Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

Physical activity, walking, and quality of life in women with depressive symptoms

BACKGROUND

Physical activity (PA) has a positive association with health-related quality of life (HRQL) in the general population. The association between PA and HRQL in those with poor mental health is less clear.

PURPOSE

To examine the concurrent and prospective dose-response relationships between total PA (TPA) and walking only with HRQL in women aged 50-55 years with depressive symptoms in 2001.

METHODS

Participants were 1,904 women born in 1946-1951 who completed mailed surveys for the Australian Longitudinal Study on Women's Health in 2001, 2004, 2007, and 2010, and reported depressive symptoms in 2001. At each time point, they reported their weekly minutes of walking, moderate PA, and vigorous PA. A summary TPA score was created that accounted for differences in energy expenditure among the three PA types. Mixed models were used to examine associations between TPA and HRQL (short form-36 [SF-36] component and subscale scores) and between walking and HRQL, for women who reported walking as their only PA. Analyses were conducted in 2013-2014.

RESULTS

Concurrently, higher levels of TPA and walking were associated with better HRQL (p<0.05). The strongest associations were found for physical functioning, vitality, and social functioning subscales. In prospective models, associations were attenuated, yet compared with women doing no TPA or walking, women doing "sufficient" TPA or walking had significantly better HRQL over time for most SF-36 scales.

CONCLUSIONS

This study extends previous work by demonstrating trends between both TPA and walking and HRQL in women reporting depressive symptoms.

A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimer's disease in older adults

Background

The incidence of Alzheimer’s disease is increasing as the global population ages. Given the limited success of pharmaceuticals in preventing this disease, a greater emphasis on non-pharmaceutical approaches is needed. The aim of this study was to quantify the association between Alzheimer’s disease and physical activity in older adults over the age of 65 years.

Methods

A meta-analytic approach was used to determine if physical activity reduced the risk of Alzheimer’s disease in individuals 65 years or older. Some evidence indicates that physical activity may improve cognitive function in older adults, while other evidence is inconclusive. The purpose of this study was to examine if prevention of Alzheimer’s disease is possible if started at a later age. The precise brain changes that occur with the onset of Alzheimer’s disease are not fully known, and therefore may still be influenced by preventative measures even in advancing age. Determining if physical activity can inhibit the onset of the disease at any age may motivate individuals to adopt an “it’s never too late” mentality on preventing the onset of this debilitating disease. Longitudinal studies of participants who were 65 years or older at baseline were included. A total of 20,326 participants from nine studies were included in this analysis.

Results

The fixed effects risk ratio is estimated as 0.61 (95% CI 0.52-0.73) corresponding to a statistically significant overall reduction in risk of Alzheimer’s disease in physically active older adults compared to their non-active counterparts.

Conclusion

Physical activity was associated with a reduced risk of Alzheimer’s disease in adults over the age of 65 years. Given the limited treatment options, greater emphasis should be paid to primary prevention through physical activity amongst individuals at high-risk of Alzheimer’s disease, such as those with strong genetic and family history.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-015-0007-2) contains supplementary material, which is available to authorized users.

Self-affirmation alters the brain's response to health messages and subsequent behavior change

Health communications can be an effective way to increase positive health behaviors and decrease negative health behaviors; however, those at highest risk are often most defensive and least open to such messages. For example, increasing physical activity among sedentary individuals affects a wide range of important mental and physical health outcomes, but has proven a challenging task. Affirming core values (i.e., self-affirmation) before message exposure is a psychological technique that can increase the effectiveness of a wide range of interventions in health and other domains; however, the neural mechanisms of affirmation's effects have not been studied. We used functional magnetic resonance imaging (fMRI) to examine neural processes associated with affirmation effects during exposure to potentially threatening health messages. We focused on an a priori defined region of interest (ROI) in ventromedial prefrontal cortex (VMPFC), a brain region selected for its association with self-related processing and positive valuation. Consistent with our hypotheses, those in the self-affirmation condition produced more activity in VMPFC during exposure to health messages and went on to increase their objectively measured activity levels more. These findings suggest that affirmation of core values may exert its effects by allowing at-risk individuals to see the self-relevance and value in otherwise-threatening messages.

Differences in health-related quality of life among subjects with frequent bilateral or unilateral knee pain: data from the Osteoarthritis Initiative study

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To examine associations between frequent bilateral knee pain (BKP) and unilateral knee pain (UKP) and health-related quality of life (QoL). We hypothesized that frequent BKP would be associated with poorer health-related QoL than would frequent UKP and no knee pain.

BACKGROUND

Knee pain is one of the most frequently reported types of joint pain among adults in the United States. It is the most frequent cause of limited physical function, disability, and reduced QoL.

METHODS

Data were collected from the Osteoarthritis Initiative public-use data sets. Health-related QoL was assessed in 2481 participants (aged 45-79 years at baseline). The Knee injury and Osteoarthritis Outcome Score QoL subscale (knee-specific measure) and the physical component summary and mental component summary (MCS) scores of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) (generic measure) were used to assess health-related QoL. Multiple regression analyses were used to examine the relationships between frequent knee pain and health-related QoL, adjusted for sociodemographic and health covariates.

