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Nemoto Y, Brown WJ, Ding D, Nguyen B, Mielke GI. Trajectories of Physical Activity and Chronic Conditions Among Mid-Aged Women. Am J Prev Med 2024:S0749-3797(24)00169-7. [PMID: 38796029 DOI: 10.1016/j.amepre.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Women's physical activity levels vary throughout adulthood. However, the associations between trajectories of physical activity and health outcomes have been little studied. The aim of this study was to examine the associations of physical activity trajectories with incident diabetes, hypertension, obesity, depression, and physical disability in mid-aged women. METHODS Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (n=11,611). Mailed surveys at 3-year intervals from 1998 (age 47-52) to 2019 (age 68-73) were used to collect data on physical activity and each outcome. The analyses were conducted in 2023/24. Physical activity trajectories from age 47-61 (2-4 time-points) were identified using group-based trajectory modeling. Cox regression models with time-varying covariates were used to examine the associations of physical activity trajectories with adverse health outcomes onset from ages 56-73 (2-5 time-points). RESULTS Trajectories of physical activity were labeled as Low (59.7% of participants), Declining (5.9%), Increasing (26.3%), and High (8.1%). The median of 9-year overall physical activity (MET.minutes/week) was 450 in the Low, 1324 in the Declining, 1399 in the Increasing, and 2323 in the High group. Compared with the Low group, the risks of diabetes, obesity and physical disability were lower in the Increasing and High groups, and the risk of depression was lower in the High group. Conversely, the risk of obesity was higher in the Declining group. CONCLUSIONS Targeting mid-aged women with declining physical activity for prevention programs could enhance health in later life.
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Affiliation(s)
- Yuta Nemoto
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia; Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan; School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan.
| | - Wendy J Brown
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Binh Nguyen
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Gregore Iven Mielke
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Duarte Junior MA, Martínez-Gómez D, Pintos-Carrillo S, Sotos-Prieto M, Ortolá R, Rodríguez-Artalejo F, Cabanas-Sánchez V. Associations of physical activity type, volume, intensity, and changes over time with all-cause mortality in older adults: The Seniors-ENRICA cohorts. Scand J Med Sci Sports 2024; 34:e14536. [PMID: 37929622 DOI: 10.1111/sms.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To assess the association of physical activity (PA) type, volume, intensity, and changes over time with all-cause mortality in older adults. METHODS We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts. PA was assessed with the EPIC questionnaire. Participants reported how many hours they spent a week in walking, cycling, gardening, do-it-yourself (DIY), sports, and housework. Then, time at each intensity (moderate PA [MPA], vigorous PA [VPA], moderate-to-vigorous PA [MVPA] and total PA) was calculated. Changes in PA were calculated from the date of the baseline interview to Wave 1. All-cause mortality was ascertained up January 31, 2022. Analyses were performed with Cox regression models, adjusting for the main confounders. RESULTS Walking, gardening, sports, and housework was associated with lower mortality (ranged 20%-46%). Also, MPA, VPA, MVPA was associated with lower risk of mortality (ranged 28%-53%). Analyses of PA change showed that, compared no PA participation (at baseline nor Wave 1), maintain walking, sports, and housework (ranged 28%-53%) and maintaining MPA, VPA, and MVPA (ranged 32%-36%) levels was linked to decreased mortality risk. Those who increased, maintained, or even decreased total PA had lower mortality (57%, 52%, and 36%, respectively) than those with consistently very low PA. CONCLUSIONS The lower mortality was observed in those with a high baseline level of total PA. Maintaining PA levels such as walking, gardening, and housework, or at all analyzed intensities, was related to lower mortality.
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Affiliation(s)
- Miguel Angelo Duarte Junior
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Salud Pintos-Carrillo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Verónica Cabanas-Sánchez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Yin R, Wang Y, Li Y, Lynn HS, Zhang Y, Jin X, Yan LL. Changes in physical activity and all-cause mortality in the oldest old population: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Prev Med 2023; 175:107721. [PMID: 37802195 DOI: 10.1016/j.ypmed.2023.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80 years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80 years or older) population using the Chinese Longitudinal Healthy Longevity Survey. METHODS Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n = 14,287), 2) remaining physically active (n = 5411), 3) shifting from being inactive to active (n = 1364), and 4) shifting from being active to inactive (n = 1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups. RESULTS A total of 15,707 participants died during follow-up (median duration of follow-up = 3.0 years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata. CONCLUSION Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.
