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Roberts KE, Beckenkamp PR, Ferreira ML, Ho EK, Carvalho-E-Silva AP, Calais-Ferreira L, Ferreira PH. The impact of aggregate positive lifestyle behaviors on low back pain resilience and care seeking. Spine J 2023; 23:1405-1413. [PMID: 37393016 DOI: 10.1016/j.spinee.2023.06.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a global issue, and the high associated costs are mainly attributed to a small proportion of people with LBP who seek care. Importantly, the impact of aggregate positive lifestyle behaviors on LBP resilience and care seeking is not known. PURPOSE This study aimed to evaluate the relationship between positive lifestyle behaviors and LBP resilience. STUDY DESIGN This study was a prospective longitudinal cohort study. PATIENT SAMPLE Data was collected as part of the AUstralian Twin BACK Study (AUTBACK). Participants who reported a lifetime previous history of LBP at baseline were included in this analysis (n = 340). OUTCOME MEASURES The outcomes of interest were the number of weeks without activity limiting LBP and total number of days of healthcare usage, health practitioner care, self-management care, and medication intake. METHODS A lifestyle behavior score was built using variables of body mass index (BMI), physical activity, smoking status, and sleep quality. Negative binomial regression analyses were used to assess the relationship between the positive lifestyle behavior score and the count outcomes of number of weeks without activity limiting LBP and number of days participants used care. RESULTS After adjusting for covariates, no association was found between participants' positive lifestyle behavior score and their number of weeks without activity limiting LBP (IRR: 1.02, 95% CI 1.00-1.05). There was a statistically significant relationship between higher positive lifestyle behavior scores and fewer number of days of participants' total healthcare usage (IRR:0.69, 95% CI 0.56-0.84), healthcare practitioner visits (IRR:0.62, 95% CI 0.45-0.84), use of self-management strategies (IRR:0.74, 95% CI 0.60-0.91), and use of pain medication (IRR:0.55, 95% CI 0.44-0.68). CONCLUSION People who adopt optimal lifestyle behaviors, such as engaging in adequate physical activity, achieving optimal quality sleep, maintaining an ideal BMI, and not smoking, may not experience less time suffering from activity limiting LBP, but are less likely to use healthcare and pain medication for their LBP.
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Affiliation(s)
- Katharine E Roberts
- Faculty of Medicine and Health, The University of Sydney, Western Avenue Camperdown, Sydney, Australia.
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Emma K Ho
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Ana P Carvalho-E-Silva
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
| | - Lucas Calais-Ferreira
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Grattan Street Parkville, Melbourne, Australia
| | - Paulo H Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Western Avenue Camperdown, Sydney, Australia
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Roberts KE, Beckenkamp PR, Ferreira ML, Duncan GE, Calais-Ferreira L, Gatt JM, Ferreira P. Positive lifestyle behaviours and emotional health factors are associated with low back pain resilience. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3616-3626. [PMID: 36208321 DOI: 10.1007/s00586-022-07404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/18/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To evaluate the relationship between lifestyle behaviours, emotional health factors, and low back pain (LBP) resilience. METHODS This retrospective longitudinal study utilised 1,065 twins with a recent history of LBP from the Washington State Twin Registry. A lifestyle behaviour score was built using variables of body mass index, physical activity engagement, sleep quality, smoking status, and alcohol consumption. An emotional health score was built using variables of the absence of depressed mood, perceived stress, and active coping. The main outcome was LBP resilience, assessed as recovery ("bouncing back"), and sustainability (maintaining high levels of function despite LBP). RESULTS After adjusting for covariates, there was no relationship between the lifestyle behaviour score (OR 1.05, 95% CI 0.97-1.15, p = 0.218) and the emotional health score (OR 1.08, 95% CI 0.98-1.19, p = 0.142) with the likelihood of recovering from LBP. There was however, evidence of a positive association between the lifestyle behaviour score (β 0.20, 95% CI 0.04-0.36, p = 0.013), the emotional health score (β 0.22, 95% CI 0.00-0.43, p = 0.049), and greater levels of sustainability. These results were confirmed by a within-pair analysis (lifestyle behaviour score: β 1.79, 95% CI 0.05-3.53, p = 0.043) and (emotional health score: β 0.52, 95% CI 0.09-0.96, p = 0.021) adjusting for genetic and early shared environmental confounding. CONCLUSION Findings from this study suggest that people who adopt optimal lifestyle behaviours and positive emotional factors are more likely to be resilient and maintain high levels of function despite suffering from LBP.
