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Wellness Activities for Older Americans

Background

There are many challenges associated with aging. But it is a more difficult process when an individual does not have certain essential tools to achieve healthy aging, such as knowledge of proper exercise and nutrition, peer support, and the ability to cope with the psychological and physical health changes due to aging. Wellness and health promotion programs help older adults to understand the complexity of and ingredients for optimal psychosocial and physical well-being. (1)

Congregate sites are places to eat a healthy meal, socialize, participate in activities, and not be alone. Many programs and centers provide comprehensive services in addition to nutritious meals for on-site and homebound participants. Although participation is declining at some congregate sites due to lack of variety of program activities (2-3) that meet participant needs, increasing activities and educational classes, particularly those related to mental health and physical health are helpful in promoting independence, functionality, health and overall well-being (2-3).

A sedentary lifestyle, due to age, depression, obesity, arthritis, stroke or respiratory diseases, is a major risk factor for disability in older adults (4-7). Research supports the importance of physical activity in reducing the risk of these debilitating conditions (5-11). The benefits of physical activity have been well documented including increased appetite, increased mobility and flexibility, and improved muscle strength and aerobic capacity (12). As a result, more active participants have better dietary intakes, improved functional capacity to perform Activities of Daily Living, reduced risk for falls, improved bone health, and improved responses to coronary heart disease, hypertension, diabetes, and osteoarthritis (5-10). Functionality is improved.

Congregate programs that offer resistance training (eg., strength training via dumbbells or machines), endurance training (eg., aerobics, walking, swimming), flexibility training (eg., stretching, yoga), and balance training (eg., Tai-chi) help benefit older adults in their pursuit of a healthy lifestyle (12-13).

According to National Evaluation of the Elderly Nutrition Program, 1993-1995, 80% of nutrition sites that provided recreation and social activities (or 67 percent of all congregate sites) offered these activities at least twice per week (14). Physical activity programs were included in this category but were not listed as a separate activity. The Surgeon General, supported by AARP, the American College of Sports Medicine, the American Geriatrics Society, the National Institute on Aging, the Center for Disease Control and Prevention, and the Office of the Assistant Secretary for Planning and Evaluation in the US Department of Health and Human Services, recommend community-based physical activity programs or community activities that include physical activity opportunities to achieve health benefits in older adults (10, 15,16). Therefore, Older Americans Nutrition Programs, that serve millions of older adults every year, are logical sites for such activities. Physical activity, partnered with good nutrition, enables participants to lead a quality and productive life.

Health promotion programs focus on educating older adults about how to increase control over and improve their health in a variety of areas; for example, nutrition, physical activity, mental health, alcohol and substance reduction, tobacco use, and other areas. Wellness programs--a type of health promotion program--involve all aspects of the individual: mental, physical, and spiritual. Both types of programs provide structured opportunities to increase knowledge and skills in specific areas, such as stress management, or environmental sensitivity. They also provide a supportive environment to nurture the emotional and intellectual aspects of participants, and aid individuals in becoming increasingly responsive to their health needs and quality of life. These programs are usually short-term and educational rather than therapeutic in nature.

The Older Americans Act Reauthorization lists a number of activities concerning health and wellness programs:
Part B-Supportive Services and Senior Centers Program.
Section 321 (a) The Assistant Secretary shall carry out a program for making grants to States under State Plans approved under section 307 for any of the following supportive services:
(1) health (including mental health), education and training, welfare, informational, recreational, homemaker, counseling, or referral services:
(7) services designed to enable older adults to attain and maintain physical and mental well-being through programs of regular physical activity, exercise, music therapy, art therapy, and dance-movement therapy;
(8) services designed to provide health screening to detect or prevent illnesses, or both, that occur most frequently in older individuals;
(17) health and nutrition education services, including information concerning the prevention, diagnosis, treatment, and rehabilitation of age-related diseases and chronic disabling conditions…

Part D - Disease Prevention and Health Promotion Services Program
Section 361
(a) The Assistant Secretary shall carry out a program for making grants to States under State Plans approved under section 307 to provide disease prevention and health promotion services and information at multipurpose senior centers, at congregate meal sites, through home-delivered meals programs, or at other appropriate sites. In carrying out such programs, the Assistant Secretary shall consult with the Directors of the Centers for Disease Control and Prevention and the National Institute on Aging.
(b) The Assistant Secretary shall, to the extent possible, assure that services provided by other community organizations and agencies are used to carry out the provisions of this part.

