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Physical frailty and cognitive frailty share biological mechanisms, but sex-specific biomarkers associated with transitions in gait speed and cognition during ageing are poorly understood.Gait speed, cognition (3MSE), body composition (DXA) and serological biomarkers were assessed annually over 9 years in 216 males (72.7 + 8.07 years) and 384 females (71.1 + 8.44 years). In females, maintaining normal gait speed was associated with lower percent body fat (IRR 0.793, p = 0.001, 95%CI 0.691–0.910) and lower lactate dehydrogenase (LDH) (IRR 0.623, p = 0.00, 95%CI 0.514–0.752), and in males, the association was with higher cholesterol (IRR 1.394, p = 0.001, 95%CI 1.154–1.684). Abnormal to normal gait speed transitions were associated with higher insulin in females (IRR 1.325, p = 0.022, 95%CI 1.041–1.685) and lower creatinine in males (IRR 0.520, p = 0.01, 95%CI 0.310–0.870). Normal to slow gait speed transitions in males were associated with IGF-1 (IRR 1.74, p = 0.022, 95%CI 1.08–2.79) and leptin in females (IRR 1.39, p = 0.043, 95%CI 1.01–1.91.) Maintaining normal cognition was associated with lower LDH in females (IRR 0.276, p = 0.013, 95%CI 0.099–0.765) and higher appendicular skeletal muscle mass in males (IRR 1.52, p = 0.02, 95%CI 1.076–2.135). Improved cognition was associated with higher leptin (IRR 7.5, p = 0.03, 95%CI 1.282–44.34) and lower triglyceride (IRR 0.299, p = 0.017, 95%CI 0.110–0.809) in males. Education was protective against cognitive decline in females (IRR 0.84, p = 0.037, 0.732–0.982). Sex-specific biomarkers of muscle (LDH, Creatinine, IGF-1, APSM) and metabolism (%fat, insulin,cholesterol, leptin, tryglycerides) were associated with gait speed and cognitive transitions. These data suggest that modifiable biomarkers of muscle and metabolism could be targeted for interventions.

OBJECTIVE To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Māori, Pacific Peoples and NZ Europeans in aged residential care (ARC). METHODS interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses. RESULTS A total of 538 Māori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID-19, while there were 549 Māori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Māori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID-19. Lower rates of hospitalisation were observed in Māori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77–84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0–64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002), both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4–25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6–1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Adipose tissue redistributes during aging resulting in increased intermuscular adipose tissue (IMAT), intramuscular, and intramyocellular lipid while subcutaneous fat decreases. IMAT has been associated with lower muscle strength, power, and quality, chronic inflammation, impaired glucose tolerance, and elevated total cholesterol in older adults. This review focused on trials investigating the role of age, physical activity and diet on IMAT. The studies agreed that IMAT increases with age and seems to be responsive to physical activity, particularly the combination of aerobic and resistance exercise. However, some reported this could occur with or without weight loss, and some reported that high IMAT at baseline may blunt the muscle quality adaptive response to physical training. Larger and longer trials are needed to differentiate the independent or synergistic effects of resistance and/or aerobic training, and obesity and weight loss combined with resistance, aerobic or combination of aerobic and resistance training on IMAT.

Background Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown. Aims To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults. Methods A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group. Discussion This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation. Trial registration Australian and New Zealand Clinical Trials Registry number—ACTRN12614000827639.

Background: Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. Objective: The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. Method: A four-Phase modified Delphi process was undertaken in which 24 individuals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. Results: In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. Conclusion: With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.

Objectives To investigate whether the Health Assessment Questionnaire Disability Index (HAQ-DI) reflects objective measures of physical function in people with osteoarthritis (OA) and rheumatoid arthritis (RA). Methods In total, 139 people, 71 with RA fulfilling the American College of Rheumatology (ACR) criteria (1987) and 68 with OA fulfilling ACR criteria for OA of the hip or knee, completed the HAQ-DI. Physical function was assessed using Timed Up and Go (TUG), 30 seconds Sit to Stand (STS), grip strength dynamometry and pedometer steps over 7 days. Results The strongest association with HAQ-DI was with the TUG (R2 of 0.671 and 0.512 in RA and OA groups, respectively). HAQ-DI and STS showed a non-linear association in both groups with R2 of 0.380 in RA and 0.359 in OA. A strong association was found between HAQ-DI and grip strength in the OA group (R2 = 0.681), whereas the RA group showed a moderate association (R2 = 0.285). There was a strong association between the HAQ-DI and pedometer measures in RA (R2 = 0.562), although this association was weak in OA (R2 = 0.156). Conclusion The HAQ-DI has a strong association with the TUG in both RA and OA. There was variable association between the HAQ-DI and other physical performance measures, as well as differences between the RA and OA cohorts. In order to form a full and accurate clinical picture, health professionals should perform both subjective patient-reported outcome measures and objective physical performance measures of disability.