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Affiliation(s)
- K E Roberts
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - P R Beckenkamp
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - M L Ferreira
- Sydney Musculoskeletal Health, Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G E Duncan
- Washington State Twin Registry, Elson S Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, USA
| | - L Calais-Ferreira
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J M Gatt
- Neuroscience Research Australia and the School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - P Ferreira
- School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Vallis M, Lee-Baggley D, Sampalli T, Shepard D, McIssaac L, Ryer A, Ryan-Carson S, Manley S. Integrating behaviour change counselling into chronic disease management: a square peg in a round hole? A system-level exploration in primary health care. Public Health 2019; 175:43-53. [PMID: 31382084 DOI: 10.1016/j.puhe.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/31/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the uptake of competency-based behaviour change counselling training within a primary healthcare setting. Specific questions concerning provider readiness for training, perceived importance of training in the context of service demands and perceptions of competence after training were addressed. STUDY DESIGN A process-focused study which adopted a complex systems approach to implementation. Each step was evaluated before the next step was developed. The design was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. METHODS Four specific primary care services were identified and behaviour change counselling training tailored to each service was provided, based on a model of training built around competencies in establishing change-based relationships, assessing and promoting readiness to change, using evidence-based behaviour modification skills when ready and addressing psychosocial determinants of behaviour within scope of practice. Before training, a manager's readiness to facilitate training and identification of peer leaders to support ongoing practice of skills were completed. RESULTS Two programs negotiated 8 h of formal training, one program received 10 h and one program received 12 h. All programs engaged in peer support activities. Despite willingness to support training, 90% of managers were ambivalent about training activities, relative to one half of healthcare providers (HCPs). Few HCPs and no managers self-identified as ready without ambivalence. Furthermore, HCPs were reluctant to be evaluated by an expert and preferred self-evaluation methods. In contrast, HCPs uniformly endorsed the relevance, value and professional commitment to all component skills of the behaviour change counselling model. At the end of the training, over 75% of staff reported receiving formal training (reach). Almost 80% of staff reported using change-based relationship skills daily, with less frequent use of skills associated with addressing psychosocial issues. The degree of corrective feedback was generally low, however. An index of competency based on formal training, frequent use and receiving corrective feedback indicated that most HCPs did not meet these criteria. CONCLUSION Training in behaviour change counselling competencies was successfully implemented in this project. The vast majority of HCPs received training, despite ambivalence. Furthermore, HCPs strongly valued these skills and used them frequently. However, they were reluctant to accept corrective feedback. Future research is needed to evaluate innovative strategies to overcome obstacles to receiving corrective feedback in the use of behaviour change counselling skills.
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Affiliation(s)
- M Vallis
- Nova Scotia Health Authority, Canada; Family Medicine, Dalhousie University, Canada.
