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Garcia RE, Blackwell TL, Forman DE, Coen PM, Nicklas BJ, Qiao Y(S, Cawthon PM, Toledo FGS, Goodpaster BH, Cummings SR, Newman AB, Glynn NW. Role of Walking Energetics and Perceived Fatigability Differs by Gait Speed: The Study of Muscle, Mobility and Aging (SOMMA). J Gerontol A Biol Sci Med Sci 2024; 79:glae187. [PMID: 39066507 PMCID: PMC11341985 DOI: 10.1093/gerona/glae187] [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: 02/06/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Slower gait speed may be driven by greater energy deficits and fatigability among older adults. We examined associations of walking energetics and perceived physical fatigability with gait speed among slower and faster walkers. Additionally, we used statistical mediation to examine the role of fatigability in the associations of walking energetics and gait speed using the Study of Muscle, Mobility and Aging (SOMMA). METHODS Perceived physical fatigability was assessed using the Pittsburgh Fatigability Scale (PFS) Physical score (range 0-50, higher = greater). A 3-phase cardiopulmonary exercise treadmill test collected peak oxygen consumption (VO2peak, mL/kg/min), energetic cost of walking (ECW, mL/kg/m), and cost-capacity ratio (VO2/VO2peak*100, %). Slower (<1.01 m/s) versus faster (≥1.01 m/s) walkers were classified using median 4-m gait speed. Linear regressions and statistical mediation analyses were conducted. RESULTS Slower walkers had lower VO2peak, higher ECW at preferred walking speed (PWS), and greater PFS Physical score compared to faster walkers (all p < .05; N = 849). One standard deviation (1-SD) higher VO2peak was associated with 0.1 m/s faster gait speed, while 1-SD higher ECW PWS, cost-capacity ratio at PWS and slow walking speed (SWS), and PFS Physical score were associated with 0.02-0.23 m/s slower gait speed. PFS Physical score was a significant statistical mediator in the associations between VO2peak (15.2%), SWS cost-capacity ratio (15.9%), and ECW PWS (10.7%) with gait speed and was stronger among slower walkers. CONCLUSIONS Slower walkers may be more influenced by perceptions of fatigue in addition to walking energetics. Our work highlights the importance of targeting both energetics and perceived fatigability to prevent mobility decline.
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Affiliation(s)
- Reagan E Garcia
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Terri L Blackwell
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Daniel E Forman
- Department of Medicine (Divisions of Cardiology and Geriatrics), University of Pittsburgh School of Medicine, and Geriatrics, Research, Education, and Clinical Center (GRECC), Pittsburgh, Pennsylvania, USA
| | - Paul M Coen
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yujia (Susanna) Qiao
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Frederico G S Toledo
- Department of Medicine (Divisions of Endocrinology and Metabolism), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, Florida, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lin C, Yeh FC, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Associations of depression and perceived physical fatigability with white matter integrity in older adults. Psychiatry Res Neuroimaging 2024; 340:111793. [PMID: 38373367 DOI: 10.1016/j.pscychresns.2024.111793] [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: 10/18/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUNDS Fatigability is prevalent in older adults. However, it is often associated with depressed mood. We aim to investigate these two psychobehavioral constructs by examining their underpinning of white matter structures in the brain and their associations with different medical conditions. METHODS Twenty-seven older adults with late-life depression (LLD) and 34 cognitively normal controls (CN) underwent multi-shell diffusion MRI. Fatigability was measured with the Pittsburgh Fatigability Scale. We examined white matter integrity by measuring the quantitative anisotropy (QA), a fiber tracking parameter with better accuracy than the traditional imaging technique. RESULTS We found those with LLD had lower QA in the 2nd branch of the left superior longitudinal fasciculus (SLF-II), and those with more physical fatigability had lower QA in more widespread brain regions. In tracts associated with more physical fatigability, the lower QA in left acoustic radiation and left superior thalamic radiation correlated with higher blood glucose (r = - 0.46 and - 0.49). In tracts associated with depression, lower QA in left SLF-II correlated with higher bilirubin level (r = - 0.58). DISCUSSION Depression and fatigability were associated with various white matter integrity changes, which correlated with biochemistry biomarkers all related to inflammation.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan; Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan.
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Gay EL, Coen PM, Harrison S, Garcia RE, Qiao YS, Goodpaster BH, Forman DE, Toledo FGS, Distefano G, Kramer PA, Ramos SV, Molina AJA, Nicklas BJ, Cummings SR, Cawthon PM, Hepple RT, Newman AB, Glynn NW. Sex Differences in the Association between Skeletal Muscle Energetics and Perceived Physical Fatigability: The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.25.24307934. [PMID: 38853946 PMCID: PMC11160809 DOI: 10.1101/2024.05.25.24307934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Greater perceived physical fatigability and lower skeletal muscle energetics are predictors of mobility decline. Characterizing associations between muscle energetics and perceived fatigability may provide insight into potential targets to prevent mobility decline. We examined associations of in vivo (maximal ATP production, ATPmax) and ex vivo (maximal carbohydrate supported oxidative phosphorylation [max OXPHOS] and maximal fatty acid supported OXPHOS [max FAO OXPHOS]) measures of mitochondrial energetics with two measures of perceived physical fatigability, Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater) and Rating of Perceived Exertion (RPE Fatigability, 6-20, higher=greater) after a slow treadmill walk. Participants from the Study of Muscle, Mobility and Aging (N=873) were 76.3±5.0 years old, 59.2% women, and 85.3% White. Higher muscle energetics (both in vivo and ex vivo ) were associated with lower perceived physical fatigability, all p<0.03. When stratified by sex, higher ATPmax was associated with lower PFS Physical for men only; higher max OXPHOS and max FAO OXPHOS were associated with lower RPE fatigability for both sexes. Higher skeletal muscle energetics were associated with 40-55% lower odds of being in the most (PFS≥25, RPE Fatigability≥12) vs least (PFS 0-4, RPE Fatigability 6-7) severe fatigability strata, all p<0.03. Being a woman was associated with 2-3 times higher odds of being in the most severe fatigability strata when controlling for ATPmax but not the in vivo measures (p<0.05). Better mitochondrial energetics were linked to lower fatigability and less severe fatigability in older adults. Findings imply that improving skeletal muscle energetics may mitigate perceived physical fatigability and prolong healthy aging.
