Promoting physical activity for elders with compromised function: the lifestyle Interventions and Independence for elders (LIFE) study physical activity intervention

Figures & data

Table 1 Description of mini-campaigns

Mini-campaign 1
Title	A group challenge: walking from Pittsburgh to Stanford! (Note: Teams were based on group randomization into the LIFE Study)
Goal and procedures	The objective was to be the first team from Pittsburgh to complete a walk between Pittsburgh and Stanford – 2,650 miles! After each center-based session, an interventionist totaled the miles for each team and then posted these miles on a map using a pin that was moved along the black highlighted route to indicate each team’s progress. Each team had a separate map and these were posted side-by-side to create a team competition. The great part of this adventure was that every team received a prize once they reached Stanford, although the first team to reach Stanford received a bonus!
How do you earn miles?	Participants earned 1 mile for every 1 minute walked during the exercise sessions. Thus, if someone walked 30 minutes, he/she earned 30 miles for their team. Along the route, information was posted on major cities as a way to increase interest in the campaign.
Mini-campaign 2
Title	Spring into LIFE. (Note: Teams were based on group randomization into the LIFE Study)
Goal and procedures	Spring into LIFE was a 6-week campaign. Each LIFE team was given a center-based group walking goal. This goal was based on their previous walking minutes and was meant to challenge the participants. The staff updated each team’s aggregate performance at the beginning of each week by plotting their progress on a visual “thermometer” displayed on the wall of the activity center. The team who exceeded its goal the most received a prize of its choosing. The winning group chose to have a pizza party! Each group who met its goal also received a prize and each group member who contributed to the campaign was rewarded 20 LIFE bucks (“LIFE bucks” are paper money that can earned by achieving attendance and walking goals and can be cashed in for small incentive items such as water bottles, pedometers, and T-shirts).
Mini-campaign 3
Title	Walk across America.
Goal and procedures	This campaign involved an entire clinic walking across America from the east to West Coast. Individual mileage was tracked at each center-based session using pedometers. Progress was displayed on a “thermometer” taped to the wall of the facility. A lot of attention was given to learning about the unique attributes of different landmarks reached. To celebrate achievements along the way, mini celebrations were held every 500 miles completed, at which time progress was announced and small incentives were distributed. When the East Coast site reached the West Coast, the achievement was acknowledged by participants from a West Coast site in the form of a letter. It was powerful for participants to feel connected to others at a distance and to feel part of a national project.

Abbreviation: LIFE, Lifestyle Interventions and Independence for Elders.

Table 2 LIFE campaign: Stride for LIFE

Definition	“Stride for LIFE” was a study-wide campaign designed to increase participation in physical activity and to facilitate achievement of walking goals. The campaign was run for 4 weeks and was offered to all participants regardless of length of time in the study.
Overview	The campaign was designed to include a kickoff session, eight onsite walking sessions, 4 weeks of tracking home logs, and a large group-closing event. To help foster a global sense of purpose during each onsite walking session, a different LIFE site was highlighted at each session using 5-minute Microsoft PowerPoint® presentations. The campaign was used in conjunction with any other incentive programs currently running at each site.
Details	The campaign goal was to have participants walk at least 10% more than they were currently walking. In addition, each site had an overall minute goal that members of the site attempted to reach by the end of the campaign. The site’s overall minutes were compiled into an overall study-wide goal. Small incentives were awarded to individuals who met their 10% goal by the end of the campaign and all individuals who achieved at least 80% attendance during the campaign were awarded fleece blankets embroidered with the LIFE logo. Some guidelines for setting goals are shown in the columns below; however, ultimately, the goal-setting process was collaborative and individualized, taking in to account such factors as level of function and physical symptoms.
Current minutes goal per session	Campaign goal, % increased	Example of minutes increased via %	Total minutes
≥40	10	4	44
30–39	20	6–8	36–47
≤29	10–30	3–9	32–38

Abbreviation: LIFE, Lifestyle Interventions and Independence for Elders.

Table 3 LIFE Study baseline characteristics

Characteristic	Physical activity intervention group (N = 818)	Physical activity group not in accelerometry substudy (N = 678)	Physical activity group in substudy (N = 140)	P-value
Age, years	78.7 ± 5.2	78.7 ± 5.2	78.7 ± 5.2	0.93
Sex				<0.01
Female	547 (66.9)	471 (69.5)	76 (54.3)
Male	271 (33.1)	207 (30.5)	64 (45.7)
Race/ethnicity				0.65
Caucasian/White	604 (73.8)	498 (73.5)	106 (75.7)
African American/Black	163 (19.9)	133 (19.6)	30 (21.4)
Latino, Hispanic or Spanish	31 (3.8)	28 (4.1)	3 (2.1)
Other/mixed	20 (2.5)	19 (2.8)	1 (0.7)
Education				0.30
No formal education (0)	7 (0.9)	7 (1.0)	0 (0.0)
Elementary school (K–8)	15 (1.8)	12 (1.8)	3 (2.1)
High school/equivalent (9–12)	248 (30.3)	208 (30.7)	40 (28.6)
College (13–17)	321 (39.2)	267 (39.4)	54 (38.6)
Postgraduate	194 (23.7)	159 (23.5)	35 (25.0)
Other	33 (4.0)	25 (3.7)	8 (5.7)
Body mass index	30.1 ± 5.9	30.2 ± 6.0	29.9 ± 5.7	0.56
High blood pressure/hypertension	573 (70.0)	484 (71.4)	89 (63.6)	0.07
Heart attack/coronary/MI	60 (7.3)	52 (7.7)	8 (5.7)	0.42
Heart failure/congestive heart failure	26 (3.2)	23 (3.4)	3 (2.1)	0.44
Cancer/malignant tumor	178 (21.8)	154 (22.7)	24 (17.1)	0.15
Diabetes/high blood sugar	198 (24.2)	157 (23.2)	41 (29.3)	0.12
Pain and/or stiffness in the knees	112 (13.7)	87 (12.8)	25 (17.9)	0.14
Pain and/or stiffness in the hips	70 (8.6)	57 (8.4)	13 (9.3)	0.74
Pain and/or stiffness in the back/spine	110 (13.4)	89 (13.1)	21 (15.0)	0.55
Chronic lung disease	130 (15.9)	115 (17.0)	15 (10.7)	0.07

Note: Data shown are mean ± standard deviation or n (%).