This study aims to appraise and summarize consistent recommendations from clinical practice guidelines (CPGs) for identification and management of frailty to maintain and improve functional independence of elderly population. A systematic search of Ovid MEDLINE, Embase, PubMed, PsycINFO, and CINAHL electronic databases using database-specific search terms in two broad areas “guidelines” and “frailty”, and a manual search of websites with the key phrase “frailty guideline” was performed. The inclusion criteria included CPGs focusing on identifying and managing frailty in population >65 years old, published in English since January 2010. Three reviewers independently assessed guideline quality using the AGREE II instrument. Data extraction was performed, followed by compilation and comparison of all recommendations to identify the key consistent recommendations. Six CPGs met the inclusion criteria; however, only three CPGs had high methodological quality in accordance with AGREE II appraisal. The average AGREE II scores of all six CPGs were: 84.5%, 68%, 46.5%, 81.5%, 56.3%, and 60.2% for domains 1–6 (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence) respectively. A total of 54 recommendations were identified, with 12 key recommendations suggested frequently by the CPGs. The AGREE II instrument identified strengths and weaknesses of the CPGs, but failed to assess clinical implications and feasibility of the guidelines. Further research is needed to improve clinical relevance of CPGs in the identification and management of frailty. The feasibility in implementing these guidelines with regards to cost-effectiveness of frailty screening warrants further investigation.

Background Obesity exacerbates age-related effects on body composition and physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting older adults with obesity is unknown. Methods In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched ~10% weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait speed, and knee strength by dynamometry. Results IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; −41% vs −28% and −23% and VAT: −36% vs −19% and −21%; p = .003 to .01); IMAT and VAT decreased in all groups more than control (between-group p < .001). ISI increased more in COMB than AEX and REX groups (86% vs 50% and 39%; p = .005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p < .05). Knee strength improved more in COMB and REX than AEX group (all p < .05). Changes in IMAT and VAT correlated with PPT (r = −0.28 and −0.39), VO2peak (r = −0.49 and −0.52), gait speed (r = −0.25 and −0.36), and ISI (r = −0.49 and −0.52; all p < .05). Conclusions Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity.

Recently Boreskie and colleagues published an editorial in the Journal of Frailty and Aging on Preventing Frailty Progression During the COVID-19 Pandemic (1). In it they proposed the SAVE programme (Socialization, Adequate nutrition, Vitamin D, Exercise) to prevent frailty. They concluded that creative thinking and concerted efforts would be needed to disseminate health recommendations to maintain the health of pre-frail and frail older adults in unprecedented times, such as those posed by the COVID-19 pandemic.

The authors apologize for a typing error that occurred in the September 2020 article that changes the meaning of a sentence.

Background Sarcopenia is the age-related loss of skeletal muscle mass and function and may exist in early middle age. Previous research in this area has focused on resistance training in older individuals; however, there is a lack of intervention trials in middle-aged adults with low relative appendicular lean soft tissue mass who may be at risk for sarcopenia in older age. Objective This randomized controlled trial aims to determine the effects of a high-intensity interval aerobic resistance training intervention on appendicular lean soft tissue mass in middle-aged adults with low relative appendicular lean soft tissue mass. Methods We will conduct a 40-week, single-blinded randomized controlled trial in 84 middle-aged adults with low appendicular lean soft tissue mass in the wider Dunedin area, New Zealand. We will randomly allocate participants to receive either a group-based, 20-week high-intensity interval aerobic resistance training intervention program or a single, 60-minute education session on current exercise recommendations. After the first 20 weeks, both groups will be given a 20-week home program. The study will assess primary and secondary outcome measures, including body composition (regional and whole-body lean soft tissue mass, fat mass, percentage body fat, measured by dual x-ray absorptiometry), blood biomarkers (cortisol, creatinine, C-reactive protein, lipid profile, hemoglobin), physical fitness (maximum oxygen consumption, blood pressure), physical activity (accelerometry), physical function (handgrip strength, sit-to-stand, gait speed, quadriceps strength), and self-reported questionnaires (health outcomes, self-efficacy, perceived enjoyment of physical activity, and multifactorial lifestyle), at baseline, 20 weeks, and 40 weeks. Physical function and self-reported questionnaires will also be measured at 10 weeks. We will assess the primary outcome measure, total body lean soft tissue mass, at baseline, 20 weeks, and 40 weeks. Analyses will be performed using intention-to-treat principles, comparing the outcomes resulting from the intervention, using linear mixed models. Results We obtained ethical approval for this study from The University of Otago Human Ethics Committee on December 10, 2018. Participant recruitment started on February 11, 2019 and was completed on May 14, 2019. Data collection started on February 25, 2019 and was completed on February 28, 2020. We expect to publish the results in January 2021. Conclusions High-intensity interval aerobic resistance training is a time-efficient form of exercise, enabling busy middle-aged adults to meet physical activity recommendations while maximizing training results. The findings can inform the development of future prevention-focused interventions aimed at counteracting the high prevalence of sarcopenia in the aging population. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12618001778279); https://tinyurl.com/y555z6fz. International Registered Report Identifier (IRRID) DERR1-10.2196/22989

Background Recent advances in treatment for stroke give new possibilities for optimizing outcomes. To deliver these prehospital care needs to become more efficient. Aim To develop a framework to support improved delivery of prehospital care. The recommendations are aimed at clinicians involved in prehospital and emergency health systems who will often not be stroke specialists but need clear guidance as to how to develop and deliver safe and effective care for acute stroke patients. Methods Building on the successful implementation program from the Global Resuscitation Alliance and the Resuscitation Academy, the Utstein methodology was used to define a generic chain of survival for Emergency Stroke Care by assembling international expertise in Stroke and Emergency Medical Services (EMS). Ten programs were identified for Acute Stroke Care to improve survival and outcomes, with recommendations for implementation of best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through public awareness, optimized prehospital triage and timely diagnostics, and quick and equitable access to acute treatments. Documentation, use of metrics and transparency will help to build a culture of excellence and accountability.