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Garcia RE, Cawthon PM, Nicklas BJ, Goodpaster BH, Coen PM, Forman DE, Cummings SR, Newman AB, Glynn NW. Usual-paced 400 m long distance corridor walk estimates cardiorespiratory fitness among older adults: The Study of Muscle, Mobility and Aging. J Am Geriatr Soc 2024; 72:858-865. [PMID: 38149438 PMCID: PMC10947881 DOI: 10.1111/jgs.18713] [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: 06/30/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET), the gold-standard method to quantify cardiorespiratory fitness (CRF), is not always feasible due to cost, access, and burden. The usual-paced 400 m long distance corridor walk (LDCW), a measure of mobility among older adults, may provide an alternate method to assess CRF. The purpose of this study was to develop and validate an estimating equation to estimate VO2 peak from average 400 m walking speed (WS) among participants in the Study of Muscle, Mobility and Aging (SOMMA). METHODS At baseline, women (58%) and men age 70 years and older enrolled in SOMMA (N = 820, 76.2 ± 4.9 years, 86% Non-Hispanic White) completed a 400 m LDCW (400 m WS = 400 m/completion time in seconds) and symptom-limited maximal CPET (Modified Balke Protocol). VO2 peak (mL/kg/min) was considered the highest 30-second average oxygen consumption during CPET. Other covariates included: age, sex, race, physical activity (7-day wrist-worn accelerometer), physical function (Short Physical Performance Battery, range 0-12), perceived physical fatigability (Pittsburgh Fatigability Scale, range 0-50), and Borg Rating of Perceived Exertion (RPE, range 6-20) at completion of the 400 m LDCW. Stepwise linear regression was used. Internal validation was completed using data-splitting method (70%; 30%). RESULTS Mean VO2 peak was 20.2 ± 4.8 mL/kg/min and mean 400 m WS was 1.06 ± 0.2 m/s. Each 0.05 m/s increment in 400 m WS was associated with a 0.40 mL/kg/min higher VO2 peak after covariate adjustment. An estimating equation including 400 m WS, age, sex, race, and RPE was developed. Internal validation showed low overall bias (-0.26) and strong correlation (r = 0.71) between predicted and measured VO2 peak values. Bland-Altman plot and regression analyses indicated predicted VO2 peak was an acceptable alternative, despite mean underestimation of 4.53 mL/kg/min among the highly fit. CONCLUSIONS Usual-paced 400 m LDCW strongly correlates with direct measures of CRF during CPET in older adults with lower fitness and can be used to test both fitness and function.
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Affiliation(s)
- Reagan E. Garcia
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M. Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Barbara J. Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, FL, USA
| | - Paul M. Coen
- Translational Research Institute for Metabolism and Diabetes, Advent Health, Orlando, FL, USA
| | - Daniel E. Forman
- Department of Medicine (Divisions of Cardiology and Geriatrics), University of Pittsburgh School of Medicine, and Geriatrics, Research, Education, and Clinical Center (GRECC), Pittsburgh, PA, USA
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Anne B. Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Santinelli FB, Ramari C, Poncelet M, Severijns D, Kos D, Pau M, Kalron A, Meyns P, Feys P. Between-Day Reliability of the Gait Characteristics and Their Changes During the 6-Minute Walking Test in People With Multiple Sclerosis. Neurorehabil Neural Repair 2024; 38:75-86. [PMID: 38229519 DOI: 10.1177/15459683231222412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Gait characteristics and their changes during the 6-minute walking test (6MWT) in people with multiple sclerosis (pwMS) have been described in the literature, which one may refer to as walking fatigability in the body function level of the International Classification of Functioning, Disability, and Health. However, whether these metrics are reliable is unknown. OBJECTIVE To investigate the between-day reliability of the gait characteristics and their changes in pwMS and healthy controls (HCs). METHODS Forty-nine pwMS (EDSS 4.82 ± 1.22 and 54.7 ± 9.36 years) and 23 HCs (50.6 ± 6.1 years) performed the 6MWT, as fast as possible but safely while wearing Inertial Measurement Units. Gait characteristics were measured in the pace, rhythm, variability, asymmetry, kinematics, coordination, and postural control domains and were obtained in intervals of 1 minute during the 6MWT. In addition, gait characteristics change in the last minute compared with the first minute were calculated for all gait variables using a fatigability index (ie, distance walking index). The intraclass correlation coefficient (ICC), Bland-Altman Plots, and Standard error of measurement were applied to investigate reliability. RESULTS Reliability of gait characteristics, minute-by-minute, and for their changes (ie, using the fatigability index) ranged from poor to excellent (pwMS: ICC 0.46-0.96; HC: ICC 0.09-0.97 and pwMS: ICC 0-0.72; HC: ICC 0-0.77, respectively). CONCLUSION Besides coordination, at least 1 variable of each gait domain showed an ICC of moderate or good reliability for gait characteristics changes in both pwMS and HC. These metrics can be incorporated into future clinical trials and research on walking fatigability.Clinical Trial Registration: NCT05412043.
