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1.  The influence of aerobic fitness on cerebral white matter integrity and cognitive function in older adults: Results of a one-year exercise intervention 
Human brain mapping  2012;34(11):2972-2985.
Cerebral white matter degeneration occurs with increasing age and is associated with declining cognitive function. Research has shown that cardiorespiratory fitness and exercise are effective as protective, even restorative, agents against cognitive and neurobiological impairments in older adults. In this study, we investigated whether the beneficial impact of aerobic fitness would extend to white matter integrity in the context of a one-year exercise intervention. Further, we examined the pattern of diffusivity changes to better understand the underlying biological mechanisms. Finally, we assessed whether training-induced changes in white matter integrity would be associated with improvements in cognitive performance independent of aerobic fitness gains. Results showed that aerobic fitness training did not affect group-level change in white matter integrity, executive function, or short-term memory, but that greater aerobic fitness derived from the walking program was associated with greater change in white matter integrity in the frontal and temporal lobes, and greater improvement in short-term memory. Increases in white matter integrity, however, were not associated with short-term memory improvement, independent of fitness improvements. Therefore, while not all findings are consistent with previous research, we provide novel evidence for correlated change in training-induced aerobic fitness, white matter integrity, and cognition among healthy older adults.
doi:10.1002/hbm.22119
PMCID: PMC4096122  PMID: 22674729
Diffusion tensor imaging; Anisotropy; Cerebrum; Cognition; Physical fitness; Aging
2.  Effects of a DVD-Delivered Exercise Intervention on Physical Function in Older Adults 
Background.
Given the rapidly increasing demographic of older adults, it is vital to implement effective behavioral strategies to improve physical function to maintain activities of daily living. However, changing physical activity in older adults remains extremely difficult. The current trial tested the efficacy of a novel, 6-month, home-based, DVD-delivered exercise program focusing on flexibility, balance, and toning on the physical function of older adults.
Methods.
Older adults (N = 307) were recruited from 83 towns and cities throughout central Illinois. The trial consisted of 4 waves of recruitment and randomization from May 2010 through January 2012. Inclusion criteria included being inactive, at least 65 years of age, English speaking, providing physician’s consent, and willingness to be randomized. Eligible participants were randomly assigned to 1 of 2 treatment conditions: the exercise intervention or a healthy aging, attentional control. Functional assessments were completed at baseline and following the 6-month DVD intervention. Measures included the Short Physical Performance Battery, assessments of flexibility and strength, and self-reported functional limitations.
Results.
Participants in the DVD intervention condition demonstrated significant improvements in the Short Physical Performance Battery (p = .005), lower extremity flexibility (p = .04), and upper body strength (p = .003). There were no effects of the intervention on self-reported functional limitations.
Conclusions.
The exercise intervention produced a clinically significant improvement in the Short Physical Performance Battery and improvements in flexibility and strength, demonstrating the effectiveness of a low-cost DVD exercise program in improving physical function in older adults.
doi:10.1093/gerona/glt014
PMCID: PMC3738028  PMID: 23401566
Clinical trial; DVD; Home-based exercise; Functional performance; Public health; Gait; Balance.
3.  Physical activity barriers and facilitators among working mothers and fathers 
BMC Public Health  2014;14:657.
Background
The transition to parenthood is consistently associated with declines in physical activity. In particular, working parents are at risk for inactivity, but research exploring physical activity barriers and facilitators in this population has been scarce. The purpose of this study was to qualitatively examine perceptions of physical activity among working parents.
Methods
Working mothers (n = 13) and fathers (n = 12) were recruited to participate in one of four focus group sessions and discuss physical activity barriers and facilitators. Data were analyzed using immersion/crystallization in NVivo 10.
Results
Major themes for barriers included family responsibilities, guilt, lack of support, scheduling constraints, and work. Major themes for facilitators included being active with children or during children’s activities, being a role model for children, making time/prioritizing, benefits to health and family, and having support available. Several gender differences emerged within each theme, but overall both mothers and fathers reported their priorities had shifted to focus on family after becoming parents, and those who were fitting in physical activity had developed strategies that allowed them to balance their household and occupational responsibilities.
