Physical activity rates among adults in the United States vary by age group with the percentage of men and women 65 years and older who meet physical activity guidelines for aerobic and strength training reported to be 15.3% and 10.8%, respectively (Elgaddal, 2022). Improved exercise capacity, body composition, psychological and cognitive well-being, chronic disease management, and reduced risk of physical disabilities are among the positive benefits of regular physical activity. It is recommended that older adults participate in structured physical activity or moderate exercise for a minimum of 150 minutes per week, with at least 2 nonconsecutive days of resistance training and balance activities (American College of Sports Medicine, 2022). However, promoting exercise among older adults who do not meet the recommended guidelines can be challenging. This Focus on Therapy will describe potential barriers to exercise participation and describe a tool that may be useful in guiding discussions with older adults about exercise participation.
There is a range of individual-level barriers associated with a low-activity lifestyle among older adults which include sociodemographic, behavioral, and health-related factors, as well as lack of time and motivation (Chen et al., 2022). Additionally, fear that exercise could bring about injury, pain, and discomfort, or exacerbate existing conditions has also been reported among older adults (Netz et al., 2008). Self-efficacy tools are useful in providing insight into an older adult's self-identified barriers and associated confidence in their ability to perform certain health behaviors including exercise (Jansons et al., 2023).
The Multidimensional Self-Efficacy Scale (MSES) is an instrument developed for the purpose of measuring self-efficacy (Rodgers et al., 2008). It is useful in identifying an individual's strengths as well as areas for improvement in relationship to their personal exercise beliefs (Borbon-Castro et al., 2020). It measures self-efficacy in three domains related to exercise: scheduling, task, and coping (Rodgers et al., 2008). By targeting the areas distinct to each patient's needs, healthcare providers and exercise physiologists can utilize behavior change interventions to coach older adults toward self-discovery, thereby developing self-confidence and motivation to exercise. These strategies may ultimately lead to sustainable exercise behaviors and improved health and well-being.
To complete the MSES, the respondent rates their perceived level of confidence from "0" (not at all confident) to "10" (completely confident) in each of three domains. Lack of time has been reported as the most frequent barrier to regular exercise participation (Jansons et al., 2023). Sample questions from the MSES aimed to identify barriers in this domain are, "How confident are you that you can include exercise in your daily routine?" and "How confident are you that you could consistently exercise three times a week?" If low confidence or a desire to improve in scheduling is identified, the clinician can educate the patient on strategies to optimize participation in exercise during their peak performance time (e.g., morning or evening) or utilize a time block in their daily routine that may include setting a timer to start and stop exercise.
Task efficacy refers to an individual's confidence in their ability to perform a specific aspect of a purposeful undertaking (e.g., a person's confidence in their ability to walk for 20 minutes at prescribed exercise intensity). Examples of MSES questions aimed to garner an understanding of the confidence level in this domain include, "How confident are you that you can complete exercise using proper technique?" and "How confident are you that you can follow directions to complete exercise?" If the clinician identifies the individual has low confidence or a desire to improve in this area, interventions can include education on self-monitoring techniques related to intensity (e.g., heart rate, rate perceived exertion) or recording daily step count using wearable activity monitors.
Coping efficacy refers to an individual's confidence in their ability to perform tasks under challenging conditions, for example when the individual's mood or affect is not optimal. A question in the MSES that can assist a provider to identify the person's coping efficacy level is, "How confident are you that you can exercise when you lack energy?" If low confidence is identified, it may be first necessary to determine if a medical condition such as depression or worsening of a medical aliment is present. If ruled out, mindfulness or imagery-focused therapeutic interventions are tools that may be useful for an individual to shift their mindset toward a more positive outlook.
Although there are a variety of strategies to assist older adults in initiating and sustaining exercise, the use of the MSES with a focus on exercise can be a useful adjunctive tool across all healthcare and fitness settings. The MSES can aid the provider in developing focused support of the individual and can empower the individual to adopt exercise routines and improve their confidence and performance in physical activity and exercise programming (Jansons et al., 2023).
Links found between viruses and neurodegenerative diseases
NIH: Research has suggested that viruses may play a role in certain neurodegenerative diseases. For example, a recent study found a link between Epstein-Barr virus infection and the risk of Multiple Sclerosis. There are also concerns about cognitive impacts from SARS-CoV-2, the virus that causes COVID-19. A research team analyzed data from the FinnGen project. This is a repository of biomedical data, or biobank, from more than 300,000 people in Finland and searched the biobank for people who had been diagnosed with one of six different conditions: Alzheimer's Disease (AD), amyotrophic lateral sclerosis (ALS), generalized dementia, vascular dementia, Parkinson's disease, (PD), and multiple sclerosis (MS) and found 45 associations between viruses and neurodegenerative diseases. The strongest association was between viral encephalitis-brain inflammation caused by a virus-and AD. A person with viral encephalitis was 30 times as likely to be diagnosed with AD as someone without encephalitis. The researchers only included cases of influenza severe enough to need hospitalization in the study. Thus, these associations only apply to the most severe cases of influenza.
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