Combined Associations of Physical Activity and Sedentary Behavior With Depressive Symptoms in Older Adults

Functional and emotional impact of COVID-19 lockdown on older adults with sarcopenia living in a nursing home: A 15-month follow-up

This study aimed to detect the functional and emotional impact of COVID-19 lockdown on institutionalized older adults with sarcopenia during a 15-month follow-up. A prospective longitudinal cohort study was conducted in a nursing home. Participants were screened for sarcopenia, and those with a score of ≥4 points according to SARC-F questionnaire were included. Assessments were performed pre-lockdown (T1), 12 months (T2) after, and at a 15-month follow-up (T3). Functional measurements included chair stand test, handgrip, biceps brachii and quadriceps femoris strengths, appendicular skeletal mass, gait speed, Short Physical Performance Battery, and Timed Up-and-Go test. Emotional assessments included Short-Form Health Survey, Geriatric Depression Scale-Short Form, and the Mini-Mental State Examination. The analyzed sample showed a reduction in bicep strength, and other upper and lower limb strength variables showed a decreasing trend with no changes regarding muscle mass. Physical performance showed a change, specifically a deterioration in the subtest related to balance. Cognitive and emotional components were affected and quality of life was decreased. It is of paramount importance to focus on sarcopenic older adults since their characteristics can deteriorate when isolation measures are conducted.

Effects of relocation of sedentary time and physical activity in older adults with diabetes mellitus

Objective

To estimate the hypothetical effects of substituting time spent in moderate-to-vigorous physical activity (MVPA) and time spent in sedentary behavior (SB) and their associations with diabetes.

Methods

A cross-sectional study using exploratory survey methods was performed in Alcobaça city in the state of Bahia, Brazil in the year 2015. A total of 473 older adults (aged ≥60 years) participated in the study. Diabetes mellitus, time MVPA, and SB were assessed in a self-reported manner. The Poisson regression was used to verify the hypothetical effects of the substitution of MVPA with SB on diabetes.

Results

The substitution of the time in MVPA with time in SB showed higher prevalence ratios of diabetes. Conversely, the substitution of the time in SB proved to be a protective factor, with risks reduced by between 4% and 19%.

Discussion

The substitution of the time spent in MVPA with the same amount of time spent on SB can lead to an increase in the probability of diabetes, and a longer reallocation time corresponded to a greater risk.

How much time of sedentary behavior is associated with depressive symptoms in community-dwelling older adults in southern Brazil?

AIMS

Identify sedentary behavior (SB) cut-off points to screen for depressive symptoms in older adults and verify the association between these conditions.

METHODS

A cross-sectional survey of 308 community-dwelling older adults was conducted. The outcome was the presence of depressive symptoms (≥6 points on the Geriatric Depression Scale-15). The exposure was SB using the self-reported time on a weekday and weekend (International Physical Activity Questionnaire). The cut-off points for SB categorization were determined by the receiver operating characteristic curve and multivariate logistic regression to verify the association.

RESULTS

Older adults who spent ≥4.5 hours/day in SB (sensitivity = 48.8%; specificity = 67.8%) were 1.81 times more likely (95%CI: 1.03;3.15) to have depressive symptoms compared to those who stayed for shorter periods.

CONCLUSIONS

There was an association between SB and depressive symptoms; therefore, older adults must have SB <4.5 hours/day to reduce the chances of developing depressive symptoms.

Do the impacts of mentally active and passive sedentary behavior on dementia incidence differ by physical activity level? A 5-year longitudinal study

BACKGROUND

It has not been determined whether mentally active sedentary behavior (MASB) and passive sedentary behavior (PSB) differentially affect cognitive function, and whether these associations differ according to physical activity (PA) level. We examined the comparative impacts of MASB and PSB on dementia onset and aimed to understand whether the associations differed by PA level.

METHODS

A 5-year longitudinal study involving all community-dwelling older adults in a rural area in Japan (n = 5,323). Dementia onset was examined using long-term care insurance data. PA was evaluated using the International Physical Activity Questionnaire and categorized as low (<2.5 MET-h/week), moderate (<16.0 MET-h/week), or high (≥16.0 MET-h/week). We also assessed PSB (TV-watching time; <1 h/day, <3 h/day, ≥3 h/day) and MASB (Book-reading time; <10 min/day, <30 min/day, ≥30 min/day). To examine the associations of MASB and PSB with dementia onset, we performed the Fine-Gray models accounting for competing risk of death.

RESULTS

During the follow-up period, 606 (11.4%) participants developed dementia. MASB was independently associated with a lower risk of dementia; the magnitude of the impact was significant at higher PA levels. There was no association between PSB and developing dementia across all PA levels. Furthermore, dementia risk for individuals with high PA levels and moderate or high MASB levels was approximately 60% lower than those with low PA levels and low MASB.