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Affiliation(s)
- Ruoyu Yin
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Yinsu Wang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China.
| | - Yaxi Li
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Henry S Lynn
- School of Public Health, Fudan University, Shanghai, China; School of Public Health, Xinjiang Medical University, Xinjiang, China.
| | - Yueqian Zhang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China.
| | - Xurui Jin
- MindRank AI Ltd., Hangzhou, Zhejiang 310000, China..
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; School of Public Health, Wuhan University, Wuhan, China; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; The George Institute for Global Health, China.
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Hassan L, Huhndorf P, Mikolajczyk R, Kluttig A. Physical activity trajectories at older age and all-cause mortality: A cohort study. PLoS One 2023; 18:e0280878. [PMID: 36701298 PMCID: PMC9879516 DOI: 10.1371/journal.pone.0280878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A physically active lifestyle is recognized as a precondition of healthy aging. However, the majority of studies exploring its association with mortality in cohorts of adults used single-time physical activity (PA) estimate, which do not consider its dynamic nature with changes that occur with aging. The aim of the present study is to explore the presence of different PA trajectories in a population-based cohort and their association with mortality. METHODS We used data of the population-based cohort study CARLA and included 1041 older adults (45-83 years at baseline) with self-reported physical activity at baseline (2002-2006), first follow-up (2007-2010) and second follow-up (2013). Trajectories were identified using growth mixture modelling. Cox proportional hazard models were used to assess the association between trajectories of PA and all-cause mortality during ~6 years since the second follow-up after adjusting for age, sex, lifestyle factors and comorbidities and after correction for classification error. In a sensitivity analysis we weighted the models to account for selection bias during follow-up. As a further sensitivity analysis, we excluded the first year of follow-up to account for reverse causation. RESULTS Three PA trajectories (categorized as consistently low, consistently moderate, and high at baseline but strongly decreasing PA across time) were identified, and 121 deaths due to all causes occurred. Compared with participants who had consistently low PA-levels throughout the follow-up period, participants who maintained moderate PA-levels were at a lower risk of all-cause mortality (hazard ratio [HR], 0.49; 95%CI, 0.30-0.70). Participants with high PA-levels at baseline but strongly decreasing PA across time, had similar mortality risk compared to the participants with consistently low PA-levels (hazard ratio [HR], 0.97; 95%CI, 0.50-1.80). The effects were strengthened in the analysis weighted for selection bias. CONCLUSIONS Our results suggest that, compared to those who had consistently low PA levels, those who maintained a moderate level of PA showed a protective effect in terms of their mortality risk but not those who displayed a decline from high PA levels.
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Affiliation(s)
- Lamiaa Hassan
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter Huhndorf
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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Salinas-Rodríguez A, Manrique-Espinoza B, Palazuelos-González R, Rivera-Almaraz A, Jáuregui A. Physical activity and sedentary behavior trajectories and their associations with quality of life, disability, and all-cause mortality. Eur Rev Aging Phys Act 2022; 19:13. [PMID: 35488197 PMCID: PMC9052456 DOI: 10.1186/s11556-022-00291-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) and sedentary behavior (SB) are not stable conditions but change over time and among individuals, and both could have deleterious effects on health-related outcomes among older adults. This study aimed to identify the longitudinal trajectories of PA and SB and estimate their association with quality of life, disability, and all-cause mortality in a national sample of older Mexican adults. METHODS Data comes from three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 3209 older adults ages 50 and above were included. PA and SB were determined by using the Global Physical Activity Questionnaire (GPAQ). Disability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0), quality of life using the WHOQOL (WHO Quality of Life) instrument, and all-cause mortality using a verbal autopsy. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of PA and SB. Three-level linear mixed effect models were used to estimate the associations of PA and SB with quality of life and disability and the Cox model for the association with all-cause mortality. RESULTS Three longitudinal trajectories of PA and SB were found: low-PA-decreasers, moderate-PA-decreasers, and high-PA-decreasers for PA; and low-maintainers, steep-decreasers, and steep-increasers for SB. Decreased quality of life, increased disability, and all-cause mortality were all consistently associated with worse PA and SB trajectories. CONCLUSIONS Our results highlight the need for health policies and prevention strategies that promote PA and limit SB in middle-aged adults. Further studies should consider these activities/behaviors as exposures that vary throughout life and work to identify vulnerable groups of older adults for whom physical activation interventions and programs would be most impactful.
