Physical activity and long-term mortality risk in older adults: A prospective population based study (NEDICES)

Long-term exercise training and inflammatory biomarkers in healthy subjects: a meta-analysis of randomized controlled trials

Objective

This meta-analysis investigated the effect of long-term exercise training (ET) including aerobic, resistance, and multicomponent ET on the levels of inflammatory biomarkers in randomized controlled trials (RCTs) involving healthy subjects.

Methods

We searched seven databases for articles until May 1st, 2023. A random-effect meta-analysis, subgroup analysis, meta-regressions as well as trim and fill method were conducted using STATA 16.0.

Result

Thirty-eight studies were included in the meta-analysis, involving 2,557 healthy subjects (mean age varies from 21 to 86 years). Long-term ET induced significantly decreased in the levels of interleukin-6 (IL-6) (SMD -0.16, 95% CI -0.30 to -0.03, p = 0.017), C-reactive protein (CRP) (SMD -0.18, 95% CI -0.31 to -0.06, p = 0.005), as well as tumor necrosis factor alpha (TNFα) (SMD -0.43, 95% CI -0.62 to -0.24, p < 0.001). Subgroup analysis revealed that Long-term ET conducted for more than 12 weeks and exercise of moderate intensity had greater anti-inflammatory effects. Meta-regression analysis showed that the reduction in CRP level induced by long-term ET was weakened by increasing exercise intensity.

Conclusion

Long-term ET induced significant anti-inflammatory effects in healthy subjects. Long-term ET-induced anti-inflammatory effects were associated with exercise of moderate intensity and training conducted for more than 12 weeks.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/# myprospero, PROSPERO, identifier CRD42022346693.

Effects of physical exercise on biomarkers of oxidative stress in healthy subjects: A meta-analysis of randomized controlled trials

This meta-analysis investigated the effect of physical exercise (PE) on the levels of oxidative biomarkers in randomized controlled trials (RCTs) involving healthy subjects. We searched five databases for articles until May 1, 2023. A random-effect meta-analysis, subgroup analysis, meta-regressions as well as trim and fill method were conducted using STATA 11.0, involving ten articles. According to the results of the meta-analysis, PE had no significant effect on superoxide dismutase (SOD), glutathione peroxidase, and catalase levels. PE induced significant increase in total antioxidant status (standardized mean difference [SMD] 1.53, 95% CI 0.73-2.32), and PE could significantly reduce the level of malondialdehyde (MDA) (SMD -1.11, 95% CI -2.15 to -0.06). Sensitivity analyses and subgroup analyses showed that male participants, body mass index (BMI) <25, exercise duration between 1 and 12 weeks, resistance exercise or multicomponent exercise, and exercise of low or moderate intensity were associated with a significant PE-induced decrease in MDA concentrations. Meta-regression analysis identified the age of the participants as a confounder of the effect of PE on SOD levels. The older age of the subjects was associated in a gradient fashion with incident SOD levels. Further RCTs are required to investigate the optimal PE protocol for people of different ages and BMI as well as the effect of PE on oxidative stress.

Association between physical activity and risk of renal function decline and mortality in community-dwelling older adults: a nationwide population-based cohort study

BACKGROUND

Physical activity (PA) is an important risk factor associated with health outcomes. However, the relationship between PA and kidney function decline in older adults remains unclear. We examined the influence of PA on kidney function decline and mortality in community-dwelling older adults.

METHODS

Adults aged ≥ 65 years with an estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m² who had available health checkup data from 2009 to 2010 were included. The cohort was followed annually through December 2015 for anthropometric, sociodemographic, and medical information including outcomes and biennially for laboratory information from the health checkup. We divided these patients into three groups according to self-reported PA (Inactive group: no leisure-time PA, Active group: vigorous activity for at least 80 min/week or a sum of moderate-intensity activity and walking for at least 300 min/week, Low-active group: level of PA between the definitions of the other two groups). Associations between the intensity of PA and death, cardiovascular death, and ≥ 50% eGFR decline were investigated.

