Effects of daytime activity on nocturnal sleep in the elderly

Effects of 12-week resistance exercise and interval training on the skeletal muscle area, physical fitness, and mental health in old women

This study aimed to determine the effects of resistance exercise and interval training on the visceral fat to skeletal muscle area, physical fitness, cognitive functions, and mental health in old women. The study was conducted among 30 older women enrolled in the National Fitness Center in Seoul. They were randomly sampled into the resistance exercise and interval training group (RI group: n=10, aged 64.10±3.35), the resistance and aerobic exercise group (RA group: n=10, aged 65.20± 5.10), and the control group (n=10, aged 63.20±2.62). Twelve weeks of exercise involving 30-min resistance exercise followed by 30-min interval training or aerobic exercise, 3 times a week, were performed by each group. A computed topography was used to the measure visceral fat area and the thigh skeletal muscle area. For physical fitness, maximum oxygen uptake, knee isokinetics muscle functions, ankle range of motion, and functional fitness of the elderly (muscle strength, cardiorespiratory endurance, flexibility, balance, and agility) were measured. For blood test, the metabolic syndrome risk factors, growth hormone, testosterone, and insulin-like growth factor-1 (IGF-1) were measured. A self-administered questionnaire was used to measure cognitive functions and quality of sleep. The 12-week RA and RI groups were effective in changing the thigh skeletal muscle area, IGF-1, knee joint extension and flexion, ankle range of motion, functional fitness, and quality of sleep. In conclusion, resistance exercise, followed by interval training or aerobic exercise, was effective in improving the skeletal muscle function indexes, physical fitness, and quality of sleep for the elderly. However, no difference was found between the two types of exercise.

Diurnal Physical Activity Patterns in Patients With Chronic Obstructive Pulmonary Disease

PURPOSE

People with chronic obstructive pulmonary disease (COPD) have reduced physical activity (PA) levels compared with healthy controls. The pattern of their PA level during the day is much less documented. A better understanding of these diurnal PA patterns could help optimize interventions targeting PA levels in this population. The aim of this study was to examine, in patients with COPD, diurnal PA patterns using accelerometer data and different approaches to data handling (arbitrary, mealtime, equal tertiles).

METHODS

Fourteen COPD patients (aged 71 ± 9 yr; forced expiratory volume in 1 sec [FEV1]: 58% ± 13% predicted) completed the study. Daily PA was assessed via accelerometry for 7 d, 24 hr/d. Diurnal PA patterns were evaluated using an arbitrary (08:00-12:00, 12:01-16:00, 16:01-20:00), mealtime (wake time-lunchtime, lunchtime-suppertime, suppertime-bedtime), and equal tertiles (tertiles 1, 2, and 3) approaches. Results were interpreted on the basis of descriptive statistics and effect sizes (Cohen f) for time-of-day changes in PA.

RESULTS

Regardless of the handling approach used, mean PA levels decreased in the evening and the effect size for time-of-day changes in PA level was large (f = 0.97; 1.82; and 1.66 for the arbitrary, mealtimes, and tertiles approaches, respectively). The observation of a decrease in the evening was highly homogeneous across our sample, particularly with the mealtime and equal tertiles handling approach.

CONCLUSION

Results from this study support prior findings that PA levels decrease substantially in the evening in patients with COPD, thereby providing a better understanding of within-day PA behavior and offering valuable insight into interventions targeting PA.

Quantitative evaluation of severity of behavioral and psychological symptoms of dementia in patients with vascular dementia

To quantitatively evaluate severity of behavioral and psychological symptoms of dementia (BPSD) for vascular dementia (VD). Changes of 51 patients with VD in BPSD between the first and 24th week were assessed using the Neuropsychiatric Inventory (NPI) and the behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale, in detrended fluctuation analysis (DFA) represented by diurnal activity (DA), evening activity (EA), and nocturnal activity (NA), and the relationships were analyzed. The subscores of activity disturbances, diurnal rhythm disturbances, and anxieties and phobias in the BEHAVE-AD score, and that of agitation, irritability, and sleep disorder in the NPI score were significantly increased compared with the first week, as was for the changes for EA in the DFA value. A linear correlation was observed between the changes of activity disturbances plus anxieties and phobias, and those of DA, and between the development of diurnal rhythm and those of EA, the vehement and autism scores and those of DA, and the difference in sleep disorder scores and those of EA, respectively. Analysis of DA, NA, and EA may reflect the fluctuational degrees of VD-BPSD, can provide a useful assessment of VD-BPSD accompanied by clinical scores for VD.

Effects of indoor gardening on sleep, agitation, and cognition in dementia patients--a pilot study

OBJECTIVE

A pilot study was performed to examine the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients.

METHOD

Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively.

RESULTS

Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved.

CONCLUSION

Indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients. Randomized controlled studies of larger sample size are needed to confirm treatment effect.

