Publications by authors named "Eeva Aartolahti"

12 Publications

  • Page 1 of 1

Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 Jul 18. Epub 2021 Jul 18.

South Karelia Social and Health Care District, Rehabilitation, Lappeenranta.

Objectives: To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty.

Design: A randomized controlled trial with a 1:1 allocation.

Setting: Home-based.

Participants: Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria.

Interventions: A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149).

Main Outcome Measures: FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months.

Results: FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity.

Conclusions: One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.
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http://dx.doi.org/10.1016/j.apmr.2021.06.017DOI Listing
July 2021

Perceived Opportunities for Physical Activity and Willingness to Be More Active in Older Adults with Different Physical Activity Levels.

Int J Environ Res Public Health 2021 06 7;18(11). Epub 2021 Jun 7.

Institute of Rehabilitation, JAMK University of Applied Sciences, FI-40100 Jyväskylä, Finland.

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% confidence interval 2.21-6.87) than not wanting to be more active compared to those perceiving good opportunities. Associations were similar at high PA levels ( < 0.001), but were not found at low PA levels. Those with moderate or high PA wish to increase their activity particularly when the perceived opportunities for activity are not optimal. Among those with low PA, perceived opportunities are not associated with a perceived need to increase physical activity. Increasing equity in physical activity in old age requires provision of support and opportunities at every level of physical activity.
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http://dx.doi.org/10.3390/ijerph18116146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201061PMC
June 2021

Effectiveness of Exergame Intervention on Walking in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Phys Ther 2021 09;101(9)

Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.

Objective: The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias.

Methods: A literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates' effect, and the certainty of evidence, respectively.

Results: In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = -0.21; 95% CI = -0.36 to -0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = -0.32; 95% CI = -0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance.

Conclusion: For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed.

Impact: Exergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.
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http://dx.doi.org/10.1093/ptj/pzab152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459884PMC
September 2021

Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 09 30;102(9):1692-1699. Epub 2021 Apr 30.

Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta.

Objective: To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures.

Design: Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up.

Setting: Home-based intervention.

Participants: Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups.

Interventions: Supervised physical exercise twice a week.

Main Outcome Measures: The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months.

Results: Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group.

Conclusions: Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.
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http://dx.doi.org/10.1016/j.apmr.2021.04.004DOI Listing
September 2021

The CARe Burn Scale-Adult Form: Translation and linguistic validation into Finnish.

Burns 2021 Feb 27. Epub 2021 Feb 27.

Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland.

Background: Burn injury can dramatically deteriorate health-related quality of life. Effective burn care may minimize the impact of the burn injury and ensure optimal functional outcome. This requires continuous improvement in burn care and assessment of treatment results. The aim of this study was to translate, culturally adapt and linguistically validate the CARe Burn Scale-Adult Form, a burn-specific patient-reported outcome measure, into Finnish.

Methods: The translation process followed the International Society for Pharmacoeconomics and Outcomes Research guidelines consisting of forward and backward translations, pilot-testing and cognitive debriefing interviews of five burn patients, and proofreading before finalizing. The process involved expert panel meetings and continuous discussion between the developers of the Scale and the research group.

Results: In the forward translation 10 amendments were required. After the backward translation, 12 items were reworded. Cognitive debriefing interviews led to three alterations enhancing the comprehensiveness and accuracy of the translation. The translation was reviewed by burn occupational therapists for practicality, resulting in 12 modifications. Minor grammatical changes were made after proofreading.

Conclusion: The Finnish version is the first foreign translation of the CARe Burn Scale. It is equivalent to the original Scale and ready for psychometric validation with burn patients in Finland.
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http://dx.doi.org/10.1016/j.burns.2021.02.017DOI Listing
February 2021

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial.

J Am Med Dir Assoc 2021 04 18;22(4):773-779. Epub 2020 Jul 18.

Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland.

Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.

Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization.

Setting And Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17.

Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.

Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004).

Conclusions And Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.
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http://dx.doi.org/10.1016/j.jamda.2020.06.005DOI Listing
April 2021

Neighborhood Mobility and Unmet Physical Activity Need in Old Age: A 2-Year Follow-Up.

J Aging Phys Act 2019 Nov 17:1-6. Epub 2019 Nov 17.