Abbreviations: K, kindergarten; LIFE, Lifestyle Interventions and Independence for Elders; MI, myocardial infarction

Table 4 Barriers/facilitators to self-regulation (%)

Factor	Rating scale
	+3	+2	+1	0	−1	−2	−3
Neighborhood environment	42.2	27.5	10.8	4.3	6.1	5.6	2.5
Family/friends	64.3	20.6	4.1	9.3	0.3	0.6	0.1
Doctor	54.2	17.8	3.7	5.0	0.1	0.5	0
	3/4	5	6	7	8	9	10
Self-efficacy for program demands	0.4	4.7	4.2	7.8	21.3	21.6	39.2
Value attributed to long-term goals	0.0	2.0	2.3	5.0	20.6	19.0	44.5

Notes: No ratings of 1 or 2 were given for either self-efficacy or value. Totals do not add up to 100% due to some missing data (below 5% in all cases). The +3 to −3 scale had verbal anchors of extreme positive influence, moderate positive influence, slight positive influence, neutral, slight negative influence, moderate negative influence, and severe negative influence. The self-efficacy and value scales ranged from 0 (not at all) to 10 (extreme).

Table 5 Patterns of activity during center-based exercise by sex

Variable	Rest bouts		Activity bouts
	Men (N = 64)	Women (N = 76)	Men (N = 64)	Women (N = 76)
Number of bouts (frequency)
0	44 (68.8%)	39 (51.3%)
1	9 (14.1%)	22 (28.9%)	44 (68.8%)	39 (51.3%)
2	6 (9.4%)	9 (11.8%)	9 (14.1%)	22 (28.9%)
3	2 (3.1%)	4 (5.3%)	6 (9.4%)	9 (11.8%)
4	1 (1.6%)	0 (0.0%)	2 (3.1%)	4 (5.3%)
5	0 (0.0%)	2 (2.6%)	1 (1.6%)	0 (0.0%)
6	1 (1.6%)	0 (0.0%)	0 (0.0%)	2 (2.6%)
7	1 (1.6%)	0 (0.0%)	1 (1.6%)	0 (0.0%)
8			1 (1.6%)	0 (0.0%)
Number of bouts	0.7 ± 1.4	0.8 ± 1.1	1.7 ± 1.4	1.8 ± 1.1
	0 (0–1)	0 (0–1)	1.0 (1–2)	1 (1–2)
Bout length (minutes)a	1.2 ± 2.3	1.6 ± 2.4	30.9 ± 15.8	26.3 ± 14.2
	0 (0–1.2)	0 (0–2.8)	32 (18–44.5)	23.7 (14.2–37.0)
Total time (minutes)b	2.5 ± 5.7	2.5 ± 3.7	36.9 ± 11.8	36.9 ± 11.6
	0 (0–1.5)	0 (0–4.5)	38.5 (30–45)	36.5 (28.5–44.5)
Counts/minutec	7.7 ± 18.3	13.7 ± 22.7	1,555 ± 970.8	1,237 ± 761.5
	0 (0–2.9)	0 (0–18.8)	1,336 (765–2,063)	1,037 (708–1,611)

Notes: Data shown are frequency, or mean ± standard deviation (SD) followed by median (interquartile range).

a Values represent the mean number of minutes per bout, calculated by taking the average of the mean bout lengths obtained for each person. Thus, if a person had one bout, the information for that bout alone is presented, but if they had six bouts, the mean of their values across those six bouts is presented;

b values represent the mean total time in activity across all bouts, calculated as the sum of the bout lengths across all bouts for an individual. Thus, if a person had one bout, the information for that bout only is presented, but if they had six bouts, the sum of the bout lengths across all six bouts is presented;

c values represent the mean number of counts/minute per bout, calculated by taking the average of the counts/minute obtained for each person. Thus, if a person had one bout, the information for that bout alone is presented, but if they had six bouts, the mean of their counts/minute across all six bouts is presented.

Figure 1 Panels (A–C) represent three representative accelerometry recordings from center-based exercise training.

Notes: In (A–C), the y-axis represents counts/minute, whereas the x-axis is the minute-by-minute time course for the training bout. The horizontal red “+” marks represent the median counts/minute achieved across the activity session; the blue circles represent the counts achieved for a given minute of activity; the horizontal blue “+” marks indicate rest periods and identify the number of the rest period with a numeric superscript, if any rest intervals were taken. The participant in Figure 1A is exercising well above the standard adult cutoff point for moderate-intensity exercise (2,690 counts/minute²¹) and has a very consistent pace across the entire exercise bout. The participants in Figure 1B and C have median activity counts well below the adult cutoff point for moderate PA with the individual in Figure 1C being the most compromised. Note that the person in Figure 1B exhibits a high degree of variability in intensity and had to take a 6-min rest stop. Such patterns are common for participants with joint pain or various chronic health conditions.

MessierSPLoeserRFMillerGDExercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion TrialArthritis Rheum20045051501151015146420

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