title: A 2-Year Follow-Up After a 2-Year RCT with Vitamin D and Exercise: Effects on Falls, Injurious Falls and Physical Functioning Among Older Women Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review Assessing the Effects of Interpersonal and Intrapersonal Behavior Change Strategies on Physical Activity in Older Adults: a Factorial Experiment A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility Short- and Long-Term Effects of Balance Training on Physical Activity in Older Adults With Osteoporosis: A Randomized Controlled Trial Maintenance of exercise-induced benefits in physical functioning and bone among elderly women Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial Effectiveness of telephone support in increasing physical activity levels in primary care patients. Long-Term Exercise in Older Adults: 4-Year Outcomes of Music-Based Multitask Training Improved physical fitness and quality of life following training of elderly patients after acute coronary events. A 1 year follow-up randomized controlled study. The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P): 2-year follow-up. Long-term effects of exercise training on physical activity level and quality of life in elderly coronary patients--a three- to six-year follow-up. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. Prompting primary providers to increase community exercise referrals for older adults: a randomized trial. Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Effects of Vitamin D and Exercise on the Wellbeing of Older Community-Dwelling Women: A Randomized Controlled Trial The long-term effects of a primary care physical activity intervention on mental health in low-active, community-dwelling older adults Long-term follow-up of very old heart failure patients enrolled in a trial of exercise training. Long-term follow-up of physical activity behavior in older adults. Patient‐centred physical therapy is (cost‐) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow‐up
abstract: Abstract Background Both exercise and vitamin D are recommended means to prevent falls among older adults , but their combined effects on fall-induced injuries are scarcely studied . Methods A 2-year follow-up of a previous 2-year r and omized controlled trial with vitamin D and exercise ( Ex ) of 409 older home-dwelling women using a factorial 2 × 2 design ( D−Ex− , D+Ex− , D−Ex+ , D+Ex+ ) . Besides monthly fall diaries , femoral neck bone mineral density ( fn-BMD ) , and physical functioning were assessed at 1 and 2 years after the intervention . Results After the intervention , S-25OHD concentrations declined to baseline levels in both supplement groups . The groups did not differ for change in fn-BMD or physical functioning , except for leg extensor muscle strength , which remained about 10 % greater in the exercise groups compared with the reference group ( D−Ex− ) . There were no between-group differences in the rate of all falls , but medically attended injurious falls reduced in D+Ex− and D−Ex+ groups compared with D−Ex−. However , all former treatment groups had less medically attended injured fallers , HRs ( 95 % CI ) being 0.62 ( 0.39–1.00 ) for D+Ex− , 0.46 ( 0.28–0.76 ) for D−Ex+ , and 0.55 ( 0.34–0.88 ) for D+Ex+ , compared with D−Ex−. Conclusions Exercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training . Although there was no difference in the rate of all falls , former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after the intervention . Vitamin D without exercise was associated with less injurious falls with no difference in physical functioning Purpose The aim of this systematic review is to assess the effect of different types of exercise on  breast cancer-related lymphedema ( BCRL ) in order to eluci date the role of exercise in this patient group . Methods A systematic data search was performed using PubMed ( December 2016 ) . The review is focused on the rehabilitative aspect of BCRL and undertaken according to the PRISMA statement with Levels of Evidence ( LoE ) assessed . Results 11 r and omized controlled trials ( 9 with LoE 1a and 2 with LoE 1b ) that included 458 women with breast cancer in aftercare were included . The different types of exercise consisted of aqua lymph training , swimming , resistance exercise , yoga , aerobic , and gravity-resistive exercise . Four of the studies measured a significant reduction in BCRL status based on arm volume and seven studies reported significant subjective improvements . No study showed adverse effects of exercise  on BCRL . Conclusion The evidence indicates that exercise can improve subjective and objective parameters in  BCRL patients , with dynamic , moderate , and high-frequency exercise appearing to provide the most positive effects Abstract Background Little is known about which behavior change strategies motivate older adults to increase their physical activity . Purpose The purpose of this study was to assess the relative effects of two sets of behavior