Introduction: Falls are a common cause of injury in New Zealand. However, falls risk and prevalence have not been investigated in Pacific peoples. To address this knowledge gap, a literature review, falls risk screening, and attitudes towards exercise as falls prevention questionnaires were conducted in a Pacific population in the southern regional town of Dunedin. Aims: To identify the attitudes towards strength and balance exercise as falls prevention within Pacific Islands peoples in Dunedin, New Zealand. Methods: Participants aged 55+ were recruited from Pacific Trust Otago, flyers, at church groups and existing exercise classes. Falls screening was assessed by the New Zealand Health Quality and Safety Commission’s Ask, Assess, Act questionnaire. Attitudes towards exercise as falls prevention intervention, was assessed using a culturally adapted version of the Attitudes to Falls-Related Intervention Scales (AFRIS). Both questionnaires were verbally administered in the participants’ native tongue. Results: Fifty respondents (mean age: 68.69, males: 39.58%, females: 60.42%) completed the questionnaires. Just over 56% indicated falls risk (62.07% female and 52.63% male) and 30% reported a fall in the last 12 months (31.03% females and 21.05% males). AFRIS highest mean score, was 6.69 (out of 7) for readiness to engage in strength and balance exercise to prevent falls. The lowest score (6.4) was ease of exercise participation. The total mean AFRIS score was 38.96 out of a possible 42. Conclusions: Self-reported falls in the past year and risk within this population was comparable to other groups and highlights the need for falls prevention that caters to cultural needs. The positive response to adding strength and balance exercise provides supporting evidence of incorporating strength and balance exercises into existing programmes

Sarcopenia and obesity are reported risk factors for falls, although the data are not consistent and most studies do not make sex comparisons. We investigated whether falls were associated with balance, gait, and body composition, and whether these relationships are sex-specific. Secondary analysis of 4-year follow-up data from of the New Mexico Aging Process Study. Albuquerque, New Mexico. 307 participants (M, n=122, 75.8 yr. SD5.5; F, n=183, 74.6yr SD6.1). Gait and balance were assessed annually using the Tinetti test. Lean body mass (LBM), appendicular skeletal muscle mass (ASM), fat free mass (FFM), total fat mass (FM) were assessed annually by DXA. Falls were assessed using bimonthly falls calendars. Hazard ratios (HR) for 2-point worsening in gait and balance score and falls were calculated by Cox proportional hazard for men and women. Baseline balance deficits, and not body composition, represented the strongest predictor of falls. For the total balance score, the variables with significant sex interactions were ASM (Male-HR 1.02 95%CI 0.60-1.73; Female-HR 1.92 95%CI 1.05-3.52, p=0.03) and FFM (Male-HR 1.04 95%CI 0.64-1.70; Female-HR 1.91 95%CI 1.12-3.24, p=0.04), after adjustment for age, sarcopenia and physical activity. The body composition relationship with balance deficits was U-shaped with the strongest predictors being low LBM in males and high FM in females. Specific body composition components and balance deficits are risk factors for falls following sex-specific patterns. Sex differences need to be explored and considered in interventions for worsening balance and falls prevention.

ObjectiveThe task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.MethodsThese recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care.Recommendations for Screening and AssessmentThe task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation).Recommendations for ManagementA comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

To reduce disability and dependence in older adults, frailty may represent an appropriate target for intervention. While preventing frailty through lifestyle interventions may be the optimal public health approach for many population groups, pharmacological approaches will likely be needed for individuals who meet frailty criteria or who have comorbid conditions that contribute to and complicate the frailty syndrome, and for those who are not compliant with lifestyle interventions. Barriers to successful development of drug treatments for frailty include variability in how the frailty syndrome is defined, lack of agreement on the best diagnostic tools and outcome measures, and the paucity of sensitive, reliable, and validated biomarkers. The International Conference on Frailty and Sarcopenia Research Task Force met in Miami, Florida, on February 28, 2018, to consider the status of treatments under development for frailty and discuss potential strategies for advancing the field. They concluded that at the present time, there may be a more productive regulatory pathway for adjuvant treatments or trials targeting specific functional outcomes such as gait speed. They also expressed optimism that several studies currently underway may provide the insight needed to advance drug development for frailty.

Objectives This study describes the incidence, nature and cause of work-related injuries in older New Zealand workers to understand the risks of work-related injury in this rapidly aging population. Methods Data for the period 2009–2013 from 25,455 injured workers aged 55–79 years, extracted from national work-related injury entitlement claims, were stratified by age group and analysed by sex, industry, injury type and cause. Age-specific claims rates were calculated by year, sex and ethnicity. Results Patterns of injury differed by age: 70–79 year olds had the highest injury rates and proportion of claims due to falls (45%), for the self-employed (32%), for the agriculture sector (24%), and for fatal injuries (5%). Discussion The burden of work-related injuries in older workers, particularly in those aged over 70, will increase with their increasing participation in work. Workplace injury prevention strategies and interventions need to consider the specific characteristics and vulnerabilities of older workers.

