The Inventory of Physical Activity Barriers: Development and Preliminary Validation

Abstract Inactivity levels among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases. To confront this concern, healthcare providers need to address the reasons for inactivity. Unfortunately, limited tools exist to address barriers of physical activity (PA). The purpose of our study was to develop and psychometrically evaluate a PA barrier scale for adults 50 years and older. The scale is called the Inventory of Physical Activity Barriers (IPAB) and it was developed, refined, and evaluated using a cross-sectional and a modified Delphi study. We had two groups of participants: 39 adults (50 years and older) provided survey pilot data for psychometric evaluation, and nine interprofessional PA experts assisted with finalizing the scale. Participants completed a demographic questionnaire, Physical Activity Vital Sign questionnaire, and IPAB. The IPAB’s refinement was guided by item-scale correlations, descriptive statistics, and consensus among the PA experts. Construct validity was examined by comparing mean IPAB scores of inactive and active participants via independent t-test. Internal consistency was assessed via Cronbach Alpha. The IPAB was refined from 172 items to 40 items and found to be internally consistent (α=.97) and able to differentiate individuals who do and do not meet the recommended 150 minutes of weekly PA (p=0.01). These preliminary results show the IPAB is a reliable assessment of PA barriers for adults 50 years and older, and are promising for the scale’s construct validity and support further psychometric evaluation of the tool.

United States,3. University of Pennsylvania,Philadelphia,Pennsylvania,United States,4. University of Pennsylvania,Cherry Hill,New Jersey,United States,5. University of Pennsylvania School of Nursing,Philadelphia,Pennsylvania,United States Approximately 85% of older adults have at least one chronic health condition.The onset of chronic health conditions and mobility issues can constrain activities, including outdoor recreation.There is limited knowledge of older adults receiving long-term services and supports (LTSS) and their satisfaction with outdoor activities over time after enrolling in services.This study examined predictors of change in ratings of satisfaction with outdoor activities.A secondary analysis was conducted of data involving structured interviews with older adults (N=470) over the first two years of receiving LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524).Participants lived in assisted living communities, nursing homes, or their home.A single item on satisfaction with outdoor activities (assessed using a 5-point Likert scale: not at all to extremely satisfied) was the primary outcome.Mixed effects linear regression modeling using a backward elimination process was used for building a final multivariable model.In the final model, older age (p<0.001) and higher overall quality of life ratings (p<0.001) at baseline were associated with slower rates of increase in outdoor satisfaction over time.Higher education level (p=0.035) at baseline was associated with a faster rate of increase in outdoor satisfaction over time.Additionally, those who moved into an assisted living community (p=0.024) or nursing home (p=0.016) at baseline were associated with faster rates of increase in outdoor satisfaction over time compared to those in the home.Knowledge of factors influencing satisfaction with outdoor activities can assist interdisciplinary teams implement interventions for individual or organizational changes.Aerobic fitness is a strong predictor of functional independence with aging.Variability in aerobic fitness is due, in part, to the efficiency of the movement of body mass while ambulating [energetic cost of walking (ECoW)].ECoW may serve as a low burden measure of fitness compared to volitional treadmill tests.We assessed the predictive ability of ECoW with later-life function and physical activity participation in healthy adults.N=75 (age = 54.7 +/-9.2;52% female) completed a treadmill test with indirect calorimetry, during which time a warm-up of 1.5 mph at 0% grade was uniform.ECoW was quantified as steady state volume of oxygen consumption (ml/kg/min) subtracted by the calculated metabolic cost of walking at given speed and grade (=7.5 ml/kg/min).Later-life (median=9 years follow-up) function was assessed using the SF-36 physical functioning subscale, and the Baecke questionnaire for physical activity.Mean EcoW was similar to calculated cost (difference = -0.14ml/kg/min) but had large variation (SD = 2.7; range = -4.4 to +17 ml/kg/min).In females, higher ECoW was predictive of better later-life function (b=1.9;p=0.04) and higher physical activity levels (b=0.09;p=0.001).In males, lower ECoW was predictive of higher physical activity levels only (b=-0.04;p=0.01).All models controlled for % body fat, age, and comorbidities.Surprisingly, in females, higher ECoW was associated with better later-life health outcomes.We hypothesize that this phenomenon may be similar to the obesity paradox, in that relatively higher non-metabolic tissue in females may serve as a stimulus for muscle and functional preservation.Physical Activity (PA) Guidelines for Americans recommend engagement in moderate or moderate-to-vigorous physical activity (MVPA) for middle-aged and older adults.Although these guidelines encourage adults to "move more and sit less," there are no explicit recommendations for engaging in Light PA (LPA).The purpose of this study was to examine the association between LPA and health Indicators among middle-aged and older adults, in the context of sedentary time (ST) and MVPA.We used baseline data from 171 individuals (Mean age: 59.3±8.51 years), participating in Colorado State University's AgingPlus program.Selected health Indicators included Body Mass Index (BMI), waist circumference (WC in cm), mean arterial pressure (MAP in mmHg), grip strength (GS in lbs), and indirect VO2max (ml/kg/min).ST and PA were measured using Actigraph accelerometers worn for 7 days (excluding wear time <500 mins/day).Linear regression analyses, controlling for sex, age group, and race, indicated that more ST was associated with greater BMI (B=3.33),greater WC (B=3.35), and lower VO2max (B=-3.09).More LPA was associated with lower BMI (B=-4.47),lower WC (B=-5.0),lower MAP (B=-2.81),and higher VO2max (B=4.64).MVPA was associated with lower BMI (B=-3.04),lower WC (B=-4.21),higher VO2max (B=4.74), and higher grip strength (B=2.33).In conclusion, more ST was associated with indicators of poorer physical health.LPA, similar to MVPA, was associated with indicators of better physical health and performance.Future longitudinal and experimental studies examining the causal relationship between LPA and physical health and performance are warranted.

