Impact of physical activity and performance on medical care costs among the Japanese elderly

The role of physical activity on healthcare utilization in China

BACKGROUND

Evidence on the role of physical activity (PA) on healthcare utilization and expenditure is limited in China. We aimed to examine the association between the total physical activity (TPA) per week, healthcare service use and expenditure.

METHODS

We extracted the data from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015. Participants more than 50 years old who completed the follow-up for the three waves were enrolled. We converted the volume of vigorous physical activity (VPA) into an equivalent volume of moderate physical activity (MPA) and calculated the TPA per week for each participant. 12,927 of the 17,708 participants in CHARLS were included in our analysis. More than one-third of participants over 50 years old never participate in any moderate or intensity activity, and the median of self-reported moderate or intensity PA was about 525 (IQR 0-1680) MET-minutes per week in 2015.

RESULTS

Compared to inactive subjects, the highest level of TPA was significantly related to the decreased risk number of inpatient visits (IRR: 0.58; 95% CI:0.50-0.67, p < 0.001), inpatient hospital days (IRR: 0.60; 95% CI: 0.42-0.84, p < 0.01), healthcare expenditure (IRR: 0.71; 95% CI: 0.65-0.79, p < 0.001) and catastrophic health expenditures (OR: 0.57; 95% CI: 0.45-0.72, p < 0.001) after adjusting for covariates.

CONCLUSIONS

Engaging in moderate-to-vigorous PA may drive a potential decrease in healthcare utilization, healthcare expenditure and household financial risk with a dose-response relationship in China, and some possible policy implications in public health may be considered to promote exercise in the middle-aged and elderly to reduce the medical burden on individuals and healthcare systems.

Impact of physical activity on healthcare costs: a systematic review

BACKGROUND

This systematic review aims to describe the relation between physical inactivity and healthcare costs, by taking into account healthcare costs of physical-inactivity-related diseases (common practice), including physical-activity-related injuries (new) and costs in life-years gained due to avoiding diseases (new), whenever available. Moreover, the association between physical inactivity and healthcare costs may both be negatively and positively impacted by increased physical activity.

METHODS

A systematic review was conducted, including records reporting on physical (in)activity in relation to healthcare costs for a general population. Studies were required to report sufficient information to calculate the percentage of total healthcare costs potentially attributable to physical inactivity.

RESULTS

Of the 264 records identified, 25 were included in this review. Included studies showed substantial variation in the assessment methods of physical activity and in type of costs included. Overall, studies showed that physical inactivity is related to higher healthcare costs. Only one study included costs of healthcare resources used in prolonged life when physical-inactivity-related diseases were averted, showing net higher healthcare costs. No study included healthcare costs for physical-activity-related injuries.

CONCLUSIONS

Physical inactivity is associated with higher healthcare costs in the general population in the short-term. However, in the long-term aversion of diseases related with physical inactivity may increase longevity and, as a consequence, healthcare costs in life-years gained. Future studies should use a broad definition of costs, including costs in life-years gained and costs related to physical-activity-related injuries.

Association between Low Forced Vital Capacity and High Pneumonia Mortality, and Impact of Muscle Power

Impaired % predicted value forced vital capacity (% FVC) is related to higher all-cause mortality in aged adults, and strong muscle force may improve this relationship. A muscle disease, sarcopenia, causes higher mortality. We aimed to identify the unknown disease that relates impaired % FVC with higher mortality in aged adults among the three major leading causes of death, and the effect of strong leg force on this relationship. Cox proportional hazard model analyzed the longitudinal Tsurugaya cohort that registered 1048 aged Japanese for 11 years. The primary outcome was the relationship between % FVC and mortality by cancer, cardiovascular disease, or pneumonia. Exposure variables were % FVC or leg force divided by 80% or median values, respectively. The secondary outcome was the effects of leg force on the relationship. Among the diseases, % FVC < 80% was related only to higher pneumonia mortality (hazard ratio [HR], 4.09; 95% CI, 1.90-8.83) relative to the % FVC ≥ 80% group before adjustment. Adding the leg force as an explanatory variable reduced the HR to 3.34 (1.54-7.25). Weak leg force might indicate sarcopenia, and its prevention may improve higher pneumonia mortality risk related to impaired % FVC, which we may advise people in clinical settings.