RESULTS

Compared with subjects with no knee pain, subjects with frequent BKP and UKP had significantly lower scores on the Knee injury and Osteoarthritis Outcome Score QoL subscale (mean difference, -35.2; standard error [SE], 0.86; P<.001 and mean difference, -29.2; SE, 0.93; P<.001; respectively) and the SF-12 physical component summary score (mean difference, -6.25; SE, 0.41; P<.001 and mean difference, -4.10; SE, 0.43; P<.001; respectively), after controlling for sociodemographic and health covariates. The SF-12 MCS score was lower among those with BKP (-1.29; SE, 0.42; P<.001). Frequent UKP was not associated with the SF-12 MCS.

CONCLUSION

Subjects with frequent BKP had lower health-related QoL than those with frequent unilateral or no knee pain, as reflected in lower Knee injury and Osteoarthritis Outcome Score QoL subscale and SF-12 physical component summary and MCS scores.

Socio-demographic, clinical and health behavior correlates of sitting time in older adults

BACKGROUND

Identifying correlates of sedentary behavior in older adults is of major importance to healthcare. To our knowledge, there are no population studies in Latin America examining which factors are associated to high sitting time in older adults. Thus, the purpose of this study is to identify socio-demographic, clinical, and health behavior correlates of sitting time in a representative sample of older adults living in Southeastern Brazil.

METHODS

A cross-sectional study was conducted in twenty-four municipalities of the Triangulo Mineiro region in the State of Minas Gerais, Southeastern Brazil. A structured questionnaire was applied to obtain information on socio-demographic, clinical, and health behavior factors. Overall sitting time was assessed using a self-report instrument. A Multiple Correspondence Analysis was used to verify the association of sitting time with socio-demographic, clinical, and health behavior factors.

RESULTS

3,296 older adults (61.5% women and 38.5% men) were included in the analysis. The overall median was 240.0 minutes of sitting time/day. The Multiple Correspondence Analysis showed that the group with the highest sitting time presented the following characteristics: women, age greater than 70 years, unschooled status, arterial hypertension, diabetes mellitus, use of medication, poor self-rated health, dependence in basic activities of daily living, and absence of regular physical activity.

CONCLUSION

This study reveals that socio-demographic, clinical, and health behavior factors are associated with high sitting time in older adults from Southeastern Brazil. The results may help to identify older adults that should be targeted in interventions aiming at reducing sitting time.

Relationships between dog ownership and physical activity in postmenopausal women

BACKGROUND

Positive associations between dog ownership and physical activity in older adults have been previously reported.

PURPOSE

The objective of this study was to examine cross-sectional associations between dog ownership and physical activity measures in a well-characterized, diverse sample of postmenopausal women.

METHODS

Analyses included 36,984 dog owners (mean age: 61.5years), and 115,645 non-dog owners (mean age: 63.9years) enrolled in a clinical trial or the observational study of the Women's Health Initiative between 1993 and 1998. Logistic regression models were used to test for associations between dog ownership and physical activity, adjusted for potential confounders.

RESULTS

Owning a dog was associated with a higher likelihood of walking ≥150min/wk (Odds Ratio, 1.14; 95% Confidence Interval, 1.10-1.17) and a lower likelihood of being sedentary ≥8h/day (Odds Ratio, 0.86; 95% Confidence Interval, 0.83-0.89) as compared to not owning a dog. However, dog owners were less likely to meet ≥7.5MET-h/wk of total physical activity as compared to non-dog owners (Odds Ratio, 1.03; 95% Confidence Interval, 1.00-1.07).

CONCLUSIONS

Dog ownership is associated with increased physical activity in older women, particularly among women living alone. Health promotion efforts aimed at older adults should highlight the benefits of regular dog walking for both dog owners and non-dog owners.

Perceived barriers and facilitators to increasing physical activity among people with musculoskeletal disorders: a qualitative investigation to inform intervention development

Purpose

Musculoskeletal conditions can impair people’s ability to undertake physical activity as they age. The purpose of this qualitative study was to investigate perceived barriers and facilitators to undertaking physical activity reported by patients accessing ambulatory hospital clinics for musculoskeletal disorders.

Patients and methods

A questionnaire with open-ended items was administered to patients (n=217, 73.3% of 296 eligible) from three clinics providing ambulatory services for nonsurgical treatment of musculoskeletal disorders. The survey included questions to capture the clinical and demographic characteristics of the sample. It also comprised two open-ended questions requiring qualitative responses. The first asked the participant to describe factors that made physical activity more difficult, and the second asked which factors made it easier for them to be physically active. Participants’ responses to the two open-ended questions were read, coded, and thematically analyzed independently by two researchers, with a third researcher available to arbitrate any unresolved disagreement.

Results

The mean (standard deviation) age of participants was 53 (15) years; n=113 (52.1%) were male. A total of 112 (51.6%) participants reported having three or more health conditions; n=140 (64.5%) were classified as overweight or obese. Five overarching themes describing perceived barriers for undertaking physical activity were “health conditions”, “time restrictions”, “poor physical condition”, “emotional, social, and psychological barriers”, and “access to exercise opportunities”. Perceived physical activity facilitators were also aligned under five themes, namely “improved health state”, “social, emotional, and behavioral supports”, “access to exercise environment”, “opportunities for physical activities”, and “time availability”.