| | - D Lee-Baggley
- Nova Scotia Health Authority, Canada; Family Medicine, Dalhousie University, Canada
| | | | - D Shepard
- Nova Scotia Health Authority, Canada
| | | | - A Ryer
- Nova Scotia Health Authority, Canada
| | | | - S Manley
- Nova Scotia Health Authority, Canada
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Saquib N, Brunner R, Desai M, Allison M, Garcia L, Stefanick ML. Association between physical health and cardiovascular diseases: Effect modification by chronic conditions. SAGE Open Med 2018; 6:2050312118785335. [PMID: 30013784 PMCID: PMC6041849 DOI: 10.1177/2050312118785335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study assessed whether the physical component summary score of the RAND-36 health-related quality-of-life survey was associated with incidence of coronary heart disease, stroke, congestive heart failure, angina, or peripheral arterial disease, and whether baseline chronic conditions modified these associations. Methods: Analysis was limited to 69,155 postmenopausal women (50–79 years) in the Women’s Health Initiative Study who had complete data on the RAND-36, the outcomes, and covariates. Chronic conditions were defined as blood pressure ⩾140/90 mm or self-reported heart disease, diabetes, hypertension, arthritis, asthma, emphysema, cancer, and/or cholesterol-reducing medication use. Outcomes data were ascertained during follow-up (1993–2005) with medical records. Results: There were 2451 coronary heart disease, 1896 stroke, 1533 congestive heart failure, 1957 angina, and 502 peripheral arterial disease events during follow-up (median 8.2 years). Participants in the lowest physical component summary quintile, compared to the highest, had a significantly higher risk of developing coronary heart disease (hazard ratio (95% confidence interval) 2.0 (1.7, 2.3)), stroke (1.8 (1.5, 2.2)), angina (2.4(2.0, 2.9)), and peripheral arterial disease (3.0 (2.0, 4.4)), irrespective of chronic conditions. Interactions between physical component summary and existing chronic conditions were not significant for any outcome except congestive heart failure (p = 0.005); after adjustment, participants in the lowest physical component summary quintile and with any chronic condition had nearly a twofold higher risk of congestive heart failure (Yes = 4.4 (3.3, 5.8) vs No = 2.4 (1.2, 4.3)). Conclusion: We found a low physical component summary score was a significant risk factor for individual cardiovascular disease incidence in postmenopausal women.
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Affiliation(s)
- Nazmus Saquib
- College of Medicine, Sulaiman Al-Rajhi Colleges, Al Bukairiyah, Saudi Arabia
| | | | - Manisha Desai
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California-San Diego, San Diego, CA, USA
| | - Lorena Garcia
- Department of Public Health Sciences, University of California-Davis, Davis, CA, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
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Sowa A, Tobiasz-Adamczyk B, Topór-Mądry R, Poscia A, la Milia DI. Predictors of healthy ageing: public health policy targets. BMC Health Serv Res 2016; 16 Suppl 5:289. [PMID: 27609315 PMCID: PMC5016728 DOI: 10.1186/s12913-016-1520-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The public health policy agenda oriented towards healthy ageing becomes the highest priority for the European countries. The article discusses the healthy ageing concept and its possible determinants with an aim to identify behavioral patterns related to healthy ageing in selected European countries. METHODS The healthy ageing is assessed based on a composite indicator of self-assessed health, functional capabilities and life meaningfulness. The logistic regression models are used to assess the impact of the healthy lifestyle index, psycho-social index and socio-economic status on the probability of healthy ageing (i.e. being healthy at older age). The lifestyle and psychosocial indexes are created as a sum of behaviors that might be important for healthy ageing. Models are analyzed for three age groups of older people: 60-67, 68-79 and 80+ as well as for three groups of countries representing Western, Southern and Central-Eastern Europe. RESULTS The lifestyle index covering vigorous and moderate physical activity, consumption of vegetables and fruits, regular consumption of meals and adequate consumption of liquids is positively related to healthy ageing, increasing the likelihood of being healthy at older age with each of the items specified in the index. The score of the index is found to be significantly higher (on average by 1 point for men and 1.1 for women) for individuals ageing healthily. The psychosocial index covering employment, outdoor social participation, indoor activities and life satisfaction is also found to be significantly related to health increasing the likelihood of healthy ageing with each point of the index score. There is an educational gradient in healthy ageing in the population below the age of 68 and in Southern and Central-Eastern European countries. In Western European countries, income is positively related to healthy ageing for females. CONCLUSIONS Stimulation physical activity and adequate nutrition are crucial domains for a well-defined public health policy oriented towards healthy ageing. The psychosocial elements related to social participation, engagement, networking and life satisfaction are also found to be health beneficial.