Predictors of Health Satisfaction in Spanish Physically Active Older Adults: A Cross-Sectional Observational Study

Studies that analyze the predictors of satisfaction with the health of the elderly are scarce. That is the reason why the objective of this study is to analyze whether the physical-psychological state, sports practice, and the use of socio-health resources are factors that predict satisfaction with health status in physically active elderly people. The Physical Activity and Quality of Life questionnaires were applied to a sample of 397 elderly people in this cross-sectional observational study. The data have been analyzed using Student's t-test chi-square test, Cohen's d, Phi Coefficient and Cramer's V. The results have shown that the lack of physical illnesses (OR = 3.920; p < 0.001) and psychological problems (OR = 1.940; p = 0.032), practicing a high level of physical activity (OR = 2.049; p = 0.001), having high scores in functional skills (OR = 8.059; p < 0.001) and using little social and health services (OR = 2.595; p < 0.001) are all predictors of being highly satisfied with one's health. In conclusion, predictors associated with high health satisfaction of active older people have been found, such as functional abilities, the existence of physical illness, psychological problems, level of physical activity, frequency of use of health and social services and satisfaction with health and social services; but it is not associated with gender or age of participants.

Benefits of sustained physical activity from middle age to early old age on quality of life in early old age

This study aimed to examine changes in physical activity (PA) over time (2009-2017) in the same participants and to determine an association between changes in PA and health-related quality of life (HRQoL) in early older adults (n = 994) using data from the Korea Health Panel Survey. HRQoL was measured using the EuroQol system, and the amount of PA was grouped into four activity levels: remained inactive, became inactive, became active, and remained active. The association of changes in PA over 8 years with HRQoL was examined using logistic regression analysis while controlling for socioeconomic and behavioral factors. Total PA decreased from 1859.72 ± 1760.01 MET-minutes in 2009 to 1264.80 ± 1251.14 MET-minutes in 2017 (P < 0.001). In 2017, 142 (14.3%) remained inactive, whereas 419 (42.2%) remained active. Participants who remained inactive in early old age were more likely to be in the lowest 10% HRQoL of the sample (odds ratio = 1.95, 95% confidence interval = 1.09-3.48). These findings indicate that health education and promotion must be prioritized for middle-aged adults, who are relatively inactive, so that they increase their current PA and improve their HRQoL to maximize the benefits of PA in old age.

High Mortality in an Older Japanese Population with Low Forced Vital Capacity and Gender-Dependent Potential Impact of Muscle Strength: Longitudinal Cohort Study

Generally, weak muscle power is associated with high mortality. We aimed to evaluate the unknown association between % predicted value forced vital capacity (FVC% predicted) and mortality in asymptomatic older people, and the impact of muscle power on this association. We analyzed the Tsurugaya cohort that enrolled Japanese people aged ≥70 for 15 years with Cox proportional hazards model. Exposure variables were FVC% predicted and leg power. The outcome was all-cause mortality. The subjects were divided into quartiles by FVC% predicted or leg power, or into two groups by 80% for FVC% predicted or by the strongest 25% for leg power. Across 985 subjects, 262 died. The males with lower FVC% predicted exhibited higher mortality risks. The hazard ratio (HR) was 2.03 (95% CI 1.30−3.18) at the lowest relative to the highest groups. The addition of leg power reduced the HR to 1.78 (95% CI 1.12−2.80). In females, FVC% predicted under 80% was a risk factor and the HR was 1.67 (95% CI 1.05−2.64) without the effect of leg power. In FVC% predicted <80% males HRs were 2.44 (95% CI 1.48−4.02) in weak and 1.38 (95% CI 0.52−3.64) in strong leg power males, relative to ≥80% and strong leg power males. Low FVC% predicted was associated with high mortality with potential unfavorable effects of weak leg power in males.

Implementing Home-based Prevention Physical Therapy: A Scoping Review and Path to Launch of HOP-UP-PT

The purpose of this study was to conduct a scoping review of the available service delivery models related to home-based fall prevention programs led by rehabilitation professionals and to describe the path to launching one such program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Topics of review included: Medicare and private billing structures available for current prevention programs and traditional rehabilitation, the Affordable Care Act and its application to reimbursement of preventive services and direct access care models, and a comparative review of CMS' Patient Driven Group Model (PDGM) home health benefit and Medicare Part B billing and reimbursement. Additionally, a path to launch one prevention-focused program, HOP-UP-PT, is described. There is emerging evidence that upstreaming fall prevention programs can help reduce falls and have money-saving downstream effects. A reimbursement model for this type of programming must be established in order ensure long-term sustainability. Although there is evidence that home-based prevention programs such as HOP-UP-PT can reduce falls and fall-risk metrics among an older adult population, there is not a clear and sustainable payment pathway, which limits proliferation of similar programs. Therefore, this preventative care model which has emerging evidence of cost savings will require reimbursement restructuring beyond what is available with existing payment models.