Transdermal fentanyl reduces pain and improves functional activity in neuropathic pain states

OBJECTIVE

The efficacy of transdermal fentanyl in chronic neuropathic pain has not been well studied. We examined the effects of transdermal fentanyl on pain and function in patients with chronic neuropathic pain states.

DESIGN

A 16-week open-label study evaluated pre- and postdrug therapy effects. An actigraph was used to record pain scores (0-10) three times a day and activity level (8 am-8 pm) continuously. Pain scores were also entered in pain diary logs.

SETTING

The study was conducted on subjects visiting the Johns Hopkins Hospital as outpatients.

PATIENTS

Patients with peripheral neuropathic pain (N = 25), complex regional pain syndrome-1 (N = 19), and postamputation pain (N = 9) were enrolled in the study.

INTERVENTIONS

After a 2-week baseline, transdermal fentanyl was titrated over 6 weeks with a dose of 25-150 microg/h based on individual response and then followed for an 8-week maintenance period.

OUTCOME MEASURES

Average pain score and activity level were compared during the last week of the baseline and maintenance periods. Subgroup effects were also examined. Other outcome measures included pain relief (0-100%), cognition, affect, and impairment of function.

RESULTS

Forty patients completed the study, and 13 withdrew at varying time points. The average dose for transdermal fentanyl was 105.6 microg/h. Significant reductions in pain (-2.94 +/- 0.27) and percent pain relief (33.7 +/- 14%) were observed. These reductions in pain were accompanied by a 37.4% average increase in daytime activity. Sedation and nausea/vomiting were the common side effects. No significant changes were observed in tests of cognition or affect.

CONCLUSIONS

Overall, there was a significant reduction in pain intensity and increase in activity in neuropathic pain patients treated with transdermal fentanyl.

The Reliability and Validity of the Physical Activity Survey in Long-Term Care

The purpose of this study was to develop and test a measure of physical activity for residents in long-term-care facilities, the Physical Activity Survey in Long-Term Care (PAS-LTC). Sixty-six activities are included in the PAS-LTC: routine physical activity, personal-care activities, structured exercise, recreational activities, caretaking activities, and repetitive activities. The study included 13 residents in a long-term-care facility, most of whom were women (62%), with an average age of 84 years (± 6.0) and an average Mini Mental State Examination score of 6 (± 6.9). There was evidence of interrater reliability of the PAS-LTC with intraclass correlations of .83-.94. There was some evidence of validity of the measure with statistically significant correlations between PAS-LTC recorded during the evening and night shifts and the number of counts of activity per the ActiGraph (r= .60 andr= .57, respectively,p< .05) and the calories estimated (r= .58 andr= .60, respectively,p< .05). The PAS-LTC completed during the day shift and total activity based on the PAS-LTC showed nonsignificant correlations of .40 or greater with the ActiGraph activity counts and calories.

Analysis of nighttime activity and daytime pain in patients with chronic back pain using a self-organizing map neural network

There may be a relationship between sleep and pain in patients with chronic back pain. We collected day-time pain and nighttime activity data from 18 patients diagnosed with chronic back pain. The patients were followed for 6 days and 5 nights. Pain levels were collected every 90 min between 0800 hours and 2,200 hours using a computerized electronic diary. Activity levels were collected using a wrist accelerometer (Actiwatch AW-64). The Actiwatch sampled activity counts every 1 min. Patients were asked to wear the Actiwatch on their non-dominant arm. The pain level measurements were interpolated using cubic splines. A mean pain level was calculated for each period 0800 hours to 2,200 hours as well as for the 6-day period. The difference between the mean pain levels for the 6-day period and each 0800 hours to 2,200 hours period was calculated for each patient. Nighttime activity data were analyzed using the Actiwatch Sleep Analysis software. Correlations were calculated between the Actiwatch Sleep Analysis variables and the mean pain level differences for each patient and period. The correlation analysis was performed with SPSS 7.5. We were unable to show any significant relationships.A different approach to analyze the data was used. A Self-Organizing Map (SOM) Neural Network was trained using the original nighttime activity level time series from 10 randomly selected patients. Recall was then performed on all the activity level data. Correlations were calculated between the pain level variance for the 6-day period for each patient and the corresponding difference in the SOM output coordinates. The correlation was found to be r = 0.73, p < 0.01). We conclude that daytime pain levels are not directly correlated with sleep in the following night and that sleep is not directly correlated with daytime pain levels on the following day in this group of patients. There appears to be a correlation between the difference in nighttime activity levels and patterns and the daytime pain variance. Patients who experience large fluctuations in daytime pain levels also show a higher variability in their nighttime activity levels and patterns. Even though we were unable to show a direct relationship between daytime pain and sleep, it may be reasonable to assume that better pain control resulting in less daytime pain fluctuations can provide more stable nighttime activity levels and patterns in this limited group of patients. By using a neural network model, we were able to extract information from the nighttime activity levels even though a traditional statistical analysis was unsuccessful.