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Affiliation(s)
- Felipe Balistieri Santinelli
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt/Pelt, Belgium
| | - Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt/Pelt, Belgium
| | - Marie Poncelet
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Daphne Kos
- National MS Center Melsbroek, Melsbroek, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Pieter Meyns
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt/Pelt, Belgium
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Schumacher BT, Kehler DS, Kulminski AM, Qiao Y(S, Andersen SL, Gmelin T, Christensen K, Wojczynski MK, Theou O, Rockwood K, Newman AB, Glynn NW. The association between frailty and perceived physical and mental fatigability: The Long Life Family Study. J Am Geriatr Soc 2024; 72:219-225. [PMID: 37814920 PMCID: PMC10843058 DOI: 10.1111/jgs.18624] [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: 05/12/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Higher levels of frailty, quantified by a frailty index (FI), may be linked to fatigue severity as tasks become more physically and mentally demanding. Fatigue, a component of frailty research, has been ambiguous and inconsistent in its operationalization. Fatigability-the quantification of vulnerability to fatigue in relation to specific intensity and duration of activities-offers a more sensitive and standardized approach, though the association between frailty and fatigability has not been assessed. METHODS Using cross-sectional data from the Long Life Family Study at Visit 2 (2014-2017; N = 2524; mean age ± standard deviation (SD) 71.4 ± 11.2 years; 55% women; 99% White), we examined associations between an 83-item FI after excluding fatigue items (ratio of number of health problems reported (numerator) out of the total assessed (denominator); higher ratio = greater frailty) and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS) (range 0-50; higher scores = greater fatigability). RESULTS Participants had mean ± standard deviation FI (0.08 ± 0.06; observed range: 0.0-0.43), PFS Physical (13.7 ± 9.6; 39.5% more severe, ≥15), and PFS Mental (7.9 ± 8.9; 22.8% more severe, ≥13). The prevalence of more severe physical and mental fatigability was higher across FI quartiles. In mixed effects models accounting for family structure, a clinically meaningful 3%-higher FI was associated with 1.9 points higher PFS Physical score (95% confidence interval (CI) 1.7-2.1) and 1.7 points higher PFS Mental score (95% CI 1.5-1.9) after adjusting for covariates. CONCLUSIONS Frailty was associated with perceived physical and mental fatigability severity. Understanding this association may support the development of interventions to mitigate the risks associated with greater frailty and perceived fatigability. Including measurements of perceived fatigability, in lieu of fatigue, in frailty indices has the potential to alleviate the inconsistencies and ambiguity surrounding the operationalization of fatigue and provide a more precise and sensitive measurement of frailty.
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Affiliation(s)
| | - Dustin S. Kehler
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander M. Kulminski
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Stacy L. Andersen
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Theresa Gmelin
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark
- Department of Clinical Biochemistry and Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne B. Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
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Cummings SR, Lui LY, Glynn NW, Mau T, Cawthon PM, Kritchevsky SB, Coen PM, Goodpaster B, Marcinek DJ, Hepple RT, Patel S, Newman AB. Energetics and Clinical Factors for the Time Required to Walk 400 Meters The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.10.23298299. [PMID: 37986884 PMCID: PMC10659495 DOI: 10.1101/2023.11.10.23298299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Walking slows with aging often leading to mobility disability. Mitochondrial energetics has been found to influence gait speed over short distances. Additionally, walking is a complex activity but few clinical factors that may influence walk time have been studied. Methods We examined 879 participants ≥70 years and measured the time to walk 400m. We tested the hypothesis that decreased mitochondrial energetics by respirometry in muscle biopsies and magnetic resonance spectroscopy in the thigh, is associated with longer time to walk 400m. We also used cardiopulmonary exercise testing to assess the energetic costs of walking: maximum oxygen consumption (VO 2 peak) and energy cost-capacity (the ratio of VO2, at a slow speed to VO 2 peak). In addition, we tested the hypothesis that selected clinical factors would also be associated with 400m walk time. Results Lower Max OXPHOS was associated with longer walk time and the association was explained by the energetics costs of walking, leg power and weight. Additionally, a multivariate model revealed that longer walk time was also significantly associated with lower VO 2 peak, greater cost-capacity ratio, weaker leg power, heavier weight, hip and knee stiffness, peripheral neuropathy, greater perceived exertion while walking slowly, greater physical fatigability, less moderate-to-vigorous exercise, less sedentary time and anemia. Significant associations between age, sex, muscle mass, and peripheral artery disease with 400m walk time were explained by other clinical and physiologic factors. Conclusions Lower mitochondrial energetics is associated with needing more time to walk 400m. This supports the value of developing interventions to improve mitochondrial energetics. Additionally, doing more moderate-to-vigorous exercise, increasing leg power, reducing weight, treating hip and knee stiffness, and screening for and treating anemia may reduce the time required to walk 400m and reduce the risk of mobility disability.
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Schumacher BT, Rosano C, Qiao YS, Rosso AL, Cawthon PM, Moored KD, Cummings SR, Kritchevsky SB, Glynn NW. Lower Physical Activity Modifies the Association between Perceived Fatigability and Executive Function but not Memory: The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.06.23298173. [PMID: 37986903 PMCID: PMC10659480 DOI: 10.1101/2023.11.06.23298173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Emerging evidence shows that perceived fatigability-the quantification of vulnerability to fatigue in relation to specific intensity and duration of activities-may be associated with cognitive function. We sought to quantify associations with multiple domains of cognitive function and the role of physical activity (PA). METHODS SOMMA participants completed the Pittsburgh Fatigability Scale (PFS) Physical and Mental subscales (each range 0-50; higher scores=greater fatigability) and three cognitive function assessments [Digit Symbol Substitution Test (DSST), executive function; Montreal Cognitive Assessment (MoCA), general function; and California Verbal Learning Test (CVLT), memory]. Linear regression quantified associations cross-sectionally between each PFS subscale and cognitive assessment scores adjusting for covariates. Effect modification by volume and intensity of accelerometer-measured PA was assessed. RESULTS In 873 participants (59.2% women; age 76.3±5.0; 85% White), mean PFS Physical, Mental, and DSST scores were 15.8±8.7, 7.7±7.8, and 55.4±13.7. After adjustments, for each 4-point higher PFS Physical and 3-point higher PFS Mental, participants had nearly one fewer correct DSST items [β coefficient and 95% confidence interval for PFS Physical: -0.69 (-1.09, - 0.29); PFS Mental: -0.64 (-0.97, -0.30)]. Volume and intensity of PA modified the association of PFS Mental and DSST ( P interactions <0.01). All associations were strongest in those with the lowest volume and intensity of PA. PFS was not associated with MoCA or CVLT. DISCUSSION Greater perceived fatigability may be associated with poorer executive function, but not memory. Individuals with greater perceived fatigability, particularly those less active, might benefit from interventions that reduce fatigability and may beneficially influence cognitive function.