Prevalence of Locomotive Organ Impairment and Associated Factors among Middle-Aged and Older People in Nan Province, Thailand

While locomotive organ impairment among older people is attracting worldwide attention, this issue has not yet been widely investigated in Thailand. This study aimed to measure locomotive organ impairment prevalence and identify the determinants of locomotive function decline among middle-aged and older people in Nan Province, Thailand. This cross-sectional study included anthropometric measurements, a two-step test to investigate locomotive function, and a structured questionnaire to obtain socio-demographic and related information. Logistic regression analysis and multiple regression analysis were used to identify the determinants of locomotive organ impairment. The study participants were aged 50–87 years old (n = 165), and 71.5% of them had begun experiencing declining locomotive function; < 6 years of school education (adjusted odds ratio: 4.46), body mass index ≥25 kg/m² (AOR: 3.06), comorbidities (AOR: 2.55), and continuous walking for <15 min (AOR: 2.51) were identified as factors associated with locomotive organ impairment. Moreover, age, knee pain, anxiety about falling in daily life, and difficulty with simple tasks were identified as factors significantly associated with exacerbated locomotive organ impairment (p < 0.05). Appropriate interventions such as guidance or follow-up and recommendations for exercises are needed to prevent locomotive organ impairment and improve treatment.

Daily steps and healthcare costs in Japanese communities

Physical inactivity is a pandemic that requires intensive, usually costly efforts for risk reduction of related chronic diseases. Nevertheless, it is challenging to determine the effectiveness of physical activity in healthcare cost reduction based on existing literature. Therefore, this study aimed to investigate the impact of physical activity (daily steps) on healthcare costs utilising the data retrieved from a health promotion project (the e-wellness Project, held in three municipalities in Japan). Evaluating the effects of daily steps, measured by pedometers, on healthcare costs by a quasi-experimental approach among participants aged 40–75 years (about 4000 person-years of observation, between 2009 and 2013), we found that a one-step-increase in the annual average daily step reduced outpatient healthcare costs by 16.26 JPY (≒ 0.11 GBD) in the short run. Based on the assumption of a dynamic relationship between the health statuses in multiple years, the long-run effects of daily steps on healthcare costs were estimated at 28.24 JPY (≒ 0.20 GBD). We determined the health benefits of walking in a sample of middle-aged and older Japanese adults by our findings that an increase in step counts reduced healthcare costs.

Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort

Background

There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA.

Methods

Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs.

Results

Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (–US$1350 (95% CI: –US$2009 to –US$690) or −15.9% (95% CI: −23.6% to −8.1%)) or high physical activity levels (–US$1200 (95% CI: –US$1777 to –US$622) or −14.1% (95% CI: −20.9% to −7.3%)) and increasers, adults who increased physical activity levels in early adulthood (–US$1874 (95% CI: US$2691 to –US$1057) or −22.0% (95% CI: −31.6% to −12.4%)) or in middle age (–US$824 (95% CI: –US$1580 to –US$69 or −9.7% (95% CI −18.6% to −0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (–US$861 (95% CI:–US$1678 to –US$45) or −10.1% (95% CI: −19.7% to −0.5%)).

Conclusion

Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood.

Twelve year trajectories of physical activity and health costs in mid-age Australian women

Background

Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women.

Methods

Data from 6953 participants in the Australian Longitudinal Study on Women’s Health (born in 1946–1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013–2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs.

Results

Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443–3013) and AUD578 (95%CI: 426–729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49–360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232–545).

Conclusion

Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

The relationship between physical activity and out-of-pocket health care costs of the elderly in Europe

BACKGROUND

Increasing health care costs represent an economic burden placed on individuals across many European countries. Against this backdrop, the aim of this study was to examine the relationship between participation in physical activity and out-of-pocket health care costs in Europe.