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Affiliation(s)
- Agnieszka Sowa
- Department of Social Policy, Institute of Labour and Social Studies, Bellottiego 3B, Warsaw, Poland.
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Grzegórzecka 20 St., 30-351, Crakow, Poland
| | - Roman Topór-Mądry
- Department of Epidemiology and Population Health, Institute of Public Health, Jagiellonian University Medical College, Grzegórzecka 20 St., 30-351, Crakow, Poland
| | - Andrea Poscia
- Institute of Public Health, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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The association between optimal lifestyle-related health behaviors and employee productivity. J Occup Environ Med 2015; 56:708-13. [PMID: 24988098 DOI: 10.1097/jom.0000000000000191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association between lifestyle-related health behaviors including sleep and the cluster of physical activity, no tobacco use, fruits and vegetables intake, and alcohol consumption termed the "Optimal Lifestyle Metric" (OLM), and employee productivity. METHODS Data were obtained from employee health assessments (N = 18,079). Regression techniques were used to study the association between OLM and employee productivity, sleep and employee productivity, and the interaction of both OLM and sleep on employee productivity. RESULTS Employees who slept less or more than 7 or 8 hours per night experienced significantly more productivity loss. Employees who adhered to all four OLM behaviors simultaneously experienced less productivity loss compared with those who did not. CONCLUSIONS Adequate sleep and adherence to the OLM cluster of behaviors are associated with significantly less productivity loss.
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Holman RR, Bethel MA, Chan JC, Chiasson JL, Doran Z, Ge J, Gerstein H, Huo Y, McMurray JJ, Ryden L, Liyanage W, Schröder S, Tendera M, Theodorakis MJ, Tuomilehto J, Yang W, Hu D, Pan C. Rationale for and design of the Acarbose Cardiovascular Evaluation (ACE) trial. Am Heart J 2014; 168:23-9.e2. [PMID: 24952856 DOI: 10.1016/j.ahj.2014.03.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 03/17/2014] [Indexed: 01/26/2023]
Abstract
Patients with cardiovascular disease and impaired glucose tolerance are at increased risk of cardiovascular events and type 2 diabetes mellitus (T2DM). Lifestyle modification or pharmacological intervention can delay progression to T2DM, but there is no clear evidence that they reduce cardiovascular risk in this population. Acarbose, an α-glucosidase inhibitor that lowers postprandial blood glucose, has been shown to reduce T2DM risk by 25%, and possibly cardiovascular risk in impaired glucose tolerance subjects without cardiovascular disease.
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Dissing AS, Gil A, Keenan K, McCambridge J, McKee M, Oralov A, Saburova L, Leon DA. Alcohol consumption and self-reported (SF12) physical and mental health among working-aged men in a typical Russian city: a cross-sectional study. Addiction 2013; 108:1905-14. [PMID: 23692519 PMCID: PMC3992912 DOI: 10.1111/add.12257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/09/2012] [Accepted: 05/14/2013] [Indexed: 11/03/2022]
Abstract
AIM To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking. DESIGN Cross-sectional study of an age-stratified random sample of a population register. SETTING : The city of Izhevsk, The Russian Federation, 2008-09. PARTICIPANTS A total of 1031 men aged 25-60 years (68% response rate). MEASUREMENTS : Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting 2 or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking and socio-demographic factors were obtained. FINDINGS : Compared with abstainers, those drinking 10-19 litres of beverage ethanol per year had a PCS score 2.66 [95% confidence interval (CI) = 0.76; 4.56] higher. Hazardous beverage drinking was associated with a lower PCS score [mean diff: -2.95 (95% CI = -5.28; -0.62)] and even more strongly with a lower MCS score [mean diff: -4.29 (95% CI = -6.87; -1.70)] compared to non-hazardous drinkers, with frequent non-beverage alcohol drinking being associated with a particularly low MCS score [-7.23 (95% CI = -11.16; -3.29)]. Adjustment for smoking and socio-demographic factors attenuated these associations slightly, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably. CONCLUSION : Among working-aged male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10-19 litres per year.