Conclusions
The results of this study suggest working mothers and fathers report similar physical activity barriers and facilitators and would benefit from interventions that teach strategies for overcoming barriers and prioritizing physical activity amidst the demands of parenthood. Future interventions might consider targeting mothers and fathers in tandem to create an optimally supportive environment in the home.
doi:10.1186/1471-2458-14-657
PMCID: PMC4227023  PMID: 24974148
Physical activity; Parenthood; Working mothers; Fathers; Focus groups
4.  Influence of allowable interruption period on estimates of accelerometer wear time and sedentary time in older adults 
The criteria one uses to reduce accelerometer data can profoundly influence the interpretation of research outcomes. The purpose of this study was to examine the influence of three different interruption periods (i.e., 20, 30, and 60 minutes) on the amount of data retained for analyses and estimates of sedentary time among older adults. Older adults (N=311; Mage=71.1) wore an accelerometer for seven days and reported wear time on an accelerometer log. Accelerometer data were downloaded and scored using 20, 30, and 60-minute interruption periods. Estimates of wear time derived using each interruption period were compared to self-reported wear time, and descriptive statistics were used to compare estimates of sedentary time. Results showed a longer interruption period (i.e., 60 minutes) yields the largest sample size and the closest approximation of self-reported wear time. A short interruption period (i.e., 20 minutes) is likely to underestimate sedentary time among older adults.
doi:10.1123/japa.2013-0021
PMCID: PMC3875619  PMID: 23752299
5.  Neurobiological markers of exercise-related brain plasticity in older adults 
The current study examined how a randomized one-year aerobic exercise program for healthy older adults would affect serum levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor type 1 (IGF-1), and vascular endothelial growth factor (VEGF) - putative markers of exercise-induced benefits on brain function. The study also examined whether (a) change in the concentration of these growth factors was associated with alterations in functional connectivity following exercise, and (b) the extent to which pre-intervention growth factor levels were associated with training-related changes in functional connectivity. In 65 participants (mean age = 66.4), we found that although there were no group-level changes in growth factors as a function of the intervention, increased temporal lobe connectivity between the bilateral parahippocampus and the bilateral middle temporal gyrus was associated with increased BDNF, IGF-1, and VEGF for an aerobic walking group but not for a non-aerobic control group, and greater pre-intervention VEGF was associated with greater training-related increases in this functional connection. Results are consistent with animal models of exercise and the brain, but are the first to show in humans that exercise-induced increases in temporal lobe functional connectivity are associated with changes in growth factors and may be augmented by greater baseline VEGF.
doi:10.1016/j.bbi.2012.10.021
PMCID: PMC3544982  PMID: 23123199
exercise; aging; functional connectivity; fMRI; default mode network; aerobic fitness; growth factors
6.  The Perceived Importance of Physical Activity: Associations with Psychosocial and Health-Related Outcomes 
Background
The purpose of this study was to assess the extent to which participation in a 12-month exercise program changed the degree of importance that older adults attached to physical activity. Additionally, associations among changes in physical activity importance and health-related and psychosocial outcomes were examined.
Methods
Community-dwelling older adults (N = 179) were recruited to participate in a 12-month exercise trial examining the association between changes in physical activity and fitness with changes in brain structure and psychological health. Participants were randomly assigned to a walking condition or a flexibility, toning, and balance condition. Physical, psychological, and cognitive assessments were taken at months 0, 6, and 12.
Results
Involvement in a 12-month exercise program increased the importance that participants placed on physical activity; this positive change was similar across exercise condition and sex. Changes in importance, however, were only associated with changes in physical health status and outcome expectations for exercise midway through the intervention. There were no significant associations at the end of the program.
Conclusions
Regular participation in physical activity can positively influence the perceived importance of the behavior itself. Yet, the implications of such changes on physical activity-related outcomes remain equivocal and warrant further investigation
PMCID: PMC3856648  PMID: 22820124
7.  A Profile for Predicting Attrition from Exercise in Older Adults 
Objectives
The purpose of this study was to determine a profile for predicting attrition among older adults involved in a 12-month exercise program.
