The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation

Abstract Addressing physical activity (PA) barriers is an essential component of increasing PA among the 56-73% of community-dwelling adults 50 years and older who are not performing the recommended 150 minutes of moderate-to-vigorous PA. As there is no feasible, multi-factorial tool to assess PA barriers among this population, we developed and validated a PA barrier assessment tool called the Inventory of Physical Activity Barriers (IPAB). We collected cross-sectional data on 503 adults (mean age 70.1), with 79 participants completing the scale twice for test-retest reliability and 64 completing a cross-over design examining the ability to use two administration formats interchangeably. Our analyses consisted of exploratory and confirmatory factor analysis, Cronbach alpha, intraclass correlation coefficient, Bland-Altman Plot, and t-tests. Using factor analysis, we identified and confirmed an eight-factor solution consisting of 27 items. The 27-item IPAB is internally consistent (alpha= 0.91), has a high test-retest reliability (intraclass correlation coefficient=0.99), and can differentiate between individuals who meet the recommended levels of PA and those who do not (p < 0.001). The IPAB scores ranged between 1.00-3.11 for the paper format (mean=1.78) and 1.07-3.48 for the electronic format (mean=1.78), with no statistical difference between the paper and electronic administration formats (p=0.94), resulting in the conclusion that the two administration formats can be used interchangeably. Participant feedback illustrates that the IPAB is easy to use, has clear instruction, and is an appropriate length. The newly validated IPAB scale can be used to develop individualized PA interventions that address PA barriers among patients 50 years and older.

however, many have difficulty achieving recommended moderate-to vigorous-intensity guidelines.This study examined the impact of low-intensity daily walking activity on executive cognitive and brain function in 66 older adults (mean age=67.26; SD=6.04).Daily walking activity was measured using a step activity monitor and brain function was assessed using functional magnetic resonance imaging during the Flanker task.Analyses included whole and region of interest (ROI) in the right middle frontal gyrus (RMFG), occipital cortex (OCC) and anterior cingulate (ACC).Partial correlations were performed between step activity, behavioral performance, and ROI activation, adjusting for age and education.Most of the step activity was in the low-intensity range.No associations were observed between step activity and task performance (p>.05).Task-related activation occurred in the RMFG, lateral OCC and paracingulate (p<.01).Increased activation in the RMFG was associated with greater amount r(62)=.390,p=.001, duration r(62)=.309,p=.013 and frequency r(62)=.327,p=.007 of step activity.Stratification by sex revealed a positive association between amount of step activity and RMFG activation in women r(44)= .360,p=.014, but not men.Whole brain correlation revealed that amount of step activity was positively associated with precuneus activation (p<.01), an area impacted early in Alzheimer's disease.These results support the benefits of low intensity daily walking activity on prefrontal function in older adults and suggest the importance of designing attainable and sustainable physical activity interventions to promote brain health in older adults.

