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Background : Diabetes-related disability occurs in approximately two-thirds of older adults with diabetes and is associated with loss of independence, increased health care resource utilization, and sedentary lifestyle. The objective of this randomized controlled trial was to determine the effect of a center-based functional circuit exercise training intervention followed by a 10-week customized home-based program in improving mobility function in sedentary older adults with diabetes. Methods : Participants (n = 111; mean age 70.5 [7.1] y; mean body mass index 32.7 [5.9] kg/m 2 ) were randomized to either a moderate-intensity functional circuit training (FCT) plus 10-week home program to optimize physical activity (FCT-PA) primary intervention or one of 2 comparison groups (FCT plus health education [FCT-HE] or flexibility and toning plus health education [FT-HE]). Results : Compared with FT-HE, FCT-PA improvements in comfortable gait speed of 0.1 m/s ( P  < .05) and 6-minute walk of 80 ft were consistent with estimates of clinically meaningful change. At 20 weeks, controlling for 10-week outcomes, improvements were found between groups for comfortable gait speed (FCT-PA vs FT-HE and FCT-HE vs FT-HE) and 6-minute walk (FCT-PA vs FCT-HE). Conclusions : Functional exercise training can improve mobility in overweight/obese older adults with diabetes and related comorbidities. Future studies should evaluate intervention sustainability and adaptations for those with more severe mobility impairments.

Objective: Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast majority at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Department of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties., Methods: Data were collected through face-to-face interviews conducted over the course of three months (September-November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition., Results: Residents reported knowing, on average, six other residents and approximately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents)., Conclusions: This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in affordable senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents., Competing Interests: Competing Interests: None declared.

Background: The Community Healthy Activities Model Program for Seniors (CHAMPS) survey, summarized into weekly caloric expenditures, is a common physical activity (PA) assessment tool among older adults. Specific types of PA reported in the CHAMPS have not been systematically analyzed. We applied latent class analysis to identify the patterns of PA among sedentary older adults with diabetes reported in the CHAMPS survey., Methods: Latent class models of PA were identified using the CHAMPS survey data reported by 115 individuals aged ≥60 years with type 2 diabetes whom volunteered for a clinical study of PA. Multinomial logistic regression was used to assess independent predictors of a specific latent class, including age, sex, and performance in physical function tests., Results: Ninety-three percent of the participants were classified into 3 latent classes. Participants in latent class 1 (60.9%) primarily reported domestic-focused activities. Participants in latent class 2 and 3 (19.5% and 19.6%, respectively) reported domestic-focused activities, in addition to leisure-time physical activities and structured exercise activities. Latent class 1, with more women than men (73% vs.27%), had the lowest caloric expenditure, whereas class 3, with fewer women than men (28% vs. 72%), had the highest caloric expenditure (all p  < 0.001). Latent class 2 had the fastest Timed-Up- and Go (7.65 ± 1.28 s; p  = 0.03)., Conclusions: Individual PA response in CHAMPS can be categorized using latent class models into meaningful patterns which can inform PA interventions. Customized PA programs should consider the heterogeneity of the activities among sedentary older adults., Trial Registration: ClinicalTrials.gov Identifier NCT00344240; retrospectively registered 23 June 2006., Competing Interests: All subjects in the study have been consented prior to participation in the study, and the study was conducted according to the Institutional Review Boards from the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan.No applicable.The authors declare that they have no competing interests. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objectives: To evaluate the differential value of a self-reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge., Design: Retrospective medical record review., Setting: Community living center postacute care (CLC-PAC) unit at a Veterans Affairs hospital., Participants: A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC-PAC from home., Methods: Cognitive status was assessed with the Mini-Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test-Revised. Self-report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS-HS) subscale. Additional demographic and admission-related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist., Main Outcome Measurements: Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC-PAC discharge., Results: A total of 19% (n = 34) of residents required increased LOC on CLC-PAC discharge. The ILS-HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS-HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35-0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model., Conclusions: The inclusion of the ILS-HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS-HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC-PAC residents., Level of Evidence: II., (Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Purpose: Compare physical activity intensity in older adults with type 2 diabetes mellitus (T2DM) using individualized, relative cutpoints with standard, absolute cutpoints., Methods: One hundred older adults with T2DM (68.9 ± 5.1 yr, 65% male, 32.7 ± 6.3 kg·m, 7.2% ± 1.1% glycosylated hemoglobin) completed a two-speed walking protocol (varying, walking between 1 and 2.5 mph), followed by a modified Bruce peak exercise test. Participants wore an accelerometer-based physical activity monitor at their waist, and oxygen consumption was measured. Afterward, participants wore the activity monitor for seven consecutive days. Linear equations for each individual were derived from the activity counts and energy expenditure measured during the walking protocol. Relative intensity cutpoints were calculated by using standard classifications of 44% oxygen consumption (V˙O2)peak to determine moderate and 59% V˙O2peak to determine vigorous intensity. Average time spent in intensity categories per day were calculated using relative and absolute (moderate, 2020 counts per minute; vigorous, 5999 counts per minute) cutpoints. t-Tests were run to compare estimated time spent in intensity category by cutpoint., Results: Mean V˙O2peak was 17.9 ± 4.5 mL·kg·min and relative cutpoints were, on average, 1033.5 counts per minute (SD, 741.2 counts per minute) for moderate and 2211.7 counts per minute (SD, 1512.4) for vigorous activity. Using the relative cutpoints, participants accumulated an average of 157.2 min (SD, 73.7 min) of light, 33.3 min (SD, 35.6 min) of moderate, and 15.6 min (SD, 26.7 min) of vigorous activity per day. Use of the absolute cutpoint resulted in significantly different estimations based on intensity category: light, 200.7 min (SD, 74.7 min; P < 0.05); moderate, 7.1 min (SD, 9.2 min; P < 0.05); and vigorous, 0.006 min (SD, 0.04 min; P < 0.05) of activity per day., Conclusions: These results suggest utilization of absolute cutpoints may underestimate daily relative intensity levels of physical activity in older adults with T2DM. This misclassification may improperly inform dose-response relationships and population-based prevalence of physical activity in these and may extend to other clinically important populations.