Background and Purpose— Feasibility of utilizing the Stroke Riskometer App (App) to improve stroke awareness and modify stroke risk behaviors was assessed to inform a full randomized controlled trial. Methods— A parallel, open-label, 2-arm prospective, proof-of-concept pilot randomized controlled trial. Participants were randomized to usual care/control or App intervention group and assessed at baseline, 3, and 6 months. The App measures stroke risk and provides information on management of risk factors. Participants were aged >19 years with at least 2 modifiable stroke risk factors identified, no prior stroke, and owned a smartphone. Results— Fifty participants (24 control, 26 App) were recruited from 148 eligible participants. Retention in the trial was 87%. Mean cardiovascular health (Life’s Simple 7) improved by 0.36 (95% CI, −2.10 to 1.38) in the App group compared with 0.01 (95% CI, −1.34 to 1.32) in controls ( P =0.6733). Conclusions— These findings support a full randomized controlled trial to test the effectiveness of the Stroke Riskometer for primary stroke prevention. Clinical Trial Registration— URL: www.anzctr.org.au . Unique Identifier: ACTRN12616000376448.

Physical activity interventions aimed at older adults are frequently lead by younger trained professionals, often who have not experienced age-related changes in health status. The goal of this paper was to describe peer-led community-based interventions to assess whether this model is feasible for improving overall health and physical functioning. Twelve studies were included, with six different peer-led community-based programs: (1) Physical Training and Nutrition, (2) Project Healthy Bones, (3) Steady As You Go, (4) A Matter of Balance/Volunteer Lay Leader Program, (5) Healthy Eating, Active Lifestyles, and (6) Healthy Changes Program. All programs showed positive effects on physical function, fall efficacy, quality of life, self-efficacy, and self-perceived health. Some reported decreased falls, frailty, and improved social activity. Peer-led programs appear promising to maintain and improve physical and social health. More research is needed to confirm the effectiveness of this approach for improving health and physical function, and reduce falls, and also assess long-term benefits and costs of this community-based intervention for older adults.

The scientific literature highlights the necessity of implementing appropriate exercise programs in nursing homes to overcome the barriers to physical activity, and avoid prolonged periods of sedentary (e.g. sitting) and autonomy decline among residents. Growing evidence indicates that exergaming approaches for physical activity promotion, such as interactive video games, lead to increased enjoyment and motivation in addition to positive cognitive and physical outcomes, while being cost effective (1). The Jintronix Rehabilitation System®(JRS), a new home-based exercise technology, that has a unique ability to adapt to individuals’ limitations (i.e. range of motion, speed, intensity, etc.), and increasing difficulty of games as well as automated reminders and feedback can provide users with an increased sense of control and self-efficacy, which is something that other systems lack (2). Previous studies have demonstrated that the JRS is feasible, acceptable and safe in various population such as community-living older adults who sustained a minor injury (3) or pre-disabled older adults without dementia or cognitive impairment (4). Given its potential, we explored the feasibility, acceptability and efficacy of the JRS on physical performance in nursing home residents both with and without MCI.

Weight loss therapy of older adults with obesity is limited by weight loss-induced decrease in bone mineral density (BMD), which could exacerbate ongoing age-related bone loss and increase the risk for fractures. Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head-to-head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one-third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed-model repeated measures analyses of variance. After 6 months of intensive lifestyle interventions, BMD decreased less in the resistance group (-0.006 g/cm2 [-0.7%]) and combination group (-0.012 g/cm2 [-1.1%]) than in the aerobic group (-0.027 g/cm2 [-2.6%]) (p = 0.001 for between-group comparisons). Serum C-telopeptide, procollagen type 1 N-propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between-group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p < .001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss-induced decrease in hip BMD and less weight loss-induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

AimTo determine if there is an association between sarcopenia, physical function and self-reported fatigue in osteoarthritis (OA) and rheumatoid arthritis (RA).MethodsA cross-sectional analysis of measurements from a cohort of 157 participants with OA or RA was performed. The relationship between muscle mass (appendicular muscle index (AMI)), physical function (timed up and go, 30-seconds sit-to-stand test, 40-meter fast-paced walk test and grip-strength) and two fatigue measures (Multidimensional Assessment of Fatigue (MAF) and a fatigue Visual Analogue Scale (VAS)) was explored using hierarchical linear regression or logistic regression with established AMI cut-offs for sarcopenia.ResultsThere were no significant differences for perceived fatigue-related variables between OA or RA sarcopenic or non-sarcopenic participants. Participants with OA had worse physical function (TUG; P = 0.029, STS; P = 0.004, WS; P = 0.003), but participants with RA had lower grip strength (PConclusionSarcopenia, when assessed by AMI, does not appear to be strongly associated with self-reported fatigue or physical function in participants with either OA or RA. Higher body fat had a moderately strong association with sarcopenia in this cross-sectional study, suggesting that body composition may be an important factor in the health of patients with longstanding OA or RA.