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Affiliation(s)
- Agnete S Dissing
- Department of Public Health, The University of CopenhagenCopenhagen, Denmark
| | - Artyom Gil
- London School of Hygiene and Tropical MedicineLondon, UK
| | | | | | - Martin McKee
- London School of Hygiene and Tropical MedicineLondon, UK
| | - Alexey Oralov
- Izhevsk State Technical UniversityIzhevsk, Russian Federation
| | | | - David A Leon
- London School of Hygiene and Tropical MedicineLondon, UK,Correspondence to: David Leon, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail:
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Robinson SM, Jameson KA, Syddall HE, Dennison EM, Cooper C, Aihie Sayer A. Clustering of lifestyle risk factors and poor physical function in older adults: the Hertfordshire cohort study. J Am Geriatr Soc 2013; 61:1684-91. [PMID: 24083502 DOI: 10.1111/jgs.12457] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the relationship between number of lifestyle risk factors (out of low physical activity, poor diet, obesity, smoking) and physical function in older community-dwelling men and women. DESIGN Cross-sectional study, Hertfordshire, United Kingdom. PARTICIPANTS Men (n = 1,682) and women (n = 1,540) aged 59 to 73. MEASUREMENTS Physical activity was assessed using an administered questionnaire with a score from 0 to 100; low activity was defined as a score of 50 or less. Diet was assessed using a food frequency questionnaire; diet quality was assessed according to a score for a principal component analysis-defined "healthy" dietary pattern. Poor diet was categorized as a dietary pattern score in the lowest quarter of the distribution. Obesity was defined as a body mass index of 30.0 kg/m(2) or more. Physical function was assessed according to self-report (SF-36); poor function was defined as a score in lowest quarter of the distribution. A subgroup of participants had objective assessments of physical function (Timed Up-and-Go Test, timed 3-m walk, chair rises, one-legged standing balance). RESULTS There was a graded increase in prevalence of poor self-reported physical function in men and women with increasing number of risk factors (men, adjusted odds ratio (AOR) for 3 or 4 risk factors vs none = 3.79, 95% confidence interval (CI) = 2.31-6.21; women, AOR = 5.37, 95% CI = 2.66-10.84). With the exception of balance, the objective assessments also showed graded relationships with number of risk factors, such that more risk factors was associated with poorer physical function. CONCLUSION These modifiable lifestyle risk factors are linked to marked differences in risk of poorer physical function in older adults. Efforts to encourage healthy lifestyles have the potential to improve physical function and to promote healthier ageing.
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Affiliation(s)
- Siân M Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Myint PK, Smith RD, Luben RN, Surtees PG, Wainwright NWJ, Wareham NJ, Khaw KT. Lifestyle behaviours and quality-adjusted life years in middle and older age. Age Ageing 2011; 40:589-95. [PMID: 21616956 DOI: 10.1093/ageing/afr058] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE to examine the relationship between combined lifestyle behaviours and quality-adjusted life years (QALYs) in a general population. METHODS a population-based study was conducted in 13,358 men and women who participated in the European Prospective Investigation into Cancer (EPIC)-Norfolk (baseline 1993-97). A score of 1 was given to each of non-smoking, physically not inactive, moderate alcohol consumption (1-14 units) and consumption of at least five portions of fruit and vegetables (vitamin C level ≥50 µmol/l). Short-Form Six-Dimension (SF-6D) health utility index scores were derived from the SF-36. QALYs were estimated up to follow-up (July 2007). RESULTS a total of 13,358 men and women were eligible to be included in the study (aged 40-79 years at baseline). A total of 12,921 people were alive at follow-up (117, 784 person-years). Mean follow-up period was ∼11.5 years. 437 (4.4% of men and 2.4% of women) died. The death rate was 6.5 times higher in people with health behaviour score 0 compared with those who scored 4 (8.4 versus 1.3%). People with higher scores had significantly higher QALYs. CONCLUSION our findings support the view that modifiable lifestyle factors are an important component in health improvement.