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Moffit RE, Cawthon PM, Nicklas BJ, Goodpaster BH, Coen PM, Forman DE, Cummings SR, Newman AB, Glynn NW. Usual-Paced 400m Long Distance Corridor Walk Estimates Cardiorespiratory Fitness among Older Adults: The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.05.23298103. [PMID: 37986795 PMCID: PMC10659523 DOI: 10.1101/2023.11.05.23298103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Cardiopulmonary exercise testing (CPET), the gold-standard method to quantify cardiorespiratory fitness (CRF), is not always feasible due to cost, access, and burden. The usual-paced 400m long-distance corridor walk (LDCW), a measure of mobility among older adults, may provide an alternate method to assess CRF among populations unable to complete maximal intensity testing. The purpose of this study was to develop and validate an estimating equation to estimate VO 2 peak from average 400m walking speed (WS) among participants in the Study of Muscle, Mobility and Aging (SOMMA). Methods At baseline, participants (N=820, 76.2±4.9 years, 58% Women, 86% Non-Hispanic White) completed a 400m LDCW (400m WS=400m/completion time in seconds) and symptom-limited maximal CPET (Modified Balke Protocol). VO 2 peak (mL/kg/min) was considered the highest 30-second average oxygen consumption during CPET. Other covariates included: age, sex, race, physical activity (7-day wrist-worn accelerometer), physical function (Short Physical Performance Battery, range 0-12), perceived physical fatigability (Pittsburgh Fatigability Scale, range 0-50), and Borg Rating of Perceived Exertion (RPE, range 6-20) at completion of the 400m LDCW. Stepwise linear regression was used. Internal validation was completed using data-splitting method (70%; 30%). Results Mean VO 2 peak was 20.2±4.8 mL/kg/min and mean 400m WS was 1.06±0.2 m/s. Each 0.05 m/s increment in 400m WS was associated with a 0.40 mL/kg/min higher VO 2 peak after adjustment for covariates. An estimating equation including 400m WS, age, sex, race, and RPE was developed. Internal validation showed low overall bias (-0.26) and strong correlation (r = 0.71) between predicted and measured VO 2 peak values. Bland-Altman plot and regression analyses indicated predicted VO 2 peak was an acceptable alternative, despite mean underestimation of 4.53 mL/kg/min among those with CPET VO 2 peak ≥25 mL/kg/min. Conclusions Usual-paced 400m LDCW strongly correlates with direct measures of cardiorespiratory fitness during CPET in older adults with lower fitness and can be used to test both fitness and function.
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Petnehazy N, Barnes HN, Newman AB, Kritchevsky SB, Cummings SR, Hepple RT, Cawthon PM. Muscle mass, strength, power and physical performance and their association with quality of life in older adults, the Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.31.23297845. [PMID: 37961491 PMCID: PMC10635249 DOI: 10.1101/2023.10.31.23297845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Sarcopenia negatively impacts quality of life. It is unclear whether different measures of muscle size, strength, physical performance, and fitness have similar associations with quality of life. Objective To describe associations of sarcopenia metrics with quality of life outcomes. Participants Community-dwelling adults aged 70+ years participating in the SOMMA (Study of Muscle, Mobility and Aging) study. Design and settings Two academic medical centers. Measurements Measures included muscle size (MRI- muscle volume. D3Cr muscle mass); strength and power (grip strength, leg extension power and strength); walking and physical performance (4m and 400m walk, SPPB (Short Physical Performance Battery), stair climb, chair stand); fitness (VO2 peak); health related quality of life (EQ-5D); and anthropometrics (weight, height, and body mass index).Results were stratified by sex. Correlations, scatterplots and linear regression models described the association between various measures of sarcopenia and fitness with overall quality of life score (EQ5D VAS) as a continuous variable. We also quantified differences between sarcopenia and fitness measures by overall QOL (Quality of Life) as a categorical variable (low, medium, high) and by QOL subcomponents (pain and discomfort, problems with usual activities, mobility, anxiety and depression, and problems with self-care) using distributionally appropriate methods. Results Walking tests and physical performance were most consistently (but modestly) associated with overall quality of life (r~0.2, p<.001) and its subcomponents. Both men and women several sarcopenia and fitness measures were more strongly associated with pain and usual activity than other QOL components. Conclusions Poor performance, lower fitness and lower strength are related to worse quality of life, particularly pain, in older adults. Future studies should quantify these relationships longitudinally.
