Physical activity trajectories and subsequent fall risk: ARIC Study

Course and trajectories of insulin resistance, incident heart failure and all-cause mortality in nondiabetic people

BACKGROUND

In nondiabetic people, the long-term effects of insulin resistance (IR) on heart failure (HF) and all-cause mortality have not been studied.

OBJECTIVES

To examine the association between IR trajectories and incident HF and all-cause mortality in a nondiabetic population.

METHODS

We studied 7835 nondiabetic participants from the Atherosclerosis Risk in Communities (ARIC) Study. We estimated IR with several methods: Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose Index (TyG Index), and metabolic score for insulin resistance (METS-IR). The latent class analysis identified two trajectories for HOMA-IR ('low level' and 'high level'), and three trajectories for TG/HDL-C, TyG index, and METS-IR ('low level', 'moderate level', and 'high level'). Cox proportional hazard models were employed to examine the association.

RESULTS

Participants in the 'high level' group of HOMA-IR trajectory patterns were more likely to have incident HF and all-cause mortality with HRs (95% CIs) of 1.29 (1.11-1.50) and 1.31(1.19-1.44), respectively, compared to the 'low level' group. Similarly, participants in the 'moderate level' and 'high level' groups of TG/HDL-C, TyG index, and METS-IR trajectories had elevated risks of incident HF and all-cause mortality. However, no increased risk was found for all-cause mortality for men in the 'moderate level' and 'high level' group of TG/HDL-C, TyG index, and METS-IR relative to the 'low level' group.

CONCLUSIONS

Long-term moderate and high IR levels were positively associated with increased risks of incident HF for both males and females. For all-cause mortality, however, consistent associations were found only in women.

Falls and patterns of physical activity participation over 18 years in the Australian Longitudinal Study on Women's Health

OBJECTIVE

To explore the relationship between long-term physical activity (PA) participation and falls.

METHODS

Participants in the Australian Longitudinal Study of Women's Health born 1946-1951 self-reported amounts of PA every 3 years since 1998 (mean age: 54 years, n=11 796). Latent class analysis described profiles of self-reported PA participation over 18 years. Associations between patterns of PA participation and self-reported falls measured in 2019 were examined using multinomial logistic regression adjusted for directed-acyclic graph-informed potential confounders, with the highly active group as the reference category.

RESULTS

Women were grouped into five PA participation profiles. Compared with consistently highly active patterns (maintaining ≥300 min/week, 22%), consistently lower levels of PA<100 min/week (18%), consistently some PA<150 min/week (18%) and decreasing PA but maintaining≥150 min/week (n=3540, 30%) had higher odds of non-injurious falls (odds Ratiolower level (OR): 1.59, 95% CI 1.29 to 1.97; ORsome PA: 1.27, 95% CI 1.04 to 1.55; ORdecreasing activity:1.29, 95% CI 1.02 to 1.63) and injurious falls (ORlow level: 1.32, 95% CI 1.06 to 1.64; ORsome PA: 1.27, 95% CI 1.04 to 1.54; ORdecreasing activity: 1.47, 95% CI 1.18 to 1.83). No association was found between increasing PA (≥150 min/week, 11%) for non-injurious (OR 1.07, 95% CI 0.89 to 1.29) and injurious falls (OR 1.07, 95% CI 0.90 to 1.29). After adjusting for potential confounders, consistently lower levels of PA remained associated with increased non-injurious falls odds (OR1998 survey: 1.40, 95% CI 1.11 to 1.77; OR2016 survey: 1.35, 95% CI 1.07 to 1.71).

CONCLUSION

The increased odds of falls among women with consistently lower levels of PA over 18 years supports ongoing participation of 150+ min/week of PA.

U-shaped association between the triglyceride-glucose index and atrial fibrillation incidence in a general population without known cardiovascular disease

OBJECTIVE

The triglyceride-glucose (TyG) index has been shown to be a new alternative measure for insulin resistance. However, no study has attempted to investigate the association of the TyG index with incident atrial fibrillation (AF) in the general population without known cardiovascular diseases.