RESULTS

Among 102,353 subjects, 32,984 (32.23%), 54,267 (53.02%), and 15,102 (14.75%) were classified into the inactive, low-active, and active groups, respectively. The active group was younger, contained a higher proportion of men, and had higher frequencies of hypertension, diabetes mellitus, drinking, and smoking than the other groups. The active group had significantly lower incidence rates of mortality, cardiovascular mortality, and kidney function decline than the other groups (all p < 0.001). The active group also showed lower all-cause (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.70-0.82) and cardiovascular mortality (HR, 0.64; 95% CI, 0.53-0.78) and protection against ≥ 50% eGFR decline (HR, 0.81; 95% CI, 0.68-0.97) compared with the inactive group in the fully adjusted Cox proportional hazards regression model.

CONCLUSIONS

High PA was an independent modifiable lifestyle factor for reducing mortality and protecting against declines in kidney function in older adults.

The health status: the ignored risk factor in dementia incidence. NEDICES cohort

BACKGROUND

The causes of the dementia decrease in affluent countries are not well known but health amelioration could probably play a major role. Nevertheless, although many vascular and systemic disorders in adult life are well-known risk factors (RF) for dementia and Alzheimer disease (AD), health status is rarely considered as a single RF.

AIM

To analyse whether the health status and the self-perceived health (SPH) could be RF for dementia and AD and to discuss its biological basis.

METHODS

We analysed different objective health measures and SPH as RF for dementia and AD incidence in 4569 participants of the NEDICES cohort by means of Cox-regression models. The mean follow-up period was 3.2 (range: 0.03-6.6) years.

RESULTS

Ageing, low education, history of stroke, and "poor" SPH were the main RF for dementia and AD incidence, whereas physical activity was protective. "Poor" SPH had a hazard ratio = 1.66 (95% CI 1.17-2.46; p = 0.012) after controlling for different confounders.

DISCUSSION

According to data from NEDICES cohort, SPH is a better predictor of dementia and AD than other more objective health status proxies. SPH should be considered a holistic and biologically rooted indicator of health status, which can predict future development of dementia and AD in older adults.

CONCLUSIONS

Our data indicate that it is worthwhile to include the SPH status as a RF in the studies of dementia and AD incidence and to explore the effect of its improvement in the evolution of this incidence.

Aerobic Exercise Attenuates Frailty in Aging Male and Female C57Bl/6 Mice and Effects Systemic Cytokines Differentially by Sex

Aerobic exercise is a promising intervention to attenuate frailty, but preclinical studies have used only male animals. We investigated the impact of voluntary aerobic exercise on frailty, biological age (FRailty Inferred Geriatric Health Timeline [FRIGHT] clock), predicted life expectancy (Analysis of FRAIlty and Death [AFRAID] clock), and mortality in both sexes and determined whether exercise was associated with changes in inflammation. Older (21-23 months) male (n = 12) and female (n = 22) C57Bl/6 mice matched for baseline frailty scores were randomized into exercise (running wheel) and sedentary (no wheel) groups. Frailty index scores were measured biweekly (13 weeks), and 23 serum cytokines were measured at midpoint and end point. Exercise levels varied between mice but not between the sexes. Exercise had no effect on mortality, but it attenuated the development of frailty in both sexes (female = 0.32 ± 0.04 vs 0.21 ± 0.01; p = .005; male = 0.30 ± 0.02 vs 0.22 ± 0.02; p = .042) and reduced frailty in older females after 10 weeks. FRIGHT scores were unaffected by exercise but increased with time in sedentary males indicating increased biological age. Exercise prevented the age-associated decline in AFRAID scores in older females such that exercised females had a longer life expectancy. We investigated whether aerobic exercise was associated with changes in systemic inflammation. Cytokine levels were not affected by exercise in males, but levels of pro-inflammatory cytokines were positively correlated with the frequency of exercise in females. Despite increases in systemic inflammation, exercise reduced frailty and increased life span in older females. Thus, voluntary aerobic exercise, even late in life, has beneficial effects on health in both sexes but may be especially helpful in older females.