Background: Many older people report a willingness to increase outdoor physical activity (PA), but no opportunities for it, a situation termed as unmet PA need. The authors studied whether lower neighborhood mobility and PA precede the development of unmet PA need.

Methods: Community-dwelling 75- to 90-year-old people (n = 700) were interviewed annually for 2 years. Unmet PA need, neighborhood mobility, and PA were self-reported. In addition, accelerometer-based step counts were assessed among a subgroup (n = 156).

Results: Logistic regression analyses revealed that lower baseline neighborhood mobility (odds ratio 3.02, 95% confidence interval [1.86, 4.90] vs. daily) and PA (odds ratio 4.37, 95% confidence interval [2.62, 7.29] vs. high) were associated with the development of unmet PA need over 2 years. The participants with higher step counts had a lower risk for unmet PA need (odds ratio 0.68, 95% confidence interval, [0.54, 0.87]).

Conclusion: Maintaining higher PA levels and finding solutions for daily outdoor mobility, especially for those with declines in health, may protect from the development of unmet PA need.
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http://dx.doi.org/10.1123/japa.2019-0047DOI Listing
November 2019

Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications Among Older People.

J Gerontol A Biol Sci Med Sci 2020 03;75(4):806-812

JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland.

Background: In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive, or no walking modifications differ in outdoor mobility.

Methods: Community-dwelling people aged 75-90 years (N = 848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 km due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (eg, walking more slowly, using an aid), and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors, and unmet physical activity need were analyzed using generalized estimation equation models.

Results: Participants with maladaptive walking modifications (n = 238) reported the most restricted life-space mobility (β = -9.6, SE = 2.5, p < .001) and autonomy in participation outdoors (β = 1.7, SE = 0.6, p = .004) and the highest prevalence of unmet physical activity need (odds ratio = 4.3, 95% confidence interval = 1.1-16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n = 285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n = 325) resembled those with no modifications, their outdoor mobility declined over time.

Conclusion: Adopting adaptive modifications may postpone decline in outdoor mobility, whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.
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http://dx.doi.org/10.1093/gerona/glz172DOI Listing
March 2020

Long-term strength and balance training in prevention of decline in muscle strength and mobility in older adults.

Aging Clin Exp Res 2020 Jan 4;32(1):59-66. Epub 2019 Mar 4.

Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.

Background: Reductions in muscle strength and poor balance may lead to mobility limitations in older age.

Aims: We assessed the effects of long-term once-weekly strength and balance training (SBT) on muscle strength and physical functioning in a community-based sample of older adults.

Methods: 182 individuals [130 women and 52 men, mean age 80 (SD ± 3.9) years] underwent supervised SBT as part of the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Isometric knee extension and flexion strength, chair rise, maximal walking speed, timed up and go (TUG) and Berg Balance Scale (BBS) were measured at baseline, after 2-year training and at post intervention follow-up. A linear mixed model was used to examine the change in physical functioning over time.

Results: During the intervention, both women (2.5 s, p < 0.001) and men (1.4 s, p = 0.013) improved their chair rise capacity. Women's knee extension and flexion strength improved by 14.1 N (p = 0.003) and 16.3 N (p < 0.001), respectively. Their maximal walking speed also improved by 0.08 m/s (p < 0.001). In men, no changes in muscle strength or walking speed occurred during training or follow-up. No changes in BBS and TUG were observed at the end of the intervention, but decrease in BBS was observed at post-intervention follow-up in men.

Conclusions: In community-dwelling older adults with variety in health and functioning supervised strength and balance training once a week may help to prevent age-related decline in mobility and muscle strength.
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http://dx.doi.org/10.1007/s40520-019-01155-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974487PMC
January 2020

Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults.

Arch Gerontol Geriatr 2015 Nov-Dec;61(3):452-7. Epub 2015 Jul 2.

Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland; Department of Physical and Rehabilitation Medicine, Central Finland Health Care District, Jyväskylä, Finland.

Aim: Strength and balance training (SBT) has remarkable health benefits, but little is known regarding exercise adherence in older adults. We examined the adherence to strength and balance training and determinants of adherence among ≥75 year old adults.

