This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis.

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Objectives-To compare the impact of negotiated vs. mainstreamed follow-up with telephone reinforcement (TR) on maintenance of physical activity (PA) after Fit and Strong! ended. Methods-A multisite comparative effectiveness trial with repeated measures.Results-Single group random effects analyses showed significant improvements at 2, 6, 12, and 18 months on PA maintenance, lower-extremity (LE) pain and stiffness, LE function, sit-stand, 6-minute distance walk, and anxiety/depression. Analyses by follow-up condition showed persons in the negotiated with TR group maintained a 21% increase in caloric expenditures over baseline at 18 months, with lesser benefits seen in the negotiated-only, mainstreamed-with-TR, and mainstreamed-only groups. Significant benefits of telephone dose were also seen on LE joint stiffness, pain, and function as well as anxiety and anxiety/depression. Conclusions-The negotiated follow-up contract that Fit and Strong! uses, bolstered by TR, is associated with enhanced long-term PA maintenance and health outcomes.Address correspondence to Dr Hughes, Center for Research on Health and Aging, 1747 W Roosevelt Road, Rm 558, Chicago, IL 60608. shughes@uic.edu. NIH Public Access Author ManuscriptAm J Health Behav. Author manuscript; available in PMC 2014 May 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript Keywords maintenance; trial; physical activity; arthritis; fit and strong Osteoarthritis (OA) is the most common chronic condition among older adults and also constitutes a major barrier to their participation in physical activity. [1][2][3] Lower-extremity joint impairment, in particular, that is caused by OA is a known risk factor for disability and institutionalization. 4,5 To date, 15 randomized trials of exercise interventions have been conducted among persons with OA. Most trials report positive short-term outcomes at 3 months or less. Only 5 have reported mixed findings on longer-term adherence and related outcomes. [5][6][7][8][9] Three of the 5 used telephone reinforcement (TR) for the maintenance phase of their studies; however, these trials did not explicitly examine the effect of this technique on maintenance itself. This paucity of data on maintenance and facilitators of maintenance of exercise behavior among persons with OA indicates an urgent need for additional studies of this issue.Fit and Strong! is an evidence-based physical activity/behavior-change program that effectively targets this highrisk group. 10,11 Fit and Strong! addresses documented strength and aerobic deficits in this population 12,13 and is inexpensive and simple to replicate as demonstrated by the fact that it has been adopted by 42 community providers to date. It is a group and facility-based program that meets for 90 minutes 3 times per week for 8 weeks (24 sessions total). The first 60 minutes consist of a multiple-component exercise program that incorporates flexibility/balance, aerobic walking and/or low impact aerobics, and lowerextremity strength training using elast...

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Objective To determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer’s dementia. Design Prospective cohort study. Setting The Chicago Health and Aging Project, a population based cohort study in the United States. Participants 2449 men and women aged 65 years and older. Main exposure A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND diet score in upper 40% of cohort distribution), late life cognitive activities (composite score in upper 40%), moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day). Main outcome Life expectancy with and without Alzheimer’s dementia in women and men. Results Women aged 65 with four or five healthy factors had a life expectancy of 24.2 years (95% confidence interval 22.8 to 25.5) and lived 3.1 years longer than women aged 65 with zero or one healthy factor (life expectancy 21.1 years, 19.5 to 22.4). Of the total life expectancy at age 65, women with four or five healthy factors spent 10.8% (2.6 years, 2.0 to 3.3) of their remaining years with Alzheimer’s dementia, whereas women with zero or one healthy factor spent 19.3% (4.1 years, 3.2 to 5.1) with the disease. Life expectancy for women aged 65 without Alzheimer’s dementia and four or five healthy factors was 21.5 years (20.0 to 22.7), and for those with zero or one healthy factor it was 17.0 years (15.5 to 18.3). Men aged 65 with four or five healthy factors had a total life expectancy of 23.1 years (21.4 to 25.6), which is 5.7 years longer than men aged 65 with zero or one healthy factor (life expectancy 17.4 years, 15.8 to 20.1). Of the total life expectancy at age 65, men with four or five healthy factors spent 6.1% (1.4 years, 0.3 to 2.0) of their remaining years with Alzheimer’s dementia, and those with zero or one healthy factor spent 12.0% (2.1 years, 0.2 to 3.0) with the disease. Life expectancy for men aged 65 without Alzheimer’s dementia and four or five healthy factors was 21.7 years (19.7 to 24.9), and for those with zero or one healthy factor life expectancy was 15.3 years (13.4 to 19.1). Conclusion A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer’s dementia. The life expectancy estimates might help health professionals, policy makers, and stakeholders to plan future healthcare services, costs, and needs.