A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> Abstract This study sought to determine whether 9 months of low- or moderate-intensity exercise training could decrease blood pressure (BP) in hypertensive men and women (mean age 64 ± 3 years). Patients underwent weekly BP evaluations for 1 month to ensure that they had persistently elevated BP and then completed a maximal treadmill exercise test to exclude those with overt coronary artery disease. The low- and moderate-intensity groups trained at 53 and 73% of maximal oxygen consumption (VO 2 max), respectively; however, total caloric expenditure per week was similar in both groups. VO 2 max did not increase in the low-intensity group with training, but increased 28% in the moderate-intensity group. Diastolic BP decreased 11 to 12 mm Hg in both training groups. Systolic BP decreased 20 mm Hg in the low-intensity group with training, which was significantly greater than the change in the control and the moderate-intensity groups. Although systolic BP decreased 8 mm Hg in the moderate-intensity training group, this reduction was not significant. Training resulted in a somewhat lower cardiac output at rest in the low-intensity group, whereas total peripheral resistance decreased slightly in the moderate-intensity training group. Plasma and blood volumes, plasma renin levels and urinary sodium excretion did not change in either group with training. Both groups manifested lower plasma norepinephrine levels after training during standing rest, but not while supine. Thus, low-intensity training may lower BP as much or more than moderate-intensity training in older persons with essential hypertension, but the underlying mechanisms are unclear. <s> BIB001 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> Purpose: The purpose of this study was to examine the evidence for causal relationships between physical activity (PA) and low back pain (LBP), osteoarthritis (OA), and osteoporosis (OP), and for dose-response relations involved. Methods: Computer database searches and personal retrieval systems were used to locate relevant literature. Results: PA can be effective in preventing LBP (Category A) but prolonged, heavy loading can lead to LBP (Category C). Specific exercises have not been found effective in treatment of acute LBP (Category A), but PA can be effective in chronic LBP (Category B), especially for diminishing the effects of deconditioning. No evidence indicates that PA directly prevents OA. Large amounts of intensive PA involving high impacts or torsional loadings or causing injuries increases risk of OA (Category C). Light or moderate PA does not increase the risk of OA (Category C). PA can be effective in the treatment and rehabilitation of OA (Category B ). High-intensity loading is osteogenic and possibly useful in prevention of OP (Category A) at the loaded site, but low to moderate loading is not osteogenic (Category D). Static efforts and slow movements are ineffective or less effective than fast application of force (Category B). The types of PA to attain the effects mentioned above are known except in the case of prevention of LBP, but dose-response relationships are poorly known; at best, semiquantitatively on the basis of just a few studies. Conclusion: Given the shown primary and/or secondary preventative effectiveness of PA regarding LBP, OA, and OP, research to elucidate the inadequately known dose-response relations should be given high priority. <s> BIB002 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss. To define long-term weight loss success, we need an accepted definition. We propose defining successful long-term weight loss maintenance as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, the picture is much more optimistic, with perhaps greater than 20% of overweight/obese persons able to achieve success. We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase. <s> BIB003 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> Although there has been increased research and clinical attention given to the effects that physical activity has on quality of life among older adults, there is a lack of consistency surrounding the use of this term. As a result, attempts to examine what causes change in quality of life have been limited. This article critically reviews the literature on physical activity and quality of life in older adults. In so doing, attention is given to both quality of life as a psychological construct represented by life satisfaction as well as a clinical and geriatric outcome represented by the core dimensions of health status or health-related quality of life. The literature is also examined to identify potential mediators and moderators in the physical activity and quality-of-life relationship. Discussion of possible mediating variables reinforces the important role of perception when considering the beneficial effects that physical activity has on quality of life. From a public health perspective, understanding what may cause change in quality of life has significant implications for the design, implementation, and promotion of physical activity programs for older adults. <s> BIB004 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> OBJECTIVE ::: There are insufficient data on the effects of long-term intensive exercise in patients with rheumatoid arthritis (RA). We undertook this randomized, controlled, multicenter trial to compare the effectiveness and safety of a 2-year intensive exercise program (Rheumatoid Arthritis Patients In Training [RAPIT]) with those of physical therapy (termed usual care [UC]). ::: ::: ::: METHODS ::: Three hundred nine RA patients were assigned to either the RAPIT program or UC. The primary end points were functional ability (assessed by the McMaster Toronto Arthritis [MACTAR] Patient Preference Disability Questionnaire and the Health Assessment Questionnaire [HAQ]) and the effects on radiographic progression in large joints. Secondary end points concerned emotional status and disease activity. ::: ::: ::: RESULTS ::: After 2 years, participants in the RAPIT program showed greater improvement in functional ability than participants in UC. The mean difference in change of the MACTAR Questionnaire score was 2.6 (95% confidence interval [95% CI] 0.1, 5.2) over the first year and 3.1 (95% CI 0.7, 5.5) over the second year. After 2 years, the mean difference in change of the HAQ score was -0.09 (95% CI -0.18, -0.01). The