Associations of older adults' physical activity and bout-specific sedentary time with frailty status: Compositional analyses from the NEIGE study

Associations Between Physical Activity and Inactivity Levels on Physical Function and Sleep Parameters of Older Adults With Frailty Phenotype

This study investigated the relationship between physical activity, inactivity, physical function, and sleep in older adults with a frailty phenotype. A total of 184 pre-frail/frail older adults were included. Physical activity, inactive behavior, and sleep parameters were assessed using a wrist-worn accelerometer. Participants were categorized into four groups based on their levels of inactivity and physical activity. The results showed that individuals with lower levels of inactivity had better lower body mean velocity and sleep regularity than those with higher levels of inactivity. Physically active older adults exhibited faster gait speed and performed better in lower body strength tests than physically inactive participants. Further analysis revealed that specific combinations of inactivity and physical activity were associated with varying levels of physical function. The findings highlight the importance of physical activity and the negative impact of inactivity on physical function and sleep in older adults with a frailty phenotype.

Exploring the interplay of frailty, physical function, physical activity, nutritional status, and their association with quality of life and depressive symptoms in older adults with the frailty phenotype

OBJECTIVE

This study aimed to explore the interplay between frailty, physical function, physical activity, nutritional status, and their impact on the quality of life and depressive status in older adults with frailty.

METHODS

A cross-sectional study involving 235 pre-frail/frail older adults residing in Spanish communities was conducted. Frailty was assessed using Fried's criteria, physical function was evaluated using the Short Physical Performance Battery, and physical activity levels were measured via wrist-worn accelerometers. Nutritional status was determined using the Mini-Nutritional Assessment alongside anthropometric measurements. Quality of life was gauged using the EuroQoL 5-Dimension 5-Level, while depressive status was assessed using the Yesavage 15-item Geriatric Depression Scale. Multivariate linear regression and logistic regression analyses were employed to elucidate the associations of these factors with quality of life and depression.

RESULTS

Our findings revealed significant correlations between various factors and quality of life. Notably, reported fatigue (β = -0.276, p = 0.002), performance in the 4-m gait test (β = -0.242, p = 0.001), the score on the short version of the Mini-Nutritional Assessment (β = 0.312, p = 0.002), and engagement in light physical activity (β = 0.180, p = 0.023) were all found to be associated with quality of life. In terms of depressive symptoms, the Mini-Nutritional Assessment score emerged as a protective factor (Odds ratio, OR: 0.812, p < 0.001), as did participation in moderate physical activity (OR: 0.988, p = 0.028). Conversely, fatigue (OR: 3.277, p = 0.003) and a slow gait speed (OR: 1.136, p = 0.045) were identified as risk factors for depressive symptoms.

CONCLUSIONS

This study underscores the detrimental association of fatigue and slow gait speed on both quality of life and depressive status among older adults with frailty. In contrast, engaging in physical activity and addressing malnutrition risk emerge as critical protective factors for enhancing quality of life and ameliorating depressive symptoms in this population.

CLINICAL TRIAL REGISTRATION

This is a study that uses cross-sectional data from a trial registered at ClinicalTrials.gov (Identifier: NCT05610605).

Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study

BACKGROUND

Given the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults.

METHODS

Data from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes.

RESULTS

Among the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time.

CONCLUSIONS

Regardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.

Use of a wearable accelerometer to evaluate physical frailty in people receiving haemodialysis

BACKGROUND

Physical frailty is a major health concern among people receiving haemodialysis (HD) for stage-5 chronic kidney disease (CKD-5). Wearable accelerometers are increasingly being recommended to objectively monitor activity levels in CKD-5 and recent research suggests they may also represent an innovative strategy to evaluate physical frailty in vulnerable populations. However, no study has yet explored whether wearable accelerometers may be utilised to assess frailty in the context of CKD-5-HD. Therefore, we aimed to examine the diagnostic performance of a research-grade wearable accelerometer in evaluating physical frailty in people receiving HD.

METHODS

Fifty-nine people receiving maintenance HD [age = 62.3 years (SD = 14.9), 40.7% female] participated in this cross-sectional study. Participants wore a uniaxial accelerometer (ActivPAL) for seven consecutive days and the following measures were recorded: total number of daily steps and sit-to-stand transitions, number of daily steps walked with cadence < 60 steps/min, 60-79 steps/min, 80-99 steps/min, 100-119 steps/min, and ≥ 120 steps/min. The Fried phenotype was used to evaluate physical frailty. Receiver operating characteristics (ROC) analyses were performed to examine the diagnostic accuracy of the accelerometer-derived measures in detecting physical frailty status.

RESULTS

Participants classified as frail (n = 22, 37.3%) had a lower number of daily steps (2363 ± 1525 vs 3585 ± 1765, p = 0.009), daily sit-to-stand transitions (31.8 ± 10.3 vs 40.6 ± 12.1, p = 0.006), and lower number of steps walked with cadence of 100-119 steps/min (336 ± 486 vs 983 ± 797, p < 0.001) compared to their non-frail counterparts. In ROC analysis, the number of daily steps walked with cadence ≥ 100 steps/min exhibited the highest diagnostic performance (AUC = 0.80, 95% CI: 0.68-0.92, p < 0.001, cut-off ≤ 288 steps, sensitivity = 73%, specificity = 76%, PPV = 0.64, NPV = 0.82, accuracy = 75%) in detecting physical frailty.

CONCLUSIONS

This study provided initial evidence that a wearable accelerometer may be a useful tool in evaluating physical frailty in people receiving HD. While the total number of daily steps and sit-to-stand transitions could significantly discriminate frailty status, the number of daily steps walked with cadences reflecting moderate to vigorous intensity of walking may be more useful in monitoring physical frailty in people receiving HD.