Methods
The parent study was a single-blinded randomized controlled trial. The study took place between 2006 and 2009 within a university setting. Older adults (N = 179) completed baseline assessments of functional performance and psychosocial measures. Participants who relinquished their consent to participate were considered “dropouts” and those remaining were classified as “completers.”
Results
A discriminant function analysis differentiated dropouts (n = 35) from completers (n = 144) at likelihood much better than chance (72% accurate overall) across four measures: frequency of forgetting, barriers self-efficacy scale, balance, and stair performance. Study dropouts exhibited a higher frequency of forgetting, lower efficacy for overcoming barriers to exercise, poorer single leg balance, and longer times to walk down stairs.
Conclusions
The results provide an initial validation of a profile for discriminating between “dropouts” and “completers,” one that may have considerable utility for screening older adults prior to study entry.
doi:10.1007/s11121-012-0325-y
PMCID: PMC3806454  PMID: 23412942
exercise; attrition; dropout; older adults
8.  Longitudinal Invariance and Construct Validity of the Abbreviated Late-Life Function and Disability Instrument in Healthy Older Adults 
Objective
To cross-validate the psychometric properties of the abbreviated Late-Life Function and Disability Instrument (LL-FDI), a measure of perceived functional limitations and disability.
Design
Baseline and 12-month follow-up assessments conducted across the course of a 12-month exercise program.
Setting
University research community.
Participants
Older healthy adults (N=179; mean ± SD age, 66.43±5.67y) at baseline; 145 were retained at follow-up.
Interventions
Not applicable.
Main Outcome Measures
LL-FDI and functional performance measures.
Results
Factor analyses confirmed the factor structure of the abbreviated LL-FDI, and all subscales met minimal criteria for temporal invariance. Significant correlations also were found between functional limitations subscales and an array of physical function performance measures, supporting the scale’s construct validity.
Conclusions
The abbreviated LL-FDI with some modifications appears to be temporally invariant in community-dwelling older adults. Additionally, moderate relationships between functional limitations and functional performance provide further support for these being conceptually distinct constructs.
doi:10.1016/j.apmr.2010.12.033
PMCID: PMC3772086  PMID: 21458777
Geriatrics; Longitudinal studies; Psychometrics; Rehabilitation
9.  Physical Activity, Function, and Quality of Life: Design and Methods of the FlexToBa™ Trial 
Contemporary Clinical Trials  2011;33(1):228-236.
The Flexibility, Toning, and Balance (FlexToBa™) Trial is a two-armed randomized controlled trial which will contrast the effects of a DVD-delivered, home-based, physical activity intervention and a Healthy Aging attention control condition on physical activity, functional performance, functional limitations, and quality of life in low active, older adults. This innovative trial will recruit 300 participants across central Illinois who will be randomized into the intervention arm or control arm of the study. The intervention will last 6 months with a 6 month follow-up. Assessments at baseline, post intervention and follow-up will include physical activity (self-report and accelerometry), a battery of functional performance measures, functional limitations, quality of life, and an array of psychological health measures. In addition, measures of external validity will be included to determine public health significance of a successful outcome. Participants will engage in a progressive series of activities focusing on flexibility, strengthening, and balance exercises which are demonstrated by a trained exercise leader and age-appropriate models on a series of DVDs. Delivery of the intervention has its basis in social cognitive theory. The specific aims of the trial are (a) to determine the effects of the DVD-delivered FlexToBa™ program on physical activity, functional performance, functional limitations, and quality of life, (b) to examine the mediators of the relationships between physical activity and functional limitations and quality of life, (c) to assess external validity indicators relative to the intervention, and (d) to determine differential effects of the intervention on psychosocial health measures.
doi:10.1016/j.cct.2011.10.002
PMCID: PMC3253879  PMID: 22024470
Physical activity; older adults; functional limitations; functional performance; quality of life
10.  Growth Trajectories of Exercise Self-Efficacy in Older Adults: Influence of Measures and Initial Status 
Objective
This study examines differential trajectories of exercise-related self-efficacy beliefs across a 12-month randomized controlled exercise trial.
