Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study

Sedentary Behaviour and Fall-related Injuries in Aging Adults: Results from the Canadian Longitudinal Study on Aging (CLSA)

Background

Falls, and more specifically, fall-related injuries, are costly to the healthcare system and can harm one's autonomy.

Objectives

To study the impact of sedentary behaviour associated with fall-related injuries and how a change in sedentary behaviour may impact the risk of a fall-related injury.

Design

From baseline to the first follow-up, cross-sectional and longitudinal data analysis from the Canadian Longitudinal Study of Aging (CLSA) cohort.

Participants

CLSA data from 43,558 Canadians aged 45-85 were included in this study.

Measurements

At baseline and follow-up, sedentary behaviour time was categorized as low (<1,080 minutes/week), moderate (1,080-1,440), or high (>1,440). Sedentary behaviour was estimated via the Physical Activity Scale for the Elderly (PASE). At follow-up, participants were dichotomized as either increased or decreased/no change in sedentary behaviour according to their categorical change between time points.

Results

Sedentary behaviour was associated with fall-related injuries independently of age, sex, number of chronic conditions, and total physical activity levels OR (95%CI) 1.10 (1.05-1.15). In contrast, a change in sedentary behaviour was not associated with the risk of fall-related injury 1.00 (0.92-1.01).

Conclusion

A higher level of sedentary behaviour is associated with injurious falls for people between 40 and 80 years old. However, a short-term change in sedentary behaviour does not influence the risk of injury-related falls. Despite the results, a more precise measure of sedentary behaviour is needed for epidemiology studies to capture changes over time better.

"If I want to be able to keep going, I must be active." Exploring older adults' perspectives of remote physical activity supports: a mixed-methods study

Introduction

Pandemic-related public health restrictions limited older adults' physical activity programs and opportunities. Physical activity supports shifted to remote options, however, information on their adoption and effectiveness is limited. This study aims to describe the remote supports received by older adults and their perceived effectiveness. Additionally, it aims to describe facilitators and barriers to remote supports for physical activity among older adults, particularly those reliant on technology.

Methods

This study used an explanatory, sequential, mixed-methods design. Community-dwelling older adults (≥ 60 years) were recruited to partake in a web-based survey and an optional semi-structured follow-up interview informed by the COM-B model. Participant characteristics, perceived effectiveness of remote supports, and the presence and severity of barriers were described. Changes in physical activity levels before and during the pandemic were analyzed using the Wilcoxon signed-rank test. Qualitative data underwent inductive thematic analysis.

Results

Fifty seven older adults (68.3 ± 7.1 years, 43 Female) completed the survey, of which 15 participants (67.4 ± 5.8 years, 12 Female) participated in interviews. The majority were Caucasian, highly educated, and resided in Canada. Total physical activity levels showed no statistically significant change from before to during the pandemic (p = 0.74); however, at-home exercise participation and technology usage increased. Pre-recorded and real-time virtual exercise supports were perceived as most effective. Main barriers included limited contact with exercise professionals, limited access to exercise equipment or space, and decreased mental wellness. Thematic analysis identified five main themes: (i) Enabled by knowledge and resources; (ii) Diverse motivations for physical activity; (iii) Fostering participation through social connection; (iv) Supervision and safety: enabling adherence; and (v) Virtual exercise: a sustainable option with technological considerations.

Conclusion

Virtual platforms show promise in supporting older adults' physical activity at home, especially for those with limited in-person access. Our study suggests that both real-time and pre-recorded virtual exercise supports are feasible, depending on technological capacity and support. While interactive real-time virtual programs allow interaction with professionals and peers, pre-recorded programs provide timing flexibility. Further research is needed to establish best practices for safe and effective virtual exercise programming, promoting its long-term adoption for supporting a wider range of older adults.

Longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women

We examined the longitudinal associations of accelerometer-measured physical activity and sedentary time with leg muscle strength (LMS), balance, and falls in middle-aged women. This was a 5-year cohort study among 308 women aged 36-56 years. We used linear mixed-effects models to examine associations of baseline and change in accelerometer-measured sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) with baseline and 5-year change in LMS and balance (timed up and go test [TUG], functional reach test [FRT], lateral reach test [LRT], and step test [ST]), and negative binomial/Poisson and log-binomial regression as appropriate to assess associations with falls after 5-year follow-up. Greater baseline MVPA was associated with better baseline LMS (β = 4.65 kg/SD, 95% CI: 1.37, 7.93) and TUG (β = -0.09 s/SD, 95% CI: -0.18, -0.01) but not with change in them over 5 years. Baseline MVPA was not associated with FRT at baseline but associated with a greater decrease in FRT (β = -0.87 cm/SD, 95% CI: -1.57, -0.17). Increased MVPA over 5 years was associated with less deterioration in FRT (β = 0.88 cm/SD, 95% CI: 0.14, 1.61). Increased sedentary time over 5 years was associated with a larger decrease in FRT (β = -0.82 cm/SD, 95% CI: -1.58, -0.07). Higher baseline LPA was associated with higher falls risk (IRR = 1.27, 95% CI: 1.02, 1.57). Higher baseline MVPA may benefit LMS and balance, while increasing MVPA in the medium term has little effect on change in these outcomes in mid-life. Detrimental association of LPA with falls may be due to greater exposures to environmental hazards.HighlightsOur study for the first time examined the longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women.Higher baseline moderate-to-vigorous physical activity (MVPA) may be beneficial for muscle strength and balance at baseline but increasing MVPA in the medium term has little effect on change in LMS or balance outcomes in middle-aged women.Higher baseline light physical activity (LPA) was associated with an increased risk of falls.The detrimental association of LPA with falls may be due to a greater exposure to environmental hazards in midlife, which needs to be clarified in future research.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Joint Association of Diabetes and Physical Activity With Falls Among Midlife and Older Adults: 2018 Behavioral Risk Factor Surveillance System

Purpose

We examined joint associations of diabetes and physical activity (PA) with falls.

Design

Complex survey (cross-sectional) design using the 2018 Behavioral Risk Factor Surveillance System (Response rate was 53% (landline phones) and 46% (cellular phones)).

Setting

National survey in the U.S.

Subjects

Adults ≥45 years who self-reported diabetes status, PA, and falls ( n = 295,282; 98.5% of eligible samples; N = 130,103,093) were classified into 4 groups: no diabetes–PA, no diabetes–no PA, diabetes–PA, diabetes–no PA.

Measures

Self-reported PA, diabetes, falls, and major health characteristics.

Analysis

Poisson regression models were used to estimate the association of groups with any (≥1 fall) falls.

Results

Compared to no diabetes–active groups, no diabetes–inactive (Relative Risk (RR) = 1.22; 95% CI: 1.18, 1.26), diabetes–active (RR = 1.25; 95% CI: 1.20, 1.30), and diabetes–inactive (RR = 1.46; 95% CI: 1.41, 1.51) groups were more likely to report falls, independent of tested covariates.

Conclusions

Leisure-time PA may mitigate the likelihood of falls in adults with and without diabetes. Our findings could be useful for healthcare providers or clinicians to promote the importance of PA in midlife and older adults who are at risk of falls and/or diabetes. More detailed longitudinal information on objectively-estimated PA and a more frequent fall calendar are warranted to prevent recall bias and temporal ambiguity (causality between PA and falls).

The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis

Background

It is generally believed that sedentary behavior (SB) increases the risk of falls among older adults, but the evidence for it remains inconsistent and scarce.

Purpose

Our study aims to provide a systematic review and meta-analysis of available evidence regarding the association of SB with falls in older adults.

Method

A comprehensive search strategy was conducted using several online databases from 1906 to March 2022. Cohort studies both concerning the association between SB and falls and involving participants over 60 years old were regarded as eligible for inclusion. Evidence was pooled by a random-effects meta-analysis. Quality assessment for individual studies was performed with the Newcastle-Ottawa Scale (NOS).