METHODS

Individuals without known cardiovascular diseases (heart failure, coronary heart disease, or stroke) from the Atherosclerosis Risk in Communities (ARIC) cohort were recruited. The baseline TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and incident AF was examined using Cox regression.

RESULTS

Of 11,851 participants, the mean age was 54.0 years; 6586 (55.6%) were female. During a median follow-up of 24.26 years, 1925 incidents of AF cases (0.78/per 100 person-years) occurred. An increased AF incidence with a graded TyG index was found by Kaplan‒Meier curves (P < 0.001). In multivariable-adjusted analysis, both < 8.80 (adjusted hazard ratio [aHR] = 1.15, 95% confidence interval [CI] 1.02, 1.29) and > 9.20 levels (aHR 1.18, 95% CI 1.03, 1.37) of the TyG index were associated with an increased risk of AF compared with the middle TyG index category (8.80-9.20). The exposure-effect analysis confirmed the U-shaped association between the TyG index and AF incidence (P = 0.041). Further sex-specific analysis showed that a U-shaped association between the TyG index and incident AF still existed in females but not in males.

CONCLUSIONS

A U-shaped association between the TyG index and AF incidence is observed in Americans without known cardiovascular diseases. Female sex may be a modifier in the association between the TyG index and AF incidence.

Trajectory of physical activity frequency and cancer risk: Findings from a population-based cohort study

BACKGROUND

Physical activity (PA) changes throughout an individual's life, but the association between such changes and cancer risk seems to be overlooked in the literature. Thus, this study aimed to examine the association between the trajectories of PA frequency and cancer incidence among middle-aged Korean adults.

METHODS

A total of 1,476,335 eligible participants (992,151 men and 484,184 women) aged ≥40 years from the National Health Insurance Service cohort (2002-2018) were included. Assessment of PA frequency was a self-reported measure, based on the question: "How many times per week do you perform exercise that makes you sweat?". PA frequency trajectories (i.e., trajectory classes of change in PA frequency) from 2002 to 2008 were identified using group-based trajectory modeling. Cox proportional hazards regression was used to assess the associations between the PA trajectories and cancer incidence.

RESULTS

Five PA frequency trajectories over 7 years were identified: persistently low (men:73.5%; women:74.7%), persistently moderate (men:16.2%; women:14.6%), high-to-low (men:3.9%; women:3.7%), low-to-high (men:3.5%; women:3.8%), and persistently high (men:2.9%; women:3.3%). Compared with persistently low frequency, maintaining a high PA frequency was associated with a lower risk of all cancers (Hazard ratio (HR) = 0.92, 95%CI = 0.87-0.98) and breast cancer (HR = 0.82, 95%CI = 0.70-0.96) among women. There was a lower risk for thyroid cancer among men in the high-to-low (HR = 0.83, 95%CI = 0.71-0.98), low-to-high (HR = 0.80, 95%CI = 0.67-0.96), and high PA trajectories (HR = 0.82, 95%CI = 0.68-0.99). There was a significant association between moderate trajectory and lung cancer in men (HR = 0.88, 95%CI = 0.80-0.95), in both smoking and non-smoking men.

CONCLUSION

Long-term persistent high frequency of PA as part of the daily routine should be widely promoted and encouraged to reduce the risk for all cancer development in women.

Life-Course Trajectories of Physical Activity and Melanoma Risk in a Large Cohort of Norwegian Women

Purpose

Physical activity (PA) is a cornerstone in disease prevention and varies throughout life. A pooled analysis of cohort studies and a meta-analysis of cohort studies found positive associations between PA and melanoma risk. However, previous studies focused on PA at specific ages and often lacked information on ultraviolet radiation (UVR) exposure. Using the population-based Norwegian Women and Cancer (NOWAC) cohort, including information on PA and UVR exposure, we estimated life-course PA trajectories from adolescence to adulthood and their associations with melanoma.