Methods
Previously inactive older adults (N = 144; M age = 66.5) were randomly assigned to one of two exercise conditions (walking, flexibility-toning-balance) and completed measures of barriers self-efficacy (BARSE), exercise self-efficacy (EXSE), and self-efficacy for walking (SEW) across a 12-month period. Changes in efficacy were examined according to efficacy type and inter-individual differences. Latent growth curve modeling was employed to (a) examine average levels and change in each type of efficacy for the collapsed sample and by intervention condition, and (b) explore subpopulations (i.e., latent classes) within the sample that differ in their baseline efficacy and trajectory.
Results
Analyses revealed two negative trends in BARSE and EXSE at predicted transition points, in addition to a positive linear trend in SEW. Two subgroups with unique baseline efficacy and trajectory profiles were also identified.
Conclusions
These results shed new light on the relationship between exercise and self-efficacy in older adults, and highlight the need for strategies for increasing and maintaining efficacy within interventions, namely targeting participants who start with a disadvantage (lower efficacy) and integrating efficacy-boosting strategies for all participants prior to program end.
doi:10.1037/a0021567
PMCID: PMC3521039  PMID: 21038962
exercise; self-efficacy; trajectories of change; aging
11.  Cardiorespiratory Fitness, Hippocampal Volume and Frequency of Forgetting in Older Adults 
Neuropsychology  2011;25(5):545-553.
Objective
The purpose of this study was to extend our earlier work to determine the extent to which cardiorespiratory fitness is associated with the frequency of memory problems via its effects on the hippocampus and spatial working memory. We hypothesized that age, sex, education, body composition, and physical activity were direct determinants of fitness which, in turn, influenced frequency of forgetting indirectly through hippocampal volume and spatial working memory.
Method
We conducted assessments of hippocampal volume, spatial working memory, frequency of forgetting, BMI, physical activity, demographic characteristics, and cardiorespiratory fitness in 158 older adults (M age = 66.49). Path analyses within a covariance modeling framework were used to examine relationships among these constructs.
Results
Sex, age, BMI, and education were all significant determinants of cardiorespiratory fitness. The hypothesized path models testing the effects of fitness on frequency of forgetting through hippocampal volume and accuracy and speed of spatial working memory all fit the data well.
Conclusions
Our findings suggest that older adults with higher levels of fitness show greater preservation of hippocampal volume which, in turn, is associated with more accurate and faster spatial memory and fewer episodes of forgetting. Given the proportion of older adults reporting memory problems, it is necessary to determine whether improvements in fitness brought about by physical activity interventions can result in subsequent attenuation of memory problems or potentially improvements in memory.
doi:10.1037/a0022733
PMCID: PMC3140615  PMID: 21500917
Frequency of Forgetting; Hippocampus Volume; Cardiorespiratory Fitness; Spatial Memory; Older Adults
12.  Self-Regulatory Processes and Exercise Adherence in Older Adults 
Background
Self-efficacy and the use of self-regulatory strategies are consistently associated with physical activity behavior. Similarly, behavioral inhibition and cognitive resource allocation, indices of executive control function, have also been associated with this health behavior.
Purpose
The purpose of this study was to examine the hypothesis that self-efficacy mediates the relationship between self-regulatory processes, such as executive function, and sustained exercise behavior.
Methods
Older adults (N = 177, mean age = 66.44 years) completed measures of executive function, self-reported use of self-regulatory strategies and self-efficacy prior to and during the first month of a 12-month exercise intervention. Percentage of exercise classes attended over the following 11 months was used to represent adherence. Data were collected from 2007 to 2010 and analyzed in 2010–2011. Structural equation models were tested examining the effect of executive function and strategy use on adherence via efficacy.
Results
As hypothesized, results showed significant direct effects of two elements of executive function and of strategy use on self-efficacy and of efficacy on adherence. In addition, there were significant indirect effects of strategy use and executive function on adherence via self-efficacy.