Results

Altogether seven publications were identified, and the age of the 24,750 individuals involved ranging from 60 to 99 years old. Overall quality of the included studies was rated as moderate-to-high quality. We found that SB was significantly associated with increased risk of falls compared with non-SB among older adults [Odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.07-1.28; I ² = 46.90%, P _{heterogeneity} = 0.07, random model]. Subgroup analyses that stratified the studies according to NOS score showed significant differences between groups. Subgroup analysis stratified by SB measurement, sample size, region, publication year, and follow-up duration showed no significant differences between groups.

Conclusion

The findings provide reliable support for the hypothesis that sedentary lifestyles are strong predictors of falls among older adults, offering critical indications to develop strategies for fall prevention.

Physical activity and recurrent fall risk in community-dwelling Japanese people aged 40-74 years: the Murakami cohort study

Background

Falls are important causes of injury and mortality in older people, and associated medical costs can be enormous. Physical activity (PA) is a potential preventive factor for falls. However, few studies have examined the effect of different types of PA on fall prevention. This study aimed to evaluate the association between PA levels and the incidence of recurrent falls by type of PA in middle-aged and older people.

Methods

This cohort study targeted 7,561 community-dwelling individuals aged 40–74 years who did not experience recurrent falls in the year before baseline. Information on PA levels, demographics, body size, lifestyle, and fall/disease history was obtained using a self-administered questionnaire in the baseline survey. Levels of total PA, leisure-time PA, and non-leisure-time PA (occupation, commuting, and housework) were estimated using metabolic equivalent (MET) scores (MET-h/day; hours spent on a given activity per day multiplied by its MET intensity). PA levels were categorized into four groups. Falls were recorded as none, once, or twice or more (recurrent falls). The outcome of the study was the incidence of recurrent falls in the past year before a survey conducted 5 years after the baseline survey. Logistic regression analyses were performed to calculate odds ratios for recurrent falls.

Results

Higher total PA and non-leisure-time PA levels were associated with a higher risk of recurrent falls (P for trend = 0.0002 and 0.0001, respectively), with the highest total PA and non-leisure-time PA groups having a significantly higher adjusted OR (1.96 [95%CI:1.33–2.88] and 2.15 [95%CI:1.48–3.14], respectively) relative to the lowest group (reference). As for leisure-time PA, the medium group had a significantly lower adjusted OR (0.70 [95%CI:0.49–0.99]) relative to the reference group. By sex, the adjusted OR in the medium leisure-time PA group was significantly lower relative to the reference group in women (0.50 [95%CI: 0.29–0.85]) but not in men.

Conclusions

Medium level leisure-time PA reduces the risk of recurrent falls in middle-aged and older people, whereas higher level non-leisure-time PA is associated with a higher risk of recurrent falls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00300-5.

Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity-related cancer risk and mortality in Black and Latina Women's Health Initiative participants

BACKGROUND

Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Health Initiative (WHI).

METHODS

Semi-Markov multistate model examined the association between ACS guideline adherence and ORC incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women. Additionally, ACS guideline adherence was examined in a subset of less common ORCs and potential effect modification by neighborhood socioeconomic status and smoking.

RESULTS

Over a median of 11.1, 12.5, and 3.7 years of follow-up for incidence, nonconditional mortality, and conditional mortality, respectively, 1191 ORCs (Black/Latina women: 841/269), 1970 all-cause deaths (Black/Latina women: 1576/394), and 341 ORC-related deaths (Black/Latina women: 259/82) were observed. Higher ACS guideline adherence was associated with lower ORC incidence for both Black (cause-specific hazard ratio [CSHR]_highvs.low : 0.72; 95% CI, 0.55-0.94) and Latina (CSHR_highvs.low : 0.58, 95% CI, 0.36-0.93) women; but not conditional all-cause mortality (Black hazard ratio [HR]_highvs.low : 0.86; 95% CI, 0.53-1.39; Latina HR_highvs.low : 0.81; 95% CI, 0.32-2.06). Higher adherence was associated with lower incidence of less common ORC (P_trend  = .025), but conditional mortality events were limited. Adherence and ORC-specific deaths were not associated and there was no evidence of effect modification.

