Health Promotion Through Primary Care: Enhancing Self-Management With Activity Prescription and mHealth Physician-based physical activity counseling for middle-aged and older adults: A randomized trial Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study. Prescribing Physical Activity Through Primary Care: Does Activity Intensity Matter? Randomized trial of exercise in sedentary middle aged women: effects on quality of life Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention. Web-based Intervention to Promote Physical Activity by Sedentary Older Adults: Randomized Controlled Trial Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study Prevalence and correlates of physician recommendations to exercise among older adults. Development and evaluation of two web-based interventions for the promotion of physical activity in older adults: study protocol for a community-based controlled intervention trial Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older The Behavioral and Clinical Effects of Therapeutic Lifestyle Change on Middle-aged Adults Promoting physical activity for elders with compromised function: the lifestyle Interventions and Independence for elders (LIFE) study physical activity intervention Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly. A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease.
Abstract Background : It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention . Remote monitoring technologies ( ie , mHealth ) hold promise for engaging patients in self-management of many chronic diseases . The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity ( eg , exercise , sedentary behavior , or both ) for improving physiological and behavioral markers of lifestyle-related disease risk . Methods : Forty-five older adults ( aged 55–75 years ; mean age 63 ± 5 years ) were r and omly assigned to receive a personal activity program targeting changes to either daily exercise , sedentary behavior , or both . All participants received an mHealth technology kit including smartphone , blood pressure monitor , glucometer , and pedometer . Participants engaged in physical activity programming at home during the 12-week intervention period and su bmi tted physical activity ( steps/day ) , blood pressure ( mm Hg ) , body weight ( kg ) , and blood glucose ( mmol/L ) measures remotely using study -provided devices . Results : There were no differences between groups at baseline ( P > 0.05 ) . The intervention had a significant effect ( F(10 488 ) = 2.947 , P = 0.001 , ηP2 = 0.057 ) , with similar changes across all groups for physical activity , body weight , and blood pressure ( P > 0.05 ) . Changes in blood glucose were significantly different between groups , with groups prescribed high-intensity activity ( ie , exercise ) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone ( P < 0.05 ) . Conclusions : Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women . Results support the novel approach of prescribing changes to sedentary behaviors ( alone , and in conjunction with exercise ) to reduce risk of developing lifestyle-related chronic conditions Sedentary behavior among older adults increases risk for chronic diseases . Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients . The Physically Active for Life ( PAL ) project was a r and omized , controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels . The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory . Twenty-four community-based primary care medical practice s were recruited into the study ; 12 were r and omized to the Intervention condition and 12 to the Control condition . Physicians in the Intervention practice s received training in the delivery of brief physical activity counseling . Subjects in the Intervention practice s ( n=181 ) received brief activity counseling matched to their stage of motivational readiness for physical activity , a patient manual , a follow-up appointment with their physician to discuss activity counseling , and newsletter mailings . Subjects in the Control practice s ( n=174 ) received st and ard care .  Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly ( PASE ) were administered to subjects in both conditions at baseline , 6 weeks following their initial appointment , and at 8 months . Results showed that at the 6-week follow-up , subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition . This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores . Results suggest that more intensive , sustained interventions may be necessary to promote the adoption of physical activity among sedentary , middle-aged , and older adults in primary care medical practice OBJECTIVE To determine whether self-reported physical activity predicts a decreased rate of coronary heart disease ( CHD ) and all-cause mortalities in middle-aged men when rates are adjusted for known confounders . DESIGN Cohort Analytic Study of Israeli government employees in 1963 . SUBJECTS Eight thous and four hundred sixty-three Israeli male government employees , aged 40 years or older , representing six areas of birth , excluding those with known cardiovascular disease in either 1963 or 1965 , from an original cohort of 10,059 . MAIN OUTCOME MEASURE Comparison of rates of death due to CHD and all causes , determined from death certificates in 21 years of follow-up , for subjects with different baseline levels of self-reported leisure-time and work-related physical activities measured in 1965 . RESULTS Self-reported leisure-time but not work-related physical activity was inversely related to both CHD ( adjusted relative risk , 0.79 ; 95 % confidence interval , 0.66 to 0.95 ) and all-cause mortalities ( adjusted relative risk , 0.91 ; 95 % confidence interval , 0.83 to 0.99 ) . Most of the apparent benefit accrued was from