ObjectiveThe provision of prescribed vitamin D to all aged-care residents has been implemented in New Zealand as part of a government-led falls prevention programme. To our knowledge, there has been no evaluation of this universal programme on vitamin D status and functional and health outcomes. Thus, we aimed to determine 25-hydroxyvitamin D (25(OH)D) concentrations and their predictors in aged-care residents across the country and to investigate whether the government-funded programme was associated with adequate vitamin D status.DesignCross-sectional survey of sociodemographic, biochemical, anthropometric, dietary and health characteristics. Blood samples were analysed for serum 25(OH)D and other biochemical measures. Multiple regression was used to examine predictors of vitamin D status.SettingSixteen residential aged-care facilities throughout New Zealand.SubjectsResidents aged ≥60 years with residency duration >12 weeks (n309).ResultsMean serum 25(OH)D was 89·9 (95 % CI 85·2, 94·5) nmol/l and monthly supplements (1250 µg (50 000 IU)) were taken by 75 % of all residents. Of those not taking a funded supplement, 65·3 % had serum 25(OH)D 1-acid glycoprotein were positively associated with higher 25(OH)D concentrations. Supplemental vitamin D from all sources was the strongest predictor, increasing serum 25(OH)D levels by more than 70 nmol/l. Furthermore, 25 % of participants had serum 25(OH)D levels >125 nmol/l.ConclusionsResidents taking supplemental vitamin D had adequate vitamin D status; however monitoring of long-term supplementation should be considered, due to the high proportion of participants with high serum 25(OH)D levels.

Frail older adults have an increased vulnerability to health and environmental stressors and are at a greater risk of functional decline, disability, loss of independence and mortality. Inadequate caloric, protein and micronutrient intakes have been positively associated with an increased risk of frailty, however this traditional single nutrient approach does not account for potential interactions and synergies of nutrients within the total diet. Using dietary patterns as a means of exploring the impact of overall food consumption offers an alternative approach to investigating associations between nutrition and frailty. The purpose of this paper is to review the existing body of knowledge about the frailty syndrome in relationship with various dietary patterns in aged populations and identify areas for further research.

Aim This study aimed to investigate reasons for ceasing participation in aqua-based exercise among older adults with osteoarthritis (OA). Methods Eleven adults over 60 years of age with OA participated in one of two focus groups, during which they discussed barriers to aqua-based exercise and the potential benefits of this exercise mode. Each focus group was audiotaped, transcribed and then analysed using the general inductive thematic approach. The investigators reached a consensus on all coding categories and then identified themes. Results Key barriers identified were: a lack of suitable classes; insufficient instructor knowledge, which often led to increased pain; cold water and the changing facilities. Key perceived benefits included increased physical ability in water and social interaction. Conclusions A greater understanding of reasons for ceasing participation in aqua-based exercise among older adults with OA may help facilitate development of suitable exercise programs that minimise barriers for this group.

ABSTRACT INTRODUCTIONPhysical inactivity is a risk factor for disease severity among people with obstructive sleep apnoea. AIMTo determine physical activity levels in patients at risk of obstructive sleep apnoea and explore their perceptions about barriers to participation in physical activity. METHODSThis was a cross-sectional observational study. Eligible participants were adults with symptoms of obstructive sleep apnoea hypopnea syndrome and Epworth Sleepiness Scale score ≥11, awaiting prioritisation for a diagnostic overnight sleep study at the local sleep clinic. Sixty participants (mean age±standard deviation: 51±12 years) each attended an individual appointment. Anthropometric measurements were taken and standardised questionnaires regarding quality of life, physical activity behaviour and perceptions of physical activity were completed. RESULTSOver one-third of the cohort did not meet World Health Organization guidelines for weekly physical activity. Hypertension, type 2 diabetes and obesity were also more prevalent in this subgroup. Low motivation and pain were commonly reported barriers to activity in participants not meeting the physical activity guidelines. Overall, 53 (88%) participants stated they would like to be more active. DISCUSSIONPhysical inactivity represents an additional risk factor for adults at high risk of obstructive sleep apnoea. Lack of motivation and pain were the most commonly perceived barriers to participation in activity. Physical activity interventions tailored to the individual, and including a motivational component, need to be included as integral components of management to reduce cardiovascular and metabolic risk factors more effectively in this group.

OBJECTIVE To systematically assess the effects of exercise interventions on body composition and functional outcomes in older adults with sarcopenia. METHODS PubMed/Medline, Embase and Cochrane Library were searched from 2006 to 2017 for exercise randomised controlled trials and controlled clinical trials in adults 60 years and older with sarcopenia. Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA-P) and Physiotherapy Evidence Database (PEDro) scale assessed internal validity. Meta-analysis and sensitivity analysis were performed. RESULTS Searches retrieved 1512 titles. Thirty-two full texts were evaluated, and six trials were included. Methodological quality was 5.5 (0-10). Meta-analysis revealed that knee-extension strength (P ≤ 0.01), timed up and go (P < 0.0001), appendicular muscle mass (P = 0.04) and leg muscle mass (P = 0.04) significantly improved in response to exercise interventions. CONCLUSIONS Exercise interventions significantly improved strength, balance and muscle mass. However, the number of trials was small and the training effect was inconsistent due to heterogeneity in exercise mode, duration and intensity. Lack of detailed description makes it impossible to reflect on the progressive resistance training approaches used. More research is needed to confirm these findings.