THE EFFECTS OF EXERCISE ON COGNITIVE FUNCTION IN OLDER ADULTS WITH DIFFERENT TYPES OF DEMENTIA: A META-ANALYSIS
Guilherme Balbim, 1 Ryan Falck, 1 Cindy Barha, 1 Jennifer Davis, 2 Samantha Starkey, 1 Alexis Bullock, 3 and Teresa Liu-Ambrose, 1 1.University of British Columbia,Vancouver,British Columbia,Canada,Kelowna,British Columbia,Canada,3. the University of British Columbia,Vancouver,British Columbia,Canada Combating dementia is a public health priority, and exercise training is one promising strategy for dementia prevention.However, its efficacy in promoting cognitive outcomes in different types of dementia remains unknown.We conducted a systematic review (N = 27) and meta-analysis (N = 24) of randomized controlled trials with cognitive function as a primary or secondary outcome.We aimed to assess the effect of exercise interventions on the cognitive function of older adults (>60 years) diagnosed with different types of dementia.We synthesized data from 2,441 older adults with dementia.Eleven trials included older adults with multiple types of dementia, eight with Alzheimer's disease, six with unspecified types of dementia, and two with vascular cognitive impairment.We performed random-effects models using robust variance estimation (RVE) and tested potential moderators using the approximate Hotelling-Zhang test (HTZ).Results suggest a small effect of exercise on cognitive function for all-cause dementia (g = 0.18; 95% CI: 0.04, 0.33; p = 0.016); however, the effects did not differ by type of dementia.Moderation analyses showed that trials that did not specify participants' severity of dementia, applied individuallevel randomization, and had higher intervention adherence demonstrated larger exercise effects on cognitive function for all-cause dementia.We conclude that exercise promotes small improvements in the cognitive function of older adults with all-cause dementia.More research including different types of dementia is needed if we hope to determine the precise effects of exercise for each type of dementia.Addressing physical activity (PA) barriers is an essential component of increasing PA among the 56-73% of community-dwelling adults 50 years and older who are not performing the recommended 150 minutes of moderate-tovigorous PA.As there is no feasible, multi-factorial tool to assess PA barriers among this population, we developed and validated a PA barrier assessment tool called the Inventory of Physical Activity Barriers (IPAB).We collected cross-sectional data on 503 adults (mean age 70.1), with 79 participants completing the scale twice for test-retest reliability and 64 completing a cross-over design examining the ability to use two administration formats interchangeably.Our analyses consisted of exploratory and confirmatory factor analysis, Cronbach alpha, intraclass correlation coefficient, Bland-Altman Plot, and t-tests.Using factor analysis, we identified and confirmed an eight-factor solution consisting of 27 items.The 27-item IPAB is internally consistent (alpha= 0.91), has a high test-retest reliability (intraclass correlation coeffi-cient=0.99),and can differentiate between individuals who meet the recommended levels of PA and those who do not (p < 0.001).The IPAB scores ranged between 1.00-3.11for the paper format (mean=1.78)and 1.07-3.48for the electronic format (mean=1.78),with no statistical difference between the paper and electronic administration formats (p=0.94),resulting in the conclusion that the two administration formats can be used interchangeably.Participant feedback illustrates that the IPAB is easy to use, has clear instruction, and is an appropriate length.The newly validated IPAB scale can be used to develop individualized PA interventions that address PA barriers among patients 50 years and older.

CAPTURING CHANGE IN BALANCE CONFIDENCE OVER 30 DAYS: INSIGHTS GAINED FROM A MICRO-LONGITUDINAL STUDY
Tai-Te Su, 1 Aileen Griffin, 2 Faith-Christina Washington, 3 Jacob Sosnoff, 4  Balance confidence reflects one's estimate of their ability to maintain balance and avoid falls.Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life.However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research.In this study, we aimed to investigate how older adults' balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change.We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month.Twenty-one participants (age=78.6±5.8,48%female) were enrolled, and individual characteristics were measured upon recruitment.Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale.We performed growth modeling techniques to examine change within a multilevel framework.Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was nonsignificant (b=0.03,SE=0.21, p=.89) on average.However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37,SE=0.13, p<.01) and decreased among those with greater physical fall risk (b=-0.18,SE=0.07, p<.01) and accurate understanding of fall risk at baseline (b=-0.24,SE= 0.12, p=.04).Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal.We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.

COMPARING THE SHORT AND ORIGINAL VER-SIONS OF THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE IN OLDER ADULTS
Chad Tiernan, 1 and Allon Goldberg, 2 1.University of grand blanc,Michigan,United States,Flint,Michigan,United States Balance confidence assessment in older adults has implications for falls and quality of life.It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended.To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed.ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed.Participants were primarily female (80.5%) between the ages of 60 and 87 years.Results indicated a strong association between the scales [r = .97,p<.001); ICC(2,1) = .80]but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16).Cronbach's alphas were .95(ABC-16) and .89(ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16.Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29).Hotelling's t-test [t(74)=2.4,p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model.In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable.Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

DESCRIPTIVE EPIDEMIOLOGY OF FALL-RELATED INJURIES AMONG OLDER ADULTS IN ONTARIO, CANADA
Nicolette Lappan, 1 Aleksandra Zecevic, 2 Yu Ming, 1 Susan Hunter, 2 and Andrew Johnson, 2 1.University of Western Ontario, University of Western Ontario, Ontario,Canada,2. Western University,London,Ontario,Canada The number of older adults is growing rapidly in the province of Ontario meaning there will be more fallrelated injuries (FRIs) in coming decades.Falls are the leading cause of injury-related hospitalizations in Canada.The purpose of this study was to describe the prevalence, circumstances, types, and locations of FRIs among older adults in Ontario.Using a population-based retrospective design, we analyzed secondary data from three health administrative databases (NACRS, DAD, RPDB) for 2010-2014.Older adults (≥ 65 years) admitted to an emergency department (ED) with a combined diagnosis of ICD-10-CA