Conclusions
Higher levels of executive function and use of self-regulatory strategies at the start of an exercise program enhance beliefs in exercise capabilities, which in turn leads to greater adherence.
doi:10.1016/j.amepre.2011.04.014
PMCID: PMC3160622  PMID: 21855742
13.  Trajectories of change in self-esteem in older adults: exercise intervention effects 
Journal of behavioral medicine  2011;34(4):298-306.
This 12-month, 2 arm, single blind randomized controlled exercise trial examined relationships among changes in multidimensional self-esteem as a function of intervention mode (i.e., walking vs. flexibility-toning-balance). Data were collected on three equidistant occasions (baseline, 6 and 12 months). One-hundred seventy-nine older adults (Mage = 66.38) began the study and 145 completed assessments at all time points. Participants completed measures of physical and global self-esteem as well as demographic information. There were no significant group differences at baseline on these demographic indicators or esteem variables. Data were analyzed using linear and parallel process growth modeling procedures. Results supported the position that across both groups, domain-level (i.e., physical self-worth) was dependent upon sub-domain-level (i.e., perceived attractiveness, strength, and condition) esteem change. Furthermore, greater improvements were observed in the flexibility-toning-balance group, in terms of perceived strength and attractiveness esteem, compared to the walking group. Our findings support theoretically-based predictions and extend the literature showing unique psychological responses conditional on specific types of physical activities.
doi:10.1007/s10865-010-9312-6
PMCID: PMC3118401  PMID: 21222223
Self perceptions; Physical activity; Growth models; Modes of exercise
14.  Non-Exercise Estimated Cardiorespiratory Fitness: Associations with Brain Structure, Cognition, and Memory Complaints in Older Adults 
There is increasing evidence that cardiorespiratory fitness (CRF) is associated with brain structure and function, and improvements in CRF through exercise training have been associated with neural and cognitive functioning in older adults. The objectives of this study were to validate the use of a non-exercise estimate of CRF, and to examine its association with cognitive function, brain structure and subjective memory complaints. Low active, older adults (N = 86; M age= 65.14) completed a physician-supervised maximal exercise test, a 1-mile timed walk, several measures of cognitive function, and a 3 Tesla structural MRI. Fitness was also calculated from an equation derived by (Jurca et al., 2005) based on age, sex, body mass index, resting heart rate, and self-reported physical activity level. Analyses indicated that all three measures of CRF were significantly correlated with one another. In addition, measures of cognitive function, hippocampus volume, and memory complaints were significantly correlated with each measure of fitness. These findings have implications for using a low-risk, low-cost, non-exercise estimate of CRF in determining fitness associations with brain structure and cognitive function in older adults. As such, this measure may have utility for larger population based studies. Further validation is required, as is determination of whether such relationships hold over the course of exercise interventions.
doi:10.1016/j.mhpa.2011.01.001
PMCID: PMC3146052  PMID: 21808657
Equation-derived CRF; cognitive function; hippocampus; older adults
15.  Beyond vascularization: aerobic fitness is associated with N-acetylaspartate and working memory 
Brain and Behavior  2012;2(1):32-41.
Aerobic exercise is a promising form of prevention for cognitive decline; however, little is known about the molecular mechanisms by which exercise and fitness impacts the human brain. Several studies have postulated that increased regional brain volume and function are associated with aerobic fitness because of increased vascularization rather than increased neural tissue per se. We tested this position by examining the relationship between cardiorespiratory fitness and N-acetylaspartate (NAA) levels in the right frontal cortex using magnetic resonance spectroscopy. NAA is a nervous system specific metabolite found predominantly in cell bodies of neurons. We reasoned that if aerobic fitness was predominantly influencing the vasculature of the brain, then NAA levels should not vary as a function of aerobic fitness. However, if aerobic fitness influences the number or viability of neurons, then higher aerobic fitness levels might be associated with greater concentrations of NAA. We examined NAA levels, aerobic fitness, and cognitive performance in 137 older adults without cognitive impairment. Consistent with the latter hypothesis, we found that higher aerobic fitness levels offset an age-related decline in NAA. Furthermore, NAA mediated an association between fitness and backward digit span performance, suggesting that neuronal viability as measured by NAA is important in understanding fitness-related cognitive enhancement. Since NAA is found exclusively in neural tissue, our results indicate that the effect of fitness on the human brain extends beyond vascularization; aerobic fitness is associated with neuronal viability in the frontal cortex of older adults.