METHODS

Individual data from the cross-national Survey of Health, Ageing and Retirement (n = 94 267) including 16 European countries were utilized. Two-part models were estimated to investigate how different levels of participation frequency in physical activity are related to out-of-pocket costs (OOPC) for people aged 50 years and older.

RESULTS

Only participation in physical activity more than once a week significantly decreases the probability of incurring any OOPC. However, all frequencies of physical activity significantly reduce the level of costs, with the highest savings being generated by participation once a week. The results reveal higher savings for men compared to women.

CONCLUSION

Physical activity can be a useful policy instrument to reduce the economic burden of out-of-pocket health care costs for an aging population in Europe. Public officials should primarily promote physical activity interventions targeting older people who are not active at all.

Associations Between Sedentary Behavior, Physical Activity, and Out-of-Pocket Health Care Expenditure: Evidence From Chinese Older Adults

OBJECTIVE

This study examined the associations between sedentary behavior, physical activity, and health care expenditures among Chinese older adults.

METHOD

We conducted a survey on 4,165 older men and women living in major cities in China. Sedentary behavior and physical activity were measured by the Physical Activity Scale for the Elderly questionnaire. Health care costs were assessed by self-reported out-of-pocket health care expenditures across outpatient care, inpatient care, medication, and formal caregiver expenses.

RESULTS

Sedentary behavior was associated with an increase in annual out-of-pocket health care expenditures by approximately USD$37 for each additional sedentary hour (p < .001). Physical activity was associated with a decrease in annual health care expenditures by approximately USD$1.2 for each one Physical Activity Scale for the Elderly score (p < .001). Physical activity was a less salient indicator of health care expenditure for men than women.

CONCLUSIONS

Reducing sedentary behavior among older men and women and promoting physical activity, especially among men, may be important strategies to reduce out-of-pocket health care expenditures in China.

The economic burden of physical inactivity: a systematic review and critical appraisal

OBJECTIVE

To summarise the literature on the economic burden of physical inactivity in populations, with emphases on appraising the methodologies and providing recommendations for future studies.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42016047705).

DATA SOURCES

Electronic databases for peer-reviewed and grey literature were systematically searched, followed by reference searching and consultation with experts.

ELIGIBILITY CRITERIA

Studies that examined the economic consequences of physical inactivity in a population/population-based sample, with clearly stated methodologies and at least an abstract/summary written in English.

RESULTS

Of the 40 eligible studies, 27 focused on direct healthcare costs only, 13 also estimated indirect costs and one study additionally estimated household costs. For direct costs, 23 studies used a population attributable fraction (PAF) approach with estimated healthcare costs attributable to physical inactivity ranging from 0.3% to 4.6% of national healthcare expenditure; 17 studies used an econometric approach, which tended to yield higher estimates than those using a PAF approach. For indirect costs, 10 studies used a human capital approach, two used a friction cost approach and one used a value of a statistical life approach. Overall, estimates varied substantially, even within the same country, depending on analytical approaches, time frame and other methodological considerations.

CONCLUSION

Estimating the economic burden of physical inactivity is an area of increasing importance that requires further development. There is a marked lack of consistency in methodological approaches and transparency of reporting. Future studies could benefit from cross-disciplinary collaborations involving economists and physical activity experts, taking a societal perspective and following best practices in conducting and reporting analysis, including accounting for potential confounding, reverse causality and comorbidity, applying discounting and sensitivity analysis, and reporting assumptions, limitations and justifications for approaches taken. We have adapted the Consolidated Health Economic Evaluation Reporting Standards checklist as a guide for future estimates of the economic burden of physical inactivity and other risk factors.

Medical costs of a low skeletal muscle mass are modulated by dietary diversity and physical activity in community-dwelling older Taiwanese: a longitudinal study

Background

Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese.

Methods

In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999–2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m²)] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m² for men and 8.50 kg/m² for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical activity (low and moderate) were obtained at baseline. Annual medical service utilization and expenditure were calculated from National Health Insurance claims until December 31, 2006. Generalized linear models were used to determine the association between the SMMI and annual medical service utilization and costs in conjunction with dietary diversity or physical activity.