change strategies to motivate increased physical activity among older adults :  interpersonal and intrapersonal . Methods Community-dwelling older adults ( N = 102 , mean age = 79 ) were r and omized in a 2 × 2 factorial experiment to receive interpersonal ( e.g. , social support , friendly social comparison ; no , yes ) and /or intrapersonal ( e.g. , goal setting , barriers management ; no , yes ) behavior change strategies , combined with an evidence -based , physical activity protocol ( Otago exercise program ) and a physical activity monitor ( Fitbit One ™ ) . Results Based on monitor data , participants who received interpersonal strategies , compared to those who did not , increased their average minutes of total physical activity ( light , moderate , vigorous ) per week , immediately ( p = .006 ) and 6 months ( p = .048 ) post-intervention . Similar , increases were observed on measures of functional strength and balance , immediately ( p = .012 ) and 6 months ( p = .003 ) post-intervention . The intrapersonal strategies did not elicit a significant increase in physical activity or functional strength and balance . Conclusions Findings suggest a set of interpersonally oriented behavior change strategies combined with an evidence -based physical activity protocol can elicit modest , but statistically and clinical ly significant , increases in older adults ’ physical activity and functional strength and balance . Future research should replicate these findings and investigate the sustained quantity of physical activity elicited by these strategies and their impact on older adults ’ quality of life and falls . Trial Registration The Clinical Trials.gov registration identifier is NCT02433249 Introduction Studies had not yet overcome the most relevant barriers to physical activity ( PA ) adherence . An exercise referral scheme ( ERS ) with mechanisms to promote social support might enhance adherence to PA in the long term . Setting A r and omised controlled trial in 10 primary care centres in Spain . Objective To assess the effectiveness of a primary care-based ERS linked to municipal re sources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period . Participants 422 insufficiently active participants suffering from at least one chronic condition were included . 220 patients ( 69.5 ( 8.4 ) years ; 136 women ) were r and omly allocated to the  intervention group ( IG ) and 202 ( 68.2 ( 8.9 ) years ; 121 women ) to the control group  ( CG ) . Interventions The IG went through a 12-week st and ardised ERS linked to community re sources and with inclusion of mechanisms to enhance social support . The CG received usual care from their primary care practice . Outcomes The main outcome measure was self-report PA with the International Physical Activity Question naire and secondary outcomes included stages of change and social support to PA practice . Data collection Participant-level data were collected via question naires at baseline , and at months 3 , 9 and 15 . Blinding The study statistician and research assessors were blinded to group allocation . Results Compared with usual care , follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA ( IG : 1373±1845 metabolic equivalents ( MET ) min/week , n=195 ; CG : 919±1454 MET min/week , n=144 ; P=0.009 ) . Higher adherence ( in terms of a more active stage of change ) was associated with higher PA level at baseline and with social support . Conclusions Prescription from ordinary primary care centres staff yielded adherence to PA practice in the long term . An innovative ERS linked to community re sources and enhancing social support had shown to be sustainable in the long term . Trial registration number NCT00714831 ; Results BACKGROUND : Physical activity ( PA ) reduces the rate of mobility disability , compared with health education ( HE ) , in at risk older adults . It is important to underst and aspects of performance contributing to this benefit . OBJECTIVE : To evaluate intervention effects on tertiary physical performance outcomes . DESIGN : The Lifestyle Interventions and Independence for Elders ( LIFE ) was a multi‐centered , single‐blind r and omized trial of older adults . SETTING : Eight field centers throughout the United States . PARTICIPANTS : 1635 adults aged 78.9 ± 5.2 years , 67.2 % women at risk for mobility disability ( Short Physical Performance Battery [ SPPB ] < 10 ) . INTERVENTIONS : Moderate PA including walking , resistance and balance training compared with HE consisting of topics relevant to older adults . OUTCOMES : Grip strength , SPPB score and its components ( balance , 4 m gait speed , and chair‐st and s ) , as well as 400 m walking speed . RESULTS : Total SPPB score was higher in PA versus HE across all follow‐up times ( overall P = .04 ) as was the chair‐st and component ( overall P < .001 ) . No intervention effects were observed for balance ( overall P = .12 ) , 4 m gait speed ( overall P = .78 ) , or grip strength ( overall P = .62 ) . However , 400 m walking speed was faster in PA versus HE group ( overall P = < .001 ) . In separate models , 29 % of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score , while 39 % was explained by change in the chair st and component . CONCLUSION : Lower extremity performance ( SPPB ) was significantly higher in the PA compared with HE group . Changes in chair‐st and score explained a considerable portion of the effect of PA on the reduction of major mobility disability‐consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability Background and Purpose : We have developed a 12-week balance training program for older adults shown to improve fall-related concerns , gait speed , balance performance , and physical function . We hypothesized that this balance training would also contribute to higher habitual physical activity ( PA ) levels and improved health-related quality of life ( HRQoL ) . The primary aim was to evaluate short- and long-term effects of the balance training program on objective ly measured habitual PA in older adults with osteoporosis . Secondary aims were to assess the effects of the balance training on HRQoL , and to study whether any effects on PA were associated with changes in HRQoL , gait speed , balance performance , fall-related concerns , and physical function . Methods : A r and omized controlled trial with follow-up at 3 , 9 , and 15 months , including 91 participants with osteoporosis ( 75.6 ± 5.4 years ) , compared a balance training group  ( n = 61 ) with a control group ( n = 30 ) . The primary outcome was effect on habitual PA measured as steps/day , dichotomized into less than 5000 or 5000 or more steps/day . Physical activity was assessed with pedometers ( Yamax ) and accelerometers ( Actigraph ) , HRQoL with the Short Form-36 ( SF-36 ) , gait with a GAITRite walkway , balance performance with Modified-Figure-Eight test and one-leg stance , fall-related concerns with Falls Efficacy Scale International , and physical function with the advanced lower extremity subscale of the question naire Late Life Function and Disability Instrument . Statistical methods used were multivariate logistic regression and logistic generalized estimating equation . Results : Sixty-eight participants completed the short-term follow-up at 3 months , and 53 participants completed the long-term follow-up at 15 months . Per- protocol analysis ( n = 68 ) showed that the odds ratio for having a daily step count of 5000 or more at 3 months was 6.17 ( 95 % confidence interval , 1.23 - 30.91 ) , P = .027 , for the intervention group compared with the control group . The longitudinal analysis ( n = 91 ) showed that the odds ratio for having a daily step count of 5000 or more at 15 months was 2.02 ( 95 % confidence interval , 0.88 - 4.64 ) , P = .096 , for the intervention group compared with the control group . The mental component sum of the SF-36 improved significantly from baseline to 3 months in the intervention group , and the physical component sum improved in both groups , but no statistically significant differences were found between groups . No associations were found between PA and changes in covariates . Discussion and Conclusions : The short-term evaluation showed that balance training increased habitual PA in community-dwelling older adults with osteoporosis . A significantly higher proportion of participants in the intervention group reached a level of 5000 or more steps/day , which is important for overall health . This effect was not associated with improvements in HRQoL , gait speed , balance performance , or fall-related concerns , and did not persist through the long-term follow-up . To accomplish a sustained PA change , a prolonged intervention or more support regarding habitual PA may be required , such as reinforcement with personalized behavior change counseling or PA on prescription Summary This study showed that about a half of the exercise-induced  gain in dynamic balance and bone strength was maintained one year after cessation of the supervised high-intensity training  of home-dwelling elderly women . However , to maintain exercise-induced gains in lower limb muscle force and physical functioning , continued training seems necessary . Introduction Maintenance of exercise-induced benefits in physical functioning and bone structure was assessed one year after cessation of 12-month r and omized controlled exercise intervention . Methods Originally 149 healthy women 70–78 years of age participated in the 12-month exercise RCT and 120 ( 81 % ) of them completed the follow-up study .  