted among 56 city defined neighbourhoods in Portland, Oregon, USA. Neighbourhood level variables were constructed using geographical information systems. Resident level variables consisted of a mix of self reports and geocoded data on the built environment. Main outcome measure: Self reported neighbourhood walking. Main results: A positive relation was found between built environment factors (density of places of employment, household density, green and open spaces for recreation, number of street intersections) and walking activity at the neighbourhood level. At the resident level, perceptions of safety for walking and number of nearby recreational facilities were positively related to high levels of walking activity. A significant interaction was observed between number of street intersections and perceptions of safety from traffic. Conclusions: Certain neighbourhood built environment characteristics related to urban form were positively associated with walking activity in the neighbourhoods of senior residents. Public health promotion of walking activity/urban mobility and the design of interventions need to consider the contribution of neighbourhood level built environment influences.

LI, F., P. HARMER, K. J. FISHER, and E. MCAULEY. Tai Chi: Improving Functional Balance and Predicting Subsequent Falls in Older Persons. Med. Sci. Sports Exerc., Vol. 36, No. 12, pp. 2046–2052, 2004. Purpose: To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons. Methods: Two hundred fifty-six healthy, physically inactive older adults aged 70–92 (mean age SD 77.48 4.95), recruited from a local health system in Portland, OR, participated in a 6-month randomized controlled trial, with allocation to Tai Chi or exercise stretching control, followed by a 6-month postintervention follow-up. Functional balance measures included Berg balance scale, dynamic gait index, and functional reach, assessed during the 6-month intervention period (baseline, 3-month, and 6-month intervention endpoint) and again at the 6-month postintervention follow-up. Fall counts were recorded during the 6-month postintervention follow-up period. Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures. Results: Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period, compared with those in the control condition (odds ratio (OR), 0.27, 95% confidence interval (CI), 0.07–0.96 for Berg balance scale; OR, 0.27, 95% CI, 0.09–0.87 for dynamic gait index; OR, 0.20, 95% CI, 0.05–0.82 for functional reach). Conclusions: Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons. Key Words: BALANCE, FALL PREVENTION, AGING

Objectives: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. Design: Randomized, controlled trial with allocation to tai chi or exercise control. Setting: General community. Participants: One hundred eighteen women and men aged 60 to 92. Intervention: 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. Measurements: 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. Results: 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

This study examined the effects of a 6-month Tai Chi exercise program on health-related quality of life (HRQL) in older individuals. Using a randomized controlled trial, ninety-four local community-residing volunteers aged 65-96 (M age = 72.8 years, SD = 5.1) were randomly assigned to a 6-month, twice a week, Tai Chi condition or a wait-list control condition. The Short-Form General Health Survey (SF-20) was used to assess change in multiple dimensions of health status involving physical-, social-, and rolefunctioning, bodily pain, mental health, and health perceptions. Results showed that, compared to the control group, participants in the Tai Chi group reported significant improvements in all functional domains of HRQL over the course of the 6-month intervention. It was concluded that a 6-month Tai Chi exercise program is effective for improving HRQL among older adults. Tai Chi, a self-paced and low intensity activity appears to be an effective, low-cost approach for promoting health in older persons.

This study examined the effect of cobblestone-mat walking on health-related outcomes in older adults. Participants (mean age 72.6, N=40) were randomized into either an 8-week cobblestone-mat walking activity (n = 22) or a control group (n = 18). Cobblestone-mat walking entailed three 45-min sessions per week. Primary outcomes included SF-12 (mental, physical), instrumental activities of daily living (IADLs), psychophysical well-being, daytime sleepiness, and pain. Secondary outcomes included resting blood pressure and perceived control of falls. The walkers experienced significantly improved SF-12 scores, IADLs, and psychophysical well-being and significantly reduced daytime sleepiness and pain. They also reported significantly improved perceptions of control over falls. A significant between-groups difference in resting diastolic blood pressure was observed, with reductions in the walkers. A significant within-group reduction in systolic blood pressure was observed in the walkers only. The data indicate that cobblestone-mat walking can significantly improve health-related outcomes in older adults.

Background: Through a re-analysis of a Tai Chi intervention data set, the study objective was to determine which, if any, subgroups of the study sample evidenced differential benefits from the intervention. Method: Re-analysis of a Tai Chi intervention study, a randomized controlled trial in Eugene and Springfield, Oregon. Physically inactive participants aged ≥65 years were randomly assigned to one of two groups: Tai Chi ( n =49) and a wait-list control ( n =45). The main outcome measure was self-reported physical function. Results: Initial latent curve analyses indicated significant Tai Chi training effects: Participants in the Tai Chi group reported significant improvements in perceived physical function compared to those in the control group. However, there was significant interindividual variability in response to Tai Chi. The overall intervention effect was further delineated by identifying two subgroups. This delineation showed that Tai Chi participants with lower levels of physical function at baseline benefited more from the Tai Chi training program than those with higher physical function scores. Inclusion of additional measures of individual characteristics at baseline, change in movement confidence, and class attendance further explained differences in treatment responses. Conclusions: Findings from this study suggest that although an intervention may show an overall effect (or no overall effect), it may be differentially effective for subgroups of participants that differ in their pre-intervention characteristics. Examination of variability in outcome measures can provide important information for refining and tailoring appropriate interventions targeted to specific subgroups.