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Affiliation(s)
- Phyo K. Myint
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
- Clinical Gerontology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Richard D. Smith
- Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert N. Luben
- Strangeway Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul G. Surtees
- Strangeway Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nicholas W. J. Wainwright
- Strangeway Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Pronk NP, Katz AS, Gallagher J, Austin E, Mullen D, Lowry M, Kottke TE. Adherence to Optimal Lifestyle Behaviors Is Related to Emotional Health Indicators Among Employees. Popul Health Manag 2011; 14:59-67. [DOI: 10.1089/pop.2010.0007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicolaas P. Pronk
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
| | - Abigail S. Katz
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Jason Gallagher
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Erin Austin
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Deborah Mullen
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Marcia Lowry
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Thomas E. Kottke
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Liao WC, Li CR, Lin YC, Wang CC, Chen YJ, Yen CH, Lin HS, Lee MC. Healthy behaviors and onset of functional disability in older adults: results of a national longitudinal study. J Am Geriatr Soc 2011; 59:200-6. [PMID: 21275933 DOI: 10.1111/j.1532-5415.2010.03272.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the combined effect of healthy behaviors on the development of functional disability in an elderly cohort. DESIGN Prospective cohort study. SETTING Taiwan Longitudinal Study in Aging from 1989, 1993, 1996, 1999, and 2003. PARTICIPANTS A national sample of 1,940 men and 1,247 women aged 60 and older without functional disability at baseline. MEASUREMENTS Functional disability was defined as difficulty with activities of daily living: taking a bath or walking 200 to 300 m. Time to functional disability was the age at midpoint between the first occurrence of disability onset in the survey year and prior survey year. Considering that the onset of disability is probably a precursor of death, for those who died without disability, time to disability onset was set at the midpoint between the last follow-up and death year. Four healthy behaviors were measured: not smoking, moderate alcohol consumption, regular exercise, and sleeping 6 to 8 hours per day. A Cox proportional hazards model with time-dependent covariates was used to analyze the association between age at the first functional disability and prior healthy behavior, after controlling for sex, time-varying disease status, marital status, and education. RESULTS Healthy behaviors were linked to the onset of functional disability. Participants who performed one or more healthy behaviors were 15% to 75% less likely to be disabled than those who performed none. CONCLUSION In the population studied, healthy behaviors were associated with lower incidence of functional disability. As the number of healthy behaviors increased, the likelihood of disability decreased.