Section 102 - Definitions
For the purposed of this Act-
(12) The term "disease prevention and health promotion services' means-
(A) health risk assessments;
(B) routine health screening, which may include hypertension, glaucoma, cholesterol, cancer, vision, hearing, diabetes, bone density, and nutrition screening;
(C) nutritional counseling and educational services for individuals and their primary caregivers;
(D) health promotion programs, including but not limited to programs relating to prevention and reduction of effects of chronic disabling conditions (including osteoporosis and cardiovascular disease), alcohol and substance abuse reduction, smoking cessation, weight loss and control, and stress management;
(E) programs regarding physical fitness, group exercise, and music, art, and dance-movement therapy…
(F) home injury control services, including screening of high-risk home environments and provision of educational programs on injury prevention (including fall and fracture prevention)in the home environment;
(G) screening for the prevention of depression, coordination of community mental health services, provision of educational activities, and referral to psychiatric and psychological services…
(I) medication management screening and education to prevent incorrect medication and adverse drug reactions…

Examples of Wellness and Physical Activity Programs

Below are examples of wellness programs from a wide variety of organizations and agencies that provide these services. Summaries provide the objectives and activities of specific programs. This list also includes suggestions for specific topics and resources for more information. Additional resources to tap for information and assistance include (1) state and county health departments, (2) cooperative extensions, (3) hospitals and health clinics, (4) colleges and universities, (5) health care practitioners, (6) federal and state public health agencies, and (7) other agencies, organizations, and businesses that relate to a specific disease, service, and/or product. There is no limit to the variety and depth of programs to offer based on the needs and interest in the community served.

  • Research, resources, and weblinks on the subjects of Education and Health Promotion posted by the National Policy and Resource Center on Nutrition and Aging

General Wellness Programs

  • Strong Bodies Healthy Seniors Program. Monterey County Area Agency on Aging. Based on the following books: Nelson ME and Wernick S. Strong Women Stay Young (revised edition). Bantam Doubleday Dell Publishing; 2000 and Nelson ME and Wernick S. Strong Women Stay Slim. Bantam Doubleday Dell Publishing; 1999. http://www.randomhouse.com/bantamdell/health.html
    http://www.aaamc.org/
  • Interdisciplinary Health Promotion Education for Low Income Older Adults. Southeast Florida Center on Aging and College of Health and Urban Affairs, School of Health, Florida International University, Miami, FL. Teams of faculty and students from physical therapy, occupational therapy, nursing, dietetics, and social work planned, organized and implemented health promotion activities and education for older adults residing in low income housing. Faculty from each discipline helped facilitate the group planning, implementation processes, and resource guidance. Activities were presented in English, Spanish, as well as Creole as needed. Activities and topics included exercise, stretching, weight training, walking programs, diabetic foot care, sexuality and aging, depression, accessing community resources, balloon volleyball, apartment safety checks, fall prevention, smart grocery shopping, relaxation and stress reduction, hurricane preparedness, hydration, memory tips, and nutrition advice. Students were challenged to learn and work with different disciplines and gained new insights and respect for each other's discipline specific knowledge. Student's perceptions of working with older adults often changed. The older adults found the program worthwhile and helpful. The project provided needed services to an underserved low income older adult population while providing students with the opportunity to work, learn, and gain experience in an interdisciplinary format. Pamela Elfenbein, PhD, MSW, Center on Aging, Florida International University, Miami, FL. (305) 919-5563 Email: elfenbep@fiu.edu
  • The Community Education Program. Goldman Institute on Aging, San Francisco, CA. This program is designed to inform older adults and caregivers about pressing health issues. Its goal is to provide up-to-date information so older adults can make informed decisions about their health and well-being. http://www.gioa.org/
  • Community Health Education Program. DuPage County Health Department, Illinois. Offers a variety of health education programs to groups of older adults at either the Health Department or other locations throughout the county. Health topics include: Arthritis, Dental Health, Depression, Diabetes, Exercise, Falls, Healthy Aging, Hypertension, Medication, Safety, Nutrition & Fitness, Osteoporosis, Smoking Cessation, and Stroke Prevention. http://www.dupagehealth.org/seniorservices/services.html
  • Yoga for Older Adults. McGaw YMCA, Evanston, IL. Yoga is a holistic approach to overall health and body maintenance, which includes energy awareness, breathing and stamina. Tai Chi for Older Adults. McGaw YMCA, Evanston, IL. Tai Chi is a graceful form of meditation through movement that facilitates relaxation and a healthier connection between the spirit, mind and body. http://www.ymcacommunity.net/mcgaw/program.asp?ProgramID=369
  • Exemplary State Programs to Prevent Chronic Disease and Promote Health, Winter 2000. Centers for Disease Control and Prevention (CDC). The CDC is working with states to implement chronic disease prevention programs that are research-based and proven to work. Strong, well-coordinated state programs supported by essential national elements, such as surveillance and prevention research, form the framework for CDC's efforts to prevent and control chronic diseases. CDC developed this document to provide states with models of state-based programs that are making a sustained contribution to reducing the burden of chronic diseases by targeting one or more of the following key objectives: reducing risk factors for chronic diseases, expanding the use of screening for early detection of chronic diseases, providing high-quality health education programs, and creating healthier communities. http://www.cdc.gov/nccdphp/exemplary/index.htm