CONCLUSIONS

Providing interventions to promote MASB, which reduces dementia risk, and PA, which increases MASB's effect on dementia incidence, can be beneficial in delaying or preventing dementia onset.

Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom

BACKGROUND

COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants.

METHODS

An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected.

RESULTS

The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format.

CONCLUSIONS

Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.

Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis

Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.

Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss

The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.

Prevalence and Factors Associated with High Concentration of Prostate-Specific Antigen: ELSIA Study

Simple Summary

Screening for prostate cancer is critical to increasing men’s longevity, and prostate-specific antigen is the primary method of screening for this cancer. Assessing the prevalence and factors associated with high concentrations of this antigen is essential and this was the objective of our study. We found associations between high concentrations of prostate-specific antigen with years of study, race/ethnicity and family arrangement, health perception, systolic blood pressure, diastolic blood pressure, metabolic diseases, alcohol consumption and sedentary behavior. These findings may guide public health policies in order to create guidelines that raise awareness to reduce risk behaviors that increase the concentrations of prostate-specific antigen.

Abstract

Background: Prostate cancer (PC) is the second most common cancer among men, behind only non-melanoma skin cancer, and the main method of screening for PC is the prostate-specific antigen (PSA). To analyze the prevalence and the factors associated with high concentration of PSA in the elderly is essential to understand this outcome, and building strategies to decrease their rates of morbidity and mortality. Methods: We performed a cross-sectional study with 96 elderly men. A high level of PSA was defined by >4.0 ng/mL. In order to identify sociodemographic, health, functional and behavioral variables, which may be associated with high levels of PSA, we carried out a multivariate analysis using Poisson regression. Results: The prevalence of high levels of PSA was 21.9% (n = 21). High levels of PSA was associated with years of study, race/ethnicity and family arrangement, health perception, systolic blood pressure, diastolic blood pressure, metabolic diseases, alcohol consumption and sedentary behavior. Conclusions: The study found a high prevalence of high PSA concentrations in the elderly and several aspects are associated, which can be a worrying factor for their health, since PSA is an important marker of prostate cancer.

Sedentary behaviors and risk of depression: a meta-analysis of prospective studies

Epidemiological evidence on the association between sedentary behaviors and the risk of depression is inconsistent. We conducted a meta-analysis of prospective studies to identify the impact of sedentary behaviors on the risk of depression. We systematically searched in the PubMed and Embase databases to June 2019 for prospective cohort studies investigating sedentary behaviors in relation to the risk of depression. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effect meta-analysis. In addition, meta-regression analyses, subgroup analyses, and sensitivity analyses were performed to explore the potential sources of heterogeneity. Twelve prospective studies involving 128,553 participants were identified. A significantly positive association between sedentary behavior and the risk of depression was observed (RR = 1.10, 95% CI 1.03-1.19, I2 = 60.6%, P < 0.01). Subgroup analyses revealed that watching television was positively associated with the risk of depression (RR = 1.18, 95% CI 1.07-1.30), whereas using a computer was not (RR = 0.99, 95% CI 0.79-1.23). Mentally passive sedentary behaviors could increase the risk of depression (RR = 1.17, 95% CI 1.08-1.27), whereas the effect of mentally active sedentary behaviors were non-significant (RR = 0.98, 95% CI 0.83-1.15). Sedentary behaviors were positively related to depression defined by clinical diagnosis (RR = 1.08, 95% CI 1.03, 1.14), whereas the associations were statistically non-significant when depression was evaluated by the CES-D and the Prime-MD screening. The present study suggests that mentally passive sedentary behaviors, such as watching television, could increase the risk of depression. Interventions that reduce mentally passive sedentary behaviors may prevent depression.

Potential influence of physical, psychological and lifestyle factors on the association between television viewing and depressive symptoms: A cross-sectional study

OBJECTIVE

To investigate the potential influence of physical, psychological, and lifestyle factors on the association between TV-viewing and depressive symptoms among Brazilian adults.

METHODS

We used cross-sectional data from the Brazilian National Survey, conducted in 2013 with 60,202 adults (≥18 years). Information regarding exposure (TV-viewing), potential influencing factors (multimorbidity, mobility, self-rated health, tobacco use, alcohol consumption, sugar consumption, and physical activity) as well as elevated depressive symptoms (through PHQ-9 - score > 9) (outcome) was collected via interview-administered questionnaires. Data on covariates were self-reported. Body mass index was estimated through the assessment of body mass and stature. Mediation models were estimated through the Karlson-Holm-Breen method.