Self-rated physical functioning , dynamic balance , leg extensor force , and bone structure were assessed . Results During the intervention , exercise  increased dynamic balance by 7 % in the combination resistance and balance-jumping training group ( COMB ) . At the follow-up , a 4 % ( 95 % CI : 1–8 % ) gain compared with the controls was still seen , while the exercise-induced isometric leg extension force and self-rated physical functioning benefits had disappeared . During the intervention , at least twice a week trained COMB subjects obtained a significant 2 % benefit in tibial shaft bone strength index compared to the controls . A half of this benefit seemed to be maintained at the follow-up . Conclusions Exercise-induced  benefits in dynamic balance and rigidity in the tibial shaft may partly be maintained one year after cessation of a supervised 12-month multi-component training in initially healthy elderly women . However , to maintain the achieved gains in muscle force and physical functioning , continued training seems necessary Background and aims : Restricted physical activity as a consequence of chronic disease or injury is a predictor of functional decline . The aim of this study was to test the hypothesis that a 6-month multidimensional training program would have sustained beneficial effects upon the physiological , functional and psychological condition of old women with a recent history of falls . Methods : Participants were 65 home-dwelling women ( 70–90 years ) identified from hospital records as having had an accidental fall . After assessment of muscle strength , balance performance , walking speed , balance confidence , and physical activity level , the participants were r and omly assigned to a control group ( n=33 ) or a training group ( n=32 ) , who performed a multidimensional training program including moderate resistance exercise and balance exercise twice weekly for 6 months . Measurements were repeated after 6 and 12 months . Results : Six months of multidimensional training result ed in significant improvements and between-group differences in isometric knee extension strength ( p<0.05 ) , trunk extension/flexion strength ( p<0.001 ) , habitual/maximal walking speed ( p<0.001 ) and balance performance ( p<0.001 ) . At follow-up , 6 months after intervention , these improvements were preserved in the training group and there was also a significant between-group difference with regard to balance confidence . No between-group differences were found concerning number of falls or physical activity level during the one-year study period . Conclusions : A multi-dimensional training program produced significant improvements in physiological and functional risk factors for falls and disability in women aged 70–90 years with a recent history of falls Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 BACKGROUND Physician counseling of patients  to increase physical activity has had limited success in changing behavior . Providing organizational support to primary care providers and their patients may increase effectiveness . OBJECTIVE This study evaluates the effectiveness of a telephone-based intervention to increase physical activity  among patients who exercised < 15 minutes daily and wanted to increase their physical activity over a 6-month period . DESIGN This was a r and omized controlled trial , conducted from 1997 to 1998 , of 316 patients aged 18 to 65 who were recruited from a mailed health risk assessment . Baseline and 6-month post-intervention telephone assessment s were conducted by telephone . SETTING One family physician 's patients in a suburban community . INTERVENTION Three sessions of telephone-delivered motivational counseling . MAIN OUTCOME MEASURES Physical activity score ( 11-item Physician-Based Assessment and Counseling for Exercise [ PACE ] ) 6 months after the intervention . RESULTS After adjusting for baseline exercise , there was a significantly higher level of self-reported exercise among individuals r and omized to the intervention at the 6-month follow-up . The mean level of activity at follow-up for the intervention group was a PACE score of 5.37 , compared to 4.98 in the control group ( p<0.05 ) . In the secondary analysis , which was limited to individuals who received the intervention , the effect was stronger ( PACE score of 5.58 compared to 4.94 , p<0.013 ) . CONCLUSIONS Patients can be recruited using a health-screening question naire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels Prospect i ve controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking . The present study aim ed to assess the effects of long-term music-based multitask exercise ( i.e. , Jaques-Dalcroze eurhythmics ) on physical function  and fall risk in older adults . A 3-year follow-up extension of a 1-year r and omized controlled trial ( NCT01107288 ) was conducted in Geneva ( Switzerl and ) , in which 134 community-dwellers aged ≥65 years at increased risk of falls received a 6-month music-based multitask exercise program .  