Physical Activities

  • HealthierUS Initiative. President Bush launched this initiative to educate Americans of all ages about the vital health benefits of simple and modest improvements in physical activity and nutritional habits. On June 21, President Bush and Assistant Secretary for Aging Josefina G. Carbonell met with seniors in Florida to discuss the importance of healthy lifestyles and regular physical activity to successful aging. http://www.whitehouse.gov/infocus/fitness/
  • SNAP (Senior Nutrition and Activity Program) Senior Services, Inc of Wichita, funded by the Kansas Health Foundation, produced SNAPshots: A Series of Articles about Nutrition & Physical Activity. Articles include Flexibility & Fitness; Exercise for Visually Impaired People; Balance; Exercise & Arthritis; Walking for Fitness. Contact info: 200 South Walnut, Wichita, Kansas 67213; phone: 316-267-0302.
  • Nutrition and Physical Activity Profile of Older Adults in Georgia...Results from a Community Intervention. Division of Aging Services 2001. The Georgia Division of Aging Services implemented a community-based nutrition and physical activity screening and intervention program called Take Charge of Your Health-Active Older Adult Speaker's Kit and Placement Leg Exercises in a congregate meal program setting. Participants improved their flexibility, walking speed, and nutrition knowledge. Georgia Department of Human Resources, Atlanta, GA. http://www2.state.ga.us/Departments/DHR/aging.html
  • Chicago Fitness Plus. Chicago Department on Aging. The largest government-sponsored senior exercise program caters to over 7000 participants, including low-income and homebound older adults. http://www.ci.chi.il.us/Aging/
  • Community Healthy Activities Model Program for Seniors. Center for Healthy and Active Living, University of California, San Francisco, CA. Comprehensive lifestyle interventions to increase physical activity using client-centered motivational, behavioral, and cognitive techniques to help participants overcome barriers, exercise safely, and develop endurance, flexibility, and strength. Participants choose their own exercise regimens. Programs also targeted to low-income and minority seniors. Purpose is to implement and evaluate safe and effective physical activity programs for older adults that incorporate strength training and endurance activities. The project's central tasks are to increase awareness of the benefits of physical activity programs, build capacity of local agencies to deliver physical activity programs, enhance the skills and confidence of older adults to engage in regular physical exercise, and increase the activity level of older adults. http://nurseweb.ucsf.edu/iha/hlthyact.htm
  • AgeFit TM first introduced its dedicated strength training and fitness programs for older adults in 1997 in Stamford, CT. Since that time, hundreds of program participants ages 65 to 95+ have reported increased functional mobility and strength, better balance, longer gait length, and improved overall health. Best of all, they reflect a positive outlook on life that comes from their renewed independence and emotional well-being. http://www.agefit.com/services.htm
  • Benefits of water exercises for older adults. Ohio University, Athens, OH. Water exercise is beneficial to older adults because movement in water puts less stress on the body. For example, when neck deep in water the body only bears 8% of its weight. In water, there is less force involved, less of a risk of injury. Immersion in water also benefits older adults with chronic conditions such as osteoarthritis. Water resistance helps strengthen muscles and improve balance, with little risk of falling. Older adults are more apt to participate if they know the benefits. http://www.ohiou.edu/news/01-02/211.html
  • Provide stretching and chair exercises.
  • Provide stationary bicycles and/or stimulate individuals to ride solo or in groups.
  • Provide dance-movement therapy or dance for entertainment, aerobics.

