The World Health Organization defines physical activity as any bodily movement produced by skeletal muscles that require energy expenditure (Physical Activity, 2020). It is recommended that older adults and those with chronic health conditions and disabilities participate in a minimum of 150 to 300 minutes of moderate, or 75 to 150 minutes of vigorous physical activity per week (Physical Activity Guidelines for Americans, 2018). Additionally, muscle strengthening activities that target all major muscle groups and balance training for older adults are recommended as part of a well-rounded physical activity program (Physical Activity Guidelines for Americans, 2018). Participation in regular physical activity can be beneficial in reducing anxiety and depression, enhancing physical function and independent living in older individuals, improving cardiovascular and respiratory function, reducing cardiovascular disease risk, and decreasing morbidity and mortality (Liguori et al., 2021). Home healthcare rehabilitation providers can play an important role in providing education on guidelines to optimize physical activity. The purpose of this column is to describe interventions within the skill set of rehabilitation providers and clinical exercise physiologists with evidence for their utility in optimizing the physical activity volumes of older adults with chronic conditions.

Several strategies have evidence of their utility in facilitating increased physical activity volumes. Included among those are behavior change techniques (Michie et al., 2015) and wearable activity monitors (Chapie & Arena, 2020). These interventions may be useful to rehabilitation providers and exercise specialists to set activity goals, to design and prescribe home exercise programs, and to establish measurable outcome metrics (Chapie & Arena, 2020). In the home healthcare setting, these techniques can be easily integrated into current practice patterns and can be useful adjuncts to supplementing and enhancing physical activity goals.

Coaching psychology is an important consideration when considering behavior change techniques that promote sustainable physical activity. This branch of psychology uses a systematic approach with a theoretical framework common in the behavior science of psychology to enhance life experiences, work performance, and/or the overall wellbeing of individuals or groups (Liguori et al., 2021; Moore et al., 2016). One subcategory of coaching psychology is the evolving domain of health and wellbeing coaching. This approach is patient-centered, with the patient being an active participant in determining their goals (Wolever et al., 2013). The technique uses self-discovery in combination with directed education by a trained coach to increase self-accountability in behavior change (Wolever et al., 2013). A specific approach in wellbeing coaching is motivational interviewing that aims to explore a person's ambivalence toward physical activity using open-ended questions, empathetic responses, reflective listening skills, and recognizing the potential for resistance to behavior change (Liguori et al., 2021; Moore et al., 2016; Pignataro & Huddleston, 2015). Motivational interviewing can be used to individualize the approach to caring for individual patients by collaboratively exploring and resolving ambivalence toward positive behavior change within the context of the home environment (Liguori et al., 2021).

Another strategy that can be employed to increase physical activity volumes is the use of wearable activity trackers (i.e., Fitbit(TM), Garmin Vivofit(TM)). There is a growing body of evidence for their utility in encouraging increased physical activity levels, and these technologies offer the opportunity for an individual to self-monitor their physical activity volumes (Kononova et al., 2019). Additionally, the health data generated from wearable activity monitors, including biometrics in the form of energy expenditure, step count, activity intensity, and distance traveled, provide an opportunity to collect health information (Chan et al., 2022) and subsequently set specific, measurable, actionable, realistic, and timely (SMART) person-centered physical activity goals. Setting short- and long-term SMART physical activity goals is vital to sustained behavior change (Liguori et al., 2021).

Individually and adjunctively wellbeing coaching strategies, such as motivational interviewing and wearable activity monitoring technologies offer home healthcare rehabilitation and clinical exercise physiologists, evidence-based tools and strategies to elicit positive behavior change. Engaging in regular physical activity can benefit an individual's health, enhance physical function, and maintain or even improve opportunities for independent living in older adults (Liguori et al., 2021). Therefore, home healthcare providers may consider incorporating these techniques and tools into the care plans of older adults with chronic conditions to empower them to sustain and increase their physical activity.

Use of melatonin supplements rising among adults

NIH: Melatonin, helps cue the body that it's time to sleep, but studies have not consistently shown that taking melatonin supplements helps with insomnia, jet lag, or recovery from shift work. Information on the long-term safety of these supplements is also lacking. It hasn't been clear how common the use of melatonin is. Researchers examined melatonin use between 1999 and 2018. More than 55,000 adults aged 20 and older reported their use of dietary supplements to a survey during those two decades. Melatonin use increased from 0.4% of survey respondents in 1999/2000 to 2.1% in 2017/2018. This trend was similar between men and women, and across age groups. Starting in 2005, respondents began reporting the use of doses greater than 5 milligrams per day. High-dose melatonin use more than tripled over the period studied, from 0.08% of study participants in 2005/2006 to 0.28% in 2017/2018. The use of high-dose melatonin remained very low overall, however, these estimates raise concerns, as the actual content of melatonin in commercial supplements may be many times higher than what's listed on the label.

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