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Affiliation(s)
- Wen-Chun Liao
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan
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Pronk NP, Lowry M, Kottke TE, Austin E, Gallagher J, Katz A. The Association Between Optimal Lifestyle Adherence and Short-Term Incidence of Chronic Conditions among Employees. Popul Health Manag 2010; 13:289-95. [DOI: 10.1089/pop.2009.0075] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicolaas P. Pronk
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
| | - Marcia Lowry
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Thomas E. Kottke
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Erin Austin
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Jason Gallagher
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Abigail Katz
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
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Myint PK, Luben RN, Surtees PG, Wainwright NWJ, Wareham NJ, Khaw KT. Physical functional health predicts the incidence of coronary heart disease in the European Prospective Investigation into Cancer-Norfolk prospective population-based study. Int J Epidemiol 2010; 39:996-1003. [PMID: 20421200 DOI: 10.1093/ije/dyq061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the relationship between physical functional health and long-term risk of coronary heart disease (CHD) independently of known risk factors in a general population. METHODS Men and women aged 40-79 years at baseline who completed a health and lifestyle questionnaire and attended a health examination during 1993-97 participating in the European Prospective Investigation into Cancer-Norfolk who were free of myocardial infarction (MI), stroke and cancer were included. Eighteen months later, physical functional health was assessed using physical component summary (PCS) scores of Short-Form 36-item questionnaire (SF-36). The incidence of CHD was ascertained by death certification and hospital record linkage up to March 2008. RESULTS A total of 14,222 men and women were included in the study. There were 389 incident CHD (total person-years = 126,896 years). People who reported better physical functional health had significantly lower risk of CHD. Using Cox proportional hazard models adjusting for age, sex, body mass index, cholesterol, systolic blood pressure, smoking, alcohol consumption, physical activity, diabetes, family history of MI, social class and aspirin usage, it was found that men and women who were in the top quartile of SF-36 PCS had half the risk of CHD [relative risk (RR) = 0.46; 95% confidence interval (CI) = 0.32-0.65] compared with the people in the bottom quartile. The relationships remained essentially unchanged after excluding incident CHD within the first 2 years of follow-up (RR = 0.48; 95% CI = 0.33-0.70). CONCLUSIONS Physical functional health predicts subsequent CHD risk independently of known risk factors in a general population. People with poor physical functional health may benefit from targeted preventive interventions.
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Affiliation(s)
- Phyo K Myint
- Ageing and Stroke Medicine Section, Health & Social Sciences Research Institute, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
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15
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Rabiei K, Kelishadi R, Sarrafzadegan N, Sadri G, Amani A. Short-term results of community-based interventions for improving physical activity: Isfahan Healthy Heart Programme. Arch Med Sci 2010; 6:32-9. [PMID: 22371717 PMCID: PMC3278940 DOI: 10.5114/aoms.2010.13504] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/18/2008] [Accepted: 08/11/2008] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION To assess the effect of a comprehensive community-based programme for increasing physical activity (PA) after 2 years of interventions. MATERIAL AND METHODS A 6-year, action-oriented, comprehensive, and integrated community-based study, entitled the Isfahan Healthy Heart Programme, was conducted in Iran from the year 2000. The interventions targeted the whole population of nearly 2,180,000 living in two cities, and were compared with another city considered as a reference. Educational, environmental and legislative interventions were conducted at the community level. Annual evaluations were performed among 6,000 representative individuals. This paper presents the changes in PA habits after 2 years of interventions for increasing PA. The PA habits were assessed by using the Baecke questionnaire, and an energy expenditure of 150 kcal for daily leisure time physical activity was adopted as a cut-off for defining active and inactive lifestyle. RESULTS In the intervention and reference areas, respectively 85 and 83% of the population were physically inactive. From 2000 to 2002, the daily PA among both genders decreased in both intervention and reference communities. Meanwhile, the leisure-time PA increased significantly in the intervention area, but decreased in the reference area. The transportation PA did not significantly change in the intervention area, but showed a remarkable decline in the reference area. CONCLUSIONS We suggest that the synergism resulting from community collaborations has been effective in improving some aspects of PA in our community. The ongoing changes in environmental factors and policies can help in increasing the worksite and transportation PA in later stages of this community-based programme.