Walking Programs

  • USA on the Move: Steps to Healthy Aging: Eating Better, Moving More. As part of this initiative, the Administration on Aging has launched a two-part project sponsored by AoA and the National Policy and Resource Center on Nutrition and Aging at Florida International University, Miami, FL. Moving More is designed to improve nutrition and physical activity in older adults. Older adults can use digital step counters to count steps daily and add steps throughout the day to reach their step goal, increasing daily steps gradually.
    http://www.fiu.edu/~nutreldr/STEPS_Program/STEPS_home.htm
  • Strong Bodies Healthy Seniors Program. Monterey County Area Agency on Aging. Based on the following books: Nelson ME and Wernick S. Strong Women Stay Young (revised edition). Bantam Doubleday Dell Publishing; 2000 and Nelson ME and Wernick S. Strong Women Stay Slim. Bantam Doubleday Dell Publishing; 1999. http://www.randomhouse.com/bantamdell/health.html
    http://www.aaamc.org/
  • Food for Thought newsletter. Monterey County Area Agency on Aging Nov/Dec 2001 issue, Walk This Way, Please...Everything You Ever Wanted to Know About Walking (Including Why You Should Do It)." http://www.aaamc.org/
  • Mayor's Walk For Senior Wellness. Florida Department of Elder Affairs and the Northeast Florida AAA. On November 10, 2001, about 300 seniors participated in a 1.8 mile walk in Jacksonville to promote health and fitness. A new wellness program was also introduced. Northeast Florida AAA, Jacksonville, FL (904) 786-5111, (888) 242-4464. http://www.myflorida.com/doea/healthfamily/learn/elderissues/doeairu.html
  • Provide treadmills and other walking, stepping, and running equipment.
Social, Cognitive, and Mental Health Improvement Programs
  • Counseling and support groups for persons/caregivers concerning dementia and Alzheimer's Disease. Alzheimer's Disease Education and Referral Center. http://www.alzheimers.org/
  • Alcohol Abuse Among Seniors report. Alcohol abuse is being called a hidden epidemic. Hidden because its symptoms often mimic or are masked by common physical and mental infirmities of aging. Hidden because doctors rarely ask about when and how much their older patients drink or what effect alcohol may have on their lives. http://www.healthinaging.org/
  • Artworks. Goldman Institute on Aging, San Francisco, CA. A unique and innovative program where professional artists design and implement projects such as painting, oral history, music and poetry at adult day health centers and in the homes of frail older adults. Through creative expression, older adults remain connected to the community and experience improved physical and emotional well-being. http://www.gioa.org/
  • Friendship Line/Center for Elderly Suicide Prevention and Geriatric Mental Health and Counseling. Goldman Institute on Aging, San Francisco, CA. Older adults often face a multitude of changes and stresses in relation to the aging process, including health concerns, physical limitations, financial problems, loss of a loved one and isolation. http://www.gioa.org/programs/cesp/cesp.html
  • Mental Wellness Tips. The Health Aging Campaign. The processes of normal aging do not have to rob older adults of their memory. This class facilitates learning about depression. New activities, hobbies, and exercise are wonderful anti-depressants. Course teach older adults about: staying active doing things that use memory, taking classes, playing games, being with people, picking up the phone just to "chat," volunteering time, getting involved with a cause, and seeking out variety and challenge in daily life. http://www.healthyaging.net/mentalwellness.htm
  • Group Psychiatric Services Program. The Southeast Public Health Center, Dupage County Health Department, IL, offers bi-monthly psychiatric services and a support group for older adults struggling with depression or mental illness. Services are provided in a group setting by an interdisciplinary team of professionals. http://www.dupagehealth.org/seniorservices/services.html
  • Bereavement Drop-In Center. Visiting Nurse Association of Manchester and Southern New Hampshire. Elliot Hospital, Manchester, NH. Drop-in center open to anyone grieving the death of a loved one. Meetings are informal, and offer a place to share thoughts and concerns with a trained bereavement volunteer or Hospice professional. http://www.elliothospital.org/classes/
  • Offer spirituality support groups.
  • Offer counseling and support for sexuality and sexual function issues.