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Affiliation(s)
- Aarón Salinas-Rodríguez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Av. Universidad #655. Colonia Santa María Ahuacatitlan ZC, 62100, Cuernavaca, Mor, Mexico
| | - Betty Manrique-Espinoza
- Center for Evaluation and Surveys Research, National Institute of Public Health, Av. Universidad #655. Colonia Santa María Ahuacatitlan ZC, 62100, Cuernavaca, Mor, Mexico
| | - Rosa Palazuelos-González
- Center for Evaluation and Surveys Research, National Institute of Public Health, Av. Universidad #655. Colonia Santa María Ahuacatitlan ZC, 62100, Cuernavaca, Mor, Mexico.
| | - Ana Rivera-Almaraz
- Center for Evaluation and Surveys Research, National Institute of Public Health, Av. Universidad #655. Colonia Santa María Ahuacatitlan ZC, 62100, Cuernavaca, Mor, Mexico
| | - Alejandra Jáuregui
- Center for Research in Nutrition and Health, National Institute of Public Health, Av. Universidad #655. Colonia Santa María Ahuacatitlan ZC, 62100, Cuernavaca, Mor, Mexico
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Wang Y, Li C, Ma Y, Zheng F, Xie W. Associations of physical activity participation trajectories with subsequent motor function declines and incident frailty: A population-based cohort study. Front Psychiatry 2022; 13:939310. [PMID: 36386976 PMCID: PMC9644212 DOI: 10.3389/fpsyt.2022.939310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maintaining physical function and delaying frailty are of significant importance in both quality of life and health longevity for successful aging. The objective of this study is to investigate whether different trajectories of long-term physical activity (PA) participation are associated with subsequent motor function declines and incident frailty in middle-aged and elderly adults. MATERIALS AND METHODS Data from 8,227 aged ≥ 50 years adults enrolled in the English Longitudinal Study of Aging were analyzed. Long-term PA participation trajectories were assessed using group-based trajectory modeling over the first 6-year period from wave 1 (2002-2003) to wave 4 (2008-2009). The longitudinal associations of PA trajectories with motor function declines and incident frailty were evaluated by a linear mixed model and Cox regression model, respectively, with follow-up of 10 years from wave 4 to wave 9 (2018-2019). RESULTS Five distinct trajectories of long-term PA participation were identified in the aging cohort, including persistently low-active trajectory (N = 2,039), increasing active trajectory (N = 1,711), declining active trajectory (N = 216), persistently moderate-active trajectory (N = 2,254), and persistently high-active trajectory (N = 2,007). Compared with the persistently low-active group, the participants in persistently moderate- and high-active groups experienced significantly decelerated grip strength decline, decreased gait speed decline, and faster chair rises after multiple-adjustment. Similarly, participants maintaining moderate- and high-active PA were also associated with a lower risk of incident frailty (multiple-adjusted hazard ratio: 0.70, 95% confidence interval: 0.62-0.80, and 0.42, 95% CI: 0.36-0.49, respectively), compared with those with persistently low PA. Notably, the participants with the increasing active trajectory got similar health benefits as those with persistently moderate and high levels of PA. CONCLUSION In addition to persistent PA, increasing PA was linked to a slower decline in motor function and lower risk of incident frailty in the cohort. Our findings suggest that regular PA is never too late.
