Increased Physical Activity and Fitness above the 50(th) Percentile Avoid the Threat of Older Adults Becoming Institutionalized: A Cross-sectional Pilot Study

Insulin resistance, C-reactive protein, diastolic to systolic blood pressure ratio and epicardial fat are related to sedentary time, and inversely related to physical activity in school-aged children

Background

Physical activity (PA) is beneficial for the overall health. Objectives are: (1) To compare metabolic (MRM) and cardiovascular-risk-markers (CRM) in children according to their PA-level; (2) to explore the associations of MRM and CRM with PA and sedentary time (ST); and (3) to identify the associations between MRM and CRM in less (LA) and more active (MA) children.

Methods

A total of 238 apparently healthy school-aged children were enrolled (132 boys/106 girls; 9.1 ± 1.8 years) and body mass index standard deviation score (BMI SDS) and blood pressure were assessed. Fasting venous blood sampling was performed to assess insulin resistance (HOMA-IR) and high-sensitivity-C-reactive protein (hsCRP). Epicardial fat, interventricular septal and left ventricular posterior wall thicknesses were assessed by high-resolution ultrasonography. PA and ST were assessed by enKid-questionnaire. Children were classified based on enKid-score as being LA and MA (below and above 50th percentile for PA).

Results

MA-children had lower values for: BMI SDS, diastolic-to-systolic blood pressure ratio, HOMA-IR and hsCRP (7.02 to 61.5% lower, p = 0.040 to p < 0.0001) compared to LA-children. MRM and CRM were positively associated with ST (p = 0.003 to p < 0.001), and negatively associated with PA (p = 0.044 to p < 0.001). Finally, MRM were positively associated with CRM (p = 0.008 to p < 0.0001). Interestingly, the latter associations were observed in LA-children but were not present in MA-children.

Conclusion

More PA is associated with better cardio-metabolic profile in school-aged children. PA seems to modulate the associations between MRM and CRM, thus reinforcing the idea that fostering PA in children may lower the risk for development of a cardio-metabolic disease.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Key factor cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults: the role of physical fitness, body composition, physical activity, health condition, and environmental hazards

Background

Fall risk assessment and determination of older adults’ individual risk profiles are crucial elements in fall prevention. As such, it is essential to establish cutoffs and reference values for high and low risk according to key risk factor outcomes. This study main objective was to determine the key physical fitness, body composition, physical activity, health condition and environmental hazard risk outcome cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults.

Methods

Five-hundred community-dwelling Portuguese older adults (72.2 ± 5.4 years) were assessed for falls, physical fitness, body composition, physical (in) activity, number of health conditions and environmental hazards, and sociodemographic characteristics.

Results

The established key outcomes and respective cutoffs and reference values used for fall risk stratification were multidimensional balance (low risk: score > 33, moderate risk: score 32–33, high risk: score 30–31, and very high: score < 30); lean body mass (low risk: > 44 kg, moderate risk: 42–44 kg, high risk: 39–41 kg, and very high: < 39 kg); fat body mass (low risk: < 37%, moderate risk: 37–38%, high risk: 39–42%, and very high: > 42%); total physical activity (low risk: > 2800 Met-min/wk., moderate risk: 2300–2800 Met-min/wk., high risk: 1900–2300 Met-min/wk., and very high: < 1900 Met-min/wk); rest period weekdays (low risk: < 4 h/day, moderate risk: 4–4.4 h/day, high risk: 4.5–5 h/day, and very high: > 5 h/day); health conditions (low risk: n < 3, moderate risk: n = 3, high risk: n = 4–5, and very high: n > 5); and environmental hazards (low risk: n < 5, moderate risk: n = 5, high risk: n = 6–8, and very high: n > 8).

Conclusions

Assessment of community-dwelling older adults’ fall risk should focus on the above outcomes to establish individual older adults’ fall risk profiles. Moreover, the design of fall prevention interventions should manage a person’s identified risks and take into account the determined cutoffs and respective interval values for fall risk stratification.