RESULTS

Individuals who reported >5 h/d of TV viewing showed a higher prevalence of depressive symptoms than those with <5 h/d of TV viewing [8.1%(99%CI:7.6%-8.6%) vs 14.2%(99%CI:12.2%-16.6%)]. The association between TV-viewing and depressive symptoms was influenced by tobacco use (Overall: 7.22%; men: 4.46%, women: 8.59%), physical activity (men: 3.99%, women: 2.28%), mobility (overall: 11.31%, men: 10.85%, women: 11.03%), and multimorbidity (overall: 9.11%, men: 11.6%, women: 6.03%). Poor self-rated health influenced the association between TV-viewing and elevated depressive symptoms only among men (15.55%). Similarly, the association between >4 h/d of TV viewing and depressive symptoms was influenced by tobacco use (men: 6.8%, women: 11.7%), physical activity for women (5.5%), self-rated health for men (14.7%), mobility (men: 8.7%, women: 17.0%), and multimorbidity (men: 9.6%, women: 12.3%).

CONCLUSIONS

Tobacco use, physical activity, mobility, multimorbidity, and self-rated health (men) mediate the relationship between high TV-viewing and elevated depressive symptoms. Longitudinal research is required to confirm/refute our data which may also be useful to contribute to public health interventions.

Association between frailty and the combination of physical activity level and sedentary behavior in older adults

Background

The combined association of physical activity and sedentary behavior with adverse health factors is not yet clear in the literature. A combined analysis of physical activity level and sedentary behavior may provide evidence of the interrelation between these behavioral variables and the frailty syndrome. Thus, the aim of this study was to examine the relationship between physical activity level, sedentary behavior and frailty in older adults.

Methods

In this study, we evaluated 457 older adults (age range = 60 to 96 years old) from the Longitudinal Study of the Elderly Health of Alcobaça, Bahia. The frailty condition was defined by the presence of three or more of the following criteria: unintentional weight loss, slow walking speed measured over a 4.57 m test, a reduction of manual grip strength and exhaustion. Based upon these criteria, participants were classified as non-frail or frail. Physical activity level and time spent in sedentary behavior were assessed with the International Questionnaire of Physical Activity. Descriptive statistics were used to characterize the sample. To examine the combined association of physical activity and sedentary behavior with frailty, chi-square and Poisson regression tests were used. Statistical significance was defined as p ≤ 0.05.

Results

The prevalence of frailty was 8.8% (n = 40), with higher prevalence observed with increasing age. Low physical activity level combined with excessive time spent in sedentary behavior (physical activity level < 150 min/wk. and sedentary behavior ≥540 min/day) was associated with frailty, resulting in a prevalence ratio of 2.83 (95% CI, 1.23 to 6.52).

Conclusion

Frailty is more prevalent among older adults who exhibit insufficient levels of physical activity combined with a great amount of time spent in sedentary behavior, even when adjusted for sociodemographic factors.

Sedentary Behavior Is Associated With Low Leisure-Time Physical Activity and High Body Fatness in Older Brazilian Adults

Sedentary behavior (SB) has emerged as a new health risk factor, including risk of premature death. This study examined the association between SB and measures of physical activity and body fatness in older Brazilian adults. Self-report measures of SB (ie, sitting time [ST]), leisure-time physical activity (LTPA), and body fatness (body mass index [BMI]) were collected from 355 older adults aged 60 years and older by trained interviewers. Statistical procedures were conducted using SPSS software with significance set at P < .05. Overall, the median ST was 3 hours per day. Mean values of LTPA and BMI for the entire sample were 90.0 (197.4) min/week and 26.5 (4.9) kg/m², respectively. Partial correlations controlling for age revealed that ST was negatively associated with LTPA (pr = -.15 [-.25; -.04]; P = .006) and positively associated with BMI (pr = .25 [.14; .35]; P < .001). Age, BMI, and LTPA emerged as independent predictors of ST, explaining a small but significant variance in ST (R ² = .12; P = .02). Furthermore, t test revealed a significant difference in LTPA and BMI between groups of different amounts of sitting. The findings suggest that prolonged ST may have a negative impact on LTPA and BMI in older Brazilian adults.

Time Spent Sitting Is Associated with Changes in Biomarkers of Frailty in Hospitalized Older Adults: A Cross Sectional Study

Background: Sedentary behavior has gained prominence in the literature as a risk factor for health and mortality independent of physical activity level; however, little is known about the relationship of sedentary behavior with frailty in older adults. The aim of this study was to investigate if time spent sitting can be used as a discriminator of frailty in older hospitalized persons.

Methods: The study included 162 hospitalized inpatients aged ≥60 years. Blood samples were taken for analyzing leukocyte counts and serum concentrations of C-reactive protein (CRP). Participants also answered a questionnaire about time spent sitting. Frailty was determined from a combination of CRP concentration and leukocyte count. Receiver operating characteristic (ROC) curves were constructed to analyse the predictive power and cut-points for time spent sitting and the presence of frailty.

Results: The areas under the ROC curves indicated that time spent sitting was an independent indicator of frailty (area under curve >0.6). The cut-off points for time spent sitting as an indicator of frailty were >257 min/day for men and >330 min/day for women.

Conclusions: Time spent sitting is associated with biomarkers of frailty in persons aged ≥60 years, indicating a need for interventions aimed at reducing sedentary behavior in this age group.