SUMMARY Importance In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining if physical activity prevents or delays mobility disability. Objective To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. Design, Setting, and Participants The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban and rural communities at 8 field centers throughout the US. We randomized a volunteer sample of 1,635 sedentary men and women aged 70–89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. Interventions Participants were randomized to a structured moderate intensity physical activity program (n=818) done in a center and at home that included including aerobic, resistance and flexibility training activities or to a health education program (n=817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. Main Outcomes and Measures The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. Results Incident major mobility disability occurred in 30.1% (n=246/818) of physical activity and 35.5% (n=290/817) of health education participants (HR=0.82, 95%CI=0.69–0.98, p=0.03). Persistent mobility disability was experienced by 120/818 (14.7%) physical activity and 162/817 (19.8%) health education participants (HR=0.72; 95%CI=0.57–0.91; p=0.006). Serious adverse events were reported by 404/818 (49.4%) of the physical activity and 373/817 (45.7%) of the health education participants (Risk Ratio=1.08; 95%CI=0.98–1.20). Conclusions and Relevance A structured moderate intensity physical activity program, compared with a health education program, reduced major mobility disability over 2.6 years among older adults at risk of disability. These findings suggest mobility benefit from such a program in vulnerable older adults. Registration ClinicalsTrials.gov identifier NCT01072500.

The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

Three experiments are presented that evaluate the feeling scale (FS) as a measure of affect during exercise. In Experiment 1,.subjects were instructed to check adjectives on the MAACL-R that they would associate with either a "good" or a "bad" feeling during exercise. As predicted, discriminant function analysis indicated that the good/bad dimension of the FS appears to represent a core of emotional expression. In Experiment 2, subjects rated how they felt during exercise at a rate of perceived exertion (RPE) of 11, 15, and 19. There was considerable heterogeneity in FS for each given RPE. Moreover, RPEs and FS ratings were only moderately correlated, r= - .56, suggesting that phenomenologically the two constructs are not isomorphic. Experiment 3 involved three 4-min bouts of exercise at 30, 60, and 90% V02max. Assessed were pre- and post-exercise affect as. .well as RPEs, responses to the FS, Ve, RR, and VO2. Results revealed that RPE and the FS were moderately related, but only at easy and hard workloads. FS ratings evidenced greater variability as metabolic demands increased, and RPEs consistently had stronger ties to physiologic cues than responses to the FS. The theoretical and pragmatic implications of these data are discussed.

Objective. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA).Methods. Three hundred sixteen communitydwelling overweight and obese adults ages 60 years and older, with a body mass index of >28 kg/m 2 , knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width.Results. Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in selfreported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups.Conclusion. The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.Arthritis is the leading cause of physical disability among older adults, affecting more than 70 million Americans, of whom the majority are women (1-4). The joint damage and chronic pain from osteoarthritis (OA), the most common form of arthritis, lead to muscle atrophy, decreased mobility, poor balance, and, eventually, physical disability (5-8). Traditional therapies include pharmacologic, surgical, and exercise interventions. Pharmacologic therapy includes the use of antiinflammatory medications that have potentially serious long-term side effects (9,10). Recent evidence also casts doubt as to the effectiveness of arthroscopic surgery for adults with mild to moderate knee OA (11).