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Affiliation(s)
- Yang Wang
- Department of Prevention and Health Care, Hospital of Health Science Center, Peking University, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Fanfan Zheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
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Cheval B, Csajbók Z, Formánek T, Sieber S, Boisgontier MP, Cullati S, Cermakova P. Association between physical-activity trajectories and cognitive decline in adults 50 years of age or older. Epidemiol Psychiatr Sci 2021; 30:e79. [PMID: 35035880 PMCID: PMC8728586 DOI: 10.1017/s2045796021000688] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
Aims To investigate the associations of physical-activity trajectories with the level of cognitive performance and its decline in adults 50 years of age or older. Methods We studied 38729 individuals (63 ± 9 years; 57% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Physical activity was self-reported and cognitive performance was assessed based on immediate recall, verbal fluency, and delayed recall. Physical-activity trajectories were estimated using growth mixture modelling and linear mixed effects models were used to investigate the associations between the trajectories and cognitive performance. Results The models identified two physical-activity trajectories of physical activity: constantly-high physical activity (N=27634: 71%) and decreasing physical activity (N=11095; 29%). Results showed that participants in the decreasing physical-activity group exhibited a lower level of cognitive performance compared to the high physical-activity group (immediate recall: ß=0.94; 95% confidence interval [CI]=0.92 to 0.95; verbal fluency: ß=0.98; 95% CI=0.97 to 0.98; delayed recall: ß=0.95; 95% CI=0.94 to 0.97). Moreover, compared with participants in the constantly-high physical-activity group, participants in the decreasing physical-activity group showed a steeper decline in all cognitive measures (immediate recall: ß=-0.04; 95% CI=-0.05 to -0.04; verbal fluency: ß=-0.22; 95% CI=-0.24 to -0.21; delayed recall: ß=-0.04; 95% CI=-0.05 to -0.04). Conclusions Physical-activity trajectories are associated with the level and evolution of cognitive performance in adults over 50 years. Specifically, our findings suggest that a decline in physical activity over multiple years is associated with a lower level and a steeper decline in cognitive performance.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Zsófia Csajbók
- National Institute of Mental Health, Klecany, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Science, Charles University, Prague, Czech Republic
| | - Tomáš Formánek
- National Institute of Mental Health, Klecany, Czech Republic
- EpiCentre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, Carouge, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Yang Y, Dixon-Suen SC, Dugué PA, Hodge AM, Lynch BM, English DR. Physical activity and sedentary behaviour over adulthood in relation to all-cause and cause-specific mortality: a systematic review of analytic strategies and study findings. Int J Epidemiol 2021; 51:641-667. [PMID: 34480556 DOI: 10.1093/ije/dyab181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Questions remain about the effect on mortality of physical activity and sedentary behaviour over time. We summarized the evidence from studies that assessed exposure from multiple time points and critiqued the analytic approaches used. METHODS A search was performed on MEDLINE, Embase, Emcare, Scopus and Web of Science up to January 2021 for studies of repeatedly assessed physical activity or sedentary behaviour in relation to all-cause or cause-specific mortality. Relative risks from individual studies were extracted. Each study was assessed for risk of bias from multiple domains. RESULTS We identified 64 eligible studies (57 on physical activity, 6 on sedentary behaviour, 1 on both). Cox regression with a time-fixed exposure history (n = 45) or time-varying covariates (n = 13) were the most frequently used methods. Only four studies used g-methods, which are designed to adjust for time-varying confounding. Risk of bias arose primarily from inadequate adjustment for time-varying confounders, participant selection, exposure classification and changes from measured exposure. Despite heterogeneity in methods, most studies found that being consistently or increasingly active over adulthood was associated with lower all-cause and cardiovascular-disease mortality compared with being always inactive. Few studies examined physical-activity changes and cancer mortality or effects of sedentary-behaviour changes on mortality outcomes. CONCLUSIONS Accumulating more evidence using longitudinal data while addressing the methodological challenges would provide greater insight into the health effects of initiating or maintaining a more active and less sedentary lifestyle.
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Affiliation(s)
- Yi Yang
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
| | - Suzanne C Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Pierre-Antoine Dugué
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Allison M Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
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9
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Kopp M, Burtscher M. Associations between physical frailty, physical activity and dementia incidence. THE LANCET. HEALTHY LONGEVITY 2021; 2:e66. [DOI: 10.1016/s2666-7568(20)30069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022] Open
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10
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Kim HR, Lee H, Seong Y, Lee E, Jung HW, Park YR, Jang IY. Longitudinal trajectory of disability in community-dwelling older adults: An observational cohort study in South Korea. BMC Geriatr 2020; 20:430. [PMID: 33115447 PMCID: PMC7594294 DOI: 10.1186/s12877-020-01834-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Disability, which is considered a health-related condition, increases care demands and socioeconomic burdens for both families and communities. To confirm the trend of dynamic longitudinal changes in disability, this study aims to explore how disability is divided by the trajectory method, which deals with time-sequenced data. Additionally, this study examines the differences in demographics, geriatric conditions, and time spent at home among the trajectory groups in community-dwelling older adults. Home time is defined as the period during which the patient was not in a hospital or health care facility during their lifetime. Methods Records of 786 community-dwelling older participants were analyzed from the Aging Study of PyeongChang Rural Area, a population-based cohort study that took place over three years. Using 7 domains of activities of daily living and 10 domains of instrumental activities of daily living, participants were grouped into no dependency (0 disabled domain), mild (1 disabled domain), and severe (2 or more disabled domains) disability groups. The longitudinal trajectory group of disability was calculated as a trajectory method. Three distinct trajectory groups were calculated over time: a relatively-stable group (78.5%; n = 617), a gradually-aggravated group (16.0%; n = 126), and a rapidly-deteriorated group (5.5%; n = 43). Results The average age of 786 participants was 73.3 years (SD: 5.8), and the percentage of female was 52.7%. It was found that 78.5% of patients showed relatively no dependence and 5.5% of older adults in a rural area showed severe dependence. Through applying the trajectory method, it was shown that the Short Physical Performance Battery (SPPB) score was 10.2 points in the relatively-stable group and 3.1 points in the rapidly-deteriorating group by the 3rd year. Additionally, by the trajectory method, the rate of decrease in home time was 3.33% in the rapidly-deteriorated group compared to the relatively-stable group. Conclusions This study shows the difference in demographics and geriatric conditions (such as SPPB) through the examination of longitudinal trajectory groups of disability in community-dwelling older adults. Significant differences were also found in the amount of home time among the trajectory groups. Supplementary information Supplementary information accompanies this paper at 10.1186/s12877-020-01834-y.
