Less exercise and more TV: leisure-time physical activity trends of Shanghai elders, 1998-2008

Time trend analysis of leisure-time activity participation among young-old adults in China 2002-2018

Background

To examine the time trends of leisure activity engagement among young-old adults aged 65–74 in China over a 16-year period.

Methods

Data for a nationally representative sample of young-old adults was sourced from the 2002–2018 Chinese Longitudinal Healthy Longevity Survey (N = 9504). Generalized estimating equations regressions were implemented to assess temporal trends for 10 different leisure-time activities. We also evaluated time trends for solitary versus social leisure-time activities.

Results

Young-old adults were less likely to engage in any form of social activities (e.g. participate in social events) over time, controlling for other confounders such as age, sex, education, income, and health characteristics. Trends in outdoor activities participation and tourism also declined over 2002-2014, but reversed in 2018. In contrast, solitary leisure activities (e.g. watching TV) became more popular. There was a significant spike in the likelihood of keeping pets from 2011 onwards, especially among urbanites.

Conclusions

The future elderly in China have tended towards home-bound and solitary leisure activities over time, which warrants policy attention and public health interventions to reverse such trends.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12838-1.

Factors Associated with Lower Cognitive Performance Scores Among Older Japanese Men in Hawaii and Japan

BACKGROUND

Few studies have compared factors related to cognitive function among people with similar genetic backgrounds but different lifestyles.

OBJECTIVE

We aimed to identify factors related to lower cognitive scores among older Japanese men in two genetically similar cohorts exposed to different lifestyle factors.

METHODS

This cross-sectional study of community-dwelling Japanese men aged 71-81 years included 2,628 men enrolled in the Kuakini Honolulu-Asia Aging Study based in Hawaii and 349 men in the Shiga Epidemiological Study of Subclinical Atherosclerosis based in Japan. We compared participant performance through Cognitive Abilities Screening Instrument (CASI) assessment in Hawaii (1991-1993) and Japan (2009-2014). Factors related to low cognitive scores (history of cardiovascular disease, cardiometabolic factors, and lifestyle factors) were identified with questionnaires and measurements. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (ORs) of a low (< 82) CASI score based on different factors.

RESULTS

CASI scores were lower in Hawaii than in Japan [21.2%(n = 556) versus 12.3%(n = 43), p < 0.001], though this was not significant when adjusted for age and educational attainment (Hawaii 20.3%versus Japan 17.9%, p = 0.328). History of stroke (OR = 1.65, 95%confidence interval = 1.19-2.29) was positively associated with low cognitive scores in Hawaii. Body mass index ≥25 kg/m2 tended to be associated with low cognitive scores in Japan; there was a significant interaction between the cohorts.

CONCLUSION

Cognitive scores differences between cohorts were mostly explained by differences in educational attainment. Conversely, cardiovascular diseases and cardiometabolic factors differentially impacted cognitive scores among genetically similar older men exposed to different lifestyle factors.

Leisure-time physical activity and its correlates in a multi-ethnic sample of adults over age 50 in Singapore

Background

To examine the prevalence and correlates of regular leisure-time physical activity (LTPA) among community-dwelling adults in Singapore.

Methods

Data was sourced from the 2018–2019 Singapore Life Panel, which asked respondents about their current LTPA participation at various time-points over a seven-month period. The final sample comprised 7684 subjects over age 50. We applied logistic regression models in our analysis.

Results

39.8% of the respondents engaged in regular LTPA, with significantly higher proportions of men than women doing so. Factors positively associated with regular LTPA in both genders were age, education, retired, income, and satisfaction with social life, whereas a negative association was found with self-rated health. The correlates of sustained LTPA participation were relatively consistent with factors predicting current participation.

Conclusions

Regular participation in recreational physical activities is important to promoting health and well-being among middle-aged and older adults as populations age. Our findings indicated that positive perceptions of social relationships and being retired are important supporting factors. The urgent development of physical activity promotion strategies and interventions are required to foster greater overall LTPA participation.

Association of leisure sedentary time with common chronic disease risk factors: A longitudinal study of China Health and Nutrition Surveys

BACKGROUND

Although the common risk factors were identified and controlled for many years, the overall prevalence of chronic diseases continued to increase in China.