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Affiliation(s)
- Katayoun Rabiei
- Isfahan Cardiovascular Research Centre, WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Control, Prevention, and Rehabilitation for Cardiac Patients in the Eastern Mediterranean Region, Isfahan, Iran
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16
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The Short-Form Six-Dimension utility index predicted mortality in the European Prospective Investigation into Cancer-Norfolk prospective population-based study. J Clin Epidemiol 2010; 63:192-8. [DOI: 10.1016/j.jclinepi.2009.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 05/04/2009] [Accepted: 05/08/2009] [Indexed: 11/20/2022]
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17
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Maraldi C, Harris TB, Newman AB, Kritchevsky SB, Pahor M, Koster A, Satterfield S, Ayonayon HN, Fellin R, Volpato S. Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study. J Am Geriatr Soc 2009; 57:1767-75. [PMID: 19737328 PMCID: PMC3149890 DOI: 10.1111/j.1532-5415.2009.02479.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the prospective relationship between alcohol consumption and incident mobility limitation. DESIGN Cohort study. SETTING The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS Three thousand sixty-one adults aged 70 to 79 without mobility disability at baseline. MEASUREMENTS Incidence of mobility limitation, defined as self-report at two consecutive semiannual interviews of any difficulty walking one-quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle-related variables, diseases, and health status indicators were assessed at baseline. RESULTS During a follow-up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person-years (person-years); men: 6.4 per 100 person-years; women: 7.3 per 100 person-years) and mobility disability (total: 2.7 per 100 person-years; men: 2.5 per 100 person-years; women: 2.9 per 100 person-years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55-0.89) and mobility disability (HR=0.66, 95% CI=0.45-0.95) than never or occasional consumption. Additional adjustment for lifestyle-related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66-1.08 and HR=0.81, 95% CI=0.56-1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship. CONCLUSION Lifestyle-related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.
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Affiliation(s)
- Cinzia Maraldi
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatric, University of Ferrara, Ferrara, Italy.
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Harrington J, Perry IJ, Lutomski J, Fitzgerald AP, Shiely F, McGee H, Barry MM, Van Lente E, Morgan K, Shelley E. Living longer and feeling better: healthy lifestyle, self-rated health, obesity and depression in Ireland. Eur J Public Health 2009; 20:91-5. [DOI: 10.1093/eurpub/ckp102] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Myint PK, Luben RN, Surtees PG, Wainwright NWJ, Bingham SA, Wareham NJ, Khaw KT. Effect of age and sex on the relationship between different socioeconomic indices and self-reported functional health in the EPIC-Norfolk population-based study. Ann Epidemiol 2009; 19:289-97. [PMID: 19362274 DOI: 10.1016/j.annepidem.2009.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relationship between different social-economic indices and physical and mental functional health of older people compared with younger people is unclear. OBJECTIVE To examine the effect of age and sex on the relationship between various social-economic indices and self-reported functional health. METHODS A population-based cross-sectional study was conducted in 19,088 participants of European Prospective Investigation into Cancer (EPIC)-Norfolk, UK, ages 40-79 years at baseline. The independent relationships between three different socioeconomic indices; occupational social class, education and residential area deprivation, and functional health measured by anglicized version of 36-item short form questionnaire (UK SF-36), were compared between older (>or=65 years) and younger (<65 years) men and women. RESULTS Residential area deprivation was significantly associated with poor physical and mental functional health independent of social class and education, and consistent in both age groups in men and women. A low level of education in younger men and being in low social class in younger women were associated with poorer physical functional health compared with their respective older counterparts. Social class had a significantly greater effect in older women compared with younger women. CONCLUSION Commonly used socioeconomic indices have differing associations with functional health depending the age and sex of an individual. Residential area deprivation predicts poor functional health in all age and sex groups. This may have implications for health policy.
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Affiliation(s)
- Phyo K Myint
- Health and Social Sciences Research Institute, Faculty of Health, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
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Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 2008; 5:e12. [PMID: 18184033 PMCID: PMC2174962 DOI: 10.1371/journal.pmed.0050012] [Citation(s) in RCA: 492] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/26/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community. METHODS AND FINDINGS We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45-79 y with no known cardiovascular disease or cancer at baseline survey in 1993-1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1-14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass-, and social class-adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21-1.60), 1.95 (1.70--2.25), 2.52 (2.13-3.00), and 4.04 (2.95-5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age. CONCLUSIONS Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age.
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Affiliation(s)
- Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
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