The association of subjective vision with objectively measured intensity-specific physical activity and bout-specific sedentary behavior among community-dwelling older adults in Japan

PURPOSE

Visual impairment is a possible cause of physical frailty. Reduced physical activity (PA) may be involved in the pathway from visual impairment to physical frailty, although the association between vision and objectively measured PA among older adults remains unclear. This study examined the sex-specific association of subjective vision with intensity-specific PA and bout-specific sedentary behavior (SB) among community-dwelling, older Japanese adults.

STUDY DESIGN

Cross-sectional study METHODS: This study used data from the Neuron to Environmental Impact across Generations study analyzing older adults (527 participants, aged 65-84 years) living in rural areas of Niigata Prefecture, Japan. Subjective vision was assessed by use of a questionnaire. Intensity-specific PA (light-intensity PA and moderate-to-vigorous PA [MVPA]), bout-specific SB, and daily step count were objectively evaluated by use of an accelerometer. The association of subjective vison with PA and SB, stratified by sex, was analyzed by means of general regression analyses, with adjustment for covariates.

RESULTS

The data of 512 participants (men: 46.9%; with poor subjective vision: 22.9%) were analyzed. Poor subjective vision was significantly associated with log MVPA (partial regression coefficient = -0.261, P = .013) and log steps (partial regression coefficient = -0.164; P = .021) among women, whereas a tendency of an association was observed with prolonged SB time among men (partial regression coefficient: 39.1; P = .073).

CONCLUSION

Older Japanese women with poor subjective vision performed less MVPA and had fewer step counts than those of participants with good subjective vision, and men with poor subjective vision had longer prolonged SB, which may all accelerate the process to physical frailty.

Risk and Protective Factors for Frailty in Pre-Frail and Frail Older Adults

This study aims to evaluate the differences in body composition, physical function, and physical activity between pre-frail/frail older adults and to detect risk and protective factors against frailty and physical frailty. Fried's criteria for frailty and physical frailty using the short-performance physical battery (SPPB) were measured in 179 older participants (75.3 ± 6.4 years old). Body weight, height, and waist, arm, and leg circumferences were obtained as body composition variables. Daily accelerometer outcomes (physical activity and inactivity) were obtained. Pre-frail participants showed overall better physical function and spent more time in physical activity and less time in long inactivity periods than frail participants (p < 0.05). Risk frailty factors were higher waist perimeter (Odds Ratio [OR]: 1.032, 95%CI: 1.003-1.062), low leg performance (OR: 1.025, 95%CI: 1.008-1.043), and inactivity periods longer than 30 min (OR:1.002, 95%CI: 1.000-1.005). Protective factors were standing balance (OR:0.908, 95%CI: 0.831-0.992) and SPPB score (OR: 0.908, 95%CI: 0.831-0.992) for frailty, handgrip strength (OR: 0.902, 95%CI: 0.844-0.964) for physical frailty, and light (OR: 0.986, 95%CI: 0.976-0.996) and moderate-to-vigorous (OR: 0.983, 95%CI: 0.972-0.996) physical activity for both. Our findings suggest that handgrip strength, balance, and physical activity are protective frailty factors and can be monitored in pre-frail older adults. Moreover, poor lower body performance and long inactivity periods are frailty risk factors, which highlights their importance in frailty assessment.

Efficacy of a multicomponent exercise training program intervention in community-dwelling older adults during the COVID-19 pandemic: A cluster randomized controlled trial

The coronavirus disease 2019 (COVID-19) pandemic caused changes in lifestyle for older adults such as reduced physical activity and community participation. Community activity centers were randomly assigned to the intervention (n = 82) or control arm (n = 85). The intervention comprised one 60 min group exercise session per week in weeks 1-8 and an online home exercise program in weeks 9-16. Physical activity, physical performance, and prefrailty rates were assessed at baseline and 16 weeks. At 16 weeks, compared to the control arm, the intervention arm exhibited improved (p < 0.05) leisure-time physical activity (phi = 0.571), vigorous physical activity (phi = 0.534), and moderate-vigorous physical activity (phi = 0.344); prefrailty rates (phi = 0.179); and short physical performance battery results (η²_p = 0.113). The intervention thus effectively improved physical activity levels, physical performance, and prefrailty rates in community-dwelling older adults during the COVID-19 pandemic.

How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review

BACKGROUND

Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world's population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide.

AIM

The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults.

METHOD

Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS).

RESULTS

Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty.

CONCLUSIONS

Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

Examining the links between regular leisure-time physical activity, sitting time and prefrailty in community-dwelling older adults

AIMS

To examine the relationship between leisure-time physical activity, sitting time and prefrailty in community-dwelling older adults.

DESIGN

Cross-sectional study.

METHODS

Between February and July 2019, 539 individuals over age 60 were recruited in northern Taiwan. Demographic, medical history, physical activity and frailty data were analysed using descriptive statistics, chi-square tests and logistic regression.

RESULTS

The prevalence of prefrailty was 24.4%; 33.2% had regular leisure-time physical activity, and 14.7% reported >6 hrs daily sitting time. Compared with individuals having regular leisure-time physical activity and shorter sitting times (daily average ≤6 hrs), those having no regular leisure-time physical activity and also shorter sitting times (adjusted OR, 1.80; 95% CI, 1.12, 2.92), or those also having regular leisure-time physical activity but longer sitting times (adjusted OR, 4.42; 95% CI, 2.22, 8.79) had an increased prefrailty risk.

CONCLUSIONS

Having no regular leisure-time physical activity or longer sitting times is associated with a higher risk of prefrailty. For sedentary older adults to prevent prefrailty, they can become more active, sit less or better yet, commit to both.