THE INVENTORY OF PHYSICAL ACTIVITY BARRIERS: DEVELOPMENT AND PRELIMINARY VALIDATION
Mariana Wingood, 1 Nancy Gell, 2 Denise Peters, 3 and Tiffany Hutchins, 3 1.University of Vermont, Waterbury, Vermont, United States, 2. The University of Vermont, Burlington, Vermont, United States, 3. University of Vermont, Burlington, Vermont, United States Inactivity levels among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases.To confront this concern, healthcare providers need to address the reasons for inactivity.Unfortunately, limited tools exist to address barriers of physical activity (PA).The purpose of our study was to develop and psychometrically evaluate a PA barrier scale for adults 50 years and older.The scale is called the Inventory of Physical Activity Barriers (IPAB) and it was developed, refined, and evaluated using a cross-sectional and a modified Delphi study.We had two groups of participants: 39 adults (50 years and older) provided survey pilot data for psychometric evaluation, and nine interprofessional PA experts assisted with finalizing the scale.Participants completed a demographic questionnaire, Physical Activity Vital Sign questionnaire, and IPAB.The IPAB's refinement was guided by item-scale correlations, descriptive statistics, and consensus among the PA experts.Construct validity was examined by comparing mean IPAB scores of inactive and active participants via independent t-test.Internal consistency was assessed via Cronbach Alpha.The IPAB was refined from 172 items to 40 items and found to be internally consistent (α=.97) and able to differentiate individuals who do and do not meet the recommended 150 minutes of weekly PA (p=0.01).These preliminary results show the IPAB is a reliable assessment of PA barriers for adults 50 years and older, and are promising for the scale's construct validity and support further psychometric evaluation of the tool.