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Affiliation(s)
- Hae Reong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoonje Seong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Pyeongchang Health Center & Country Hospital, Gangwon-do, South Korea
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11
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Laddu DR, Parimi N, Stone KL, Lapidus J, Hoffman AR, Stefanick ML, Langsetmo L. Physical Activity Trajectories and Associated Changes in Physical Performance in Older Men: The MrOS Study. J Gerontol A Biol Sci Med Sci 2020; 75:1967-1973. [PMID: 32232383 DOI: 10.1093/gerona/glaa073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physical activity (PA) is important to maintaining functional independence. It is not clear how patterns of change in late-life PA are associated with contemporaneous changes in physical performance measures. METHODS Self-reported PA, gait speed, grip strength, timed chair stand, and leg power were assessed in 3,865 men aged ≥ 65 years at baseline (2000-2002) and Year 7 (2007-2009). Group-based trajectory modeling, using up to four PA measures over this period, identified PA trajectories. Multivariate linear regression models (adjusted least square mean [95% confidence interval {CI}]) described associations between-PA trajectories and concurrent changes in performance. RESULTS Three discrete PA patterns were identified, all with declining PA. Linear declines in each performance measure (baseline to Year 7) were observed across all three PA groups, but there was some variability in the rate of decline. Multivariate models assessing the graded response by PA trajectory showed a trend where the high-activity group had the smallest declines in performance while the low-activity group had the largest (p-for trend < .03). Changes in the high-activity group were the following: gait speed (-0.10 m/s [-0.12, -0.08]), grip strength (-3.79 kg [-4.35, -3.23]), and chair stands (-0.38 [-0.50, -0.25]), whereas changes in the low-activity group were the following: gait speed (-0.16 [-0.17, -0.14]), grip strength (-4.83 kg [-5.10, -4.55]), and chair stands (-0.53 [-0.59, -0.46]). Between-group differences in leg power trajectories across PA patterns were not significant. CONCLUSIONS Declines in functional performance were higher among those with lower PA trajectories, providing further evidence for the interrelationship between changes in PA and performance during old age.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, University of Illinois at Chicago
| | - Neeta Parimi
- California Pacific Medical Center Research Institute, San Francisco
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco
| | - Jodi Lapidus
- School of Public Health, Portland State University, Oregon
| | - Andrew R Hoffman
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University, Palo Alto, California
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, California
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
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12
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Sanchez-Sanchez JL, Izquierdo M, Carnicero-Carreño JA, García-García FJ, Rodríguez-Mañas L. Physical activity trajectories, mortality, hospitalization, and disability in the Toledo Study of Healthy Aging. J Cachexia Sarcopenia Muscle 2020; 11:1007-1017. [PMID: 32163233 PMCID: PMC7432572 DOI: 10.1002/jcsm.12566] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/03/2019] [Accepted: 02/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity (PA) is a recognized contributor to healthy aging. However, the majority of studies exploring its associations with adverse outcomes in cohorts of older adults use single-time PA estimates, which do not consider its dynamic nature. The aim of the present study is to explore the presence of different PA trajectories in the Toledo Study of Healthy Aging and their association with adverse outcomes. Our hypothesis is that prospectively maintaining or increasing PA is associated with a reduced risk of adverse outcomes. METHODS We used data from 1679 participants enrolled in the Toledo Study of Healthy Aging. Trajectories based on the Physical Activity Scale for the Elderly were identified using group-based trajectory modelling. Cox and logistic regression were used to investigate associations between PA trajectories and mortality and hospitalization, and incident and worsening disability, respectively. Mortality was ascertained by linkage to the Spanish National