light physical activity on less than a daily basis . These inverse relationships persisted after adjustment for age , systolic blood pressure , cigarette smoking , total and high-density lipoprotein cholesterol levels , body mass index , psychosocial factors , and other potential confounders . CONCLUSION Baseline levels of self-reported leisure-time physical activity predicted a decreased rate of CHD and all-cause mortalities in employed middle-aged Israeli men followed up prospect ively for 21 years Abstract Background : Physical activity guidelines recommend engaging in moderate- and vigorous-intensity physical activity to elicit health benefits . Similarly , these higher intensity ranges for activity are typically targeted in healthy living interventions ( ie , exercise prescription ) . Comparatively less attention has been focused on changing lower intensity physical activity ( ie , sedentary activity ) behaviors . The purpose of this study was to explore the effects of prescribing changes to physical activity of various intensities ( ie , sedentary through exercise ) through the primary care setting . Methods : Sixty older adults ( aged 55–75 years ; mean age 63 ± 5 years ) volunteered to participate , and were r and omly assigned to 4 groups : 3 receiving an activity prescription intervention targeting a specific intensity of physical activity ( exercise , sedentary , or both ) , and 1 control group . During the 12-week intervention period participants followed personalized activity programs at home . Basic clinical measures ( anthropometrics , blood pressure , aerobic fitness ) and blood panel for assessing cardiometabolic risk ( glucose , lipid profile ) were conducted at baseline ( week 0 ) and follow-up ( week 12 ) in a primary care office . Results : There were no differences between groups at baseline ( P > 0.05 ) . The intervention changed clinical ( F(5 , 50 ) = 20.458 , P = 0.000 , ηP2 = 0.672 ) and blood panel measures ( F(5 , 50 ) = 4.576 , P = 0.002 , ηP2 = 0.314 ) of cardiometabolic health . Post hoc analyses indicted no differences between groups ( P > 0.05 ) . Conclusion : Physical activity prescription of various intensities through the primary care setting improved cardiometabolic health status . To our knowledge , this is the first report of sedentary behavior prescription ( alone , or combined with exercise ) in primary care . The findings support the ongoing practice of fitness assessment and physical activity prescription for chronic disease management and prevention Increasing physical activity is currently considered to be a possible prevention strategy for cancer , obesity , and cardiovascular disease , either alone or in combination with dietary changes . This paper presents results of a r and omized trial of moderate-to-vigorous intensity exercise in middle aged , sedentary women ; specifically , we report changes in and correlates of quality of life and functional status of this exercise intervention program for both the short ( three months ) and longer term ( 12 months ) . The intervention group showed a significant increase in Mental Health score from baseline to 3 months ( p < .01 ) , significantly greater than the change in the control group at 3 months ( p < .01 ) . A similar trend among exercisers was observed for the General Health score ( p < .01 ) , and this finding was significantly greater than the change in control group at 3 months ( p = .01 ) . Change in Social Support – Affection were predictors of the changes in quality of life variables . This study documented improvements in quality of life and general functioning that occurred as a result of participating in an exercise intervention in sedentary middle-aged women The main goal of the preventive intervention study in one community of the German CINDI ( Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO ) area was to improve cardiovascular health by reducing the risk factors smoking , hypertension , obesity , hypercholesterolaemia , and by changing sedentary lifestyle . The intervention was performed by using the special " Three-Level- Strategy " , which is characterised by activities of primary care physicians in the usual consulting hour ( 1st level ) , with patient groups in their practice s ( 2nd level ) , and at community level ( 3rd level ) where a special work group and a co-ordinating general practice are co-operating . To evaluate the occurrence of the risk factors in practice and the local population , four cross-sectional r and om sample s ( N(total ) = 4881 ) were carried out in seven practice s from 1992 to 1995 . On the community level , 23 special exercise-based health groups ( N(total ) = 600 ) were established and were investigated by means of a question naire , related to behaviour and health beliefs . A " Local Health Information System " facilitated the evaluation , the management of the data , and the organisation of the health programme . The results of the practice sample s showed a significant reduction of smoking ( -17.8 % ) and hypertension ( -31.5 % ) ( p < 0.01 ) . The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants ( 83.8 % ) . The participants considerably improved their health behaviour : 82 % discussed health in their family , 37.3 % stated an increase of healthy nutrition , 52 % of relaxation ; 86.2 % intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings . We conclude that the practice -based " Three-Level- Strategy " provides a strong support for successful long-term prevention of cardiovascular risk , particularly , when exercise-based health training sessions are performed in order to change sedentary lifestyle . When organised on community level , they might have a positive impact on the health behaviour of the whole community . Physical activity can be used as a " prodrug " for