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      The Lifestyle Interventions and Independence for Elders Study: Design and Methods

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          Abstract

          Background.

          As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.

          Methods.

          The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.

          Results.

          LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.

          Conclusions.

          Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

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          Most cited references80

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          Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

          Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.
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            The Modified Mini-Mental State (3MS) examination.

            E Teng, H Chui (1987)
            The Mini-Mental State (MMS) examination is a widely used screening test for dementia. The Modified Mini-Mental State (3MS) incorporates four added test items, more graded scoring, and some other minor changes. These modifications are designed to sample a broader variety of cognitive functions, cover a wider range of difficulty levels, and enhance the reliability and the validity of the scores. The 3MS retains the brevity, ease of administration, and objective scoring of the MMS but broadens the range of scores from 0-30 to 0-100. Greater sensitivities of the 3MS over the MMS are demonstrated with the pentagon item drawn by 249 patients. A summary form for administration and scoring that can generate both the MMS and the 3MS scores is provided so that the examiner can maintain continuity with existing data and can obtain a more informative assessment.
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              Social Foundations of Thought and Action: A Social-Cognitive View

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                Author and article information

                Journal
                J Gerontol A Biol Sci Med Sci
                gerona
                gerona
                The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
                Oxford University Press
                1079-5006
                1758-535X
                November 2011
                08 August 2011
                08 August 2011
                : 66A
                : 11
                : 1226-1237
                Affiliations
                [1 ]Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
                [2 ]Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
                [3 ]Department of Exercise Science
                [4 ]Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
                [5 ]Pennington Biomedical Research Center, Baton Rouge, Louisiana
                [6 ]Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
                [7 ]Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
                [8 ]Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
                [9 ]Department of Health Research and Policy
                [10 ]Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, California
                [11 ]Section on Gerontology and Geriatric Medicine, Department of Medicine, Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, North Carolina
                [12 ]Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
                [13 ]Institute on Aging, College of Medicine, University of Florida, Gainesville
                [14 ]Department of Epidemiology and Medicine, University of Pittsburgh, Pennsylvania
                [15 ]Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
                [16 ]Clinical Trials Branch
                [17 ]Section on Geriatrics and Gerontology, National Institute on Aging, Bethesda, Maryland
                Author notes
                Address correspondence to Roger A. Fielding, PhD, Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111. Email: roger.fielding@ 123456tufts.edu

                Decision Editor: Luigi Ferrucci, MD, PhD

                Article
                10.1093/gerona/glr123
                3193523
                21825283
                dc7ea9cf-17d7-4a3f-9a42-d29045da8e91
                © The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 February 2011
                : 19 June 2011
                Categories
                Journal of Gerontology: MEDICAL SCIENCES
                Articles

                Geriatric medicine
                exercise,physical function,disability,physical activity,geriatrics
                Geriatric medicine
                exercise, physical function, disability, physical activity, geriatrics

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