Results

After 8 follow-up years, regardless of gender, participants in the high-risk group reported significantly more hospitalization (days and expenditure) and total medical expenditure. Participants in the high-risk group who had low dietary diversity made fewer annual outpatient (14%), preventive care (19%), and dental (40%) visits, but exhibited longer hospitalization (102%) than did those who had a low SMMI and high dietary diversity. Similar patterns were observed in the corresponding medical expenditures. The findings were similar when considering physical activity. Being in the low-risk group in conjunction with having high dietary diversity or more physical activity was associated with the lowest annual adjusted mean hospitalization days with expenditure, and also total expenditure.

Conclusions

A lower SMMI was associated with more hospitalization days and costs. However, high dietary diversity and more physical activity can attenuate the effects of lower SMMI on medical service utilization and expenditure.

Effects of a Lifestyle-Based Physical Activity Intervention on Medical Expenditure in Japanese Adults: A Community-Based Retrospective Study

Background. This study aimed to investigate whether a lifestyle-based physical activity program could contribute to reduced medical expenditure. Methods. The study participants were 60 adults aged 63.1 (standard deviation, 4.4) years in the intervention group; the case-control group consisted of 300 adults who were randomly selected from Japan's national health insurance system. This community-based retrospective study incorporated a 3-year follow-up. Results. The total and outpatient medical expenditure in the intervention group were significantly lower than in the control group: total expenditure, $US640.4/year; outpatient expenditure, $369.1/year. The odds ratio for outpatient visiting was 6.47-fold higher in the control than in the intervention group. Conclusion. Our study suggests that a health program to promote physical activity can result in reduced total medical expenditure, outpatient medical expenditure, and possibly also inpatient medical expenditure.

[The costs of physical inactivity in the world: a general review]

There is convincing evidence in the scientific literature of the effectiveness of regular physical activity and physical exercise in the conservation of health and the prevention of various ailments. However, studies into the association between costs of medical services and physical inactivity have not been duly addressed. International studies have quantified these costs and revealed the association between physical activity and/or sedentary behavior. Therefore, this review sought to gather information available from several countries and analyze the global costs associated with physical inactivity over the past few decades. The results of twenty-four original and well-researched articles in nine countries, including Brazil, were analyzed. The results showed that physical inactivity, irrespective of the method of classification, is burdensome to the economy of health worldwide, and directly responsible for the high cost of medication, the incidence of hospitalization and the frequency of medical appointments. The costs of the group of the physically inactive population affected by chronic diseases feature among the major components of the total costs involved in public health.

High circulating adiponectin levels predict decreased muscle strength among older adults aged 70 years and over: A prospective cohort study

BACKGROUND AND AIMS

Population-based researches indicate that circulating adiponectin is inversely associated with muscle strength. However, interpretation of the findings has been limited by the use of a cross-sectional design. This study aimed to examine the prospective relationship between baseline circulating adiponectin concentration and change in muscular function-related physical performance in older adults.

METHODS AND RESULTS

A 1-year prospective cohort study of Japanese community-dwelling elderly was conducted between 2002 and 2003. Four hundred thirty-four older persons participated in the measurements of physical function, including leg extension power, functional reach, timed up-and-go test, and 10-m maximum walking speed, at baseline and follow-up. After adjustment for potential covariates, higher serum adiponectin concentration was found to be significantly associated with poorer physical performance at baseline (leg extension power [watt], P < 0.001; functional reach [cm], P < 0.001; log timed up-and-go test, P = 0.007; log 10-m maximum walking speed, P < 0.001). The results of the prospective analysis by analysis of covariance indicated that the elderly with higher serum adiponectin concentrations (tertiles) at baseline tended to have a decreased performance in leg extension power (means [95% confidence interval]: lowest, -105 [-125, -85.7]; middle, -117 [-135, -97.8]; highest, -140 [-160, -120], watt, P for trend = 0.021) and timed up-and-go test (lowest, -0.08 [-0.28, -0.12]; middle, -0.10 [-0.29, 0.10]; highest, 0.28 [0.07, 0.48], s, P for trend = 0.019), but not two other functioning.

CONCLUSION

High circulating adiponectin concentration may be an indicator of decreased physical performance, especially muscle strength, in older adults.

Inadequate physical activity and health care expenditures in the United States

This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U.S. health care expenditures.

Health care costs associated with prolonged sitting and inactivity

BACKGROUND

Physical inactivity and prolonged sitting are associated with negative health outcomes.

PURPOSE

To examine the health-related costs of prolonged sitting and inactivity in middle-aged women.