Death Index; disability was evaluated through the Katz Index; and hospitalization was defined as the first admission to Toledo Hospital. Models were adjusted by age, sex, smoking, Charlson Index, education, cognitive impairment, polypharmacy, and Katz Index at Wave 2. RESULTS We found four PA-decreasing and one PA-increasing trajectories: high PA-consistent (n = 566), moderate PA-mildly decreasing (n = 392), low PA-increasing (n = 237), moderate PA-consistent (n = 191), and low PA-decreasing (n = 293). Belonging to the high PA-consistent trajectory group was associated with reduced risks of mortality as compared with the low PA-decreasing group [hazard ratio (HR) 1.68; 95% confidence interval (CI) = 1.21-2.31] and hospitalization compared with the low PA-increasing and low PA-decreasing trajectory groups (HR 1.24; 95% CI = 1.004-1.54 and HR 1.25; 95% CI = 1.01-1.55, respectively) and with lower rates of incident [odds ratio (OR) 3.14; 95% CI = 1.59-6.19] and worsening disability (OR 2.16; 95% CI = 1.35-3.45) in relation to the low PA-decreasing trajectory group and at follow-up. Increasing PA during late life (low PA-increasing group) was associated with lower incident disability rates (OR 0.38; 95% CI = 0.19-0.82) compared with decreasing PA (low PA-decreasing group), despite similar baseline PA. CONCLUSIONS Our results suggest that sustaining higher PA levels during aging might lead to healthy aging, characterized by a reduction in adverse outcomes. Our study supports the need for enhancing PA participation among older populations, with the goal of reducing personal and economic burden in a worldwide aging population.
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Affiliation(s)
- Juan Luis Sanchez-Sanchez
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Antonio Carnicero-Carreño
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Fransico José García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatrics Department, Virgen Del Valle Hospital, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatrics Department, Getafe University Hospital, Ctra. de Toledo, Getafe, Spain
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13
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Peeters G, Romero-Ortuno R, Lawlor B, Kenny RA, McHugh Power J. Clustering of Behavioral Changes and Their Associations With Cognitive Decline in Older Adults. J Am Med Dir Assoc 2020; 21:1689-1695.e1. [PMID: 32718797 DOI: 10.1016/j.jamda.2020.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine (1) the clustering of reduced falls-efficacy, social withdrawal, and physical activity withdrawal in Irish adults aged 50 years and older, and (2) the concurrent and prospective associations of these clustered behaviors with cognitive decline. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS Data were from 4571 participants (mean age 64.5 ± 8.6, 54.9% women) in The Irish Longitudinal Study on Ageing, a population-based study. METHODS Changes in social and physical activity and falls-efficacy from 2012/2013 to 2014/2015 were used to define the behaviors of social withdrawal, physical activity withdrawal, and reduced falls-efficacy. Patterns of behaviors were associated with concurrent (2012/2013-2014/2015) and prospective (2014/2015-2016/2017) changes in immediate recall, delayed recall, and verbal fluency using random effects mixed models. RESULTS Eighty-six percent of participants had social withdrawal, physical activity withdrawal, or reduced falls-efficacy, and 15% had all 3 behaviors. Participants with all 3 behaviors showed the greatest declines in immediate recall (concurrent: B = -0.51, confidence interval [CI] = -0.77 to -0.25; prospective: B = -0.51, CI = -0.78 to -0.25), delayed recall (concurrent: B = -0.40, CI = -0.61 to -0.18; prospective: B = -0.47, CI = -0.69 to -0.25) and verbal fluency (concurrent: B = -1.05, CI = -1.58 to -0.52; prospective: B = -1.29, CI = -1.83 to -0.74). CONCLUSIONS AND IMPLICATIONS The clustering of social withdrawal, physical activity withdrawal, and reduced falls-efficacy is common. Presence of multiple behaviors was associated with greater cognitive declines, suggesting a cumulative association of these behaviors with cognitive decline. These findings guide (1) identification of vulnerable groups, (2) intervention design, and (3) care planning for people presenting with 1 or more of these changes in behavior.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College, Dublin, Ireland; Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, The Netherlands.