The total number of older adults has increased markedly in recent decades with concurrent escalation in the proportion with a body mass index ≥30 kg/m2. Community-based studies indicate that obesity has a significant impact on the physical functioning and independence of older adults and increases the risk for nursing home admission. This review aims to describe the prevalence of obesity in nursing homes and the impact of such on individual health and aged care resources and to explore whether intervention strategies could improve obesity and quality of life in the nursing home population.

Objectives The main aim of this study was to compare the perceptions of general practitioners (GPs) and primary care nurses (PCNs) in the Southern Region of New Zealand regarding their provision of chronic illness care. Whether PCNs rated their frequency of providing aspects of chronic illness care higher than GPs was a key question. Methods The modified version of the Patient Assessment of Chronic Illness Care (PACIC) was used to compare the perceptions of GPs and PCNs. Results Surveys were received from 77% of practices in the Southern region. Responding PCNs were more likely than their GP counterparts to document they provided aspects of chronic illness care ‘most of the time’ or ‘always’ in 18 activities from the six M-PACIC domains. Their level of providing patients with formal care plans was surprisingly low. Conclusion This level of engagement of PCNs with chronic illness care was no surprise. The low number reporting they provided patients with a care plan, most of the time or always, was unexpected. Aspects of care planning, however, were reported as taking place more frequently. This discrepancy between the process of care planning and the outcome, a care plan, is not unique to this region of New Zealand and warrants further research.

Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia.In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs - aerobic training, resistance training, or combined aerobic and resistance training - or to a control group (no weight-management or exercise program). The primary outcome was the change in Physical Performance Test score from baseline to 6 months (scores range from 0 to 36 points; higher scores indicate better performance). Secondary outcomes included changes in other frailty measures, body composition, bone mineral density, and physical functions.A total of 141 participants completed the study. The Physical Performance Test score increased more in the combination group than in the aerobic and resistance groups (27.9 to 33.4 points [21% increase] vs. 29.3 to 33.2 points [14% increase] and 28.8 to 32.7 points [14% increase], respectively; P=0.01 and P=0.02 after Bonferroni correction); the scores increased more in all exercise groups than in the control group (P0.001 for between-group comparisons). Peak oxygen consumption (milliliters per kilogram of body weight per minute) increased more in the combination and aerobic groups (17.2 to 20.3 [17% increase] and 17.6 to 20.9 [18% increase], respectively) than in the resistance group (17.0 to 18.3 [8% increase]) (P0.001 for both comparisons). Strength increased more in the combination and resistance groups (272 to 320 kg [18% increase] and 288 to 337 kg [19% increase], respectively) than in the aerobic group (265 to 270 kg [4% increase]) (P0.001 for both comparisons). Body weight decreased by 9% in all exercise groups but did not change significantly in the control group. Lean mass decreased less in the combination and resistance groups than in the aerobic group (56.5 to 54.8 kg [3% decrease] and 58.1 to 57.1 kg [2% decrease], respectively, vs. 55.0 to 52.3 kg [5% decrease]), as did bone mineral density at the total hip (grams per square centimeter; 1.010 to 0.996 [1% decrease] and 1.047 to 1.041 [0.5% decrease], respectively, vs. 1.018 to 0.991 [3% decrease]) (P0.05 for all comparisons). Exercise-related adverse events included musculoskeletal injuries.Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Funded by the National Institutes of Health; LITOE ClinicalTrials.gov number, NCT01065636 .).

To determine 1) age-adjusted transition probabilities to worsening physical/cognitive function states, reversal to normal cognition/physical function, or maintenance of normal state; 2) whether these transitions are modulated by sex, BMI, education, hypertension (HTN), health status, or APOE4; 3) whether worsening gait speed preceded cognition change, or vice versa. Analysis of 9-year prospective cohort data from the New Mexico Aging Process Study. Setting: Healthy independent-living adults. Participants: 60+ years of age (n= 598). Gait speed, cognitive function (3MSE score), APOE4, HTN, BMI, education, health status. Over 9 years, 2129 one-year transitions were observed. 32.6% stayed in the same state, while gait speed and cognitive function (3MSE scores) improved for 38% and 43% of participants per year, respectively. Transitions to improved function decreased with age (P

BACKGROUND: The unintentional death rate from falls is higher among American Indians from the US Southwest than from other regions in the country. The Zuni Pueblo is a geographically isolated, rural American Indian community located in western New Mexico. Education and screening for falls risk is lacking in this community and may be needed to reduce falls and falls-related illness and death. COMMUNITY CONTEXT: Building on a 17-year relationship with the Zuni Health Initiative, meetings were held with Zuni tribal leadership, staff from the Zuni Senior Center and Zuni Home Health Services, members of the Zuni Comprehensive Community Health Center, Indian Health Service, and Zuni community health representatives (CHRs) to discuss elder falls in the community. Existing infrastructure, including CHRs who were already trained and certified in diabetes education and prevention, provided support for the study. METHODS: Tribal leadership agreed that CHRs would be trained to administer the Centers for Disease Control and Prevention's (CDC's) Stay Independent checklist to assess falls risk. They administered the checklist during one-on-one interviews in Shiwi (Zuni native language), English, or both to a convenience sample of 50 Zuni elders. OUTCOMES: Mean age of participants was 72 (standard deviation, 7.4) years, and 78% were women. Fifty-two percent reported at least 1 fall during the past year; 66% scored 4 or more on the CDC Stay Independent checklist, indicating elevated risk for falls. CHRs reported that the checklist was easy to administer and culturally accepted by the elder participants. INTERPRETATION: This study broadened the Zuni Health Initiative to include falls risk screening. Self-reported falls were common in this small sample, and the incidence was significantly higher than the national rate. These results highlight the need for community engagement, using culturally acceptable falls screening, to promote falls education and implement falls prevention programs. Language: en