METHODS

Australian Longitudinal Study on Women's Health participants (born 1946-1951) answered questions about time spent sitting, walking, and in moderate and vigorous leisure activities in 2001 (n=6108); 2004 (n=5902); 2007 (n=5754); and 2010 (n=5535) surveys. Sitting time was categorized as low (0-4); moderate (5-7); and high (≥8 hours/day). Physical activity was categorized as inactive (<40); low (40-600); moderate (600-1200); and high (≥1200 MET-minutes/week). National health insurance claims data averaged over the survey year ±1 year were used to calculate annual costs (Australian dollars [AU$]). Differences between categories in median costs were estimated using quantile regression over four surveys with bootstrapped 95% CIs. Analyses were performed in 2013.

RESULTS

In 2010, annual median costs were AU$689 (interquartile range [IQR]=274, 1541) in highly active participants; AU$741 (IQR=279, 1690) in inactive participants; AU$671 (IQR=273, 1551) in participants with low sitting time; and AU$709 (IQR=283, 1575) in participants with high sitting time. The difference in median costs for inactive and highly active participants was AU$94 (CI=57, 131) after adjustment for confounders. No statistically significant associations were found between sitting time and costs. When sitting and physical activity were combined, high sitting time did not add to the inactivity-associated increased costs. Associations were consistent across normal-weight, overweight, and obese subgroups.

CONCLUSIONS

Physical inactivity, but not prolonged sitting, was associated with higher health-related costs in middle-aged women.

Effects of a multimodal exercise program in pedal dexterity and balance: study with Portuguese older adults of different contexts

This study investigated the effects of a multimodal exercise program (MEP) on pedal dexterity and balance in two groups of older adult participants (65–92 years of age) from a psychiatric hospital center (HC), a residential care home (RCH), and a daily living center (DLC). The experimental group (EG) trained three times per week for 12 months, and the control group (CG) maintained their normal activities. The Mini-Mental State Examination and the Modified Baecke Questionnaire, as well as the Pedal Dexterity and the Tinetti tests, were applied to all subjects before and after the experimental protocol. Furthermore, the foot preference was controlled using the Lateral Preference Questionnaire proposed by Coren [10]. In the EG, the results from the Pedal Dexterity test showed that both males and females from the RCH and DLC improved their performances after the MEP. In the HC, the males slightly decreased their performance with both feet, contrarily to females. Both males and females from the CG decreased their pedal dexterity performance, namely, with the non-preferred foot. Concerning the Tinetti test, the EG of both males and females from the HC, the RCH (males were better than females regarding the gender factor), and the DLC improved their balance after the MEP. In the CG, no significant effects or interactions were found for any of the context groups.

Evaluation of locomotive disability using loco-check: a cross-sectional study in the Japanese general population

BACKGROUND

The purposes of this study were to reveal the prevalence of locomotive syndrome (LS) evaluated by loco-check in the Japanese general population and to analyze the relationship between radiographic knee osteoarthritis (OA) and lumbar spondylosis, metabolic syndrome and LS. Furthermore, we evaluated LS according to functional examinations.

METHODS

Seven hundred twenty-two volunteers aged 56.6 ± 13.6 years participated in the Iwaki Health Promotion Project in 2010 and were classified into two groups: LS (one or more disabilities) or non-LS (no disability) according to the criteria of LS proposed by the Japanese Orthopaedic Association. Radiographic knee OA and lumbar spondylosis were defined according to the Kellgren-Lawrence grade. Metabolic syndrome was defined as the presence of two or more risk factors in addition to visceral obesity. The prevalence of LS associated with knee OA, lumbar spondylosis and metabolic syndrome was compared statistically. Also, data of six functional examinations were compared between the non-LS and LS groups.

RESULTS

The prevalence of LS was 21.2 % in males and 35.6 % in females and increased with aging regardless of gender. The prevalence of LS with knee OA was 48.7 %, with lumbar spondylosis was 33.8 %, and with metabolic syndrome was 43.4 %. The non-LS group had significantly better performance in the functional reach and sit and reach tests than the LS group in males and females by age-adjusted comparison.

CONCLUSION

The prevalence of LS in the general population was higher in females than in males. A strong risk factor for LS was radiographic knee OA. Also, those with LS had loss of skeletal muscle mass, balancing and flexibility. This study showed that evaluation by loco-check was an acceptable tool to detect the early stage of locomotive disability for LS, and interventional prevention for strength, balancing and flexibility would be helpful for those with LS.