Four years following original trial enrolment , 52 subjects ( baseline mean ± SD age , 75 ± 8 years ) who ( i ) have maintained exercise program participation through the 4-year follow-up visit ( “ long-term intervention group ” , n = 23 ) or ( ii ) have discontinued participation following original trial completion ( “ control group ” , n = 29 ) were studied . They were reassessed in a blind fashion , using the same procedures as at baseline . At 4 years , linear mixed-effects models showed significant gait ( gait speed , P = 0.006 ) and balance ( one-legged stance time , P = 0.015 ) improvements in the long-term intervention group , compared with the control group . Also , long-term intervention subjects did better on Timed Up & Go , Five-Times-Sit-to-St and and h and grip strength tests , than controls ( P < 0.05 , for all comparisons ) . Furthermore , the exercise program reduced the risk of falling ( relative risk , 0.69 ; 95 % confidence interval , 0.5–0.9 ; P = 0.008 ) . These findings suggest that long-term maintenance of a music-based multitask exercise program is a promising strategy to prevent age-related physical decline in older adults . They also highlight the efficacy of sustained long-term adherence to exercise for falls prevention AIMS Cardiac rehabilitation including exercise training is of proven value in ischaemic heart disease . However , elderly patients frequently are not encouraged to participate in such programmes . This study evaluates the physiological effects and self-reported quality of life after an aerobic outpatient group-training programme in subjects above the age of 65 years . METHODS AND RESULTS A consecutive series of 101 patients ( males 80 % ) aged 65 - 84 ( mean 71 ) years recovering from an acute coronary event were r and omized to either a supervised out patient group-training programme ( n=50 ) or to a control group ( n=51 ) . The two groups were well balanced as regards clinical characteristics . The compliance in the training group was 87 % . Exercise tolerance increased in the trained group from 104 to 122 and 111 W after 3 and 12 months respectively . The corresponding values were 102 , 105 and 105 W among controls . Parameters , such as quality of life , self-estimated level of physical activity , fitness and well-being were grade d higher by the trained patients than those who served as controls on the two occasions of follow-up . CONCLUSIONS Aerobic group-training of elderly patients recovering from an acute coronary event beneficially influences physical fitness and several parameters expressing quality of life . Great care has to be taken to preserve the initial effects by continued training BACKGROUND It is well recognized that physical activity ( PA ) is important for older adults ; yet , clinicians remain pessimistic about the ability of older adults with compromised function to adhere to long-term treatment and to maintain behavior change once treatment has been terminated . METHODS We examined the functional status of older adults at a field center ( Wake Forest University ) 2 years after completing 12 months of treatment in the Lifestyle Interventions and Independence for Elders Pilot study . At baseline , participants were r and omized to either a PA or a successful aging ( SA ) control group .  Outcome measures included an interview assessment of PA , the Short Physical Performance Battery ( SPPB ) , and performance on a 400-m self-paced walking test . RESULTS Two years after the formal intervention had ended , participants who were originally in the PA group continued to engage in more minutes of moderate PA and tended to have better SPPB and walking speed than those in the SA group ( effect sizes [ ES ] : SPPB = 0.40 , walking speed = 0.37 ) . Seven ( 12.7 % ) participants in the PA group failed the 400-m walk at the 36-month follow-up assessment , whereas this number was 11 ( 21.6 % ) in the SA group . CONCLUSION Older adults who have compromised physical function are able to sustain some of the benefits derived from participating in structured PA 2 years after supervised treatment has been terminated BACKGROUND AND PURPOSE Physical activity and exercise as part of cardiac rehabilitation after an acute coronary event improves exercise capacity and quality of life in most patients . The aim of the present study was to evaluate physical activity level , health-related quality of life ( HRQL ) and perceived health three to six years after an acute myocardial infa rct ion or an episode of unstable angina pectoris in elderly patients and compare this to earlier follow-up examination data . METHOD STUDY DESIGN three to six years ( mean 4.4 years ) after r and omization a question naire about physical activity level , HRQL and perceived health was mailed to all subjects alive ( n = 93 ) ( response rate 96 % ) . The original study population consisted of 101 patients aged > or = 65 years admitted to the Coronary Care Unit at the Karolinska Hospital because of an acute coronary event between 1994 and 1997 . The patients were r and omized to either a three-month period of aerobic group training three times a week ( n = 50 ; acute myocardial infa rct ion 29 , unstable angina pectoris 21 ) or served as control subjects ( n = 51 ; acute myocardial infa rct ion 31 , unstable angina pectoris 20 ) . RESULTS Since the