Conclusion

It was clear from the breadth of the data that meaningful supports and interventions must be multidimensional. They should have the capacity to address a variety of physical, functional, social, psychological, motivational, environmental, lifestyle, and other perceived barriers. It would appear that for such interventions to be effective, they should be flexible enough to address a variety of specific concerns.

Associations of television viewing time with adults' well-being and vitality

OBJECTIVE

Television (TV) viewing, a common leisure-time sedentary behaviour, is associated adversely with cardio-metabolic health, fatigue, depression and mental health. However, associations of TV viewing time with health-related quality of life attributes are less well understood. We examined associations of TV viewing time with physical well-being, mental well-being and vitality in a large population-based sample of Australian adults.

METHOD

The study sample comprised 4,483 men and 5,424 women (mean age 51±14years) from the Australian Diabetes, Obesity and Lifestyle study (1999-2000). Multiple linear regressions examined associations of TV viewing time (h/day) with the SF-36v1 physical and mental health component summary scores and the vitality sub-score, adjusting for leisure-time physical activity and waist circumference.

RESULTS

Each 1-h/day increment in TV viewing time was associated with lower physical (-0.56 [95% CI: -0.77, -0.34]) and mental (-0.41 [-0.70, -0.12]) component summary scores and vitality (-0.51 [-0.81, -0.21]). Associations remained significant after adjustment for leisure-time physical activity and waist circumference. There was a gender interaction for the association of TV viewing time with vitality (significant in men only).

CONCLUSIONS

TV viewing time is associated adversely with physical well-being, mental well-being and vitality. Further studies are required to better understand potential causal relationships and variations by gender and leisure-time physical activity.

Physical activity and health-related quality of life: US adults with and without limitations

PURPOSE

The purpose of this study was to examine the dose-response relationship between physical activity (PA) and health-related quality of life (HRQOL) among adults with and without limitations.

METHODS

We dichotomized HRQOL as ≥14 unhealthy (physical or mental) days (past 30 days), or <14 unhealthy days. By using a moderate-intensity minute equivalent, PA categories were as follows: inactive, 10-60, 61-149, 150-300, and >300 min/week. Persons with limitations reported having problems that limited their activities or required use of special equipment. Age-adjusted prevalence estimates and logistic regression analyses were performed with 2009 Behavioral Risk Factor Surveillance System data (n = 357,665), controlling for demographics, BMI, smoking, and heavy alcohol use.

RESULTS

For adults without limitations, the odds of ≥14 unhealthy days were lower among adults obtaining any PA (10-60 min/week, AOR = 0.79, 95 % CI 0.70, 0.88), compared with those inactive. A quadratic trend (P < 0.001) indicated enhanced HRQOL with each PA level, but improvements were less marked between lower and upper sufficient PA categories (150-300 and >300 min/week). Because of a significant age interaction, persons with limitations were stratified by age (18-34, 35-64, and 65+ years). Findings for persons aged 35 years or older with limitations were similar to those without limitations. Lower odds of poor HRQOL for persons aged 18-34 years with limitations were associated with recommended levels of PA (150-300 min/week; AOR = 0.61, 95 % CI 0.43, 0.88 and >300 min/week; AOR = 0.58, 95 % CI 0.43, 0.80).

CONCLUSIONS

PA is positively associated with HRQOL among persons with and without limitations.

Differences in health-related quality of life between three clusters of physical activity, sitting time, depression, anxiety, and stress

BACKGROUND

Physical inactivity, sitting behaviour, and mental health problems are detrimental to health-related quality of life but typically are considered as independent determinants. This study tested how these factors clustered together as profiles of subgroups of people and whether the clusters differed as a function of physical and mental health-related quality of life.

METHODS

In 2012, Australian adults (N =1,014) self-reported their physical and mental health-related quality of life, physical activity, sitting time, depression, anxiety, and stress using a web-based survey. Cluster analysis was used to identify subgroups of health behaviour and mental health profiles, and ANOVA was used to test for between-cluster differences in health-related quality of life.

RESULTS

Three subgroups were identified: people with higher psychological stress (n =13%), people with higher amounts of sitting time (n =45%), and people with lower amounts of sitting time (n =42%). There were no differences in mental health-related quality of life between subgroups; however people represented by the subgroup of higher amounts of sitting time had significantly lower physical health-related quality of life than the other two subgroups, F(2, 1011) =10.04, p < .01.

CONCLUSIONS

Interventions should consider that (1) physical activity, sitting time, and psychological distress are aspects of multifaceted behavioural-psychological profiles, and (2) reductions of sitting time may have major impacts for physical health-related quality of life.

The association of major patterns of physical activity, sedentary behavior and sleep with health-related quality of life: a cohort study

OBJECTIVE

To examine the prospective association of patterns of physical activity, sedentary behavior and sleep with health-related quality of life (HRQL) in the general population of Spain.

METHODS

A cohort study with 4271 individuals aged ≥ 18 years was recruited in 2008-2010 and followed-up prospectively through 2012. Activity patterns were derived from factor analysis. HRQL was assessed with the SF-12 questionnaire, and suboptimal HRQL was defined as a score below the sex-specific sample median.