Smart technology vs. face-to-face physical activity interventions in older adults: a systematic review protocol

OBJECTIVE

The objective of this review is to determine the effect of physical activity interventions delivered via smart technology compared with face-to-face interventions for improving physical activity and physical function in older adults.

INTRODUCTION

Physical activity is a modifiable risk factor for multiple noncommunicable diseases and reduces the risk of premature mortality. Despite this, one in four adults does not meet recommended levels of physical activity. This pattern of inactivity increases with age. Smart technology, such as wearables, tablets, or laptops, is one solution for improving physical activity. Research has shown that different smart technology solutions can increase physical activity in older adults. While individual studies support smart technology to increase physical activity, there are no systematic reviews comparing the effects of smart technology with traditional face-to-face physical activity interventions.

INCLUSION CRITERIA

We will include randomized controlled trials of physical activity interventions delivered via smart technology (eg, wearables, tablets, computers) compared with face-to-face (ie, in person) interventions for community-dwelling older adults aged 60 years or older.

METHODS

We will search four databases (AMED, CINAHL, Embase, MEDLINE) from inception for relevant studies. All abstracts and full texts will be screened independently and in duplicate. Risk of bias, data extraction, and quality assessment will be completed in the same manner. If possible, a meta-analysis will be performed of the primary outcomes of physical activity, physical function, and adherence rate. Subgroup analyses will be conducted by type of physical activity, and type of smart technology, where possible.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020135232.

Physical activity and risk of Parkinson's disease and parkinsonism in a prospective population-based study (NEDICES)

To investigate whether physical activity (PA) is a protective factor for the incidence of Parkinson's disease (PD) and parkinsonism after three years of follow-up. All participants of this study were obtained from the Neurological Disorders in Central Spain (NEDICES), a prospective population-based cohort survey of older subjects (≥65 years) that comprised 5278 census-based participants at baseline (1994-1995). A modified version of Rosow-Breslau questionnaire was applied to categorize PA into active versus sedentary group. The final diagnosis of PD and parkinsonism was made by an expert neurologist. Cox regression models (CRM) adjusted for several covariates (sex, age, education, alcohol consumption, tobacco, stroke, hypertension and body mass index) were used to calculate the association between PA (active group vs. sedentary) and risk of PD and parkinsonism after three years. 22 incident PD and 25 incident parkinsonism cases were identified among 2943 participants with available PA information (57.1% female; mean age = 73.28 ± 6.24 years) after three years of follow-up. The CRM showed that the active group (vs. sedentary) showed a lower risk of parkinsonism (Hazard ratio (HR) = 0.18; 95% CI [0.07-0.51]; p = 0.0001). However, this effect was restricted to men (HR = 0.34; 95% CI [0.11-0.99], p < 0.05) for incident PD. PA may be a protective factor for incident parkinsonism, whereas this effect was only significant for men in the case of PD. The mechanisms implicated for brain maintenance in active individuals and the neurophysiological differences behind the role of sex on PD are discussed.

Demographics and stress as risk factors associated with mortality in older adults who provide daily support and who receive daily support

ABSTRACT Objective: Despite the greater vulnerability of care providers, the literature shows that their mortality rate is considerably lower compared to care recipients. The aim of the present study was to analyze the mortality rates of community-dwelling older adults who provided support in activities of daily living (ADL) (group PC) and older adults who received in activities of daily living (group RC) in a four-year period considering the effects of age, sex and schooling in both groups and stress in in group PC. Methods: 261 older adults PC and 279 older adults RC participated in the study. In 2014, we collected data on demographic characteristics and functioning. In 2018, the participants were contacted a second time and information on deaths was obtained. The mortality rate was calculated for each group. Results: Death cases in four years were considerably higher among the group who were receiving support. The mortality rate was 12.6% in the PC group and 31.2% in the RC group. In deceased PC, 69% presented with high-perceived stress in baseline. About half of the PC were independent, whereas the RC group exhibited some functional dependence in 2014. There was no association between risk factors in the group PC, however the female sex was marginally associated with the risk of mortality among the RC (HR: 1.7 [95% CI: 0.9-3.0]). Conclusion: Some demographic characteristics have been considered risk factors for the mortality of the old age population, however these were not confirmed in this study among the older adults who provided and received care.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