Chronic Disease Prevention and Treatment / Health Screening

  • Statewide Health Education and Awareness Campaign Model. Minnesota Board on Aging Three campaigns: Strike Out Stroke (1999), Arthritis Doesn't Have to Slow You Down (2000) and Alzheimer's Disease (2001) emphasized physical activities to benefit each of these conditions. (651) 296-2879. http://www.mnaging.org/
  • The Active Aging Community Task Force Project. Center for Healthy and Active Living, University of California, San Francisco, CA. Funded by the Robert Wood Johnson Foundation. This project expands into 17 California regions a proven community task force model for setting up strength training classes for persons over the age of 60. The aims of the project are to increase community awareness of risk factors and prevention and treatment strategies for osteoporosis and falls, and increase the number of community-based strength training classes for persons over the age of 60. The community task forces will develop and implement work plans to identify community sites in which to establish new strength training classes, and identify the persons to be trained to lead the classes. http://nurseweb.ucsf.edu/iha/hlthyact.htm
  • Talk about Prescriptions is an online resource in an effort to improve communication about appropriate medicine use from the National Council on Patient Information and Education http://www.talkaboutrx.org/
  • Screening and treatment information for heart disease, high blood pressure, stroke. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=1200000
  • Screening and treatment information on diabetes. American Diabetes Association. http://www.diabetes.org/main/application/commercewf
  • Screening and treatment information for various forms of cancer. American Cancer Society. http://www.cancer.org/
  • Importance of Vision Screening (press release). National Eye Institute. About one in eight Americans aged 65 and over are visually impaired or blind. http://www.nei.nih.gov/news/pressreleases/032002.htm
  • Stroke Screening. Jefferson Health System, Philadelphia, PA. Learn the warning signs and risk factors for stroke and "mini-strokes" or TIA's. A 15-minute screening includes blood pressure and heart rate check. Discuss personal risk factors with a nurse. Stroke screenings is available, free of charge, at various locations in the community. http://www.mainlinehealth.org/neighbors/e3front.dll?durki=5831
  • Focus on food labels to help diabetic adults. An intense 10-session nutrition education program developed by Penn State and the University of North Carolina at Greensboro to help improve eating patterns and meet treatment goals. The older adults in this study not only changed their diets but also had greater improvements in their blood sugar and cholesterol levels than did people who were not counseled through this new approach. http://www.hhdev.psu.edu/news/news_res/2_18_02_diab.html
  • Dental care for urgent oral problems. Dupage County Health Department, IL. Provides care for tooth pain, bleeding, infection and/or swelling, etc. at no charge. Patients are qualified in advance of treatment to verify financial and residential eligibility. Referrals to low cost dental services are also provided. http://www.dupagehealth.org/seniorservices/services.html
  • Immunizations for tetanus, diphtheria, flu and pneumonia (seasonal) are available at local public health centers. Dupage County Health Department, IL.
  • Fall prevention programs. Dupage County Health Department, IL. http://www.dupagehealth.org/seniorservices/services.html
  • Managing Your Hearing Loss (Lip Reading - Beginning), City of Sunnyvale, CA Parks and Recreation. Class teaches techniques to manage hearing loss and improve speech understanding. It is designed for those with or without hearing aids. http://www.ci.sunnyvale.ca.us/leisure-services/activities/older-adults/health.htm
  • Urinary Incontinence - You Are Not Alone. Elliot Hospital, Manchester, NH. Educational session on how urinary incontinence can be effectively treated. http://www.elliothospital.org/classes/index.html