Methods

Total PA across different domains (recreation, occupation, transport, household) was reported for ages 14 and 30 years, and when responding to the questionnaire (31-76 years) using a 10-point scale, validated to rank PA levels in Norwegian females. We estimated life-course PA trajectories using a latent class mixed model in 152,248 women divided into three subcohorts depending on age at questionnaire completion: 31-39 (n = 27,098), 40-49 (n = 52,515) and ≥50 years (n = 72,635). The unique 11-digit identity number of Norwegian citizens was used to link NOWAC to the Cancer Registry of Norway for information on cancer diagnoses, emigration and death. Associations between PA trajectories and melanoma risk were estimated in each subcohort using multivariable Cox regression.

Results

Five classes of individual life-course PA trajectories were identified in subcohort 31-39 years (low, moderate, high, decreasing, increasing PA) and four in subcohorts 40-49 and ≥50 years (low, moderate, high, decreasing PA). No significant association was found between life-course PA trajectories and melanoma risk in any subcohort. Hazard ratios (95% confidence intervals) for the high versus moderate trajectory were 0.92 (0.66-1.29), 1.15 (0.97-1.37) and 0.90 (0.78-1.05) for subcohorts 31-39, 40-49 and ≥50 years, respectively.

Conclusion

Our results do not support a positive association between PA and melanoma risk found in previous studies, which is important for public health guidelines promoting regular PA.

Daily and hourly patterns of physical activity and sedentary behavior of older adults: Atherosclerosis risk in communities (ARIC) study

This cross-sectional study of older adults ≥ 65 years describes daily and hourly patterns of accelerometer-derived steps, sedentary, and physical activity behaviors and examines differences by day of the week and sociodemographic and health-related factors to identify time-use patterns. Data were from 459 Atherosclerosis Risk in Communities (ARIC) study participants (60% female; mean ± SD age = 78.3 ± 4.6 years; 20% Black) who wore a hip accelerometer ≥ 4 of 7 days, for ≥ 10 h/day in 2016. We used linear mixed models to examine daily patterns of steps, sedentary, low light, high light, and moderate-to-vigorous intensity physical activity (MVPA). Differences by sex, median age ( Collapse

Key Words

• Accelerometer
• Elderly
• Movement
• Steps
• Time-use

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MESH Headings Collapse

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Affiliation(s)

Erin E. Dooley The University of Alabama at Birmingham, Birmingham, AL, USA
Lisa A. Pompeii Baylor College of Medicine, Houston, TX, USA
Priya Palta Columbia University Irving Medical Center, New York, NY, USA
Pablo Martinez-Amezcua Columbia University Irving Medical Center, New York, NY, USA
Bjoern Hornikel The University of Alabama at Birmingham, Birmingham, AL, USA
Kelly R. Evenson Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Jennifer A. Schrack Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Kelley Pettee Gabriel The University of Alabama at Birmingham, Birmingham, AL, USA

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Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

BACKGROUND

Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

METHODS

In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

FINDINGS

We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).

INTERPRETATION

Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

FUNDING

US Centers for Disease Control and Prevention.

Distinct physical activity and sedentary behavior trajectories in older adults during participation in a physical activity intervention: a latent class growth analysis

BACKGROUND

This study aimed to identify latent moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) trajectories in older adults participating in a randomized intervention trial and to explore associations with baseline social-cognitive predictors.

METHODS

Data were assessed at baseline (T0, participants were inactive or had recently become active), after a ten-week physical activity intervention (T1), and a second 24-week intervention phase (T2). Latent class growth analysis was used on accelerometer-assessed weekly MVPA and daily SB, respectively (n = 215 eligible participants). Activity changes within trajectory classes and baseline social-cognitive predictor differences between trajectory classes were analyzed.

RESULTS

A "stable insufficient MVPA" (n = 197, p for difference in MVPA level at T0 and T2 (pT0-T2) = .789, effect size (Cohen's d) = .03) and a "stable high MVPA" trajectory (n = 18, pT0-T2 = .137, d = .39), as well as a "slightly decreasing high SB" (n = 63, p for difference in SB (pT0-T2) = .022, d = .36) and a "slightly increasing moderate SB" trajectory (n = 152, pT0-T2 = .019, d = .27) emerged. Belonging to the "stable high MVPA" trajectory was associated with higher action planning levels compared to the "stable insufficient MVPA" trajectory (M = 5.46 versus 4.40, d = .50). Belonging to the "decreasing high SB" trajectory was associated with higher action self-efficacy levels compared to the "increasing moderate SB" trajectory (M = 5.27 versus 4.72, d = .33).