RESULTS

Three main activity patterns were identified. A higher adherence to the pattern named "vigorous activity-seated at the computer" was inversely associated with a suboptimal score in the physical-composite summary (PCS) of the SF-12 (multivariate adjusted odds ratio [aOR] for the highest vs. the lowest quartile 0.71; 95% confidence interval [IC] 0.55-0.90; p-trend=0.003). The "light activity-seated for reading" pattern was inversely associated with a suboptimal score in the mental-composite summary (aOR=0.73; 95% CI=0.61-0.89; p-trend=0.002). However, a higher adherence to the "seated for watching TV-daytime sleeping" pattern was directly associated with suboptimal PCS (aOR=1.35; 95% CI=1.10-1.66; p-trend=0.008).

CONCLUSION

Patterns including any physical activity were associated with better physical or mental HRQL. However, a pattern defined by sedentary behavior with diurnal sleep showed worse HRQL and should be a priority target of preventive interventions.

Direct and indirect relationships between physical activity and happiness levels among older adults: a cross-sectional study

OBJECTIVES

The purposes of this study were to examine if physical activity (PA) is associated to happiness and to investigate if social functioning and health status mediate this association.

METHOD

Participants of this cross-sectional study were 323 men and women, age 60 or over, who were covered by the medical insurance of the French National Education System, France. They received by mail a self-report questionnaire that asked for information about general health, PA, and happiness.

RESULTS

In multinomial logistic regressions, the total volume of PA was associated to higher levels of happiness, but this association disappeared in the presence of social functioning. A structural equation modelling (SEM) showed an indirect association between PA and happiness, which was mediated by participants' health status and social functioning; in this SEM model, social functioning was the only variable directly associated to happiness.

CONCLUSION

Complex associations among PA, health status, and social functioning appear to determine happiness levels in older adults.

A life-course perspective on physical functioning in women

OBJECTIVE

To validate Kalache & Kickbusch's model: namely, that functional capacity peaks in early adulthood, then declines at a rate dependent on fitness level until a "disability threshold" is reached.

METHODS

Data came from the Australian Longitudinal Study on Women's Health, which followed three cohorts from 1996 to 2011: a young, a mid-aged and an older cohort (born in 1973-78, 1946-51 and 1921-26, respectively). The Short Form (36) Health Survey was used to measure physical functioning (score 1-100). The disability threshold was the mean physical functioning score in older women requiring assistance with daily activities (62.8). The relationship between age and physical functioning was modelled using spline regression for the entire sample, and by baseline physical functioning quintile and physical activity level.

FINDINGS

PHYSICAL DECLINE QUICKENED WITH AGE: 0.05 annual units (95% confidence interval, CI: -0.13 to 0.22) at ages 18-23 years (i.e. no decline); -2.43 (95% CI: -2.64 to -2.23) at ages 82-90 years. Decline was faster in quintiles with lower baseline physical functioning in the younger and mid-age cohorts and in quintiles with higher baseline physical functioning in the older cohort. The disability threshold was reached at a mean age of 79 years, but the range was 45-88 years, depending on baseline physical functioning and physical activity.

CONCLUSION

Age and physical decline are not linearly related, as traditionally believed; decline accelerates with age. However, baseline physical functioning, but not physical activity, influences the rate of decline.

[Health and social services used by the rural elderly]

OBJECTIVES

To describe the use of health and social services, and to analyze the influence of functional capacity for Instrumental Activities of Daily Living (IADL) and other factors in their use.

METHOD

Cross-sectional study in a non-institutionalized population older than 64 years old in a basic rural health area of Zaragoza.

DEPENDENT VARIABLES

use of different health and social services. Main independent variable: functional capacity for IADL according to the Lawton-Brody. Confounding variables: sociodemographic, physical exercise, comorbidity, self-perceived health, walking aids, social resources and economic resources (OARS-MAFQ). The relationship between the use of services and functional capacity for IADL was assessed using crude OR (ORC) and adjusted (adjusted OR) with CI95% by means of multivariate logistic regression models.

RESULTS

The use of social and health services increased with age and worse functional capacity for IADL. The increased use of health services was related with bad stage of health, limited social and economic resources, physical inactivity and female. The increased use of home help services was related with limited social resources, low education level and male. Regular physical activity and using walking aids were associated with greater participation in recreational activities.

CONCLUSIONS

The probability of using social and health services increased in older people with impaired functional capacity for IADL. The specific use of them changed according to differences in health, demographic and contextual features.

Age, physical inactivity, obesity, health conditions, and health-related quality of life among patients receiving conservative management for musculoskeletal disorders

Background

Musculoskeletal conditions and insufficient physical activity have substantial personal and economic costs among contemporary aging societies. This study examined the age distribution, comorbid health conditions, body mass index (BMI), self-reported physical activity levels, and health-related quality of life of patients accessing ambulatory hospital clinics for musculoskeletal disorders. The study also investigated whether comorbidity, BMI, and self-reported physical activity were associated with patients’ health-related quality of life after adjusting for age as a potential confounder.