| | - Roman Romero-Ortuno
- Global Brain Health Institute, Trinity College, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College, Dublin, Ireland; Department of Psychiatry, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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14
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Brown JD, Lo-Ciganic WH, Shao H, Pahor M, Manini TM. Trajectories of Short Physical Performance Battery Are Strongly Associated with Future Major Mobility Disability: Results from the LIFE Study. J Clin Med 2020; 9:jcm9082332. [PMID: 32707877 PMCID: PMC7465072 DOI: 10.3390/jcm9082332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023] Open
Abstract
Short Physical Performance Battery (SPPB) assessment is a widely used measure of lower extremity function, strength, and balance. In the Lifestyles Interventions and Independence for Elders (LIFE) Study, baseline SPPB and changes throughout the trial were strongly associated with major mobility disability (MMD). This study further investigated this association by identifying trajectories of SPPB and evaluating the predictive validity of SPPB trajectories for future MMD. Participants (n = 1635) aged 70-89 years were randomized to a physical activity or health education intervention and assessed every 6 months for MMD. We used group-based trajectory models (GBTMs) to identify trajectories of a binary outcome for a decrease from baseline SPPB of ≥1. Multinomial logistic regression explored baseline factors associated with group membership. Survival analyses evaluated the association between trajectories with MMD. The GBTM identified a 3-group model which included a "No Decline" group (46.0%), "Late Decline" group (27.7%), and an "Early Decline" group (26.3%). Adjusting for all other baseline characteristics, group assignment during the previous follow-up visit was strongly associated with MMD at the subsequent period. Comparisons between groups showed a 2-to-3-fold increase in MMD comparing the "Late" to "No" decline group and a 4-to-5-fold increase in MMD comparing the "Early" to "No" decline group. Group membership and impact on MMD was not different between intervention arms. Group-based trajectories of SPPB scores identified distinct subgroups in LIFE Study participants. Using these group assignments in outcome models were highly associated with MMD. GBTMs have potential to identify and improve prediction of aging-related decline to better design and identify patients for interventions.
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Affiliation(s)
- Joshua D. Brown
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (W.-H.L.-C.); (H.S.)
- Correspondence:
| | - Wei-Hsuan Lo-Ciganic
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (W.-H.L.-C.); (H.S.)
| | - Hui Shao
- Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL 32610, USA; (W.-H.L.-C.); (H.S.)
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.P.); (T.M.M.)
| | - Todd M. Manini
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.P.); (T.M.M.)
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15
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Aggio D, Papachristou E, Papacosta O, Lennon LT, Ash S, Whincup P, Wannamethee SG, Jefferis BJ. Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality. J Epidemiol Community Health 2019; 74:130-136. [PMID: 31704805 PMCID: PMC6993021 DOI: 10.1136/jech-2019-212706] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/09/2019] [Accepted: 10/19/2019] [Indexed: 01/18/2023]
Abstract
Introduction It is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear. Methods 3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978–1980 (aged 40–59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019. Results Three PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA. Conclusions A dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.
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Affiliation(s)
- Daniel Aggio
- Primary Care and Population Health, University College London, London, UK
| | | | - Olia Papacosta
- Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Primary Care and Population Health, University College London, London, UK
| | - Sarah Ash
- Primary Care and Population Health, University College London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Barbara J Jefferis
- Primary Care and Population Health, University College London, London, UK
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16
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Cohen Y, Zisberg A, Chayat Y, Gur-Yaish N, Gil E, Levin C, Rand D, Agmon M. Walking for Better Outcomes and Recovery: The Effect of WALK-FOR in Preventing Hospital-Associated Functional Decline Among Older Adults. J Gerontol A Biol Sci Med Sci 2019; 74:1664-1670. [DOI: 10.1093/gerona/glz025] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention.
Methods
A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer.
Results
Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19).
Conclusions
The WALK-FOR intervention is effective in reducing HAFD.
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Affiliation(s)
- Yaniv Cohen
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
| | - Yehudit Chayat
- HaEmek Medical Center, Clalit Health Services, Afula, Israel
| | - Nurit Gur-Yaish
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
| | - Efrat Gil
- Clalit Health Services, Haifa and West Galilee and Carmel Hospital, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Chedva Levin
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
- Department of Nursing, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology – Lev Academic Center, Jerusalem, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
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