Background: Postural instability is a cardinal sign of idiopathic Parkinson’s disease (IPD) leading to increased fall risk; however, the exact reason for this instability is unclear. Objectives: This systematic review critically explored the relationships between factors contributing to or impacting on postural instability in people with IPD. Methods: Ten databases were searched for studies, with an experimental or observational design, which met the following criteria: (1) participants diagnosed with IPD; (2) included a measure or perturbation of postural stability or balance; and (3) investigated at least one factor contributing to or impacting on postural instability. The Generic Appraisal Tool for Epidemiology (GATE) checklist was used to rate the methodological quality of selected studies. Results: Fifty-seven studies were selected, of which 42 were rated to have moderate-to-high quality. Factors contributing to or impacting on postural instability were broadly categorized as: (1) sensory dysfunction...

OBJECTIVE: Assess feasibility and impact of adding a long-term condition self-management program (Living a Healthy Life, LHL) into Steady as You Go (SAYGO) fall prevention exercise classes. METHOD: Four-day LHL leader training workshop to deliver six weekly program. Focus groups explored feasibility and acceptability. Chronic disease self-efficacy, balance confidence, health behaviours and status were measured at 6 weeks, 3, 6 and 12 months. RESULTS: Four leaders and 17 participants volunteered. Focus groups revealed that becoming a leader was considered stressful. Participants valued discussions about managing health, strategies for better communication with doctors, keeping track of medications, action plans and nutrition labels. Between 6-week and 12-month follow-up, self-rated health increased. CONCLUSION: Although participants valued LHL information, the low participation rates, time commitment and stress of becoming a leader and leading classes suggest that adding LHL to other fall prevention programs will need further consideration around integration of the programs.© 2016 AJA Inc. Language: en

Obesity in older adults is ubiquitous in many developed countries and is related to various negative health outcomes, making it an important public health target for intervention. However, treatment approaches for obesity in older adults remain controversial due to concerns surrounding the difficulty of behavior change with advancing age, exacerbating the age-related loss of skeletal muscle and bone, and the feasibility of long-term weight maintenance and related health consequences. This review serves to systematically examine the evidence regarding weight loss interventions with a focus on obese (body mass index 30 kg/m2 and above) older adults (aged 65 years and older) and some proposed mechanisms associated with exercise and caloric restriction (lifestyle intervention). Our findings indicate that healthy weight loss in this age group can be achieved through lifestyle interventions of up to a one-year period. Most interventions reviewed reported a loss of lean body mass and bone mineral density with weight loss. Paradoxically muscle quality and physical function improved. Inflammatory molecules and metabolic markers also improved, although the independent and additive effects of exercise and weight loss on these pathways are poorly understood. Using our review inclusion criteria, only one small pilot study investigating long-term weight maintenance and associated health implications was found in the literature. Future research on lifestyle interventions for obese older adults should address the loss of bone and lean body mass, inflammatory mechanisms, and include sufficient follow up to assess long-term weight maintenance and health outcomes.

This study aimed to (a) identify factors that motivate older adults to participate in aqua-based exercise; (b) identify potential barriers; and (c) compare perceptions between older adults with and without osteoarthritis (OA). Fifteen adults above 60 years of age participated in one of three focus groups during which they discussed perceived benefits, motives, and barriers to aqua exercise. Pain reduction was considered a major benefit among those with OA, improved health and fitness was a principal benefit for those without OA. All participants felt that the instructor could act as both a motivator and barrier; the most significant barrier was cold changing facilities in winter. With the exception of pain reduction, perceived benefits, motivators, and barriers to aqua-based exercise are similar among older adults with and without OA. A greater understanding of these factors may help us to facilitate older adults with OA to initiate and adhere to aqua-based exercise.

The review paper by Dr. Guyonnet and colleagues (1) is a comprehensive assessment of nutritional frailty and emphasizes the challenges and importance of bringing frailty identification and interventions into the clinical setting.