Nutrition

  • USA on the Move: Steps to Healthy Aging: Eating Better, Moving More. As part of this initiative, the Administration on Aging has launched a two-part project sponsored by AoA and the National Policy and Resource Center on Nutrition and Aging at Florida International University, Miami, FL. This pilot project is designed to improve nutrition and physical activity in older adults. Eating Better focuses on improving eating habits. It uses a guide (to be developed) that includes simple healthy recipes and tips to improve diets.
    http://www.aoa.dhhs.gov/nasua-factsheet-rev211.pdf http://www.fiu.edu/~nutreldr/STEPS_Program/STEPS_home.htm
  • Nutrition screening, nutrition assessment, nutrition education, and nutrition counseling. See resources and bibliographies at the National Policy and Resource Center on Nutrition and Aging. Nutrition care resources: http://www.fiu.edu/~nutreldr/Resources/resources_index.htm#3
    Nutrition care bibliographies: http://www.fiu.edu/~nutreldr/Bibliographies/Journals_and_Reports/Journals_and_Reports.htm#5
    Also the American Dietetic Association. http://www.eatright.org/
    Cooperative Extension Services http://www.reeusda.gov/statepartners/usa.htm
    University of Nebraska Cooperative Extension http://lancaster.unl.edu/food/
  • Guidelines for food shopping, food safety and food preparation. Check online resources from the Center and other resources noted above. Use of vitamins, minerals, herbal, and food supplements. Check online resources from the Center. Also the Alternative Medicine Foundation. http://www.amfoundation.org/
  • Nutrition for a Healthy & Active Lifestyle. City of Sunnyvale, CA Parks and Recreation. This course focuses on how aging effects nutritional needs and how to prevent or alleviate many of the complications associated with growing older through sound nutrition practices. Special topics include nutrition's role in the prevention and treatment of heart disease, osteoporosis, arthritis and cancer. Current research and some controversial topics such as vitamin and herbal supplements, the French Paradox and red wine's possible role in prevention of heart disease are reviewed. The course provides practical nutrition information as well as behavioral strategies to make healthy eating part of one's life. http://www.ci.sunnyvale.ca.us/leisure-services/activities/older-adults/health.htm

Living Activities

  • Rx for Communication. Comprehensive Health Education Foundation, Seattle, WA. A program to help older adults communicate more effectively with their doctors and pharmacists. The program is designed to be provided by local staff or volunteers after a one-day training and using curriculum materials that include a step-by-step guide for the sessions, masters of participant handouts, transparencies, and a video. (800) 323-2433. http://www.chef.org/more.htm
  • 55 Alive Safe Driving Class. AARP. An 8-hour class reinforces safe driving habits and reviews the rules of the road. Many insurance companies offer a discount to those completing the class. http://www.mainlinehealth.org/neighbors/e3front.dll?durki=5831
  • Elder Abuse Prevention Program. Goldman Institute on Aging, San Francisco, CA. A nationally recognized model in providing individual and group counseling to elderly victims of abuse. The program also provides training and education to older adults, community groups, and professionals. Additionally, the program heads up the San Francisco Consortium for Elder Abuse Prevention. http://www.gioa.org/
  • Financial planning advise from AARP. http://www.aarp.org/finance/
    Prescription Drugs: What You Should Know. AARP. Taking medicine is more than taking medicines on time. It's also taking them at the right time of day, with the right foods, and following all directions. http://www.aarp.org/wiseuse/ http://www.aarp.org/confacts/health/drugs.html
  • Managed Care: Using Drug Coverage. AARP. How managed care plan use formularies to determine what drugs it will pay for? How can one minimize co-pays? http://www.aarp.org/hcchoices/9ways/six.html
  • Internet for Seniors. AARP. Elliot Hospital, Manchester, NH. This class introduces techniques for "surfing the net" for older adults. Basic terminology and theory is reviewed. Internet exercises provides hands on learning and an informational handout is distributed to participants. http://www.elliothospital.org/classes/