Exercise-induced immune system response: Anti-inflammatory status on peripheral and central organs

A wide array of molecular pathways has been investigated during the past decade in order to understand the mechanisms by which the practice of physical exercise promotes neuroprotection and reduces the risk of developing communicable and non-communicable chronic diseases. While a single session of physical exercise may represent a challenge for cell homeostasis, repeated physical exercise sessions will improve immunosurveillance and immunocompetence. Additionally, immune cells from the central nervous system will acquire an anti-inflammatory phenotype, protecting central functions from age-induced cognitive decline. This review highlights the exercise-induced anti-inflammatory effect on the prevention or treatment of common chronic clinical and experimental settings. It also suggests the use of pterins in biological fluids as sensitive biomarkers to follow the anti-inflammatory effect of physical exercise.

Cross-cultural Adaptation and Psychometric Properties of the Arabic Version of the Rapid Assessment of Physical Activity

Objectives

The purpose of the study was to cross-culturally adapt the Rapid Assessment of Physical Activity (RAPA) for Arabic speaking people and examine the test-retest reliability and the construct validity in Saudi older adults.

Methods

Test-retest reliability was assessed over two testing visits occurring one week apart. The construct validity was examined between RAPA and Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) tests.

Results

The original RAPA was translated into Arabic following standardized guidelines. For the test-retest reliability, the weighted kappa was 0.87 (95% confidence interval: 0.76–0.98), which indicates good reliability. There was a significant correlation between the Arabic version of RAPA and the SPPB (Spearman’s correlation coefficients (r) = 0.536, p < 0.001), and the TUG test (r = -0.435, p < 0.010).

Conclusions

The Arabic version of the RAPA questionnaire adapted for Saudi older adults provides an easy, valid, and reliable way to measure physical activity.

Temporal trends in the healthy soldier effect in a cohort of Royal Norwegian Navy servicemen followed for 67 years

OBJECTIVES

To investigate temporal trends in the 'healthy soldier effect' (HSE) among 28 300 Royal Norwegian Navy servicemen who served during 1950-2004.

METHODS

Standardised mortality ratios (SMRs) for all causes, diseases and external causes were calculated from national rates for the entire study period (1951-2017), and for seven successive follow-up periods after the first recorded day of Naval service, for the overall cohort and for two subgroups: land-based personnel and vessel crews. Poisson regression, expressed as rate ratios, was used to compare all-cause mortality between the subgroups.

RESULTS

In the overall cohort, SMRs for all-cause mortality increased steadily during the first six 10-year follow-up periods, from 0.52 to 0.94, which was still lower than national rates. After 60 years, the lower mortality compared with national rates was no longer statistically significant (SMR=0.93). Low non-neoplastic disease mortality contributed most to the longevity of the HSE. For neoplastic diseases, there was a mortality deficit only for the first and third 10-year follow-up periods. External-cause mortality rose to national rates after 40 years. An HSE was present among vessel crews, but their total mortality rate was 24% higher than that among land-based personnel, who also showed a longer-lasting HSE.

CONCLUSIONS

The HSE eroded gradually over time but was still present at 60 years of follow-up for all-cause mortality. The effect was strongest and most long-lived for non-neoplastic disease, lasted up to 40 years for external causes, and was relatively short for cancers. Land-based personnel showed stronger and longer-lasting HSE than vessel crews.

Effects of Physical Exercises and Verbal Stimulation on the Functional Efficiency and Use of Free Time in an Older Population under Institutional Care: A Randomized Controlled Trial