CONCLUSIONS

Change occurred heterogeneously in latent (not directly observed) subgroups, with significant positive trajectories only observed in the highly sedentary.

TRIAL REGISTRATION

German Registry of Clinical Trials, DRKS00016073 , Registered 10 January 2019.

Protein and physical activity in older persons

PURPOSE OF REVIEW

The aim of this study was to highlight recent evidence on protein requirement and physical activity recommendations in older adults and their interrelationship.

RECENT FINDINGS

Higher protein intake in older adults is beneficial for better physical function, reduced fracture risk, healthy ageing and lower mortality. However, the association between protein quality and health remains inconsistent. Higher physical activity is associated with a lower risk of physical dependence, frailty, cognitive impairment and mortality. Prospectively increasing or even sustaining physical activity can be protective against adverse health outcomes compared with decreasing physical activity. There is a synergistic protective effect of protein intake and physical activity on health. Data on the bidirectional link between protein intake and physical activity are scarce. Whether increasing physical activity can help to increase energy intake (and thus protein intake) and vice versa require further research.

SUMMARY

The key role of protein intake and physical activity in optimizing health in older adults is well established. The synergistic effects of these two modifiable lifestyle factors strengthen the need to consider dietary and physical activity recommendations together. Future research may examine the bidirectional link between diet and physical activity, which could potentially be one of the strategies to increase the uptake of recommendations for protein intake and physical activity in older adults.

Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort

Background

The impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated.

Methods and Results

We studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2.

Conclusions

Risk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Risk factors associated with history of falls in adults with intellectual disability

BACKGROUND

Adults with intellectual disability (ID) have a higher risk for falls than the general population.

AIM

The purpose of this study was to identify risk factors for falls in adults with ID using objective measurements.

METHODS

Eighty adults with ID (men 36 women 44 age 43 ± 13 years) provided data on falls history, health problems or limitations in daily life, physical activity (PA), and physical performance. We conducted independent-samples t-tests, and Chi-square (χ²) tests to examine the difference between fallers and non-fallers. Multivariate logistic regressions were performed to identify the independent effects of risk factors for falls in adults with ID.

RESULTS

Fallers had significantly lower SPPB, mobility, and moderate PA than non-fallers (p <  .05). Fallers were more likely to be older, need support with activities of daily living (ADLs), and have arthritis or rheumatism, walking problem, and limitations to participating in PA than non-fallers (p <  .05). Among these variables, only needing support with ADLs remained a significant independent predictor of falls in a multivariate model.

CONCLUSION

Support need for ADLs can predict falls in individuals with ID. Caregivers may need to closely monitor adults with ID who need support for ADLs.

A clinical guide to the pathophysiology, diagnosis and treatment of osteosarcopenia

Advances in medicine have paved the way for older persons to live longer, but with more years spent living with disability and dependency. Many older persons are living with comorbidities such as osteoporosis (loss of bone mass) and sarcopenia (loss of muscle mass and function), two diseases that, when concurrent, form osteosarcopenia, a newly identified musculoskeletal syndrome. Osteosarcopenia impedes mobility and diminishes independence and thus quality of life. Evidence suggests the pathology of this syndrome comprises genetic polymorphisms, alterations in mechanotransduction, and localized or systemic crosstalk between growth factors and other proteins (myokines, osteokines, adipokines). As a direct result of an aging society, health outcomes such as falls and fractures will rise as the prevalence of osteosarcopenia increases. Two major risk factors for osteosarcopenia (other than age itself) are physical inactivity and poor nutrition. Addressing these modifiable risk factors can prevent, or at least delay, the onset of osteosarcopenia. Pharmaceutical treatments for osteosarcopenia are currently unavailable, although research trials are underway. This review provides an update from basic and clinical sciences on the biology, epidemiology (prevalence, risk factors and diagnosis) and treatments for osteosarcopenia, and recommends future research priorities to improve health outcomes for those living with or at risk of osteosarcopenia.