Stepping-forward affordance perception test cut-offs: Red-flags to identify community-dwelling older adults at high risk of falling and of recurrent falling

The stepping-forward affordance perception test (SF-APT) fills an important gap within the screening of falls risk factors by considering the perception of affordances. The test showed to be a valid instrument for community-dwelling older adults falls risk assessment. The present study aimed to distinguish and test the key outcomes of the SF-APT usable for falls risk assessment in community-dwelling older adults to determine the respective cut-offs. This cross-sectional study enrolled 347 participants (73.1 ± 6.2 years; non-fallers: 57.9%; fallers: 42.1%; recurrent-fallers: 17.9%). Falls occurrence and SF-APT outcomes were assessed. Analyses were performed using multivariate binary logistic regression analysis and receiver operating characteristic (ROC). The area under the ROC curve was computed (AUC) for each built model explaining falling or recurrent falling. Results distinguished the Estimated stepping-forward, and Absolute-error in interaction with Error-tendency as the SF-APT key outcomes for falls risk assessment [AUC_falling: 0.665 (CI 95%: 0.608–0.723); AUC_{falling recurrently}: 0.728 (CI 95%: 0.655–0.797)]. Computed cut-offs’ analysis showed that (i) a boundary stepping-forward estimation >58 cm plus an underestimation bias >5 cm (>42^nd percentile) avoid older adults to be recurrent-fallers, and (ii) a boundary stepping-forward estimation >62 cm plus an underestimation bias >6 cm (>54^th percentile) avoid older adults to be fallers. In conclusion, results suggest that SF-APT is a valuable tool for falls risk assessment in community-dwelling older adults. Interventions targeting the prevention of falls should consider the above key outcomes and the respective cut-offs as alert red-flags.

Reliability and construct validity of the stepping-forward affordance perception test for fall risk assessment in community-dwelling older adults

Thus far, few studies have examined the estimation and actual performance of locomotor ability in older adults. To our knowledge, there are no studies examining the relationship between stepping-forward estimation versus ability and fall occurrence. The aim of this study was to develop and assess the reliability and validity of a new test for fall risk assessment in community-dwelling older adults. In total, 347 participants (73.1 ± 6.2 years; 266 women) were assessed for their perception of maximum distance for the stepping-forward and action boundary. The test was developed following the existing literature and expert opinions. The task showed strong internal consistency. Intraclass correlation ranged from 0.99 to 1 for intrarater agreement and from 0.83 to 0.97 for interrater agreement. Multivariate binary regression analysis models revealed an area under the curve (AUC) of 0.665 (95% CI: 0.608–0.723) for fallers and 0.728 (95% CI: 0.655–0.797) for recurrent fallers. The stepping-forward affordance perception test (SF-APT) was demonstrated to be accurate, reliable and valid for fall risk assessment. The results showed that a large estimated stepping-forward associated with an underestimated absolute error works as a protective mechanism for fallers and recurrent fallers in community-dwelling older adults. SF-APT is safe, quick, easy to administer, well accepted and reproducible for application in community or clinical settings by either clinical or nonclinical care professionals.

Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)

Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short–medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.

Physical activity and fitness are associated with verbal memory, quality of life and depression among nursing home residents: preliminary data of a randomized controlled trial

BACKGROUND

Few studies have simultaneously examined changes in physical, cognitive and emotional performance throughout the aging process.

METHODS

Baseline data from an ongoing experimental randomized study were analyzed. Physical activity, handgrip, the Senior Fitness Test, Trail Making Test A, Rey Auditory-Verbal Learning Test, Quality of Life-Alzheimer's Disease Scale (QoL-AD) and the Goldberg Depression Scale were used to assess study participants. Logistic regression models were applied.

TRIAL REGISTRATION

ACTRN12616001044415 (04/08/2016).

RESULTS

The study enrolled 114 participants with a mean age of 84.9 (standard deviation 6.9) years from ten different nursing homes. After adjusting for age, gender and education level, upper limb muscle strength was found to be associated with Rey Auditory-Verbal Learning Test [EXP(B): 1.16, 95% confidence interval (CI): 1.04-1.30] and QoL-AD [EXP(B): 1.18, 95% CI: 1.06-1.31]. Similarly, the number of steps taken per day was negatively associated with the risk of depression according to the Goldberg Depression Scale [EXP(B): 1.14, 95% CI: 1.000-1.003]. Additional analyses suggest that the factors associated with these variables are different according to the need for using an assistive device for walking. In those participants who used it, upper limb muscle strength remained associated with Rey Auditory-Verbal Learning Test [EXP(B): 1.21, 95% CI: 1.01-1.44] and QoL-AD tests [EXP(B): 1.19, 95% CI: 1.02-1.40]. In those individuals who did not need an assistive device for walking, lower limb muscle strength was associated with Rey Auditory-Verbal Learning Test [EXP(B): 1.35, 95% CI: 1.07-1.69], time spent in light physical activity was associated with QoL-AD test [EXP(B): 1.13, 95% CI: 1.00-1.02], and the number of steps walked per day was negatively associated with the risk of depression according to the Goldberg Depression Scale [EXP(B): 1.27, 95% CI: 1.000-1.004].