Methods

A cross-sectional survey was undertaken in three ambulatory hospital clinics for musculoskeletal disorders. Participants (n=224) reported their reason for referral, age, comorbid health conditions, BMI, physical activity levels (Active Australia Survey), and health-related quality of life (EQ-5D). Descriptive statistics and linear modeling were used to examine the associations between age, comorbidity, BMI, intensity and duration of physical activity, and health-related quality of life.

Results

The majority of patients (n=115, 51.3%) reported two or more comorbidities. In addition to other musculoskeletal conditions, common comorbidities included depression (n=41, 18.3%), hypertension (n=40, 17.9%), and diabetes (n=39, 17.4%). Approximately one-half of participants (n=110, 49.1%) self-reported insufficient physical activity to meet minimum recommended guidelines and 150 (67.0%) were overweight (n=56, 23.2%), obese (n=64, 28.6%), severely obese (n=16, 7.1%), or very severely obese (n=14, 6.3%), with a higher proportion of older patients affected. A generalized linear model indicated that, after adjusting for age, self-reported physical activity was positively associated (z=4.22, P<0.001), and comorbidities were negatively associated (z=−2.67, P<0.01) with patients’ health-related quality of life.

Conclusion

Older patients were more frequently affected by undesirable clinical attributes of comorbidity, obesity, and physical inactivity. However, findings from this investigation are compelling for the care of patients of all ages. Potential integration of physical activity behavior change or other effective lifestyle interventions into models of care for patients with musculoskeletal disorders is worthy of further investigation.

Sedentary behavior and health outcomes among older adults: a systematic review

Background

In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age.

Methods

We searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study.

Results

We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions.

Conclusion

This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

Household physical activity and mortality in older adults: a national cohort study in Spain

OBJECTIVE

To examine the association between household physical activity (HPA) and all-cause mortality in a cohort of older adults from Spain, and the role of sedentary time on this association.

METHOD

Prospective cohort study of 2874 individuals aged ≥ 62 years. In 2003, the time spent in HPA and the time spent seated were self-reported. The association of HPA with all-cause mortality through 2011 was assessed with Cox regression.

RESULTS

During the follow-up, 970 participants died. In men, HPA was inversely associated with the risk of death only among those with longer sitting time (≥ 8 h/d): compared to those who did not do HPA, the mortality hazard ratio (HR) was 0.80 (95% confidence interval (CI): 0.60-1.08) and 0.43 (95% CI: 0.27-0.69) for those who spent >0 to 2h/d and >2h/d in HPA, respectively (P for trend<0.001). In women, sitting time did not modify the study association. Thus, compared to women who spent <2h/d in HPA, the HR for mortality was 0.72 (95% CI: 0.56-0.93) and 0.52 (95% CI: 0.39-0.70) for those who spent >2 to 4h/d, and >4h/d in HPA, respectively (P for trend<0.001).

CONCLUSION

In women, HPA is associated with reduced mortality regardless of sitting time. HPA may also contribute to longer survival among men with longer sitting time.

Physical activity, functional capacity, and step variability during walking in people with lower-limb amputation

Physical activity is important for general health. For an individual with amputation to sustain physical activity, certain functional capacity might be needed. Gait variability is related to the incidence of falls. This study explored the relationship between physical activity and a few common performance measures (six-minute walk test, step length variability, step width variability, and comfortable walking speed) in individuals with unilateral lower-limb amputation. Twenty individuals completed the study (age: 50±11yrs). Twelve of them had transtibial amputation, seven had transfemoral amputation, and one had through-knee amputation. Gait data was collected by the GaitRite instrumented walkway while participants performed a 3-min comfortable walking trial followed by a six-minute walk test. Physical activity was indicated by the mean of 7-day step counts via a pedometer. Gait variability was calculated by the coefficient of variation. Pearson correlation analysis was conducted between physical activity level and the 4 performance measures. Significance level was set at 0.05. Physical activity correlates strongly to comfortable walking speed (r=0.76), six-minute walk distance (r=0.67), and correlates fairly to step width variability (r=0.44). On the contrary, physical activity is inversely related to step length variability of the prosthetic leg (r=-0.46) and of the sound leg (r=-0.47). Having better functional capacity and lateral stability might enable an individual with lower-limb amputation to engage in a higher physical activity level, or vise versa. However, our conclusions are only preliminary as limited by the small sample size.

Continued sedentariness, change in sitting time, and mortality in older adults

PURPOSE

Prolonged sitting time (ST) is associated with higher mortality. However, previous studies used only a single measure of ST at baseline, so they could not directly assess the effect of continued exposure to high ST, or of changes in ST, on mortality. We prospectively assessed the association of continued sedentariness and of changes in ST for 2 yr with subsequent long-term all-cause mortality.

METHODS

This study was based on a prospective cohort of 2635 persons representative of the Spanish population 60 yr and older. ST was self-reported in 2001 and 2003. The median of ST was used as the cutoff to define excessive ST. Individuals were classified as consistently sedentary (> median in 2001 and 2003), newly sedentary (≤ median in 2001 and > median in 2003), formerly sedentary (> median in 2001 and ≤ median in 2003), and consistently nonsedentary (≤ median in 2001 and 2003). The association of ST in the period 2001-2003 with all-cause mortality from 2003 through 2011 was assessed with Cox regression and adjusted for the main confounders, including physical activity.