Older people in institutional care are, for the most part, physically inactive and do not interact with each other or medical staff. Therefore, reducing sedentary behaviour is a new, important, and modifiable lifestyle variable that can improve the health of elderly people. The aim of the project was to assess the degree of improvement in functional performance and the possibility of changing habitual, free time behaviour among elderly people under institutional care by applying physical training with verbal stimulation. The study covered older people, aged 65–85 years, who are living a sedentary lifestyle in care homes in Southeastern Poland. Those who met the eligibility criteria were enrolled in the study and were assigned, at random, to one of four parallel groups: basic exercises (n = 51), basic exercises combined with verbal stimulation (n = 51), functional exercise training (n = 51), and functional exercise training with verbal stimulation (n = 51). No statistically significant differences in baseline characteristics were observed across the groups. Data were collected at baseline and at 12 and 24-weeks following the completion of the intervention. In the group with functional exercise training with verbal stimulation, in comparison to the group with basic exercises, the greatest positive short-term impact of intervention was demonstrated in terms of functional fitness (increased by 1.31 points; 95% confidence interval (CI) = 0.93–1.70), gait speed (improved by 0.17 m/s, 95% CI = 0.13–0.22), hand grip strength (by over 4 kg; 95% CI = 2.51–4.95), and upper-limb flexibility (by 10 cm; 95% CI = 5.82–12.65). There was also a significant increase in the level of free-time physical activity and an improvement in the quality of life, especially as expressed in the domain of overall physical functioning. Our study showed that a functional exercise program, combined with verbal stimulation, is effective at improving physical fitness and raising the level of free-time physical activity.

Mobility Difficulties, Physical Activity, and All-cause Mortality Risk in a Nationally representative Sample of Older Adults

Background

This study sought to determine the association between levels of physical activity and mobility difficulties and time to death while accounting for the effect of several confounders. We also examined the possible interaction between them and how various daily-life mobility difficulties could predict all-cause mortality.

Methods

A nationally representative sample of 2,074 noninstitutionalized adults aged 60 years and older was analyzed. Vital status over a 3-year follow-up period was ascertained through national registers or by asking participants' relatives. Kaplan-Meier survival curves were stratified by levels of physical activity and mobility difficulties. Unadjusted and adjusted Cox proportional hazards regression models (by age, gender, marital status, years of education, multimorbidity, tobacco and alcohol consumption, depression, and memory function) were calculated, and interactions between the predictors and the covariates were explored.

Results

There was a dose-gradient effect of physical activity on time to death, with high levels associated with a 51% lower risk of dying, compared with moderate physical activity. Each unit increase in mobility functioning was associated with a 2% drop in mortality. Difficulties in standing for long periods, getting where one wants to go or extending arms to reach objects, were also found to be strong predictors of all-cause mortality.

Conclusions

Our results confirm the importance of older adults practicing moderate-to-vigorous physical activity. The assessment of self-reported difficulties in daily-life mobility activities, such as standing for long periods or not being able to move around, could be used in health settings as a screening for mortality risk.

Effect of the Auricular Acupoint Associated with Physical Exercise in Elderly People: A Randomized Clinical Test

OBJECTIVE

To analyze the effect of auricular acupoint associated with physical exercise on balance, mobility, and fear of falling in the elderly.

METHOD

The study is characterized as a clinical, controlled, and randomized trial with 22 elderly people divided into two groups: kinesiotherapy group (n = 11) and kinesiotherapy/auriculotherapy group (n = 11). The instruments used for evaluation were Falls Efficacy Scale International; Berg Balance Scale, and Timed up and Go Test. The intervention was performed with frequency 2×/week for 8 weeks. In the kinesiotherapy/auriculotherapy group, in addition to kinesiotherapy, auriculotherapy was applied in specific acupoints. The Shapiro-Wilk test was used to determine the normality of the data, and for comparison, analysis of variance was used for repeated measures of two factors.

RESULTS

There was a significant intragroup reduction for the Timed up and Go Test (p = 0.00) and Falls Efficacy Scale International (p = 0.00), and significant intragroup Berg Balance Scale (p = 0.00) for both groups.

CONCLUSION

The auricular acupoint did not influence the balance, mobility, and fear of falling in the elderly studied.

Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults

Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone health. This review explores current evidence for the benefits of PA, and targeted exercise regimes for the prevention and treatment of osteoporosis in older adults. In particular, the outcomes of interventions involving resistance training, low- and high-impact weight bearing activities, and whole-body vibration therapy are discussed. Finally, we present recommendations for future research that may maximise the potential of exercise in primary and secondary prevention of osteoporosis in the ageing population.