CONCLUSIONS

Muscle strength and physical activity are factors positively associated with a better performance on the Rey Auditory-Verbal Learning Test, QoL-AD and Goldberg Depression Scale in older adults with mild to moderate cognitive impairment living in nursing homes. These associations appeared to differ according to the use of an assistive device for walking. Our findings support the need for the implementation of interventions directed to increase the strength and physical activity of individuals living in nursing homes to promote physical, cognitive and emotional benefits.

TRIAL REGISTRATION

ACTRN12616001044415 (04/08/2016).

Exercise merging physical and cognitive stimulation improves physical fitness and cognitive functioning in older nursing home residents: a pilot study

The main purpose of this pilot study was to examine the feasibility and the effects of a multimodal exercise intervention on the physical and cognitive functioning of institutionalized older people. Twenty-one older adults (83.5 ± 4.9 years) living in two nursing home residences, were tested on two occasions 4 weeks apart to establish a baseline measure, and then engage in the exercise program twice weekly for 8 weeks. Participants were tested again after the exercise program. Almost all physical fitness and cognitive tests were unchanged at baseline measures, but after the exercise program, significant improvements (p < 0.05) were found in all physical fitness variables (strength, cardiorespiratory endurance, flexibility and balance) and in the majority of cognitive variables (visual attention, executive functioning and information processing speed). Exercise merging physical and cognitive stimulation could have broad impacts in the individual's level of functioning and should be promoted in nursing home residences for the elderly.

The Association Between Physical Activity With Cognitive Function and Brain-Derived Neurotrophic Factor in People With Parkinson’s Disease: A Pilot Study

The objective of this study was to examine the effect of physical capacity on the relationship of brain-derived neurotrophic factor (BDNF) with cognitive function in people with PD. For this study, serum BDNF levels were measured in 29 PD participants and 30 healthy controls. Cognitive function was assessed using the Montreal Cognitive Assessment (MOCA) scale. Physical capacity was evaluated using the 6-min walk distance (6-MWD). Participants were categorized into low or high physical capacity group according to their 50th percentile 6-MWD. It was found that MOCA total score correlated with serum BDNF level (r = .44, P = .012) in the entire PD sample. This correlation remained significant only in the low physical capacity group (r = .62; P = .03) but not in the high physical capacity group (r = .31; P = .22). It was concluded that the relationship of BDNF with cognitive function might be dependent on physical capacity. The results are preliminary, thus future studies are needed to confirm these findings.

Role of physical activity, physical fitness, and chronic health conditions on the physical independence of community-dwelling older adults over a 5-year period

The variability in the individual characteristics and habits could help determine how older adults maintain independence. The impact of the variability in physical activity, physical fitness, body composition, and chronic health conditions (co-morbidities) on the independence of older adults, especially over time, is seldom examined. This study aims to analyze quantitatively the impact of baseline values and changes in physical activity, physical fitness, body composition, and co-morbidities on the physical independence of community-dwelling, older adults over a 5-year period. Data from 106 and 85 community-dwelling adults (≥60 years) were collected at baseline and after five years, respectively. Linear regression selected the main predictors of changes in physical independence as follows: the baseline physical independence (β=0.032, R(2)=9.9%) and co-morbidities (β=-0.191, R(2)=6.3%) and the changes in co-morbidities (β=-0.244, R(2)=10.8%), agility (β=-0.288, R(2)=6.7%), aerobic endurance (β=0.007, R(2)=3.2%), and walking expenditure (β=0.001, R(2)=5.1%) (p<0.05). In conclusion, baseline physical independence, baseline co-morbidities, and changes in co-morbidities, walking, agility, and aerobic endurance predicted physical independence over five years regardless of age and gender. Gains of up to 8.3% in physical independence were associated with improvements in these variables, which corresponds to regaining independence for performing one or two activities of daily living.