CONCLUSIONS

Adherence to the ACS guidelines was associated with lower risk of ORCs and less common ORCs but was not for conditional ORC-related mortality.

LAY SUMMARY

Evidence on the association between the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and cancer remains scarce for women of color. Adherence to the guidelines and risk of developing one of 13 obesity-related cancers among Black and Latina women in the Women's Health Initiative was examined. Women who followed the lifestyle guidelines had 28% to 42% lower risk of obesity-related cancer. These findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.

Physical activity and risk of benign proliferative epithelial disorders of the breast, in the Women's Health Initiative

BACKGROUND

Recreational physical activity (PA) has been shown to be inversely associated with breast cancer risk. However, the association of recreational PA with benign proliferative epithelial disorders (BPED) of the breast, conditions associated with increased risk of breast cancer, has not been adequately studied.

METHODS

We used data from an ancillary study of benign breast disease conducted among the 68 132 postmenopausal women (aged 50-79 at recruitment) participating in the Women's Health Initiative randomized clinical trials. All clinical trial participants underwent annual or biennial mammogram screening. During the follow-up, for women who reported breast biopsies but were cancer free, the associated histological sections were obtained and subjected to standardized central pathology review. Self-reported recreational PA at baseline (n = 61 684) and at 3 years of the follow-up (n = 55 923) were quantified as metabolic equivalents [MET]-h/week. There were 1624 confirmed BPED cases during an average follow-up time of 7.7 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Higher average PA over 4 years was associated with lower risk of non-atypical BPED (P-trend = 0.02). There was a 6% lower risk of non-atypical BPED for every 5 MET-h/week increase between baseline and year 3 (HR = 0.94, 95% CI 0.89-0.99). Compared with women who remained inactive (PAbaseline and PAyear3 <9 MET-h/week), those who became active (PAbaseline<9 MET-h/week to PAyear3 ≥9 MET-h/weekee), remained active (PAbaseline and PAyear3 ≥9 MET-h/week), or decreased activity (PAbaseline ≥9 MET-h/week to PAyear3 <9 MET-h/week) had lower BPED risk.

CONCLUSIONS

Recreational physical activity after menopause was associated with lower BPED risk among postmenopausal women.

Associations between Daily Movement Distribution, Bone Structure, Falls, and Fractures in Older Adults: A Compositional Data Analysis Study

With aging, bone density is reduced, increasing the risk of suffering osteoporosis and fractures. Increasing physical activity (PA) may have preventive effects. However, until now, no studies have considered movement behaviors with compositional data or its association to bone mass and structure measured by peripheral computed tomography (pQCT). Thus, the aim of our study was to investigate these associations and to describe movement behavior distribution in older adults with previous falls and fractures and other related risk parameters, taking into account many nutritional and metabolic confounders. In the current study, 70 participants above 65 years old (51 females) from the city of Zaragoza were evaluated for the EXERNET-Elder 3.0 project. Bone mass and structure were assessed with pQCT, and PA patterns were objectively measured by accelerometry. Prevalence of fear of falling, risk of falling, and history of falls and fractures were asked through the questionnaire. Analyses were performed using a compositional data approach. Whole-movement distribution patterns were associated with cortical thickness. In regard to other movement behaviors, moderate-to-vigorous PA (MVPA) showed positive association with cortical thickness and total true bone mineral density (BMD) at 38% (all p < 0.05). In addition, less light PA (LPA) and MVPA were observed in those participants with previous fractures and fear of falling, whereas those at risk of falling and those with previous falls showed higher levels of PA. Our results showed positive associations between higher levels of MVPA and volumetric bone. The different movement patterns observed in the groups with a history of having suffered falls or fractures and other risk outcomes suggest that different exercise interventions should be designed in these populations in order to improve bone and prevent the risk of osteoporosis and subsequent fractures.