    Background References

    1. Older Adults and Mental Health: Issues and Opportunities, Chapter 4 - Supportive Services and Health Promotion. Administration on Aging. January 10, 2000. Available at: http://www.aoa.dhhs.gov/mh/report2001/chapter4.html.
    2. 1998 AoA State Program Reports. Administration on Aging. Available at: http://www.aoa.dhhs.gov/napis/98spr/default.htm.
    3. Evaluation of Dine-Out Programs. Prepared by Suburban Area Agency on Aging and Community Network. August 9, 2000. Contact: Diane Sleazak, Deputy Director, Suburban Area Agency on Aging: 708-3; diane.slezak@s3a.com.
    4. Kramarow E, Lentzner H, Rooks R, Weeks J, Saydah S. Health and Aging Chartbook. Health, United States, 1999. Hyattsville, MD: National Center for Health Statistics. 1999.
    5. Rader MC, Vaughen JL. Management of the frail and deconditioned patient. South Med J. 1994;87(5):S61-65.
    6. Vorhies D, Riley BE. Deconditioning. Clin Geriatr Med. 1993;9:745-763.
    7. Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LM, Appelbaum M, Doraiswamy PM, Krishnan KR. Effects of exercise training on older patients with major depression. Arch Intern Med.1999;159:2349-2356.
    8. American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 1998;30:992-1008. Also available at: http://www.acsm-msse.org.
    9. Hurley BF, Roth SM. Strength training in the elderly: Effects on risk factors for age-related diseases. Sports Med. 2000;4:249-268.
    10. US Dept of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta, GA: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion;1996. Also available at: http://www.cdc.gov/nccdphp/sgr/sgr.htm.
    11. Yates SM, Dunnagan TA. Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2001;56:M226-230.
    12. Carlson JE, Ostir GV, Black SA, Markides KS, Rudkin L, Goodwin JS. Disability in older adults 2: Physical activity as prevention. Behav Med. 1999. 24(4):157-168.
    13. Jette AM, Lachman M, Giorgetti MM, Assmann SF, Harris BA, Levenson C, Wernick M, Krebs D. Exercise-it's never too late: the strong-for-life program. Am J Public Health. 1999;89:66-72.
    14. Ponza M, Ohls JC, Millen BE. Serving Elders At Risk: The Older American Act Nutrition Programs, National Evaluation of the Elderly Nutrition Program, 1993-1995. Washington, DC: Mathematica Policy Research Inc; 1996. http://www.aoa.gov/aoa/pages/nutreval.html
    15. The Robert Wood Johnson Foundation. National Blueprint: Increasing physical activity among adults age 50 and older. Available at: http://www.rwjf.org/app/rw_publications_and_links/rw_pub_other.jsp
    16. US Dept of Health and Human Services. Physical activity fundamental to preventing disease. Office of the Assistant Secretary for Planning and Evaluation; June 20, 2002. Also available at: http://aspe.hhs.gov/health/reports/physicalactivity/physicalactivity.pdf

Compiled by Lester Rosenzweig, MS, RD and Lauren Rhee, MS, RD, and staff of the National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami, FL. Contact: nutritionandaging@fiu.edu

This project is supported, in part, by a grant from the Administration on Aging,
Department of Health and Human Services (DHHS). Grantees undertaking projects under government
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS policy.

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Posted on 07/19/02

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National Resource Center on Nutrition, Physical Activity & Aging
| Florida International University, OE 200, Miami, FL 33199
Phone: 305-348-1517 | Fax: 305-348-1518 | E-mail:
nutritionandaging@fiu.edu

This website is supported, in part, by a grant from the Administration on Aging, Department of Health and Human
Services (DHHS). Grantees undertaking projects under government sponsorship are encouraged to express freely their
findings and conclusions. Points of view or opinions do not, therefore, reflect official DHHS policy.