Background: Concurrent chemoradiotherapy (concurrent CRT) to treat head and neck cancer is associated with significant reductions of weight, mobility, and quality of life (QOL). An intervention focusing on functional exercise may attenuate these losses., Methods: We allocated patients to a 14-week functional resistance and walking program designed to maintain physical activity during cancer treatment (MPACT group; n = 11), or to usual care (control group; n = 9). Outcomes were assessed at baseline, and 7 and 14 weeks., Results: Compared to controls, the MPACT participants had attenuated decline or improvement in several strength, mobility, physical activity, diet, and QOL endpoints. These trends were statistically significant (p < .05) in knee strength, mental health, head and neck QOL, and barriers to exercise., Conclusion: In this pilot study of patients with head and neck cancer undergoing concurrent CRT, MPACT training was feasible and maintained or improved function and QOL, thereby providing the basis for larger future interventions with longer follow-up. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1086-E1096, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: Downward reaching may lead to falls in older adults, but the underlying mechanisms are poorly understood. This study assessed differences between younger and older adults in postural control and losses of balance when performing a forward reach to the floor in 2 possible real-world situations, with and without full foot contact with the floor., Methods: Healthy younger (n = 13) and older (n = 12) women reached as fast as possible to a target placed at their maximal forward reaching distance on floor, either standing on their whole foot or on the shortest base of support (BOS) that they were willing to perform a toe touch with., Results: Compared with younger women, older women used a 50% larger BOS when stooping down to touch their toes and had 22% less maximal forward reaching distance on the floor. Older women were twice as likely to lose their balance as younger women while performing a rapid forward floor reach (χ(2)(2) = 3.9; p < .05; relative risk = 1.91; 95% CI = 0.99-3.72). Postural sway, measured as center of pressure excursions and center of pressure root mean square error, did not differ between younger and older women anteriorly, but posteriorly, older women decreased their sway in full foot BOS and increased their sway in forefoot BOS (Age × BOS, p < .05). Leg strength was reduced in older versus younger women and was correlated with maximal reach distance (r = .65-.71)., Conclusions: Healthy older women performing a rapid maximum forward reach on the floor, particularly when using their forefoot for support, are at an increased risk for losing their balance.