THE RELATIONSHIP BETWEEN COGNITIVE DECLINE AND SEDENTARY TIME Lorraine Phillips, and Mary Bowen, University of Delaware, Newark, Delaware, United States
Early identification of functional decline in older adults with mild cognitive impairment (MCI) provides the opportunity to initiate behavioral interventions to slow decline.More frequent breaks in sedentary time has been associated with greater lower extremity function.This longitudinal study examined the effect of 6-month change in cognitive function on monthly sedentary time, controlling for lower extremity function, among community-dwelling older adults with MCI.Twenty adults with Montreal Cognitive Assessment Score (MoCA) between 19-25, who were age ≥ 60 years old, and ambulatory, wore an actigraph for 6 months and participated in monthly in-person assessments.Measures included MoCA change (baseline to month 6), Short Physical Performance Battery (SPPB; baseline, months 3 and 6); sedentary time and physical activity intensity; and falls (monthly).The sample was 70% female, 60% non-Hispanic white, with a mean age of 77 years.Sixteen participants provided complete data for mixed-model analysis.Over 6 months, 11 falls occurred among 7 participants.The mean MoCA score declined from 22.7 to 21.9 while SPPB remained stable.Overall time spent in sedentary behavior was high (71%) and physical activity intensity was low (light and moderate combined= 26.1%).
Results of multi-level analysis with sedentary time as a continuous Level-1 variable and MoCA change scores, SPPB scores, and age in Level-2 showed that negative change in MoCA (β=-0.11;p≤0.05) was associated with increased sedentary time.Given sedentary time increases as cognitive function declines, older adults with MCI could benefit from interventions designed to interrupt sedentary time as well as increase physical activity.

TIME-VARYING ASSOCIATIONS OF PHYSICAL ACTIVITY ON WEEKDAYS AND WEEKEND DAYS IN MINORITY OLDER ADULTS
Derek Hevel, 1 Laurie Kennedy-Malone, 2 Kourtney Sappenfield, 1 Heidi Scheer, 1 Christine Zecca, 1 and Jaclyn Maher, 1 1.University of North Carolina at Greensboro,Greensboro,North Carolina,United States,2. UNCG School of Nursing,Greensboro,North Carolina,United States Older adults are insufficiently physically active, and therefore, are at an increased health risk.However, less is known about the moment-to-moment physical activity behavior patterns that change across the day.The current study utilized accelerometry to better understand diurnal physical activity patterns.Minority older adults (N=91, age M=70.14, 96% Black/African American) participated in an 8-day study where they wore an ActivPAL accelerometer to measure physical activity.Physical activity was operationalized as stepping in the 60-minute window (±30-min) around a given moment.Time varying-effect modeling was used to determine how physical activity patterns change over the course of weekdays and weekend days.Results are rounded to the 5-min interval.On weekdays, time spent stepping increased from 8:00am (B=7.16,95%CI: 5.04, 9.27) until peaking at 11:10am (B=8.46,95%CI: 6.59, 10.33), slowly decreased to the lowest point at 6:10pm (B=6.72,95%CI: 4.82, 8.62), and then increased slightly in the evening.On weekend days, time spent stepping was lowest at 8:00am (B=4.47,95%CI: 2.14, 6.80), peaked at 12:20pm (B=5.50, 95%CI: 3.22, 7.78), gradually decreased until 5:50pm (B=5.21,95%CI: 2.90, 7.52), and then increased slightly in the evening.Minority older adults engage in more stepping time around mid-day, but less stepping in the late afternoon to early evening on both weekdays and weekend days.Self-care activities (e.g., mealtime, bed-time routines) may influence older adults' physical activity.This work identifies vulnerable times during the day when older adults engage in relatively low levels of physical activity which may be of interest for interventions.Providers in Arkansas wrote 105.4 opioid prescriptions for every 100 persons in 2017-nearly twofold greater than the average U.S. rate of 58.7 opioid prescriptions (CDC, 2017).This makes AR the second highest opioid prescribing state.AR-IMPACT (Arkansas Improving Multi-Disciplinary Pain Care and Treatment) is a tele-video case conference education model which was designed to improve AR providers' knowledge and behavior in pain management and improve awareness of opioid-sparing alternatives.Conference panelists include a geriatrician, psychiatrist, physical therapist,

TECHNOLOGY A RURAL TELE-VIDEO MODEL: RESULTS FROM EDUCATING PRACTITIONERS ABOUT OPIOIDS AND ALTERNATIVE PAIN MANAGEMENT
Leah Tobey, 1 Robin McAtee, 2 and Corey Hayes, 2 1.University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States, 2. UAMS, Little Rock, Arkansas, United States