OBJECTIVE

We presumed the leisure sedentariness as a latent but pivotal factor of chronic diseases, and examined its distribution and changing trend, analysed its interaction effects on common risk factors, which could provide a new perspective for the prevention and management.

METHODS

A total of 5013 participants were screened out from China Health and Nutrition Survey. Random-effects ordered logistic models were used for ordinal dependent variables, and fixed-effects or random-effects logit models were used for binary dependent variables.

RESULTS

From 2004 to 2011, the prevalence of high leisure sedentary time (LSED) increased by 58.58%. Members of the high LSED group were likely to choose fast food, salty snacks, soft drinks and more likely to smoke or drink alcohol compared with those of the low LSED group. However, they preferred walking, sports and body building more than those of the low LSED group.

CONCLUSIONS

For the unhealthy dietary, tobacco and alcohol consumption, more targeted introduction and guidance related to sedentary time should be promoted. Meanwhile, the appeal for physical exercise as well as adequate facilities should be initiated.

Leisure Activity Engagement Among the Oldest Old in China, 1998-2018

Objectives. To examine the trends of leisure activity engagement among the oldest old in China for the past 2 decades.Methods. Our panel data came from the Chinese Longitudinal Healthy Longevity Survey, which systematically asked respondents about their current participation in leisure activities over a 20-year period. The final sample contained 66 789 interviews from 1998 to 2018. We applied generalized estimating equations regression models in our analysis.Results. Compared with 1998, odds ratios of television watching among Chinese oldest old individuals increased by about 2 to 3 times in 2018. Meanwhile, the odds ratio of exercise declined by 24%, mostly in men; playing cards and mah-jongg declined by about 30% for men. Results also showed that reading became less popular in the oldest old, and Chinese women tended to do more housework than before.Conclusions. Our findings indicated that Chinese oldest old persons have become more sedentary and solitary in the past 2 decades. The negative trend in leisure activity engagement among the elderly Chinese population warrants policy attention, and the urgent development of public health interventions is required to reverse such trends.

A healthy diet and physical activity are important to promote healthy ageing among older Chinese people

Objective

To examine the associations between multiple health behaviours and health outcomes among older Chinese adults.

Methods

Data from the World Health Organization’s Study on global AGEing and adult health Wave 1 (2007–2010), collected among the older Chinese population, were included in this study. Smoking, diet, and physical activity were analysed by linear regression for any associations with depressive symptoms, quality of life (QoL), cognitive function, and physical function.

Results

A total of 13 367 participants aged >49 years were included in the analyses. After controlling for key socioeconomic factors, healthy diet was significantly associated with higher QoL (β = 0.099) and better cognitive function (β = 0.023). Physical activity was significantly associated with fewer depressive symptoms (β = –0.020), higher QoL (β = 0.086), better cognitive function (β = 0.072), and better physical function (β = –0.155 [higher scores = poorer physical function]). No relationship was found between smoking and any health-related outcome included in this study.

Conclusion

This study demonstrates the importance of healthy diet and physical activity for health outcomes in the older Chinese population.

Prevention in the elderly: A necessary priority for general practitioners

Prevention is viewed as a key issue for general practice, yet there is a lack of evidence regarding general practitioners' interventions in both middle-aged and elderly people. This is despite the fact that recommendations and key indicators for monitoring the use of clinical preventive strategies aimed at these groups are available and that both the World Health Organization and European Commission endorse the importance of interventions for healthy and active ageing. This paper draws on two keynote presentations given at the 2015 autumn meeting of the European General Practice Research Network (EGPRN) in Edirne, Turkey (17-20 October 2015). According to the EU2020 strategy, general practitioners should design and implement prevention services and programmes to promote healthy and active ageing. Their primary focus should be on interventions on multimorbid patients, either by improving prescribing and adherence to medical plans or by targeting to fall and frailty prevention and vaccination uptake.

Individual educational attainment, neighborhood-socioeconomic contexts, and self-rated health of middle-aged and elderly Chinese: Exploring the mediating role of social engagement

Analyzing the 2011-2013 China Health and Retirement Longitudinal Study with 14,507 respondents from 393 neighborhoods, and applying generalized linear mixed-effects model, this study examines how individual-level education and neighborhood-socioeconomic contexts affect health through social engagement. Findings reveal that measures of social engagement-social activity and productive activity-are significantly related to self-rated health and partially mediate the effects of individual-level education. Neighborhood-socioeconomic contexts have independent effects on self-rated health beyond individual socio-demographics, and social activity mediates the effects of neighborhood recreational facilities. This study is among the first to simultaneously explore the health effects of individual and neighborhood-level socioeconomic conditions.