To compare the effectiveness of tai chi and low-level exercise in reducing falls in older adults; to determine whether mobility, balance, and lower limb strength improved and whether higher doses of tai chi resulted in greater effect.Randomized controlled trial.Eleven sites throughout New Zealand.Six hundred eighty-four community-residing older adults (mean age 74.5; 73% female) with at least one falls risk factor.Tai chi once a week (TC1) (n = 233); tai chi twice a week (TC2) (n = 220), or a low-level exercise program control group (LLE) (n = 231) for 20 wks.Number of falls was ascertained according to monthly falls calendars. Mobility (Timed-Up-and-Go Test), balance (step test), and lower limb strength (chair stand test) were assessed.The adjusted incident rate ratio (IRR) for falls was not significantly different between the TC1 and LLE groups (IRR = 1.05, 95% confidence interval (CI) = 0.83-1.33, P = .70) or between the TC2 and LLE groups (IRR = 0.88, 95% CI = 0.68-1.16, P = .37). Adjusted multilevel mixed-effects Poisson regression showed a significant reduction in logarithmic mean fall rate of -0.050 (95% CI = -0.064 to -0.037, P.001) per month for all groups. Multilevel fixed-effects analyses indicated improvements in balance (P.001 right and left leg) and lower limb strength (P.001) but not mobility (P = .54) in all groups over time, with no differences between the groups (P = .37 (right leg), P = .66 (left leg), P = .21, and P = .44, respectively).There was no difference in falls rates between the groups, with falls reducing similarly (mean falls rate reduction of 58%) over the 17-month follow-up period. Strength and balance improved similarly in all groups over time.

Background:Social isolation is a significant problem for frail older adults and the determinants ofsocial engagement are poorly understood. Objectives:This study explored the social engagement of frail eldersto identify personal attributes associated with social engagement. Design, Setting and Participants:A cross-sectional sample of seventy-three people receiving home-based care in one town on the South Island of NewZealand (mean age 82 (7.2) yrs, n=51 Females, 21 Males). Measurements:Face-to-face semi-structuredinterviews and questionnaires. Functional independence was measured using Nottingham Extended Activities ofDaily Living (EADL), self-efficacy by General Self Efficacy Scale, and 2 open-ended questions were piloted onsocial activities and helping others. Results:Regression models identified two statistically associatedcomponents of social engagement: social activities and civic involvement. Contributions to families andcommunity organizations and exercise were important social activities. Personal attributes included perceivedfunctional independence and self-efficacy. Conclusions:In frail older adults, a measurement of socialengagement should address activities older adults identify as important, including exercise. Independence, self -efficacy, and social engagement may interact in reinforcing cycles of empowerment and could play a role indeveloping interventions to retain and maintain function in frail older adults.

Cardiovascular complications have emerged as a major concern for cancer patients. Many chemotherapy agents are cardiotoxic and some appear to also alter lipid profiles, although the mechanism for this is unknown. We studied plasma lipid levels in 12 breast cancer patients throughout their chemotherapy. Patients received either four cycles of doxorubicin and cyclophosphamide followed by weekly paclitaxel or three cycles of epirubicin, cyclophosphamide and 5'-fluorouracil followed by three cycles of docetaxel. Patients demonstrated a significant reduction (0.32 mmol/L) in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (apoA1) levels (0.18 g/L) and an elevation in apolipoprotein B (apoB) levels (0.15 g/L) after treatment. Investigation of the individual chemotherapy agents for their effect on genes involved in lipoprotein metabolism in liver cells showed that doxorubicin decreased ATP binding cassette transporter A1 (ABCA1) via a downregulation of the peroxisomal proliferator activated receptor γ (PPARγ) and liver X receptor α (LXRα) transcription factors. In contrast, ABCA1 levels were not affected by cyclophosphamide or paclitaxel. Likewise, apoA1 levels were reduced by doxorubicin and remained unaffected by cyclophosphamide and paclitaxel. Doxorubicin and paclitaxel both increased apoB protein levels and paclitaxel also decreased low density lipoprotein receptor (LDLR) protein levels. These findings correlate with the observed reduction in HDL-C and apoA1 and increase in apoB levels seen in these patients. The unfavourable lipid profiles produced by some chemotherapy agents may be detrimental in the longer term to cancer patients, especially those already at risk of cardiovascular disease (CVD). This knowledge may be useful in tailoring effective follow-up care plans for cancer survivors.

To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group).Quasi-experimental evaluation with 12-month follow-up.Community.Older adults with increased fall risk (N=118; mean age, 75.5 y; age range, 65-94 y), with 23% drop out at 12 months.Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist-administered program and comparison group (n=25) 1-hour weekly seated exercise classes.Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months.At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48-1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group.This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.

This study assessed whether an upgrade of playgrounds in a community was associated with changes in the physical activity of local children. The study used a natural experiment design with a local authority project to upgrade two community playgrounds as the intervention and a matched control community. Children’s physical activity was measured by an Actigraph GT1M accelerometer worn for 8 days, enabling up to 6 days of data to be analyzed. A self-administered parent/guardian questionnaire was used to collect additional data, including perceptions of the neighborhood, school-travel modes, days involved in extracurricular activities, ethnicity, caregiver age, caregiver sex, household vehicle access, and household income. At baseline, 184 children (5–10 years old) participated. Of these, 156 completed the 1-year follow-up assessment (20% lost to follow-up). There was statistically significant evidence that change in mean total daily physical activity was associated with on an interaction between participant’s body mass index (BMI) z-score and her or his community of residence (p = 0.006), with the intervention being associated with higher levels of activity for children with lower BMIs but lower levels for children with higher BMIs. Physical activity is not the only focus of local authority playground provision as playgrounds also have benefits for social development and fundamental movement skills. However, making sure that physical activity is always included in the design rationale and that playgrounds are designed to encourage and sustain physical activity could be a useful population health intervention. The effects of such interventions on different subgroups are of importance, especially if the effects differ over levels of BMI.