A 3‐D tomographic inversion approach based on a surface‐consistent model for static corrections is presented in this paper. Direct, reflected, and refracted waves are used simultaneously to update the near‐surface model. We analyze the characteristics of the first‐break traveltime in complicated low‐velocity layers. To improve the accuracy for the velocity model, the various first‐break times from direct, reflected, and refracted waves are considered for model inversion. A fractal algorithm which overcomes the error caused by wavelet shape differences is applied to pick first breaks. It also overcomes the leg jump of refractions. The method can pick a large number of first breaks automatically. The raypaths and traveltimes are calculated with a 3‐D ray tracer that does not increase computation time for complicated geological models. Our method can determine the raypath associated with minimum traveltimes regardless of wave mode (direct, refracted, or reflected). We use a least‐squares approach in conjunction with a matrix decomposition to reconstruct a 3‐D velocity model from the actual first‐break times obtained from 3‐D data. Finally, long‐ and short‐wavelength static corrections are calculated concurrently, based on the reconstructed velocity profile. The method can be applied to wide‐line profiles, crooked lines, and 2‐D and 3‐D seismic survey geometries. The results applied to a real 3‐D data example indicate that the 3‐D tomographic static corrections are effective for field data.

Fuzhong Li1,2 1Oregon Research Institute, Eugene, OR, USA; 2Shanghai University of Sport, Shanghai, People’s Republic of ChinaBackground: Limits of stability, defined as the ability to maintain the center of gravity within the boundary of the base of support, is critically important for older adults in performing their activities of daily living. However, few exercise programs specifically tailored to enhance limits of stability exist. The primary purpose of this study was to determine whether a therapeutically designed intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), could improve limits of stability in older adults. A secondary purpose was to examine concomitant change in limits of stability and physical performance as a result of the intervention.Methods: A single-group design was used in which 145community-dwelling older adults (average age: 75years) were enrolled in TJQMBB classes, participating twice weekly for 48weeks. Primary outcome measures were three indicators of limits of stability (LOS) (endpoint excursion, movement velocity, and directional control), with secondary measures of physical performance being Timed Up and Go and 50-foot speed walk (in seconds), which were assessed at baseline, 24weeks, and 48weeks. Changes in the repeated measures of outcome variables were analyzed via latent curve analysis.Results: At 48weeks, a significant rate of change (improvement) over time was observed in the three limits of stability indicators (endpoint execution: 8.30% LOS, P

Using Tai Chi as an exercise mode, this study examined the association between self-efficacy and physical function. Ninety-four healthy, physically inactive older adults (M age = 72.8 years, SD = 5.1) were randomly assigned to either a 6-month, twice a week, Tai Chi condition or a wait-list control condition. Outcome variables included self-reports of movement efficacy and physical function assessed at baseline, middle, and termination of the study. Multisample latent curve analyses revealed a significant rate of change attributable to the Tai Chi intervention in both self-efficacy and physical function, with participants experiencing significant improvements over the course of the intervention. Analyses also showed a positive association between self-efficacy and physical function, indicating that improvements in older adults' self-efficacy of movement as a function of Tai Chi were related to increased levels of perceived physical capability. This study uncovered the need for further exploration of the relationship between exercise self-efficacy and physical function for enhancing health-related quality of life in older adults.

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; Muthen, 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 ...

Background Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Currently, no evidence-based fall prevention strategies exist that specifically target female cancer survivors. The purpose of the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is to compare the efficacy of two distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops. Methods/Design We will conduct a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50–75 years old, who have completed chemotherapy for cancer comparing 1) tai chi 2) strength training and 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs twice per week for six months and will be followed for an additional six months after formal training stops. The primary outcome in this study is falls, which will be prospectively tracked by monthly self-report. Secondary outcomes are maximal leg strength measured by isokinetic dynamometry, postural stability measured by computerized dynamic posturography and physical function measured by the Physical Performance Battery, all measured at baseline, 3, 6 and 12 months. The sample for this trial (N=429, assuming 25% attrition) will provide adequate statistical power to detect at least a 47% reduction in the fall rate over 1 year by being in either of the 2 exercise groups versus the control group. Discussion The GET FIT trial will provide important new knowledge about preventing falls using accessible and implementable exercise interventions for women following chemotherapy for cancer. ClinicalTrials.gov NCT01635413