Accelerometer-Measured Sedentary Patterns are Associated with Incident Falls in Older Women

BACKGROUND/OBJECTIVE

Falls cause significant problems for older adults. Sedentary time is associated with lower physical function and could increase the risk for falls.

DESIGN

Prospective study.

SETTING

Sites across the United States.

PARTICIPANTS

Older women (N = 5,545, mean age 79 years) from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study.

MEASUREMENTS

Accelerometers worn at the hip for up to 1 week collected measures of daily sedentary time and the mean sedentary bout duration, a commonly used metric for sedentary accumulation patterns. For up to 13 months after accelerometer wear, women reported daily whether they had fallen on monthly calendars.

RESULTS

In fully adjusted models, the incident rate ratios (95% confidence interval) for quartiles 1 (lowest), 2, 3, and 4 of sedentary time respectively were 1.0 (ref.), 1.07 (0.93-1.24), 1.07 (0.91-1.25), and 1.14 (0.96-1.35; P-trend = .65) and for mean sedentary bout duration was 1.0 (ref.), 1.05 (0.92-1.21), 1.02 (0.88-1.17), and 1.17 (1.01-1.37; P-trend = .01), respectively. Women with a history of two or more falls had stronger associations between sedentary time and falls incidence compared with women with a history of no or one fall (P for interaction = .046).

CONCLUSIONS

Older women in the highest quartile of mean sedentary bout duration had a significantly increased risk of falling. Women with a history of frequent falling may be at higher risk for falling if they have high sedentary time. Interventions testing whether shortening total sedentary time and/or sedentary bouts lowers fall risk are needed to confirm these observational findings.

Falls and Physical Activity among Cataract Patients in Vietnam

PURPOSE

To investigate the relationship between falls, physical activity, and other socio-demographic and visual factors among cataract patients in Ho Chi Minh City, Vietnam.

METHODS

A cross-sectional study was conducted between April and November 2018. Patients presenting to two hospitals with age-related unilateral or bilateral cataract, aged ≥50 years, literate, and scheduled for a first-eye cataract surgery were recruited. The International Physical Activity Questionnaires short form was used to measure physical activity. Visual disability score was self-reported using the Catquest-9SF. The number of falls in the last 12 months prior to data collection were self-reported. Visual acuity and contrast sensitivity were measured using standard protocols.

RESULTS

A total of 340 patients had complete data, the majority of whom were women (62.4%), living with a spouse (66.5%), had an education level of Grade 5 or below (68.2%), and a monthly income from medium to high (58.5%). Average age was 65.7 years. A total of 135 falls were reported in the last 12 months with 27.6% reporting ≥1 fall and 7.1% ≥2 falls. Persons with high (adjusted Prevalence Ratio (aPR) = 2.4, 95%CI = 1.2, 4.7) and low (aPR = 2.4, 95%CI = 1.2, 4.6) physical activity levels had more falls compared to those with moderate levels. Women (aPR = 1.7, 95%CI = 1.04, 2.7) and those with medium income (aPR = 2.9, 95%CI = 1.2, 6.9) were more likely to fall. Poor binocular logMAR visual acuity with habitual correction (aPR = 2.3, 95%CI = 1.1, 4.6) and poor visual disability scores (aPR = 1.4, 95%CI = 1.02, 2.0) were associated with falling.

CONCLUSION

Patients with a moderate level of physical activity were less likely to fall compared to those with low or high levels although this U-shape relationship needs to be further investigated in prospective interventional trials. Men and those with high monthly income, better visual acuity and visual disability score were also less likely to fall. Cataract patients might be advised to maintain a moderate level of physical activity while waiting for surgery. Strategies to prevent falls may also prioritise cataract surgery for women and those with lower income.

Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women

Objective: Physical activity (PA) may slow aging-related declines in physical functioning (PF), but the relationship of PA and falls is not well understood. This study examined the association of PA and PF with falls. Methods: The Study of Women's Health Across the Nation participants (n = 1597; age: 65.1 years ± 2.7) reported PF and PA in 2012-2013 and falls in 2016-2017. Four phenotypes were identified: high PA-high PF, high PA-low PF, low PA-high PF, and low PA-low PF. Results: One-third (29.3%) reported ≥1 fall. Women with low PA-low PF (RR = 1.32; 95% CI: 1.06, 1.66) and with high PA-low PF (RR = 1.37; 95% CI: 1.07, 1.74) were more likely to fall than high PA-high PF. Over time, women with worsening PF had increased fall risk (RR = 1.43; 95% CI: 1.17, 1.74), but women who increased PA did not. Discussion: Poor PF increases the risk of falls, regardless of PA. However, increasing PA does not necessarily increase fall risk, reinforcing the importance of PA engagement.

Association between accelerometer-measured physical activity and falls among community-dwelling older people living in cold, snowy areas

PURPOSE

The aim of the present study was to investigate the association between falls, including falls on frozen roads, and physical activity among older people living in cold, snowy regions in Japan.

METHODS

Participants were subjects of the Japan Gerontological Evaluation Study 2016 who had agreed to the Hokkaido additional visit survey in winter 2017/18 and lived in cold, snowy regions in Japan. The analysis included 461 participants (mean age 74.7 years; standard deviation 2.8 years; 46.5% male). Sociodemographic characteristics, physical activity (min/day of moderate-to-vigorous intensity physical activity [MVPA] and light intensity physical activity, and walking steps/day) measured by accelerometer, cognitive function, depression, visual impairment, and history of stroke were surveyed. Poisson regression analyses were performed to clarify the association between prevalence of falls and physical activity.

RESULTS

Of those who reported a fall with location, 86 (69.9%) fell on frozen roads, 24 (19.5%) fell on unfrozen roads and 13 (10.6%) fell indoors. There were significant positive associations between MVPA (adjusted prevalence ratio [aPR] Tertile [T] 3 vs T1, 1.73; 95% confidence interval [CI], 1.04-2.87) and all falls. When limited to falls on frozen roads, higher MVPA levels and walking steps were associated with falls on frozen roads (MVPA, aPR T3 vs T1, 2.16; 95% CI, 1.19-3.94; walking steps, aPR T3 vs T1, 2.49; 95%CI 1.33-4.68).

CONCLUSION

The risk of falls, especially on frozen roads, increased among active older people living in cold, snowy regions, and environmental factors should be considered when determining prevention strategies.

The Relationships Between Physical Performance, Activity Levels, and Falls in Older Men

BACKGROUND

Physical performance and activity have both been linked to fall risk, but the way they are jointly associated with falls is unclear. We investigated how these two factors are related to incident falls in older men.

METHODS

In 2,741 men (78.8 ± 5 years), we evaluated the associations between activity and physical performance and how they jointly contributed to incident falls. Activity was assessed by accelerometry. Physical performance was measured by gait speed, dynamic balance (narrow walk), chair stand time, grip strength, and leg power. Falls were ascertained by tri-annual questionnaires.

RESULTS

Men were grouped into four categories based on activity and performance levels. The greatest number of falls (36%-43%) and the highest fall rate (4.7-5.4/y among those who fell) (depending on the performance test) occurred in men with low activity/low performance, but most falls (57%-64%) and relatively high fall rates (3.0-4.35/y) occurred in the other groups (low activity/high performance, high activity/high performance and high activity/low performance; 70% of men were in these groups). There were interactions between activity, performance (gait speed, narrow walk), and incident falls (p = .001-.02); predicted falls per year were highest in men with low activity/low performance, but there was also a peak of predicted falls in those with high activity.