Background: Backward falls are often associated with injury, particularly among older women. An age-related increase occurs in center of pressure variability when standing and leaning. So, we hypothesized that, in comparison to young women, older women would display a disproportionate decrease of speed and accuracy in the primary center of pressure submovements as movement amplitude increases., Methods: Ground reaction forces were recorded from thirteen healthy young and twelve older women while performing rapid, targeted, center of pressure movements of small and large amplitude in upright stance. Measures included center of pressure speed, the number of center of pressure submovements, and the incidence rate of primary center of pressure submovements undershooting the target., Findings: In comparison to young women, older women used slower primary submovements, particularly as movement amplitude increased (P<0.01). Even though older women achieved similar endpoint accuracy, they demonstrated a 2 to 5-fold increase in the incidence of primary submovement undershooting for large-amplitude movements (P<0.01). Overall, posterior center of pressure movements of older women were 41% slower and exhibited 43% more secondary submovements than in young women (P<0.01)., Interpretations: We conclude that the increased primary submovement undershoots and secondary center of pressure submovements in the older women reflect the use of a conservative control strategy near the posterior limit of their base of support., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Rapid center of pressure (COP) movements are often required to avoid falls. Little is known about the effect of age on rapid and accurate volitional COP movements. We hypothesized that COP movements to a target would be slower and exhibit more submovements in older versus younger adults, particularly in posterior versus anterior movements. Healthy older (N=12, mean age=76 years) and young women (N=13, mean age=23 years) performed anterior and posterior lean movements while standing on a force plate, and were instructed to move their COP 'as fast and as accurately as possible' using visual feedback. The results showed that rapid posterior COP movements were slower and had an increased number of submovements and ratio of peak-to-average velocity, in comparison to anterior movements (p<.005). Moreover, older compared to younger adults were 27% slower and utilized nearly twice as many compensatory submovements (p<.005), particularly when moving posteriorly (p<.05). Older women also had higher ratios of peak-to-average COP velocity than young (p<.05). Thus, despite moving more slowly, older women needed to take more frequent submovements to maintain COP accuracy, particularly posteriorly, thereby providing evidence of a compensatory strategy that may be used for preventing backward falls., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Impaired vision, cognition, and divided attention performance predict falls. Requiring both visual and cognitive input, the ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. We compared healthy young and older adults in the time taken to step accurately under conditions of increasing cognitive and visual demand., Methods: Healthy Young (n = 42, mean age 21) and Older (n = 37, mean age 70) participants were required to step accurately on an instrumented walkway under conditions of increasing visual and cognitive demand. Based on the paper-and-pencil neuropsychological test, the Trail Making Test (P-TMT) A and B, participants stepped on instrumented targets with increasing sequential numbers (Walking Trail Making Test A [W-TMT A]) and increasing sequential numbers and letters (Walking Trail Making Test B [W-TMT B]), under conditions of Low as well as Normal lighting., Results: W-TMT performance time increased with increased age (Older vs Young), decreased light (Low vs Normal), and increased cognitive demand (Trails B vs Trails A). W-TMT performance time was disproportionately increased in Low light and in the Older group under the highest cognitive demand (W-TMT B) conditions. Paired W-TMT A-B differences were three times higher in the Older group than in the Young group. In the Older group, the correlation between W-TMT results and P-TMT B was particularly strong (p <.001)., Conclusions: The time to perform a stepping accuracy task, such as may be required to avoid environmental hazards, increases under reduced lighting and with increased cognitive demand, the latter disproportionately so in older adults.

Gait disorders predict functional decline in older adults. They are often the result of multiple causes, so a full assessment should consider different sensorimotor levels and should include a focused physical examination and evaluation of functional performance. Exercise and medical and surgical interventions are effective and can reduce the degree of gait disorder, but usually not without some residual impairment. Orthoses and mobility aids are also important interventions to consider.

Background: Measures of maximal oxygen uptake (VO(2max)) are limited in disabled older adults, and measures of submaximal oxygen uptake (VO(2)) may better predict functional mobility limitations. These measures may include oxygen-uptake kinetics at the onset of submaximal exercise or during recovery. We sought to determine whether the lag in oxygen uptake at the beginning of exercise (oxygen deficit) and excess oxygen uptake above rest following exercise (excess postexercise oxygen consumption) (a) predict physical performance in impaired older adults with decreased aerobic function, and (b) predict physical performance better than peak VO(2)., Methods: Two groups of community-dwelling volunteers aged 65 or older were recruited according to their performance on a maximal graded exercise test. Using the Social Security Administration criterion of disability of a peak VO(2) 18 (Unimpaired, n = 21, mean +/- SEM age 76 +/- 1 years)., Results: The mean +/- SEM peak VO(2) was 58% lower in the Impaired (14 +/- 1 ml/kg/min) than the Unimpaired (24 +/- 1 ml/kg/min) adults. The time constant for oxygen deficit, tc(deficit), was more than twice as high in the Impaired than the Unimpaired (p <.05), and the time constant for excess postexercise oxygen consumption, tc(EPOC), tended to be higher in the Impaired than the Unimpaired (by 43%, p =.09). Measures of submaximal oxygen-uptake kinetics were as strong or more strongly predictive of functional mobility performance than peak VO(2) in both Unimpaired and Impaired older adults. The major predictor of functional performance for the Unimpaired was a measure of oxygen deficit accruing during exercise (tc(deficit)), and for the Impaired, it was a measure of oxygen debt during recovery, tc(EPOC)., Conclusions: Measurement of submaximal oxygen-uptake kinetics may provide a more practical and relevant assessment of deconditioning in frail older adults, and may eventually supplant maximal (peak) oxygen uptake as a predictor of functional disability in older adults.