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Affiliation(s)
- Nora Petnehazy
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Haley N Barnes
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Russel T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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11
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Cummings SR, Newman AB, Coen PM, Hepple RT, Collins R, Kennedy, MS K, Danielson M, Peters K, Blackwell T, Johnson E, Mau T, Shankland EG, Lui LY, Patel S, Young D, Glynn NW, Strotmeyer ES, Esser KA, Marcinek DJ, Goodpaster BH, Kritchevsky S, Cawthon PM. The Study of Muscle, Mobility and Aging (SOMMA): A Unique Cohort Study About the Cellular Biology of Aging and Age-related Loss of Mobility. J Gerontol A Biol Sci Med Sci 2023; 78:2083-2093. [PMID: 36754371 PMCID: PMC10613002 DOI: 10.1093/gerona/glad052] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The Study of Muscle, Mobility and Aging (SOMMA) aims to understand the biological basis of many facets of human aging, with a focus on mobility decline, by creating a unique platform of data, tissues, and images. METHODS The multidisciplinary SOMMA team includes 2 clinical centers (University of Pittsburgh and Wake Forest University), a biorepository (Translational Research Institute at Advent Health), and the San Francisco Coordinating Center (California Pacific Medical Center Research Institute). Enrollees were age ≥70 years, able to walk ≥0.6 m/s (4 m); able to complete 400 m walk, free of life-threatening disease, and had no contraindications to magnetic resonance or tissue collection. Participants are followed with 6-month phone contacts and annual in-person exams. At baseline, SOMMA collected biospecimens (muscle and adipose tissue, blood, urine, fecal samples); a variety of questionnaires; physical and cognitive assessments; whole-body imaging (magnetic resonance and computed tomography); accelerometry; and cardiopulmonary exercise testing. Primary outcomes include change in walking speed, change in fitness, and objective mobility disability (able to walk 400 m in 15 minutes and change in 400 m speed). Incident events, including hospitalizations, cancer diagnoses, fractures, and mortality are collected and centrally adjudicated by study physicians. RESULTS SOMMA exceeded its goals by enrolling 879 participants, despite being slowed by the COVID-19 pandemic: 59.2% women; mean age 76.3 ± 5.0 years (range 70-94); mean walking speed 1.04 ± 0.20 m/s; 15.8% identify as other than Non-Hispanic White. Over 97% had data for key measurements. CONCLUSIONS SOMMA will provide the foundation for discoveries in the biology of human aging and mobility.
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Affiliation(s)
- Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul M Coen
- Translational Research Institute, AdventHealth, Orlando, Florida, USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Robin Collins
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Kimberly Kennedy, MS
- Department of Internal Medicine, Section on Gerontology & Geriatric Medicine and the Sticht Center for Healthy aging and Alzheimer’s Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michelle Danielson
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathy Peters
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Terri Blackwell
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Eileen Johnson
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Theresa Mau
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Eric G Shankland
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Li-Yung Lui
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Sheena Patel
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Dani Young
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Nancy W Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karyn A Esser
- Department of Physiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - David J Marcinek
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Bret H Goodpaster
- Translational Research Institute, AdventHealth, Orlando, Florida, USA
| | - Stephen Kritchevsky
- Department of Internal Medicine, Section on Gerontology & Geriatric Medicine and the Sticht Center for Healthy aging and Alzheimer’s Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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12
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Glynn NW, Qiao YS. Measuring and Understanding the Health Impact of Greater Fatigability in Older Adults: A Call to Action and Opportunities. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2023; 11:188-201. [PMID: 38074079 PMCID: PMC10707490 DOI: 10.1080/21641846.2023.2252612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Different from fatigue, an instantaneous state of tiredness, weakness and lack of energy, fatigability is a trait that contextualizes whole-body fatigue to the level of activity (i.e., intensity and duration) with which the fatigue is associated. Fatigability can be perceived or performance-related. Measuring fatigability improves upon traditional fatigue measures by accounting for self-pacing as older adults likely slow down or limit their daily activity to maintain fatigue in a tolerable range. Anchoring fatigue to activities/tasks improves sensitivity and allows for meaningful comparisons across individuals/between studies, as well as evaluating change over time and treatment effects. Two well-validated approaches are utilized to measure perceived fatigability: 1) a 5-minute slow-paced (1.5 mph/0.67 m/s, 0% grade) treadmill walk immediately followed by Borg rating of perceived exertion; and 2) a self-administered 10-item questionnaire, Pittsburgh Fatigability Scale, with both physical and mental subscales. Many walking-based performance fatigability measures are based on certain lap time or distance, while the Pittsburgh Performance Fatigability Index uses raw accelerometry data to quantify percent of cadence decline over the entire long distance walking tasks. Perceived fatigability prevalence ranges from 20-90% in older adults varying by assessment tool, and is higher with advancing age and in women compared to men. Fatigability is associated with physical and cognitive function, fall risk, mobility decline, and mortality. Unfortunately, the available research lacks representativeness in terms of racial and ethnic diversity. The time is now to incorporate our established sensitive and validated fatigability measures into global research and clinical practice to better understand mechanistic underpinnings and reveal intervention effects to reduce the burden and lessen the consequences of greater fatigability worldwide.
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Affiliation(s)
- Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA 15261
| | - Yujia Susanna Qiao
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA 15261
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13
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Welburn S, Fanning E, Cauley J, Brown P, Strotmeyer E, Boudreau R, Bear T, Moored K, Cawthon P, Stone K, Glynn N. Role of Perceived Physical and Mental Fatigability Severity on Prospective, Recurrent, and Injurious Fall Risk in Older Men. J Gerontol A Biol Sci Med Sci 2023; 78:1669-1676. [PMID: 36801938 PMCID: PMC10460552 DOI: 10.1093/gerona/glad061] [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: 04/19/2022] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Falls occur annually in 25% of adults aged ≥65 years. Fall-related injuries are increasing, highlighting the need to identify modifiable risk factors. METHODS Role of fatigability on prospective, recurrent, and injurious fall risk was examined in 1 740 men aged 77-101 years in the Osteoporotic Fractures in Men Study. The 10-item Pittsburgh Fatigability Scale measured perceived physical and mental fatigability (0-50/subscale) at Year 14 (2014-16); established cut-points identified men with more severe perceived physical (≥15, 55.7%), more severe mental (≥13, 23.7%) fatigability, or having both (22.8%). Prospective, recurrent (≥2), and injurious falls were captured by triannual questionnaires ≥1 year after fatigability assessment; risk of any fall was estimated with Poisson generalized estimating equations, and likelihood of recurrent/injurious falls with logistic regression. Models adjusted for age, health conditions, and other confounders. RESULTS Men with more severe physical fatigability had a 20% (p = .03) increased fall risk compared with men with less physical fatigability, with increased odds of recurrent and injurious falls, 37% (p = .04) and 35% (p = .035), respectively. Men with both more severe physical and mental fatigability had a 24% increased risk of a prospective fall (p = .026), and 44% (p = .045) increased odds of recurrent falling compared with men with less severe physical and mental fatigability. Mental fatigability alone was not associated with fall risk. Additional adjustment for previous fall history attenuated associations. CONCLUSIONS More severe fatigability may be an early indicator to identify men at high risk for falls. Our findings warrant replication in women, as they have higher rates of fatigability and prospective falls.