CONCLUSIONS

In community-dwelling older men, many falls occur in those with the lowest activity/worst physical performance but fall risk is also substantial with better activity and performance. Activity/physical performance assessments may improve identification of older men at risk of falls, and allow individualized approaches to prevention.

The association between physical activity and risk of falling in older adults: A systematic review and meta-analysis of prospective cohort studies

This study investigated the association between physical activity (PA) and risk of falling in older adults and suggests effective PA guidelines based on intensity and amount of PA. We found 10 prospective cohort studies with a total of 58,241 older adult participants and summarized the relative ratio of risk of falling. Older adults who participated in PA had a decreased risk of falling [0.976 (95% CI: 0.957-0.996, p = 0.019)], and inactive older adults had an increased risk of falling [1.082 (95% CI: 1.007-1.163, p = 0.031)]. Older adults who participated in moderate to vigorous intensity PA with low amount of PA had an increased risk of falling [1.217 (95% CI: 1.055-1.403, p<0.007)], when older adults who participated in moderate (3 Metabolic Equivalent: METs or higher) to vigorous intensity PA (6 METs or higher) with very high amount of PA were used as a reference. We recommend participating in PA, including moderate to vigorous intensity PA and a more than medium amount of PA, and avoiding inactivity for older adults to reduce the risk of falling.

The Impact of Physical Activity and Function on Falls in Assisted Living Residents

The purpose of this study was to describe physical activity and function of older adults in assisted living communities and test the association between moderate and vigorous activity and falls. This study used baseline data from 393 participants from the first two cohorts in the Function-Focused Care in Assisted Living Using the Evidence Integration Triangle study. The majority of participants were female (N = 276, 70%) and White (N = 383, 97%) with a mean age of 87 years (SD = 7). Controlling for age, cognition, gender, setting, and function, the time spent in moderate or vigorous levels of physical activity was associated with having a fall in the prior 4 months. Those who engaged in more moderate physical activity were 0.6% less likely to have a fall (OR = 0.994, Wald statistic = 5.54, p = .02), and those who engaged in more vigorous activity were 2% less likely to have a fall (OR = 0.980, Wald statistic = 3.88, p = .05).

Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in community-dwelling older people.

DESIGN

Systematic literature review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older adults.

MEASURES

A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (≥2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response meta-analysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.

RESULTS

People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.18-2.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P < .001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).

CONCLUSIONS/IMPLICATIONS

The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.

Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women

OBJECTIVES

To investigate associations between sarcopenia, obesity, and sarcopenic obesity and incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women.

DESIGN

Prospective cohort study.

SETTING

Three Women's Health Initiative (WHI) clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL).

PARTICIPANTS

Postmenopausal women aged 50 to 79 enrolled in the WHI who underwent bone and body composition scans using dual-energy x-ray absorptiometry at baseline (N = 11,020).

MEASUREMENTS

Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage greater than 42%. Sarcopenic obesity was defined as co-occurrence of sarcopenia and obesity. The fall outcome was defined as falling 2 or more times in any year during 7 years of follow-up. The risk of falls associated with sarcopenic obesity were analyzed using log binomial regression models stratified according to age and race/ethnicity.

RESULTS

Sarcopenic obesity was associated with greater risk of falls in women aged 50 to 64 (relative risk (RR) = 1.35, 95% confidence interval (CI)=1.17-1.56) and 65 to 79 (RR = 1.21, 95% CI=1.05-1.39). Sarcopenic obesity related fall risk was higher in Hispanic women (RR = 2.40, 95% CI=1.56-3.67) than non-Hispanic white women (RR = 1.24, 95% CI=1.11-1.39).

CONCLUSION

In a multiethnic cohort of postmenopausal women, sarcopenic obesity-related fall risk was high in women younger than 65 and those age 65 and older. Sarcopenic obesity posed the highest risk for falls in Hispanic women. The findings support identification of causal factors and health disparities in sarcopenic obesity to customize fall prevention strategies and ameliorate this significant public health burden. J Am Geriatr Soc 66:2314-2320, 2018.

