A cluster analysis of device-measured physical activity behaviours and the association with chronic conditions, multi-morbidity and healthcare utilisation in adults aged 45 years and older

How can physical activity promotion be optimised in general practice: a narrative review of the literature

BACKGROUND

Physical inactivity is a significant contributor to preventable chronic health conditions worldwide. General practice has been identified as a setting to improve physical activity levels through exercise promotion during consultations. However, physical activity promotion in general practice is unstructured and suboptimal.

AIMS

The aim of this study is to review the literature pertaining to factors that influence physical activity promotion in general practice and to answer the research question: what are the experiences of patients and GPs with physical activity promotion in consultations?

METHODS

Online databases were searched for relevant papers using predetermined inclusion and exclusion criteria. Papers retrieved were original research only, involving patients, general practitioners or practice nurses. A PRISMA approach to study selection was followed.

RESULTS

Of 464 papers retrieved, 20 were included in the review. Physical activity promotion is acceptable to patients but some do not appreciate its health benefits. A personalised approach is important to patients, including tailored advice and setting meaningful goals. Studies involving general practitioners and practice nurses report that they are aware of the importance of physical activity and their role in its promotion, but time is the primary barrier. Strategies identified include demedicalisation of physical activity, resources such as patient handouts as well as signposting to community initiatives, social prescribers and collaboration with exercise professionals.

CONCLUSION

General practice has the potential to effectively promote physical activity but system- and practitioner-level changes are necessary to achieve meaningful change.

Physical Behavior Profiles Among Older Adults and Their Associations With Physical Capacity and Life-Space Mobility

We identified data-driven multidimensional physical activity (PA) profiles using several novel accelerometer-derived metrics. Participants aged 75, 80, and 85 (n = 441) wore triaxial accelerometers for 3-7 days. PA profiles were formed with k-means cluster analysis based on PA minutes, intensity, fragmentation, sit-to-stand transitions, and gait bouts for men and women. Associations with physical capacity and life-space mobility were examined using age-adjusted general linear models. Three profiles emerged: "Exercisers" and "actives" accumulated relatively high PA minutes, with actives engaging in lighter intensity PA. "Inactives" had the highest activity fragmentation and lowest PA volume, intensity, and gait bouts. Inactives showed lower scores in physical capacity and life-space mobility compared with exercisers and actives. Exercisers and actives had similar physical capacity and life-space mobility, except female exercisers had higher walking speed in the 6-min walk test. Our findings demonstrate the importance of assessing PA as multidimensional behavior rather than focusing on a single metric.

Association between Quality of Life, Confinement, and Sex in Adults: A Multigroup Structural Equation Analysis

The state of confinement during the COVID-19 pandemic affected the quality of life of the general population. This study aims to define and contrast an explanatory model of the quality of life in adults and to analyze the relationships between these variables based on the state of confinement and sex. A total of 872 people from Chile aged between 17 and 50 (M = 21.70 years; SD= 3.272), of both sexes (60.90% male and 39.1% female) participated in this research, of whom 46.6% were not confined when tested and 53.4% were confined, analyzing the quality of life. A model of multi-group structural equations was performed, which adjusted very well (χ2 = 559.577; DF = 38; p < 0.001; IFC = 0.934; NFI = 0.916; IFI = 0.934; RMSEA = 0.061). The results show a positive and direct relationship among all the variables studied and the structural equation model proposed according to confinement and sex reveals a good fit in all the evaluation indexes. Stress and sleep, personality, and introspection were the indicators with the greatest influence in the four models, followed by the family and friends indicator with a medium correlation strength, such as the health monitoring dimension, although this was not as influential in confined individuals. The main conclusions are that the best adjustments are obtained in confined adults and females, and the data show that the psychological indicators obtained (stress and sleep, personality, and introspection) have the greatest influence on adults in the four models proposed with regard to their quality of life.

Multimorbidity is associated with lower total 24-hour movement activity among US adults

Objective

Having chronic conditions may result in reduced physical and cognitive function but less is known about multimorbidity with daily movement. We examined the association of multimorbidity and device-measured total daily movement in a nationally representative sample of US adults aged ≥ 30 years from the 2011-2014 National Health and Nutrition Examination Surveys.

Methods

Any multimorbidity (≥2 conditions) and complex multimorbidity (≥3 conditions across ≥ 3 body systems) were quantified using 16 chronic conditions via self-report and/or clinical thresholds. Total movement over 24-hours (Monitor-Independent Movement Summary units [MIMS-units]) was measured using a wrist-worn device (ActiGraph GT3X). Multivariable linear regression examined the association of 1) each chronic condition, 2) number of conditions, 3) any multimorbidity, and 4) complex multimorbidity with total movement. Covariates included age, gender, race/ethnicity, educational attainment, and smoking status.

Results

Among US adults (N = 7304, mean age: 53.2 ± 0.34 years, 53.2% female, 69.4% Non-Hispanic White), 62.2% had any multimorbidity with 34.2% having complex multimorbidity. After adjustment, a higher number of chronic conditions was associated with incrementally lower total movement (β MIMS-units [95% CI] compared to those with no chronic conditions; one: -419 [-772, -66], two: -605 [-933, -278], three: -1201 [-1506, -895], four: -1908 [-2351, -1465], 5+: -2972 [-3384, -2560]). Complex multimorbidity presence was associated with -1709 (95% CI: -2062, -1357) and -1269 (-1620, -918) lower total movement compared to those without multimorbidity and multimorbidity but not complex, respectively.

Conclusions

Multimorbidity was associated with lower 24-h movement among US adults and may be helpful for identifying adults at risk for low movement.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).