one-year follow-up examination eight subjects had died : five in the intervention group and three in the control group . At r and omization , the level of physical activity level was similar in the two groups . Those in the intervention group improved their level of physical activity significantly over time ( p = 0.05 ) in contrast to the control group . Measurements of HRQL showed no statistical difference between the groups by use of the EuroQol instrument . However , a small advantage for the intervention group measured over time was noted . CONCLUSION It is important to include elderly patients in cardiac rehabilitation programmes after an acute coronary event , since even a short period of supervised exercise training has the potential to positively influence physical activity level for as long as three to six years Importance Effective long-term treatments are needed to address the obesity epidemic . Numerous wearable technologies specific to physical activity and diet are available , but it is unclear if these are effective at improving weight loss . Objective To test the hypothesis that , compared with a st and ard behavioral weight loss intervention ( st and ard intervention ) , a technology-enhanced weight loss intervention ( enhanced intervention ) would result in greater weight loss . Design , Setting , Participants R and omized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012 , with data collection completed by December 2014 . Interventions Participants were placed on a low-calorie diet , prescribed increases in physical activity , and had group counseling sessions . At 6 months , the interventions added telephone counseling sessions , text message prompts , and access to study material s on a website . At 6 months , participants r and omized to the st and ard intervention group initiated self-monitoring of diet and physical activity using a website , and those r and omized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity . Main Outcomes and Measures The primary outcome of weight was measured over 24 months at 6-month intervals , and the primary hypothesis tested the change in weight between 2 groups at 24 months . Secondary outcomes included body composition , fitness , physical activity , and dietary intake . Results Among the 471 participants r and omized ( body mass index [ BMI ] , 25 to < 40 ; age range , 18 - 35 years ; 28.9 % nonwhite , 77.2 % women ) , 470 ( 233 in the st and ard intervention group , 237 in the enhanced intervention group ) initiated the interventions as r and omized , and 74.5 % completed the study . For the enhanced intervention group , mean base line weight was 96.3 kg ( 95 % CI , 94.2 - 98.5 ) and 24-month weight 92.8 kg ( 95 % CI , 90.6- 95.0 ) [ corrected ] . For the st and ard intervention group , mean baseline weight was 95.2 kg ( 95%CI,93.0 - 97.3 ) and 24-month weight was 89.3 kg ( 95%CI , 87.1 - 91.5 ) [ corrected ] . Weight change at 24 months differed significantly by intervention group ( estimated mean weight loss , 3.5 kg [ 95 % CI , 2.6 - 4.5 } in the enhanced intervention group and 5.9 kg [ 95 % CI , 5.0 - 6.8 ] in the st and ard intervention group ; difference , 2.4 kg [ 95 % CI , 1.0 - 3.7 ] ; P = .002 ) . Both groups had significant improvements in body composition , fitness , physical activity , and diet , with no significant difference between groups . Conclusions and Relevance Among young adults with a BMI between 25 and less than 40 , the addition of a wearable technology device to a st and ard behavioral intervention result ed in less weight loss over 24 months . Devices that monitor and provide feedback on physical activity may not offer an advantage over st and ard behavioral weight loss approaches . Trial Registration clinical trials.gov Identifier : NCT01131871 OBJECTIVES To determine whether a clinic-based physical activity promotion intervention can lead to more community-based exercise referrals by providers and higher exercise motivation in patients . DESIGN Cluster r and omized , controlled trial . SETTING Seattle Veterans Affairs General Internal Medicine Clinic . PARTICIPANTS Thirty-one physicians and nurse practitioners were r and omized to a physical activity counseling intervention  or control condition ( counseling about tobacco cessation ) . Three hundred thirty-six patients aged 50 and older and visiting a study provider were enrolled . INTERVENTION Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were " contemplative " about regular exercise . MEASUREMENTS Process measures of health behavior assessment and provider advice , exercise stage-of-change , proportion of participants reporting regular physical activity . RESULTS At baseline , 172 intervention patients and 164 controls were similar with respect to sex , age , comorbidity score , and exercise motivation level . Forty-five percent of all intervention patients and 35 % of controls reported receiving exercise advice ( P=.07 ) . Intervention patients who were contemplative about exercise were even more likely to receive  exercise advice than contemplative controls ( 59 % vs 38 % ; P=.02 ) . After 4 months , 35 % of all intervention patients reported regular exercise , compared with 28 % of controls ( P=.06 ) . CONCLUSION Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise . Patients may be more likely to start regular exercise as a result of this advice OBJECTIVE To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls . DESIGN Prospect i ve 2-year follow-up of a r and omized placebo-controlled intervention trial . SETTING Postward rehabilitation in a geriatric hospital in Germany . PARTICIPANTS Fifty-seven geriatric patients ( mean age , 84.3+/-4.4 y ) with a history of severe falls . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients . MAIN OUTCOME MEASURES Strength , functional performance , fall-related psychologic parameters , and physical activity assessed by st and ardized protocol s 2 years after the training intervention , compared with baseline results . RESULTS Motor performance decreased substantially in both groups . As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention , differences between the groups were still significant in most functional performances 2 years later . Functional decline was greater in persons who were institutionalized or being cared for by family members . Physical activity , which increased during the exercise intervention , returned to low baseline levels . CONCLUSIONS Improved functional performance in the training group did not lead to an increased level of physical activity after training , which might have preserved the functional improvements . In mobility-restricted , frail , geriatric patients such as our study population , training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy Background : Evidence for the effects of exercise and vitamin D supplementation on quality of life ( QoL ) , fear of falling ( FoF ) and mental wellbeing in older adults is conflicting . Objective : To study the effects of vitamin D supplementation and multimodal group exercise on psychosocial functions of wellbeing , including QoL , mental wellbeing and FoF. Method : This is a 2-year , double-blind , placebo-controlled vitamin D and open exercise intervention trial with 409 older Finnish women ( 70 - 80 years of age ) r and omized to 4 treatment arms : ( 1 ) placebo without exercise , ( 2 ) vitamin D ( 800 IU/day ) without exercise , ( 3 ) placebo and exercise , and ( 4 ) vitamin D ( 800 IU/day ) with exercise . Exercisers participated in group exercise twice per week for 12 months and once per week for the subsequent 12 months , plus home exercises . Results : When comparing with the placebo without exercise group , there were no statistically significant differences between groups receiving either vitamin D , exercise or both treatments for changes in QoL or mental wellbeing ( although a slight decline was seen in mental wellbeing in those receiving vitamin D only , p = 0.044 ) . The initial slight reduction in FoF was significant in all intervention groups compared with controls ( p < 0.05 ) , but this was only temporary . Conclusion : Neither vitamin D nor exercise contributes to better QoL , FoF or mental wellbeing in community-dwelling healthy older women with sufficient vitamin D levels Objectives : To examine the effect that physical activity delivered via two different versions of the Green Prescription ( a primary care physical activity scripting program ) had on depressive symptomatology and general mental health functioning over a 12-month period in non-depressed , low-active , community-dwelling older adults . Method : Two hundred and twenty-five participants from the Healthy Steps study took part in the present study . Healthy Steps participants were r and omized to receive either the st and ard time-based or a modified pedometer-based Green Prescription .  Depression , mental health functioning and physical activity were measured at baseline , post-intervention ( 3 months post-baseline ) and at the 9-month follow-up period . Results : At post-intervention , a positive association was found between increases in leisure-time physical activity and total walking physical activity and a decrease in depressive symptomatology ( within the non-depressed range of the GDS-15 ) and an increase in perceived mental health functioning , regardless of intervention allocation . These improvements were also evident at the follow-up period for participants in both intervention allocation groups . Conclusion : Our findings suggest that the st and ard time-based Green Prescription and a modified pedometer-based Green Prescription are both effective in maintaining and improving mental health in non-depressed , previously low-active older adults Little is known about how physical and psychological status changes with time in older heart failure patients . The authors followed up a cohort of 82 patients ( mean age , 80.5 years ) enrolled in a r and omized controlled trial of exercise training in heart failure .  