RESULTS

Among the study participants, 846 died between 2003 and 2011. Compared with persons who were consistently sedentary, the hazard ratios (95% confidence interval) for mortality were 0.91 (0.76-1.10) in those who were newly sedentary, 0.86 (0.70-1.05) in formerly sedentary individuals, and 0.75 (0.62-0.90) in those who remained consistently nonsedentary. The results were similar across strata defined according to obesity, morbidity, functional limitations, or meeting recommendations for physical activity.

CONCLUSION

Compared with older adults who were consistently sedentary during 2 yr, consistently nonsedentary individuals showed reduced all-cause mortality. Individuals who changed ST experienced an intermediate reduction in mortality.

The perspectives of older women with chronic neck pain on perceived effects of qigong and exercise therapy on aging: a qualitative interview study

Chronic pain is prevalent in elderly populations. The goals of this study were 1) to understand the results of a randomized clinical trial – Qigong and Exercise Therapy for Elderly Patients with Chronic Neck Pain (QIBANE) – that showed no difference between qigong, exercise therapy, and no-treatment on quality of life, and 2) to understand how elderly individuals with chronic pain experience interventions of qigong and exercise therapy. A qualitative interview study was conducted with 20 QIBANE participants. Interviews asked about motivation for and expectations of trial participation, experiences with the exercise classes (qigong or exercise therapy), and changes in pain experience. Interviews were transcribed, entered into the software program ATLAS.ti, and coded thematically by two coders. Content analysis was performed. All interviewees reflected positively on their QIBANE experience and described their participation in QIBANE as helpful. However, what was discussed in both groups when they talked about “positive experiences” in the study differed between the two groups. For example, themes that emerged in the exercise-therapy group related to difficulties associated with aging and staying physically active. In the interviews with qigong group members, emergent themes related to qigong as a method that improved bodily experiences and influenced daily activities. The effects that exercise therapy and qigong have on an elderly population cannot be captured by health-related quality-of-life measurements, such as the Short Form (36) Health Survey. Broader concepts of quality of life that include the concepts of self-efficacy and positive affect may be more appropriate. The results presented in this study suggest that for this population group, the approach of patient-centered outcomes is especially pertinent in order to design meaningful intervention studies in the elderly. This means that research questions, interventions, and outcome measurements need to take into account the special situation of elderly people.

Integrated medical care management and behavioral risk factor reduction for multicondition patients: behavioral outcomes of the TEAMcare trial

PURPOSE

The purpose of the study was to compare behavioral outcomes (physical activity, sedentary behavior, smoking cessation, diet) between the intervention and usual care conditions from the TEAMcare trial.

METHODS

TEAMcare was a randomized trial among 214 adults with depression and poorly controlled diabetes and/or coronary heart disease that promoted health behavior change and pharmacotherapy to improve health. Behavioral outcomes were measured with the International Physical Activity Questionnaire (physical activity, sitting time) and the Summary of Diabetes Self-Care Activities Measure (smoking, diet, exercise). Poisson regression models among completers (N=185) were conducted adjusting for age, education, smoking status and depression.

RESULTS

Intervention participants had more days/week following a healthy eating plan [relative rate=1.2, 95% confidence interval (CI)=1.1-1.4] and more days of participation in 30 min of physical activity (relative rate=1.2, 95% CI=1.1-2.0) compared to usual care. Intervention participants were more likely to meet physical activity guidelines (7.5% increase) compared to usual care (12% decrease; P=.053).

CONCLUSION

Diet and activity generally improved for those receiving the intervention, while there were no differences in some aspects of diet (fruit and vegetable and high-fat food intake), smoking status and sitting time between conditions in the TEAMcare trial.

Prevalence of sedentary behavior in older adults: a systematic review

Sedentary behavior is a cluster of behaviors adopted in a sitting or lying posture where little energy is being expended. Sedentary behavior is a risk factor for health independent to inactivity. Currently, there are no published systematic reviews on the prevalence of sedentary behavior objectively measured in, or subjectively reported by, older adults. The aim of this systematic review was to collect and analyze published literature relating to reported prevalence of sedentary behavior, written in English, on human adults, where subjects aged 60 years and over were represented in the study. 23 reports covered data from 18 surveys sourced from seven countries. It was noted that sedentary behavior is defined in different ways by each survey. The majority of surveys included used self-report as a measurement of sedentary behavior. Objective measurements were also captured with the use of body worn accelerometers. Whether measurements are subjective or objective, the majority of older adults are sedentary. Almost 60% of older adult’s reported sitting for more than 4 h per day, 65% sit in front of a screen for more than 3 h daily and over 55% report watching more than 2 h of TV. However, when measured objectively in a small survey, it was found that 67% of the older population were sedentary for more than 8.5 h daily.

The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis

BACKGROUND

the worldwide population is ageing. One expected consequence of this is an increase in morbidity and an associated increased demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects in residents of long-term care facilities.

OBJECTIVE

to examine the effects of physical rehabilitation on activities of daily living (ADL) in elderly residents of long-term care facilities.

METHODS

systematic review with meta-analysis of randomised controlled trials. We included studies that compared the effect of a physical rehabilitation intervention on independence in ADL with either no intervention or an alternative intervention in older people (over 60 years) living in long-term care facilities. We searched 19 databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, Web of Knowledge and Google Scholar. Two researchers independently screened papers and extracted data. Outcomes of included studies were combined in a standardised mean difference random-effects meta-analysis.