Exercícios físicos, força muscular e atividades de vida diária em mulheres idosas

O objetivo foi investigar as relações entre força muscular nos membros inferiores e nos superiores, prática de exercícios físicos e atividades de vida diária em mulheres idosas recrutadas na comunidade. Um mil quinhentas e trinta e oito idosas com idade média = 72,07 ± 5,46, renda familiar média = 3,59 ± 3,96 SM, sem déficit cognitivo sugestivo de demência. Foram submetidas a medidas de força de preensão manual e velocidade de marcha; a itens de autorrelato sobre prática regular de exercícios físicos; de desempenho de 13 atividades avançadas de vida diária (AAVD) de natureza social (ex: trabalhar, viajar e frequentar igreja) e de 3 atividades instrumentais de vida diária (AIVD) manejar dinheiro, fazer compras e usar transporte, 1.538 idosas com idade média = 72,07 ± 5,46, renda familiar média = 3,59 ± 3,96 SM, sem déficit cognitivo sugestivo de demência. Foram preditivos de pior desempenho em atividades de vida diária (AVD): baixa força muscular (OR = 2,48 para comprometimento da preensão e da marcha e 1,66 para comprometimento em qualquer dos critérios), baixa renda (OR = 2,46 e 2,45 para < 1 e para 1,1 a 3,0 SM) e sedentarismo (OR 2,08). A funcionalidade de mulheres idosas é afetada pelo envelhecimento fisiológico e por condições contextuais e de estilo de vida.

[Impact of level of physical activity on healthcare utilization among Korean adults]

PURPOSE

This study was done to identify the impact of physical activity on healthcare utilization among Korean adults.

METHODS

Drawing from the 2008 Korean National Health and Nutrition Examination Survey (NHANES IV-2), data from 6,521 adults who completed the Health Interview and Health Behavior Surveys were analyzed. Association between physical activity and healthcare utilization was tested using the χ²-test. Multiple logistic regression analysis was used to calculate the odds ratios of using outpatient and inpatient healthcare for different levels of physical activity after adjusting for predisposing, enabling, and need factors. A generalized linear model applying a negative binomial distribution was used to determine how the level of physical activity was related to use of outpatient and inpatient healthcare.

RESULTS

Physically active participants were 16% less likely to use outpatient healthcare (OR, 0.84; 95% CI, 0.74-0.97) and 23% less likely to use inpatient healthcare (OR, 0.77; 95% CI, 0.63-0.93) than physically inactive participants. Levels of outpatient and inpatient healthcare use decreased as levels of physical activity increased, after adjusting for relevant factors.

CONCLUSION

An independent association between being physically active and lower healthcare utilization was ascertained among Korean adults indicating a need to develop nursing intervention programs that encourage regular physical activity.

C-reactive protein (CRP) is a predictor of high medical-care expenditures in a community-based elderly population aged 70 years and over: the Tsurugaya project

Because CRP is a strong independent predictor of various diseases, it was hypothesized that CRP may be a useful predictor or treatment target for medical-care expenditures. The aim of this study was to investigate the relationship between CRP and medical-care expenditures in a community-dwelling elderly population. This prospective cohort study was conducted including 925 Japanese subjects aged ≥70 years. A high-sensitivity CRP assay was used by applying the nephelometric method. Hospitalizations, outpatient visits, and expenditures were ascertained through computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance (NHI) Association. Since medical-care expenditures were not normally distributed, the category of high medical-care expenditures (>75th percentile of medical-care expenditures: inpatient expenditures >$494/month; outpatient expenditure >$522/month; total expenditures >$1103/month) was used to examine the relation of CRP levels with medical-care expenditures. Multiple logistic regression analysis was used to examine the relationship between CRP cutoff points (low concentrations: <1.0mg/L; intermediate concentrations: 1.0-3.0mg/L; or high concentrations: ≥3.0 mg/L) and medical-care expenditures during 6 year-follow up period. After adjustment for potential confounding factors, a positive association of CRP with hospitalization, and total expenditures (p for trend=0.03 and 0.02, respectively) was found. An elevated baseline CRP level is an independent predictor of increases in prospective medical-care expenditures among community-dwelling elderly. Further study is required to clarify whether reducing CRP by intervention is a cost-effective measure.