Methods: 182 community-dwelling individuals (aged 75-98 years, 71% female) began group-based SBT as part of a population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Adherence was defined as the proportion of attended sessions relative to offered sessions. Participants were classified based on their adherence level into low (≤33.3%), moderate (33.4-66.5%) and high (≥66.6%) adherers.

Results: The mean length of training was 19 ± 9 months, and 68% continued participation for at least two years. The mean training adherence was 55 ± 29% for all participants and 18%, 53% and 82% for low, moderate and high adherers, respectively. High adherence was predicted by female sex; younger age; better cognition; independence in Instrumental Activities of Daily Living; higher knee extension strength; faster walking speed; and better performance on the Berg Balance Scale and Timed Up and Go tests. Poorer self-perceived health and the use of a walking aid were related to low adherence.

Conclusions: Long-term continuation of training is possible for older community-dwelling adults, although poorer health and functional limitations affect training adherence. Our findings have implications for tailoring interventions and support for older adults to optimize their exercise adherence.
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http://dx.doi.org/10.1016/j.archger.2015.06.016DOI Listing
January 2016

Health and physical function predicting strength and balance training adoption: a community-based study among individuals aged 75 and older.

J Aging Phys Act 2014 Oct 13;22(4):543-9. Epub 2013 Nov 13.

Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.

This study was conducted to determine the characteristics of health and physical function that are associated with not starting strength and balance training (SBT). The study population consisted of 339 community-dwelling individuals (75-98 years, 72% female). As part of a population-based intervention study they received comprehensive geriatric assessment, physical activity counseling, and had the opportunity to take part in SBT at the gym once a week. Compared with the SBT-adopters, the nonadopters (n = 157, 46%) were older and less physically active, had more comorbidities and lower cognitive abilities, more often had sedative load of drugs or were at the risk of malnutrition, had lower grip strength and more instrumental activities of daily living (IADL) difficulties, and displayed weaker performance in Berg Balance Scale and Timed Up and Go assessments. In multivariate models, higher age, impaired cognition, and lower grip strength were independently associated with nonadoption. In the future, more individually-tailored interventions are needed to overcome the factors that prevent exercise initiation.
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http://dx.doi.org/10.1123/japa.2013-0113DOI Listing
October 2014

Relationship between functional vision and balance and mobility performance in community-dwelling older adults.

Aging Clin Exp Res 2013 Oct 4;25(5):545-52. Epub 2013 Sep 4.

Department of Health Sciences, University of Jyväskylä, P.O. Box 35 (LL), FIN 40014, Jyväskylä, Finland,

Background And Aims: Vision is an important prerequisite for balance control and mobility. The role of objectively measured visual functions has been previously studied but less is known about associations of functional vision, that refers to self-perceived vision-based ability to perform daily activities. The aim of the study was to investigate the relationship between functional vision and balance and mobility performance in a community-based sample of older adults.

Methods: This study is part of a Geriatric Multidisciplinary Strategy for the Good Care of the Elderly project (GeMS). Participants (576) aged 76-100 years (mean age 81 years, 70 % women) were interviewed using a seven-item functional vision questionnaire (VF-7). Balance and mobility were measured by the Berg balance scale (BBS), timed up and go (TUG), chair stand test, and maximal walking speed. In addition, self-reported fear of falling, depressive symptoms (15-item Geriatric Depression Scale), cognition (Mini-Mental State Examination) and physical activity (Grimby) were assessed. In the analysis, participants were classified into poor, moderate, or good functional vision groups.

Results: The poor functional vision group (n = 95) had more comorbidities, depressed mood, cognition decline, fear of falling, and reduced physical activity compared to participants with moderate (n = 222) or good functional vision (n = 259). Participants with poor functional vision performed worse on all balance and mobility tests. After adjusting for gender, age, chronic conditions, and cognition, the linearity remained statistically significant between functional vision and BBS (p = 0.013), TUG (p = 0.010), and maximal walking speed (p = 0.008), but not between functional vision and chair stand (p = 0.069).

Conclusion: Poor functional vision is related to weaker balance and mobility performance in community-dwelling older adults. This highlights the importance of widespread assessment of health, including functional vision, to prevent balance impairment and maintain independent mobility among older population.
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http://dx.doi.org/10.1007/s40520-013-0120-zDOI Listing
October 2013
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