RESULTS

thirteen of 14 studies identified were included in the meta-analysis. Independence in ADL was improved by 0.24 standard units (95% CI: 0.11-0.38; P = 0.0005). This is equivalent to 1.3 points on the Barthel Index (0-20 scale). No significant differences in effect were found based on participant or intervention characteristics. Larger sample size and low attrition were associated with smaller estimates of effect. All studies were assessed to be at risk of bias.

CONCLUSIONS

physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.

Physical activity, psychological distress, and receipt of mental healthcare services among cancer survivors

PURPOSE

Physical activity confers multiple health benefits in the general population. This study examined the associations of physical activity with serious psychological distress (SPD) and receipt of mental healthcare services among U.S. adult cancer survivors.

METHODS

We analyzed data from 4,797 cancer survivors (aged ≥18 years) and 38,571 adults without cancer who participated in the 2009 Behavioral Risk Factor Surveillance System. SPD was assessed using the Kessler-6 questionnaire. Adjusted prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.

RESULTS

Overall, 6.6 % of cancer survivors (vs. 3.7 % of adults without cancer, P < 0.001) reported having SPD, and 14.0 % of cancer survivors (vs. 10.0 % of adults without cancer, P < 0.001) reported receiving mental healthcare services; the percentages decreased with increasing physical activity levels. After multivariate adjustment, compared to cancer survivors who were physically inactive, cancer survivors who engaged in physical activity >0 to <150 min/week and ≥150 min/week were 62 % and 61 % (P < 0.001 for both) less likely to report SPD, respectively; cancer survivors who engaged in physical activity ≥150 min/week were 33 % (P < 0.05) less likely to report receiving mental healthcare services. Additionally, the inverse association between physical activity and receiving mental healthcare services persisted among women with breast or reproductive cancers and among men and women with gastrointestinal cancers.

CONCLUSION

The inverse associations between physical activity and SPD or receiving mental healthcare services suggest that physical activity may play a role in improving mental health among cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Healthcare clinicians may consider routinely monitoring and assessing the psychological well-being of cancer survivors and educate them about the potential benefits of physical activity in improving their mental health.

Sedentary behavior, health-related quality of life, and fatigue among breast cancer survivors

BACKGROUND

Many cancer survivors experience declines in health-related quality of life (HRQOL) and increases in fatigue as a result of cancer and its treatment. Exercise is linked to improvements in these outcomes, but little is known about the role of sedentary behavior. In a large, ethnically-diverse cohort of breast cancer survivors, we examined the relationship between sedentary time, HRQOL, and fatigue, and examined if that relationship differed by recreational moderate-vigorous physical activity (MVPA) level.

METHODS

Participants were 710 women diagnosed with stage 0-IIIA breast cancer in the Health, Eating, Activity, and Lifestyle Study. Women completed questionnaires at approximately 30-months postdiagnosis (sedentary time; recreational MVPA) and 41-months postdiagnosis (HRQOL; fatigue). In multivariate models, we regressed these outcomes linearly on quartiles of daily sedentary time, and a variable jointly reflecting sedentary time quartiles and MVPA categories (0; >0 to <9; ≥9 MET-hrs/wk).

RESULTS

Sedentary time was not independently related to subscales or summary scores of HRQOL or fatigue. In addition, comparisons of women with high vs. low (Q4:Q1) sedentary time by MVPA level did not result in significant differences in HRQOL or fatigue.

CONCLUSION

In this breast cancer survivor cohort, self-reported sedentary time was not associated with HRQOL or fatigue, 3.5 years postdiagnosis.

Physical rehabilitation for older people in long-term care

BACKGROUND

The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long-term care residents. This is an update of a Cochrane review first published in 2009.

OBJECTIVES

To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long-term care through the review of randomised and cluster randomised controlled trials.

SEARCH METHODS

We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment.

SELECTION CRITERIA

Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting.

MAIN RESULTS

We included 67 trials, involving 6300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation.

AUTHORS' CONCLUSIONS

Physical rehabilitation for long-term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

Combined impact of traditional and non-traditional health behaviors on mortality: a national prospective cohort study in Spanish older adults

BACKGROUND

Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. In this study, we examined the combined impact of three traditional (smoking, physical activity and diet) and three non-traditional health behaviors (sleep duration, sedentary time and social interaction) on mortality among older adults.

METHODS

A cohort of 3,465 individuals, representative of the Spanish population aged ≥60 years, was established in 2000/2001 and followed-up prospectively through 2011. At baseline, the following positive behaviors were self-reported: never smoking or quitting tobacco >15 years, being very or moderately physically active, having a healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, spending <8 h/d in sitting time, and seeing friends daily. Analyses were performed with Cox regression and adjusted for the main confounders.