Socioeconomic status, frailty, and subjective well-being: A moderated mediation analysis in elderly Chinese

The study examined the mechanisms underlying the link between socioeconomic status and subjective well-being and explored the role of social activities using a representative sample of older adults ( N = 2773) in Shanghai, China. Results show that frailty mediated the relationship between socioeconomic status and subjective well-being, and social activities moderated the model, such that the mediation effect of frailty was significant only when social activities were lower. Moreover, the moderated mediation model was significant only for women, not for men. Findings highlight the importance of addressing frailty of older adults and promoting social activities (especially for elderly women) in future interventions.

Social Engagement and Health

What are the social factors that matter most to the health of elderly Chinese? Are there any gender and age differences? Using a representative sample of elderly Chinese in Shanghai, the most developed city in China with the nation’s largest proportion of elderly residents, this study found that economic conditions, chronic health status, living arrangements, social activity participation, and caring for grandchildren are factors that are most important to the health of elderly Chinese. This is true for both self-rated health and psychological well-being. The beneficial effects of participation in social activities are particularly salient for elderly women and for the old–old, whereas the salutary effects of caring for grandchildren are more substantial for elderly men and for the young–old. Our findings suggest the importance of social engagement in promoting health and successful aging of elderly Chinese and disclose the moderating roles of gender and age in this focal relationship.

Education and Psychological Distress of Older Chinese

Objective: The goal of this study is to examine whether and how education predicts distress for older Chinese and whether this association varies by age, gender, and rural/urban residence. Method: The random-effect panel model and Heckman selection model were used to analyze four waves of data with a total sample size of 54,405 from the Chinese Longitudinal Healthy Longevity Survey. Results: We found the following: (a) There is a persistent and negative association between education and distress among older Chinese; (b) education predicts lower levels of distress over time and this is particularly true for males, urban residents, and the young-old; and (c) the effect of education on distress is largely explained by physical health, economic conditions, and a three-dimensional framework of leisure-time activities.Discussion: Our findings strengthen the external validity of the relationship between education and health and suggest the dynamic patterns on the subgroup variations within the association in China.

The longitudinal exercise trend among older Swedes aged 53-84 years - a 16-year follow-up study

Background

Many older adults are physically inactive and inactivity increases with age. This knowledge comes from cross-sectional studies. Cross-sectional studies may miss important trajectories within the older adults as a result of retirements, and poor health impact of promotional efforts. The aim of this study was to analyse, longitudinally, the annual effects of age group and birth cohort on self-reported regular exercise in the Swedish population aged 53–84 years during a 16-year period, for each sex separately.

Methods

A random sample of non-institutionalized persons was interviewed three times from 1988 to 2004 by professional interviewers. In addition to three time-related variables – year of interview, age at the time of the interview, and year of birth – we included the following explanatory variables in the analyses: educational level, body mass index, smoking, and self-reported health status. The data were analysed by a mixed model with a random intercept.

Results

The total prevalence of self-reported regular exercise increased between 1988/89 and 2004/05 among both men and women, from 27.1 to 43.1% and from 21.1 to 41.1%, respectively. There was a mean annual change in all age-groups in exercise of between 0.76 and 1.24% among men and between 0.86 and 1.38% among women. Low prevalence of self-reported regular exercise was associated with low educational level, obesity, smoking, and poor self-reported health, although those with poor self-reported health the greatest increase of physical activity.

Conclusions

There was a steady, albeit inadequate, increase in self-reported regular exercise in older adults between 1988 and 2004. Physical activity promotion in older adults should be of high priority for both primary and secondary prevention of diseases, especially among groups with known risk factors for low levels of exercise.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults

Background

Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples’ engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 – 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned?

Methods

The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression.

Results

The odds of being defined as a ‘never walker’ were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households.

Conclusions

Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults

BACKGROUND

Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples' engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 - 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned?

METHODS

The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression.

RESULTS

The odds of being defined as a 'never walker' were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households.