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Affiliation(s)
- Sharon C Welburn
- Department of Kinesiology and Health Sciences, Columbus State University, Columbus, Georgia,USA
| | - Erin E Fanning
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, and The New York State Psychiatric Institute, New York, New York, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd M Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Moored KD, Qiao Y(S, Rosso AL, Toledo FGS, Cawthon PM, Cummings SR, Goodpaster BH, Kritchevsky SB, Glynn NW. Dual Roles of Cardiorespiratory Fitness and Fatigability in the Life-Space Mobility of Older Adults: The Study of Muscle, Mobility and Aging (SOMMA). J Gerontol A Biol Sci Med Sci 2023; 78:1392-1401. [PMID: 36715332 PMCID: PMC10395561 DOI: 10.1093/gerona/glad037] [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: 09/26/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Cardiorespiratory fitness and perceived fatigability are interrelated components of physical capacity that may jointly influence movement within one's living environment (life-space mobility). We examined whether fitness and fatigability were associated with life-space mobility in community-dwelling older adults, and whether the association of fitness with life-space varied by the level of perceived fatigability. METHODS Participants were from the Study of Muscle, Mobility and Aging (SOMMA) baseline cohort (N = 775, mean age 76.1 years). Life Space Assessment scores incorporated level, frequency, and assistance used (personal, devices) for life-space mobility. Fitness was measured as VO2peak from symptom-limited treadmill testing. Fatigability cut-points included: (i) Borg Rating of Perceived Exertion (RPE) ≥ 10 after a fixed-speed (1.5 mph) treadmill test, (ii) the Pittsburgh Fatigability Scale (PFS) Physical ≥ 15, and (iii) PFS Mental ≥ 13. The total count of cut-points was used as a composite fatigability measure (range: 0-3). Linear regressions were adjusted for demographic, lifestyle, and health confounders. RESULTS Better fitness was associated with greater life-space, but the association plateaued at higher fitness levels (VO2peak > 18). Life-space was significantly lower for individuals meeting ≥2 fatigability criteria (vs none), attributable mainly to more severe physical, but not mental, fatigability. In moderation analyses, the fitness-life-space association was significant only for those with RPE ≥ 10 but did not differ by PFS. CONCLUSION Fitness below a critically low threshold was associated with limited life-space mobility, suggesting that certain older individuals may need to operate close to their maximum aerobic capacity to traverse daily environments; these associations were driven by those with more severe physical fatigability.
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Affiliation(s)
- Kyle D Moored
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Frederico G S Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Bret H Goodpaster
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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15
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Linnhoff S, Haghikia A, Zaehle T. Fatigability-related oscillatory brain activity changes in people with MS. Mult Scler Relat Disord 2023; 69:104457. [PMID: 36512955 DOI: 10.1016/j.msard.2022.104457] [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: 10/04/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue, a multidimensional and challenging symptom associated with various underlying conditions, can manifest as a subjective feeling and a performance fatigability. The latter is often defined as an objectively measurable performance decline with time on task. Both syndromes are highly prevalent in people with multiple sclerosis (pwMS) and are often resistant to medical therapy. In the absence of valid and reliable objective parameters, the current cognitive fatigue diagnosis remains purely subjective. Assessing brain wave activity changes has repeatedly been a viable strategy for monitoring cognitive fatigue in healthy subjects. In this study, we aimed to investigate oscillatory brain activity changes and their associations with subjective fatigue in pwMS. METHODS We enrolled 21 pwMS and 21 healthy controls (HC) in this study. Subjects performed a sustained attention task divided into six blocks over the course of 30 minutes, and underwent resting state EEGs before and after the task. During the task, subjects were repeatedly asked to rate their subjective levels of mental fitness, mental exhaustion, and mind wandering. Using Linear Mixed Models, we explored fatigability-related changes by focusing on the time course of changes in reaction time variability, subjective ratings of fatigability, as well as frontomedial theta, and occipital alpha power. We further investigated initial and fatigability-induced differences between pwMS and HC at rest. Finally, Pearson correlations were used to examine the relationship between subjective fatigue and objective fatigability parameters. RESULTS Our results revealed a systematically stronger fatigability development in pwMS that was objectively measurable. PwMS reported lower mental fitness levels and demonstrated greater variability in reaction times with time on task. Occipital alpha power significantly increased during the task. Especially for upper alpha power, this increase was significantly more prominent in pwMS compared to HC. However, the time-on-task-induced changes in our study were not associated with the subjective fatigue ratings. CONCLUSIONS The results of this study expand the understanding of the neural mechanisms underlining cognitive fatigability and may complement the fatigue diagnosis and therapy monitoring with quantitative objective methods.
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Affiliation(s)
- Stefanie Linnhoff
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg 39120, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Leipziger Street 44, Magdeburg 39120, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany.