Six-minute walk test , accelerometry , functional status , quality of life , anxiety , and depression were measured at baseline , 3 months , 6 months , and a mean of 19 months post-enrollment . There were no significant differences between the exercise and control groups at long-term follow-up . Six-minute walk distance declined by only 0.2 m/month in those attending final follow-up ( vs 4.6 m/month in nonattenders ; P=.03 ) . Similar results were seen for other outcomes . Only a small proportion of the variance in change of any of the outcomes was explained by differences in baseline variables OBJECTIVE To examine the contribution of social-cognitive factors ( self-efficacy and affect ) in predicting long-term physical activity in a sample of older adults ( N=174 ) . DESIGN A prospect i ve design assessed physical activity and psychosocial variables at 2 and 5 years following a 6-month r and omized , controlled exercise trial . MAIN OUTCOME MEASURES The primary outcome variable was self-reported physical activity , with previous behavior , self-efficacy , and affect assessed as determinants of physical activity . RESULTS Covariance modeling analyses indicated that physical activity at Year 2 was the strongest predictor of physical activity at 5-year follow-up . Both self-efficacy and affect at Year 2 were also associated with physical activity at Year 5 , as was original treatment condition . Variables accounted for 35 % of the variance in Year 5 activity . CONCLUSION Older adults with higher levels of physical activity , more positive affect , and higher self-efficacy at Year 2 were more likely to continue to be active at Year 5 . This study is one of the longest follow-ups of exercise behavior in older adults and has implication s for structuring environments to maximize the maintenance of physical activity Abstract Background Despite the well‐known health benefits of physical activity , it is a great challenge to stay physically active for frail – older adults with mobility limitations . The aim of this study was to test the ( cost‐ ) effectiveness of a patient‐centred physical therapy strategy ( Coach2Move ) in which individualized treatment ( motivational interviewing , physical examination , individualized goal setting , coaching and advice on self management , and physical training ) is combined to increase physical activity level and physical fitness and , thereby , to decrease the level of frailty . Methods A r and omized controlled trial was performed in 13 physical therapy practice s with measurements at 3 and 6 months . Eligible patients were aged 70 years or over and had mobility problems ( i.e. difficulties with walking , moving , getting up and changing position from bed or chair to st and ing , or stair climbing ) . The primary outcome was physical activity ( total and moderate intensity ) in minutes per day . Secondary outcomes were as follows : frailty , walking speed and distance , mobility , and quality of life . Data were analysed using linear mixed models for repeated measurements . Healthcare costs and quality ‐adjusted life years ( QALYs ) were computed and combined using net monetary benefit ( NMB ) for different willingness to pay thresholds . Data on costs , QALYs , and NMBs were analysed using linear mixed models . Results One hundred and thirty patients participated in this study . At 6 months , the between‐group difference was significant for moderate‐intensity physical activity in favour of the Coach2Move group [ mean difference : 17.9 min per day ; 95 % confidence interval ( CI ) 4.0 to 34.9 ; P = 0.012 ] . The between‐group difference for total physical activity was 14.1 min per day ( 95 % CI −6.6 to 34.9 ; P = 0.182 ) . Frailty decreased more in the Coach2Move group compared with usual care [ mean difference : −0.03 ( 95 % CI : −0.06 to −0.00 ; P = 0.027 ) ] . Compared with usual treatment , the Coach2Move strategy result ed in cost savings ( € 849.8 ; 95 % CI : 1607 to 90 ; P = 0.028 ) , an improvement in QALYs , ( 0.02 ; 95 % CI : 0.00 to 0.03 ; P = 0.03 ) , and a higher NMB at every willingness to pay threshold . Conclusions Older adults with mobility problems are able to safely increase physical activity in their own environment and reduce frailty . This study emphasizes both the potential cost‐effectiveness of a patient‐centred approach in the frail elderly and the importance of physical activity promotion in older adults with mobility limitations
target: Exercise interventions have small clinical benefits on  PA  levels in community-dwelling older adults , with a decline in the observed improvement after six months of the intervention cessation
background: Exercise is a form of physical activity ( PA ) .
  PA is an important marker of health and quality of life in older adults .
  The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure , and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65 + year-old adults .