CONCLUSIONS

Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

Behavioral medicine and prevention of non-communicable diseases in China: current challenges and future directions

PURPOSE

We describe the emergence of recent public health challenges in China, particularly those regarding lifestyle-related non-communicable diseases (NCDs). We also summarize some recent examples of behavioral medicine research and practice in relation to the prevention and control of NCDs in China. Finally, we describe recent changes in the public health system in China and how behavioral medicine research and practice can be incorporated into this system to address these public health challenges.

METHODS

We considered research and policy literature from both China and Western countries in order to evaluate the relevance of the field of behavioral medicine for addressing the rising NCDs in China.

RESULTS

Rapid economic development and related social and environmental changes have brought about increasing wealth and lifestyle changes in China, along with new public health challenges related to the prevention and control of NCDs. The field of behavioral medicine has much to offer China in addressing these public health challenges. Although behavioral medicine research and practice are still at an early stage in China, there are encouraging signs of its development, particularly resulting from international collaborations with researchers from Western countries. The next stage of this field's development in China will involve increased integration of behavioral medicine into public health education, training, and the health system. However, this process of integration will need to build on China's traditional approaches to public health training, research, and practice.

CONCLUSIONS

Although the field of behavioral medicine in public health is still in its infancy in China, we argue that the practice and principles of behavioral medicine are important for successfully addressing the substantial burden of NCDs now and in the future.

A new classification of function and disability in China: subtypes based on performance-based and self-reported measures

OBJECTIVES

To develop a new classification method to describe incidence and prevalence of function and disability and their predictors in Chinese older adults.

METHODS

Data were obtained from 16,020 older adults in the 2002 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The subtypes of function and disability were defined by combining physical performance (PP) tests and self-reported assessments of activities of daily living (ADL).

RESULTS

The most prevalent subtype involved PP limitations without ADL dependency. Rural living made it more likely that an individual with physical performance limitations would be independent in ADL, whereas city residence made dependence in ADL more likely, regardless of whether performance limitations were present.

DISCUSSION

Self-reported and performance-based tools can be used in combination to estimate conceptually different subtypes of function and disability, with different epidemiological rates of incidence and different social, medical, and environmental predictors.

Fitness and health-related quality of life dimensions in community-dwelling middle aged and older adults

Background

The aim of the present study was to identify the physical fitness (PF) tests of a multi-component battery more related to the perception of problems in each dimension of the health-related quality of life (HRQoL) assessed by the EuroQol 5 dimensions 3 level questionnaire (EQ-5D-3L) in community-dwelling middle-aged and older adults

Methods

A cross-sectional study was conducted with 7104 participants (6243 females and 861 males aged 50-99 years) who were recruited in the framework of the Exercise Looks After You Program, which is a public health program designed to promote physical activity (PA) in community-dwelling middle-aged and older adults. Participants were assessed by the EQ-5D-3L questionnaire and a battery of fitness tests. The responses to each EQ-5D-3L dimension were collapsed into a two-tier variable consisting of «perceive problems» and «do not perceive problems». Correlation coefficients for the relationships between the HRQoL variables, between the PF variables, and between the HRQoL and PF variables were obtained. Two logistic regression models, one adjusted and one unadjusted, were developed for each EQ-5D-3L dimension.

Results

There were significant correlations between all variables except anxiety/depression and the back scratch test. The PF tests that correlated best with the HRQoL dimensions were the Timed Up-and-Go Test (TUG) and the 6-min walk; pain/discomfort and anxiety/depression correlated less well. All PF tests correlated, especially the TUG and 6-min walk tests. Unadjusted logistic models showed significant goodness of fit for the mobility and pain/discomfort dimensions only. Adjusted logistic models showed significant goodness of fit for all dimensions when the following potential confounding variables were included: age, gender, weekly level of PA, smoking and alcohol habits, body mass index, and educational level. For all dimensions, the highest odds ratios for the association with PF tests were with the TUG; this was observed with both the unadjusted and adjusted models.

Conclusions

The perception of problems, as measured by the EQ-5D-3L dimensions, was associated with a lower level of fitness, particularly for those dimensions that relate more closely to physical components. The PF tests that associated most closely with the perception of problems in the HRQoL dimensions were the TUG and the 6-min walk. This information will aid the design and assessment of PA programs that aim to improve HRQoL.