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16
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Qiao Y(S, Moored KD, Boudreau RM, Roe LS, Cawthon PM, Stone KL, Cauley JA, Glynn NW. Changes in Objectively Measured Physical Activity Are Associated With Perceived Physical and Mental Fatigability in Older Men. J Gerontol A Biol Sci Med Sci 2022; 77:2507-2516. [PMID: 35385877 PMCID: PMC9799193 DOI: 10.1093/gerona/glac082] [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: 11/30/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Lower physical activity (PA) is associated with greater perceived fatigability, a person-centered outcome. The association between change in PA and fatigability with advanced age has yet to be established. METHODS Community-dwelling older men (N = 1 113, age = 84.1 ± 3.9 years at Year 14) had free-living PA assessed using SenseWear Armband prospectively at Year 7 (2007-2009) and Year 14 (2014-2016) of Osteoporotic Fractures in Men Study, a longitudinal cohort established in 2000 (baseline). We categorized percent changes in PA into groups (large decline → large increase) for 4 metrics: step count, light intensity PA (LIPA, metabolic equivalents [METs] >1.5 to <3.0), moderate-to-vigorous PA (MVPA, METs ≥ 3.0), and sedentary behavior (SB, METs ≤ 1.5, excluding sleep). Perceived physical and mental fatigability were measured (Year 14) with the Pittsburgh Fatigability Scale (PFS, higher score = greater fatigability; range = 0-50). Associations between each metric of percent changes in PA and fatigability were examined using linear regression, adjusted for demographics, change in health conditions, and Year 7 step count or total PA (METs > 1.5). RESULTS Men declined 2 336 ± 2 546 (34%) steps/d, 24 ± 31 (25%) LIPA min/d, 33 ± 58 (19%) MVPA min/d, and increased 40 ± 107 (6%) SB min/d over 7.2 ± 0.7 years. Compared to large decline (% change less than -50%), those that maintained or increased step count had 3-8 points lower PFS Physical scores; those who maintained or increased LIPA and MVPA had 2-3 and 2-4 points lower PFS Physical scores, respectively (all p ≤ .01). Associations were similar, but smaller, for PFS Mental scores. CONCLUSION Older men who maintained or increased PA had lower fatigability, independent of initial PA. Our findings inform the types and doses of PA that should be targeted to reduce fatigability in older adults.
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Affiliation(s)
- Yujia (Susanna) Qiao
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren S Roe
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Katie L Stone
- California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Moored KD, Qiao Y(S, Boudreau RM, Roe LS, Cawthon PM, Cauley JA, Glynn NW. Prospective Associations Between Physical Activity and Perceived Fatigability in Older Men: Differences by Activity Type and Baseline Marital Status. J Gerontol A Biol Sci Med Sci 2022; 77:2498-2506. [PMID: 35134905 PMCID: PMC9799181 DOI: 10.1093/gerona/glac030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lower physical activity has been cross-sectionally associated with greater perceived fatigability, defined as self-reported fatigue anchored to activity intensity and duration. The temporality of this relationship, and whether it differs by activity type or marital status, remains unclear. METHODS In the Osteoporotic Fractures in Men Study (N = 1 759), self-reported total, exercise, and household activity were assessed using the Physical Activity Scale for the Elderly across 7 visits (2000-2016). The Pittsburgh Fatigability Scale (range: 0-50; higher scores = greater fatigability) measured physical (mean = 16.6 ± 9.7) and mental (mean = 7.8 ± 8.3) fatigability at Year 14. Least absolute deviation and linear regression were used to examine associations between baseline and change in activity over 14 years with subsequent fatigability. Models were adjusted for demographic, health, and lifestyle factors. RESULTS After adjustment, lower baseline (β= -0.08, 95% confidence interval [CI]: -0.12, -0.04) and greater annual declines in total activity (β = -0.09, 95% CI: -0.14, -0.05) were prospectively associated with higher Pittsburgh Fatigability Scale (PFS) Physical scores. Associations were similar for mental fatigability (both p < .05). Lower baseline leisure exercise, but not baseline household activity, predicted higher PFS Physical scores (β = -0.10 vs -0.001). In contrast, greater declines in household activity, but not declines in exercise, were associated with higher PFS Physical scores (β = -0.09 vs -0.03). Lower baseline household activity predicted higher PFS Mental scores only for unmarried men (β = -0.15, 95% CI: -0.29, -0.01, interaction p = .019). CONCLUSIONS Baseline total activity and leisure exercise, and declines in total and household activity, were associated with higher subsequent perceived fatigability in older men. Marital status may mitigate the contribution of household activity to subsequent fatigability.
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Affiliation(s)
- Kyle D Moored
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lauren S Roe
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatics, University of California San Francisco, San Francisco, California, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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18
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Katz R, Gay EL, Kuipers AL, Lee JH, Honig LS, Christensen K, Feitosa MF, Wojczynski MK, Glynn NW. Association of leukocyte telomere length with perceived physical fatigability. Exp Gerontol 2022; 170:111988. [PMID: 36302456 DOI: 10.1016/j.exger.2022.111988] [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: 03/26/2022] [Revised: 09/22/2022] [Accepted: 10/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Leukocyte telomere length (LTL) is a potential genomic marker of biological aging, but its relation to fatigability, a prognostic indicator of phenotypic aging (e.g., functional decline) is unknown. We hypothesized shorter LTL would predict greater perceived physical fatigability, but that this association would be attenuated by adjusting for chronological age. METHODS Two generations of participants (N = 1997; 309 probands, 1688 offspring) were from the Long Life Family Study (age = 73.7 ± 10.4, range 60-108, 54.4 % women), a longitudinal cohort study of aging. LTL was assayed at baseline. Perceived physical fatigability was measured 8.0 ± 1.1 years later using the validated, self-administered 10-item Pittsburgh Fatigability Scale (PFS, 0-50, higher scores = greater fatigability). Generalized estimating equations were generated to model the association between LTL and PFS Physical scores. RESULTS Prevalence of greater physical fatigability (PFS scores≥15) was 41.9 %. Using generalized estimating equations, a one kilobase pair shorter LTL was associated with higher PFS Physical scores (β = 1.8, p < .0001), accounting for family structure, and adjusting for field center, follow-up time, sex, and follow-up body mass index, physical activity, and chronic health conditions. When age was included as a covariate, the association was fully attenuated (β = 0.1, p = .78). CONCLUSION LTL may provide an alternative method for estimating an individual's lifetime exposure to chronic stressors, but does not appear to provide additional information not captured by chronological age. Further research is needed to characterize the interaction between age, LTL, and perceived fatigability, and develop a method of identifying individuals at risk for deleterious aging.