RESULTS

During an average nine-year follow-up, 1,244 persons died. Hazard ratios (95% confidence interval) for all-cause mortality among participants with two, three, four, five and six compared to those with zero to one positive behaviors were, respectively, 0.63 (0.46 to 0.85), 0.41 (0.31 to 0.55), 0.32 (0.24 to 0.42), 0.26 (0.20 to 0.35) and 0.20 (0.15 to 0.28) (P for trend <0.001). The results were similar regardless of age, sex and health status at baseline. Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger. Adding the three non-traditional to the four traditional behaviors improved the model fit (likelihood ratio test, P <0.001) and the accuracy of mortality prediction (c-statistic: + 0.0031, P = 0.040).

CONCLUSIONS

Adherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults.

Quality of life of seniors living in the community and in long term care facilities: a comparative study

OBJECTIVES: to compare the perceptions of quality of life (QOL) and to identify factors associated with QOL among seniors living in the community in Porto Alegre, RS and institutionalized seniors from the countryside of Minas Gerais, Brazil. METHOD: this study used secondary data from two cross-sectional epidemiological studies. The sample consisted of 288 seniors living in the community and 76 institutionalized seniors. An instrument addressing socio-demographic data and the WHOQOL-BREF were administered. RESULTS: bivariate analysis showed that age, gender, schooling, self-reported health, and leisure presented statistically significant differences between institutionalized and non-institutionalized seniors. The Psychological and Social Relationships domains also presented statistically significant differences. The variables that presented significant correlation in multivariate analysis in relation to the Psychological domain were education, assessments of health, leisure and in relation to the Social domain, education and age. CONCLUSION: being institutionalized did not influence the older adults' perceptions of QOL, but the socio-demographic characteristics and self-assessments of health did.

Physical activity and nutrition behavioural outcomes of a home-based intervention program for seniors: a randomized controlled trial

Background

This intervention aimed to ascertain whether a low-cost, accessible, physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth, Australia.

Methods

A 6-month home-based randomised controlled trial was conducted on 478 older adults (intervention, n = 248; control, n = 230) of low to medium socioeconomic status. Both intervention and control groups completed postal questionnaires at baseline and post-program, but only the intervention participants received project materials. A modified fat and fibre questionnaire measured nutritional behaviours, whereas physical activity was measured using the International Physical Activity Questionnaire. Generalised estimating equation models were used to assess the repeated outcomes over both time points.

Results

The final sample consisted of 176 intervention participants and 199 controls (response rate 78.5%) with complete data. After controlling for demographic and other confounding factors, the intervention group demonstrated increased participation in strength exercise (p < 0.001), walking (p = 0.029) and vigorous activity (p = 0.015), together with significant reduction in mean sitting time (p < 0.001) relative to controls. Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance (p < 0.001), fat intake (p = 0.021) and prevalence of frequent fruit intake (p = 0.008).

Conclusions

A minimal contact, low-cost and home-based physical activity program can positively influence seniors’ physical activity and nutrition behaviours.

Trial registration

anzctr.org.au Identifier: ACTRN12609000735257

Sedentary behavior and physical activity are independently related to functional fitness in older adults

The last decades of life have been traditionally viewed as a time of inevitable disease and frailty. Sedentary living and physical activity may influence capacity to perform activities that are needed to maintain physical independence in daily living. A total of 117 males and 195 females, aged 65-103years, were assessed for physical activity and sedentary time with accelerometers and for functional fitness with the Senior Fitness Test battery. Based on the individual scores for each fitness item, a Z-score was created. Associations between functional fitness with sedentary time and moderate-to-vigorous physical activity (MVPA) were analyzed. A negative association was found between the composite Z-score for functional fitness and the sedentary time, even adjusting for MVPA and other confounders. On the other hand, MVPA was positively associated with the composite Z-score for functional fitness, independently of the sedentary time. In conclusion elderly who spend more time in physical activity or less time in sedentary behaviors exhibit improved functional fitness and other confounders. The results reinforce the importance of promoting both the reduction of sedentary behaviors and the increase of MVPA in this age group, as it may interfere at older ages in order to preserve functional fitness and performance of daily functioning tasks.

Lifestyle and health-related quality of life: a cross-sectional study among civil servants in China

Background

Health-related quality of life (HRQoL) has been increasingly acknowledged as a valid and appropriate indicator of public health and chronic morbidity. However, limited research was conducted among Chinese civil servants owing to the different lifestyle. The aim of the study was to evaluate the HRQoL among Chinese civil servants and to identify factors might be associated with their HRQoL.

Methods

A cross-sectional study was conducted to investigate HRQoL of 15,000 civil servants in China using stratified random sampling methods. Independent-Samples t-Test, one-way ANOVA, and multiple stepwise regression were used to analyse the influencing factors and the HRQoL of the civil servants.

Results

A univariate analysis showed that there were significant differences among physical component summary (PCS), mental component summary (MCS), and TS between lifestyle factors, such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness (P < 0.05). Multiple stepwise regressions showed that there were significant differences among TS between lifestyle factors, such as breakfast, sleep time, physical exercise, operating computers, sedentariness, work time, and drinking (P < 0.05).

Conclusion

In this study, using Short Form 36 items (SF-36), we assessed the association of HRQoL with lifestyle factors, including smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness in China. The performance of the questionnaire in the large-scale survey is satisfactory and provides a large picture of the HRQoL status in Chinese civil servants. Our results indicate that lifestyle factors such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness affect the HRQoL of civil servants in China.