median radiographic damage of the large joints did not increase in either group. In both groups, participants with considerable baseline damage showed slightly more progression in damage, and this was more obvious in the RAPIT group. The RAPIT program proved to be effective in improving emotional status. No detrimental effects on disease activity were found. ::: ::: ::: CONCLUSION ::: A long-term high-intensity exercise program is more effective than UC in improving functional ability of RA patients. Intensive exercise does not increase radiographic damage of the large joints, except possibly in patients with considerable baseline damage of the large joints. <s> BIB005 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> CONTEXT ::: Exercise is associated with mortality benefits but simply expending energy through any activity in an individual's free-living environment may confer survival advantages. ::: ::: ::: OBJECTIVE ::: To determine whether free-living activity energy expenditure is associated with all-cause mortality among older adults. ::: ::: ::: DESIGN, SETTING, AND PARTICIPANTS ::: Free-living activity energy expenditure was assessed in 302 high-functioning, community-dwelling older adults (aged 70-82 years). Total energy expenditure was assessed over 2 weeks using doubly labeled water. Resting metabolic rate was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of total energy expenditure. Free-living activity energy expenditure was calculated as: (total energy expenditure x 0.90) - resting metabolic rate. Participants were followed up over a mean of 6.15 years (1998-2006). ::: ::: ::: MAIN OUTCOME MEASURES ::: Free-living activity energy expenditure (3 tertiles: low, <521 kcal/d; middle, 521-770 kcal/d; high, >770 kcal/d) and all-cause mortality. ::: ::: ::: RESULTS ::: Fifty-five participants (18.2%) died during follow-up. As a continuous risk factor, an SD increase in free-living activity energy expenditure (287 kcal/d) was associated with a 32% lower risk of mortality after adjusting for age, sex, race, study site, weight, height, percentage of body fat, and sleep duration (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96). Using the same adjustments, individuals in the highest tertile of free-living activity energy expenditure were at a significantly lower mortality risk compared with the lowest tertile (hazard ratio, 0.31; 95% confidence interval, 0.14-0.69). Absolute risk of death was 12.1% in the highest tertile of activity energy expenditure vs 24.7% in the lowest tertile; absolute risks were similar to these for tertiles of physical activity level. The effect of free-living activity energy expenditure changed little after further adjustment for self-rated health, education, prevalent health conditions, and smoking behavior. According to self-reports, individuals expending higher levels of free-living activity energy were more likely to work for pay (P = .004) and climb stairs (P = .01) but self-reported high-intensity exercise, walking for exercise, walking other than for exercise, volunteering, and caregiving did not differ significantly across the activity energy expenditure tertiles. ::: ::: ::: CONCLUSIONS ::: Objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality in healthy older adults. Simply expending energy through any activity may influence survival in older adults. <s> BIB006 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> There is a general belief that physical activity and exercise have positive effects on mood and anxiety and a great number of studies describe an association of physical activity and general well-being, mood and anxi- ety. In line, intervention studies describe an anxiolytic and antidepressive activity of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological shortcomings. The aim of this paper is to critically review the currently available litera- ture with respect to (1) the association of physical activity, exercise and the prevalence and incidence of depression and anxiety disorders and (2) the potential therapeutic activity of exercise training in patients with depression or anxiety disorders. Although the association of physical activity and the prevalence of mental disorders, including depression and anxiety disorders have been repeatedly described, only few studies examined the association of physical activity and mental disorders prospectively. Reduced incidence rates of depression and (some) anxiety disorders in exercising subjects raise the question whether exercise may be used in the prevention of some mental disorders. Besides case series and small uncontrolled studies, recent well controlled studies suggest that exercise training may be clinically effective, at least in major depression and panic disorder. Although, the evidence for positive effects of exercise and exercise training on depression and anxiety is growing, the clinical use, at least as an adjunct to established treatment approaches like psychotherapy or pharmacotherapy, is still at the beginning. Further studies on the clinical effects of exer- cise, interaction with standard treatment approaches and details on the optimal type, intensity, frequency and dura- tion may further support the clinical administration in patients. Furthermore, there is a lack of knowledge on how to best deal with depression and anxiety related symptoms which hinder patients to participate and benefit from exercise training. <s> BIB007 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle. <s> BIB008 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> BACKGROUND ::: With age reaction time, coordination and cognition tend to deteriorate, which may lead to gait impairments, falls and injuries. To reduce this problem in elderly and to improve health, well-being and independence, regular balance and strength exercises are recommended. However, elderly face strong barriers to exercise. ::: ::: ::: OBJECTIVE ::: We developed Active Lifestyle, an IT-based system for active and healthy aging aiming at improving elderly's balance and strength. Active Lifestyle is a proactive training application, running on a tablet, which assists, monitors and motivates elderly to follow personalized training plans autonomously at home, while integrating them socially. The objective is to run a pilot study to investigate: (i) the feasibility of assisting the autonomous, physical training of independently living elderly with the Active