health promotion in a holistic way Background Physical activity ( PA ) for older adults has well-documented physical and cognitive benefits , but most seniors do not meet recommended guidelines for PA , and interventions are lacking . Objectives This study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen . Methods A total of 368 sedentary men and women ( M=60.3 ; SD 4.9 ) were recruited , screened , and assessed online . They were r and omized into treatment and control groups and assessed at pretest , at 12 weeks , and at 6 months . After treatment group participants rated their fitness level , activity goals , and barriers to exercise , the Internet intervention program helped them select exercise activities in the areas of endurance , flexibility , strengthening , and balance enhancement . They returned to the program weekly for automated video and text support and education , with the option to change or increase their exercise plan . The program also included ongoing problem solving to overcome user-identified barriers to exercise . Results The multivariate model indicated significant treatment effects at posttest ( P=.001 ; large effect size ) and at 6 months ( P=.001 ; medium effect size ) . At posttest , intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants . At 6 months , treatment participants maintained large gains compared to the control participants on all 14 outcome measures . Conclusions These results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants . More research is needed to replicate the study results , which were based on self-report measures . Research is also needed on intervention effects with older population BACKGROUND The health benefits of leisure-time physical activity are well known , but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear . We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population . METHODS In this prospect i ve cohort study , 416,175 individuals ( 199,265 men and 216,910 women ) participated in a st and ard medical screening programme in Taiwan between 1996 and 2008 , with an average follow-up of 8·05 years ( SD 4·21 ) . On the basis of the amount of weekly exercise indicated in a self-administered question naire , participants were placed into one of five categories of exercise volumes : inactive , or low , medium , high , or very high activity . We calculated hazard ratios ( HR ) for mortality risks for every group compared with the inactive group , and calculated life expectancy for every group . FINDINGS Compared with individuals in the inactive group , those in the low-volume activity group , who exercised for an average of 92 min per week ( 95 % CI 71 - 112 ) or 15 min a day ( SD 1·8 ) , had a 14 % reduced risk of all-cause mortality ( 0·86 , 0·81 - 0·91 ) , and had a 3 year longer life expectancy . Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4 % ( 95 % CI 2·5 - 7·0 ) and all-cancer mortality by 1 % ( 0·3 - 4·5 ) . These benefits were applicable to all age groups and both sexes , and to those with cardiovascular disease risks . Individuals who were inactive had a 17 % ( HR 1·17 , 95 % CI 1·10 - 1·24 ) increased risk of mortality compared with individuals in the low-volume group . INTERPRETATION 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit , even for individuals at risk of cardiovascular disease . FUNDING Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes BACKGROUND This study explored the prevalence of and factors associated with physician suggestions to exercise in a sample of older adults . METHODS We conducted telephone interviews of a r and om sample of members of two Medicare health maintenance organizations ( HMOs ) in Northern California . Participants were 893 community-dwelling older adults of whom 63 % were women , 52 % were married , and 12 % were in a minority group . Mean years of education was 14.8 + /- ( 2.6 ) and mean years of age was 74.9 + /- ( 6.5 ) . The associations between patient self-reports of ever receiving physician recommendations to exercise and the following categories of variables were assessed : demographics , health-related quality of life , medical conditions , health/risk behaviors , and health knowledge/interest/satisfaction . RESULTS The prevalence of older adults in this study ever receiving a  physician suggestion to exercise  was 48.2 % . In a multivariate logistic regression model , being younger , sedentary , and having a higher body mass index were independently ( p < or = .05 ) and positively associated with increased reports of having ever received a  physician 's advice to exercise .  Those who were precontemplators ( not thinking about changing physical activity behavior ) , and those who reported greater frequency of endurance exercise were less likely to report receiving a physician recommendation to exercise  ( p < or = .05 ) . CONCLUSIONS Although physician advice appeared to be targeted to subgroups that could benefit , physician advice on exercise could be particularly increased for patients over 75 years of age , those currently not thinking about an increase in physical activity , and those currently active patients who may benefit from ongoing physician advice to promote maintenance Background Regular physical activity ( PA ) is a key contributor to healthy ageing . However , despite known health benefits , only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization . The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA ( i.e. , intervention groups 1 and 2 ) compared to a delayed intervention control group of older adults aged 65 to 75 years . Methods / Design Study participants will be r and omly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region : a ) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA ( subjective self-monitoring , intervention group 1 ) ; b ) participants in the second arm will receive access to the web-based intervention for 10 weeks and , in addition , track PA using Fitbit Zips ( objective self-monitoring , intervention group 2 ) ; c ) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community . In addition , weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups ( e.g. , neighborhood walks , strength and balance exercises ) . To evaluate short-term effects of the intervention on physical and psychological health , PA , physical fitness , and cognitive and psychological variables will be assessed at baseline and 12-week follow-up . Discussion This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65–75 years . Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults . Trial registration German Clinical Trials Register DRKS00010052 ( Date of registration 07–11 - 2016 ) Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Objectives The effectiveness of community level interventions depends to a great extent on adherence . Currently , information on factors related to adherence in older adults from developing countries is scarce . Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country . Design , setting and participants Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects ( 65–67.9 years at baseline ) with low to medium socioeconomic status from 10 health centers r and omized to receive a physical activity intervention as part of the CENEX cluster trial ( IS RCT N48153354 ) . Measurements Using a multilevel regression model , the relationship between adherence ( defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months ) and individual , intervention-related and context ual factors was evaluated . We also conducted 40 semi-structured interviews with older adults ( n=36 ) and instructors ( n=4 ) . Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence . Results Adherence to physical activity intervention was 42.6 % ( CI 95 % 39.5 to 45.6 ) . Depression , diabetes mellitus , percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence ( p<0.05 ) while being retired , participation in physical activity prior to the intervention , and green areas per habitant were positively associated with adherence ( p<0.05 ) . The qualitative interviews identified three primary barriers to adherence : current health problems , lack of time due to commitments for caring for family members , and being employed , and two primary facilitators to adherence : the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others . Conclusion In order to enhance effectiveness of community exercise interventions , strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Introduction Chronic diseases such as cancer , cardiovascular disease , stroke , and diabetes are responsible for most deaths in the United States . Lifestyle factors — poor nutrition , sedentary living , and tobacco use — appear to play a prominent role in the development of many chronic diseases . This study determined the behavioral and clinical impact of a therapeutic lifestyle-modification intervention on a group of community volunteers . Methods Participants included 348 volunteers aged 24 to 81 years from the Rockford , Ill , metropolitan area who participated in a r and omized clinical trial . The intervention group attended a 40-hour educational course delivered as lectures during a 4-week period . Participants learned the importance of making better lifestyle choices and how to make improvements in nutrition and physical activity . Changes in nutrition , physical activity behavior , and several chronic disease risk factors were assessed at baseline and 6 months . Results Intervention participants showed significant 6-month improvement in all nutrition and physical activity measures except calories from protein and whole-grain servings and all clinical measures except blood glucose , total cholesterol , triglycerides , and high-sensitivity C-reactive protein . Total cholesterol and low-density lipoprotein cholesterol were worse after 6 months in both groups but only significantly worse in the control group . The control group experienced small but significant improvements in systolic and diastolic blood pressure and high-density lipoproteins . Change-score comparisons between the intervention and control groups were significant for all nutrition and physical activity variables except total steps per week and daily sodium intake and were also significant for the clinical measures of weight , body fat , and body mass index . Conclusion This therapeutic lifestyle-modification program can significantly improve nutrition and physical activity behavior and can reduce many of the risk factors associated with common chronic diseases The Lifestyle Interventions and Independence for Elders ( LIFE ) Study is a Phase III r and omized controlled clinical trial ( Clinical trials.gov identifier : NCT01072500 ) that will provide definitive evidence regarding the effect of physical activity ( PA ) on major  mobility disability in older adults ( 70–89 years old ) who have compromised physical function . This paper describes the methods employed in the delivery of the LIFE Study PA intervention , providing insight into how we promoted adherence and monitored the fidelity of treatment . Data are presented on participants ’ motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training . Prior to the onset of training , 31.4 % of participants noted slight conflict with being able to meet the dem and s of the program and 6.4 % indicated that the degree of conflict would be moderate . Accelerometry data collected during PA training revealed that the average intensity – 1,555 counts/minute for men and 1,237 counts/minute for women – was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults . Also , a sizable