Body composition and physical function in the Women's Health Initiative Observational Study

Physical function is critical for mobility and quality of life. We hypothesized that higher total lean mass is associated with higher physical function, and body fat inversely associated, among postmenopausal women. Women's Health Initiative Observational Study participants at Pittsburgh, PA; Birmingham, AL; and Tucson-Phoenix, AZ (1993–1998) completed dual-energy X-ray absorptiometry scans and the Rand SF-36 questionnaire at baseline and 3 y (N = 4526). Associations between quartiles (Q1–4) of lean or fat mass and physical function were tested using linear regression, adjusted for demographics, lifestyle factors, medical history, and scanner serial number. At baseline, participants had a mean ± SD age of 63.4 ± 7.4 y and BMI of 27.4 ± 5.8 kg/m². Higher percent lean mass was positively associated with physical function at baseline (Q4, 83.6 ± 0.6 versus Q1, 74.6 ± 0.7; p < 0.001), while fat mass (kg and %) was inversely associated (e.g., Q4, 73.7 ± 0.7 versus Q1, 84.2 ± 0.7 kg; p_trend < 0.001). Physical function had declined across the cohort at 3 y; the highest relative lean mass quartile at baseline conferred a lesser decline in physical function than the lowest (Q4, −3.3 ± 0.6 versus Q1–7.0 ± 0.6; p_trend < 0.001), while the highest fat mass quartile (% and kg) conferred greater decline (ex. Kg Q4, −6.7 ± 0.7 versus Q1–2.8 ± 0.6; p_trend < 0.001). Increased fat mass (≥5%), but not lean mass, was associated with lower physical function at 3 y (p < 0.001). Adiposity, as well as lean mass, requires consideration in the prediction of physical function among postmenopausal women over time.

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Lean mass (%) is positively associated with physical function in menopause.

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Body fat is negatively associated with physical function in menopause.

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Decline in physical function is more rapid with gains in fat during menopause.

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Body composition influence on functional decline is more evident among women <65 y.

Accelerometer-Measured Moderate to Vigorous Physical Activity and Incidence Rates of Falls in Older Women

OBJECTIVES

To examine whether moderate to vigorous physical activity (MVPA) measured using accelerometry is associated with incident falls and whether associations differ according to physical function or history of falls.

DESIGN

Prospective study with baseline data collection from 2012 to 2014 and 1 year of follow-up.

SETTING

Women's Health Initiative participants living in the United States.

PARTICIPANTS

Ambulatory women aged 63 to 99 (N = 5,545).

MEASUREMENTS

Minutes of MVPA per day measured using an accelerometer, functional status measured using the Short Physical Performance Battery (SPPB), fall risk factors assessed using a questionnaire, fall injuries assessed in a telephone interview, incident falls ascertained from fall calendars.

RESULTS

Incident rate ratios (IRRs) revealed greater fall risk in women in the lowest quartile of MVPA compared to those in the highest (IRR = 1.18, 95% confidence interval = 1.01-1.38), adjusted for age, race and ethnicity, and fall risk factors. Fall rates were not significantly associated with MVPA in women with high SPPB scores (9-12) or one or fewer falls in the previous year, but in women with low SPPB scores (≤ 8) or a history of frequent falls, fall rates were higher in women with lower MVPA levels than in those with higher levels (interaction P < .03 and < .001, respectively). Falls in women with MVPA above the median were less likely to involve injuries requiring medical treatment (9.9%) than falls in women with lower MVPA levels (13.0%) (P < .001).

CONCLUSION

These findings indicate that falls are not more common or injurious in older women who engage in higher levels of MVPA. These findings support encouraging women to engage in the amounts and types of MVPA that they prefer. Older women with low physical function or frequent falls with low levels of MVPA are a high-risk group for whom vigilance about falls prevention is warranted.