Lifestyle system, (ii) the adherence of the participants to the training plans, and (iii) the effectiveness of the motivation instruments built into the system. ::: ::: ::: METHODS ::: After three introductory meetings, 13 elderly adults followed personalized two-weeks strength and balance training plans using the Active Lifestyle app autonomously at home. Questionnaires were used to assess the technological familiarity of the participants, the feasibility aspects of the physical intervention, and the effectiveness of the motivation instruments. Adherence to the exercise plan was evaluated using the performance data collected by the app during the study. ::: ::: ::: RESULTS ::: A total of 13 participants were enrolled, of whom 11 (85%) completed the study (mean age 77 ± 7 years); predominantly females (55%), vocational educated (64%), and their past profession requiring moderate physical activity (64%). The Active Lifestyle app facilitated autonomous physical training at home (median=7 on a 7-point Likert scale), and participants expressed a high intention to use the app also after the end of the study (median=7). Adherence with the training plans was 73% (89% on the balance exercises and 60% on the strength exercises). The outcome from our questionnaires showed that without the app the participants did not feel motivated to perform exercises; with the support of the app they felt more motivated (median=6). Participants were especially motivated by being part of a virtual exercise group and by the capability to automatically monitor their performance (median=6 for both). ::: ::: ::: CONCLUSIONS ::: This study shows that the Active Lifestyle app prototype has valuable potential to support physical exercise practice at home and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to the knowledge base into mobile-based applications for elderly, in that it shows that elderly users can learn to work with mobile-based systems. The Active Lifestyle app proved viable to support and motivate independently living elderly to autonomously perform balance and strength exercises. <s> BIB009 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> Background: Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home. Objective: The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed. Methods: A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study. Results: Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed. Conclusions: ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time. [J Med Internet Res 2013;15(8):e159] <s> BIB010 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> V. PHYSICAL HEALTH <s> The purpose of this pilot study was to test a mobile app that combines exercise, health education, and bingo (Bingocize®) to improve functional performance, health knowledge, and adherence. Senior volunteers were assigned to use the app on tablets twice a week for 10 weeks or a use the app to play only modified bingo. Pre/post functional performance and health education knowledge were compared using Mixed ANOVA (p<.05). Health knowledge ( λ=6.06, F (1,10)=6.50, p=.029, =.394), Short Physical Performance Battery ( λ=.584, F(1, 10) =6.41, p=.032, =.416) , and gait velocity (λ=6.10, F (1,10)=6.40, improved in the experimental group only. Adherence was equivalent in both groups. Bingocize®and ef fective way to teach older adults health information, while improving functional performance. <s> BIB011
Maintaining physical health involves doing physical activities and eating healthy. In fact, about two-thirds of the factors for aging well depends on one's lifestyle  . In older adults, regular and moderate intensity of physical activity has been shown to reduce the risks of the onset of chronic conditions like cardiovascular disease BIB008 , type II diabetes  , osteoporosis BIB002 , hypertension BIB001 , depression BIB007 , and rheumatoid arthritis BIB005 ; weight maintenance/obesity BIB003 ; and improved cognitive function  . It also positively impacts quality of life BIB004 , promotes independent living among older adults BIB008 and reduces risk of mortality BIB006 . In spite of benefits from physical activity, sedentary lifestyle (lack of physical activity) is quite prevalent among older adults in United States. In fact, according to the 2014 Behavioral Risk Factor Surveillance System (BRFSS), only 14.4 percent of older adults, aged between 65-74 years, and only 7.9 percent of adults, aged 75 years or more, met the recommended levels of physical activity (both aerobic and muscle-strengthening activities)  . Thus, to promote physical activity among older adults (under Healthy People 2010 initiative)  ; low-cost, effective and sustainable interventions have been developed. These interventions (computertailored) have been proven to positively change physical activity among older adults. A number of tablet-based applications have been designed to promote physical exercise among older adults BIB010 - BIB011 . For instance, Silveira et al. developed a tablet-based application, ActiveLifestyle to aid strength exercise among older adults BIB010 , BIB009 . It assists and monitors the older adults during autonomous home-based physical workouts. Step-bystep instructions and a video demonstrating an exercise help the user perform the exercise. Upon completion of the exercise, the user provides feedback on his/her performance. The user's progress towards the goals set by the user is shown through a metaphor of a flower. The flower grows at the end of every workout session. Further, the flower has a mood status, reflecting the daily mood of the user, entered at the end of the entire workout session. The application provides group and individualized motivational messages to the user for helping him/her achieve the workout goals. Thirteen older adults (70 years and older), with no severe illnesses were trained to use the ActiveLifestyle application for two weeks, for performing balance and strength exercises. 11 out of 13 enrolled participants completed the study. The majority of the participants intended to use the application again and would recommend it to their friends/family. The participants also appreciated the training videos. However, they did not like the sound of the alarm. The participants appreciated the flower metaphor and felt it motivating. The social group motivated the participants as well. However, the mood status of the flower did not have a high impact on their motivation.