doi:10.1002/brb3.30
PMCID: PMC3343297  PMID: 22574272
Aging; brain; exercise; fitness; human; N-acetylaspartate; working memory
16.  Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time 
The purpose of this study was to validate the Physical Activity Enjoyment Scale (PACES) in a sample of older adults. Participants within two different exercise groups were assessed at two time points, 6 months apart. Group and longitudinal invariance was established for a novel, 8-item version of the PACES. The shortened, psychometrically sound measure provides researchers and practitioners an expedited and reliable instrument for assessing the enjoyment of physical activity.
doi:10.1186/1479-5868-8-103
PMCID: PMC3206413  PMID: 21951520
17.  Construct validation of a non-exercise measure of cardiorespiratory fitness in older adults 
BMC Public Health  2010;10:59.
Background
Cardiorespiratory fitness (CRF) is associated with a decreased risk of all-cause mortality but is rarely assessed in medical settings due to burdens of time, cost, risk, and resources. The purpose of this study was to test the construct validity of a regression equation developed by Jurca and colleagues (2005) to estimate CRF without exercise testing in community dwelling older adults.
Methods
Participants (n = 172) aged 60 to 80 years with no contraindications to submaximal or maximal exercise testing completed a maximal graded exercise test (GXT) and the submaximal Rockport 1-mile walk test on separate occasions. Data included in the regression equation (age, sex, body mass index, resting heart rate, and physical activity) were obtained via measurement or self-report. Participants also reported presence of cardiovascular conditions.
Results
The multiple R for the regression equation was .72, p < .001 and CRF estimated from this equation was significantly correlated with the MET value from the GXT (r = 0.66) and with CRF estimated from submaximal field testing (r = 0.67). All three CRF indices were significantly and inversely associated with reporting more cardiovascular conditions.
Conclusions
This research provides preliminary evidence that a non-exercise estimate of CRF is at least as valid as field test estimates of CRF and represents a low-risk, low-cost, and expedient method for estimating fitness in older adults.
doi:10.1186/1471-2458-10-59
PMCID: PMC2831835  PMID: 20144197
18.  Plasticity of Brain Networks in a Randomized Intervention Trial of Exercise Training in Older Adults 
Research has shown the human brain is organized into separable functional networks during rest and varied states of cognition, and that aging is associated with specific network dysfunctions. The present study used functional magnetic resonance imaging (fMRI) to examine low-frequency (0.008 < f < 0.08 Hz) coherence of cognitively relevant and sensory brain networks in older adults who participated in a 1-year intervention trial, comparing the effects of aerobic and non-aerobic fitness training on brain function and cognition. Results showed that aerobic training improved the aging brain's resting functional efficiency in higher-level cognitive networks. One year of walking increased functional connectivity between aspects of the frontal, posterior, and temporal cortices within the Default Mode Network and a Frontal Executive Network, two brain networks central to brain dysfunction in aging. Length of training was also an important factor. Effects in favor of the walking group were observed only after 12 months of training, compared to non-significant trends after 6 months. A non-aerobic stretching and toning group also showed increased functional connectivity in the DMN after 6 months and in a Frontal Parietal Network after 12 months, possibly reflecting experience-dependent plasticity. Finally, we found that changes in functional connectivity were behaviorally relevant. Increased functional connectivity was associated with greater improvement in executive function. Therefore the study provides the first evidence for exercise-induced functional plasticity in large-scale brain systems in the aging brain, using functional connectivity techniques, and offers new insight into the role of aerobic fitness in attenuating age-related brain dysfunction.
doi:10.3389/fnagi.2010.00032
PMCID: PMC2947936  PMID: 20890449
exercise; aging; functional connectivity; fMRI; default mode network; executive function; aerobic fitness

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