subgroup required one or more rest stops . These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function . Moreover , the concept of what constitutes “ moderate ” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription OBJECTIVE the effects of regular exercise over 5 years on mortality and ADL impairment were evaluated in elderly people . DESIGN intervention study . SETTING Tsuru City , Yamanashi Prefecture , Japan . METHODS the subjects of this study were 245 elderly people living at home . Of these individuals , 155 ( 56 males aged 76.5+/-4.2 years at the baseline level ; 99 females aged 76.2+/-4.8 years ) who voluntarily participated in our original health-promoting programme were regarded as an intervention group . The remaining 90 ( 29 males aged 77.6+/-5.2 years at the baseline level ; 61 females aged 77.3+/-5.1 years ) were regarded as a control group . The programme was a 5-year intervention consisting of collective sessions given six times a year every 2 months . The intervention was a combination of an exercise programme based on theories of exercise physiology and a support programme based on health education theories . The relative risks of death and ADL impairment adjusted for age , presence or absence of cardiovascular or musculo-skeletal disorders , and functional fitness level at the baseline were calculated using logistic regression analysis . RESULTS the rates of participant compliance per year were 67.7 % in the first year of the intervention period and gradually decreased thereafter to 43.9 % in the last year . Amongst female subjects the percentage of those who exercised habitually at the end of the study period was the same as that in the baseline in the intervention group but was significantly lower at the end of the study in the control group ( chi2 = 10.576 , P < 0.01 ) . The relative risk of death in the intervention group was 1.0 ( 95 % CI 0.22 - 4.51 ) amongst the males and 0.16 ( 95 % CI 0.03 - 0.81 ) amongst the females . Relative risk of ADL impairment was 0.22 ( 95 % CI 0.03 - 1.42 ) amongst the males and 0.36 ( 95 % CI 0.13 - 1.02 ) amongst the females . CONCLUSION These findings suggest that the improved mortality and state of independence in the female portion of the intervention group occurred as a result of increased physical exercise levels in daily life . However , validation of our results must await research that employs a r and omized control trial to avoid various biases and confounding factors between the intervention and the control groups BACKGROUND Physical activity is a major modifiable risk factor for cardiovascular disease , but it is unclear what combination of feasible approaches , using existing re sources in primary care , work best to initiate increased physical activity . AIM To assess three approaches to initiate increased physical activity . DESIGN OF STUDY R and omised controlled ( 2 X 2 X 2 ) factorial trial . SETTING Four general practice s. METHOD One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were r and omised to eight groups defined by three factors :  prescription by general practitioners ( GPs ) for brisk exercise not requiring a leisure facility ( for example , walking ) 30 minutes per day , 5 days per week ; counselling by practice nurses , based on psychological theory to modify intentions and perceived control of behaviour , and using behavioural implementation techniques ( for example , contracting , ' rehearsal ' ) ; use of the Health Education Authority booklet ' Getting active , feeling fit ' . RESULTS Single interventions had modest effects . There was a trend from the least intensive interventions ( control + /- booklet ) to the more intensive interventions ( prescription and counselling combined + /- booklet ) for both increased physical activity and fitness ( test for trend , P = 0.02 and P = 0.05 , respectively ) . Only with the most intense intervention ( prescription and counselling combined ) were there significant increases in both physical activity and fitness from baseline ( Godin score = 14.4 , 95 % confidence interval [ CI ] = 7.8 to 21 , which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m , respectively , 95 % CI = 11.1 to 45.8 ) . Counselling only made a difference among those individuals with lower intention at baseline . CONCLUSION Feasible interventions using available staff , which combine exercise prescription and counselling explicitly based on psychological theory , can probably initiate important increases in physical activity
This review summarised in detail the effects  SD exercise interventions had on sedentary middle-aged individuals alongside the adherence to the prescriptions .
SD exercise was seen to be beneficial for improving metabolic outcomes physical characteristics , cardiorespiratory fitness and functional measures
Many chronic diseases and illnesses are caused by the lifestyle , including the physical activity habits , of an individual .
As such , consistent high levels of exercise should be encouraged across the lifespan , to limit the risk of developing one of these conditions and allowing for healthy aging to occur .
Exercise prescriptions that encourage high completion and adherence rates in an independent manner and improve health related outcomes should be provided to individuals .
To date , no review has identified optimal prescriptions of exercise to achieve this in sedentary middle-aged adults and this is important , given the higher risk of developing illnesses in this population as they age .
This review examines the effects prescriptions of self-directed ( SD ) exercise has on adherence and health related outcomes in sedentary middle-aged individuals in good general health currently and aims to identify the most suitable forms of planned SD exercise that can be carried out independently .