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Affiliation(s)
- Rain Katz
- School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emma L Gay
- School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison L Kuipers
- School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph H Lee
- Sergievsky Center, Taub Institute, Department of Epidemiology, Columbia University, New York, NY, USA; Sergievsky Center, Taub Institute, Department of Neurology, Columbia University, New York, NY, USA
| | - Lawrence S Honig
- Sergievsky Center, Taub Institute, Department of Neurology, Columbia University, New York, NY, USA
| | - Kaare Christensen
- Department of Public Health, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary K Wojczynski
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Nancy W Glynn
- School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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19
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Moored KD, Rosso AL, Gmelin T, Qiao Y(S, Carlson MC, Cawthon PM, Cauley JA, Glynn NW. Life-space Mobility in Older Men: The Role of Perceived Physical and Mental Fatigability. J Gerontol A Biol Sci Med Sci 2022; 77:2329-2335. [PMID: 34718553 PMCID: PMC9678195 DOI: 10.1093/gerona/glab286] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical performance and fatigue can limit mobility within the larger environment (life-space mobility). It is unknown whether perceived fatigability, self-reported fatigue anchored to activity intensity and duration, is independently associated with life-space. METHODS We assessed this cross-sectionally in Visit 4 (2014-2016) of the Osteoporotic Fractures in Men Study (MrOS; N = 1 672, Age: Mean = 84.2 ± 4.0 years). The Pittsburgh Fatigability Scale (PFS, range: 0-50; higher = greater fatigability) measured physical (Mean = 16.1 ± 9.4) and mental fatigability (Mean = 7.5 ± 7.9). Life Space Assessment scores incorporated level, frequency, and assistance used for life-space mobility (range: 0-120, higher = greater life-space mobility; life-space constriction: inability to leave neighborhood without assistance). Separate multiple linear and logistic regressions for physical and mental fatigability were sequentially adjusted for demographic, health/lifestyle, and performance measures. RESULTS The mean life-space mobility score was 84.6 ± 21.8, and 18% (n = 296) of men had life-space constriction. Higher physical and mental fatigability were both associated with lower life-space mobility in models adjusted for health and lifestyle factors (Physical PFS: B = -2.37, 95% confidence interval [CI]: [-3.39, -1.35]; Mental PFS: B = -1.79, 95% CI: [-2.73, -0.84]). Men with higher fatigability also had increased risk of life-space constriction (Physical PFS: OR = 1.59, 95% CI: [1.32, 1.92]; Mental PFS: OR = 1.25, 95% CI: [1.08, 1.46]). Associations were larger in magnitude for physical versus mental fatigability. Adjusting for physical performance measures more strongly attenuated associations for physical compared to mental fatigability. CONCLUSIONS Fatigability is linked with real-world mobility in older men, independent of their physical health. This association may be driven by separate physical and cognitive mechanisms worth examining further in longitudinal studies.
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Affiliation(s)
- Kyle D Moored
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
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20
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Qiao Y(S, Harezlak J, Moored KD, Urbanek JK, Boudreau RM, Toto P, Hawkins M, Santanasto AJ, Schrack JA, Simonsick EM, Glynn NW. Development of a Novel Accelerometry-Based Performance Fatigability Measure for Older Adults. Med Sci Sports Exerc 2022; 54:1782-1793. [PMID: 35763596 PMCID: PMC9481701 DOI: 10.1249/mss.0000000000002966] [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] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Efforts to study performance fatigability have been limited because of measurement constrains. Accelerometry and advanced statistical methods may enable us to quantify performance fatigability more granularly via objective detection of performance decline. Thus, we developed the Pittsburgh Performance Fatigability Index (PPFI) using triaxial raw accelerations from wrist-worn accelerometer from two in-laboratory 400-m walks. METHODS Sixty-three older adults from our cross-sectional study (mean age, 78 yr; 56% women; 88% White) completed fast-paced ( n = 59) and/or usual-paced 400-m walks ( n = 56) with valid accelerometer data. Participants wore ActiGraph GT3X+ accelerometers (The ActiGraph LLC, Pensacola, FL) on nondominant wrist during the walking task. Triaxial raw accelerations from accelerometers were used to compute PPFI, which quantifies percentage of area under the observed gait cadence-versus-time trajectory during a 400-m walk to a hypothetical area that would be produced if the participant sustained maximal cadence throughout the entire walk. RESULTS Higher PPFI scores (higher score = greater fatigability) correlated with worse physical function, slower chair stands speed and gait speed, worse cardiorespiratory fitness and mobility, and lower leg peak power (| ρ | = 0.36-0.61 from fast-paced and | ρ | = 0.28-0.67 from usual-paced walks, all P < 0.05). PPFI scores from both walks remained associated with chair stands speed, gait speed, fitness, and mobility, after adjustment for sex, age, race, weight, height, and smoking status; PPFI scores from the fast-paced walk were associated with leg peak power. CONCLUSIONS Our findings revealed that the objective PPFI is a sensitive measure of performance fatigability for older adults and can serve as a risk assessment tool or outcome measure in future studies and clinical practice.
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Affiliation(s)
- Yujia (Susanna) Qiao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN
| | - Kyle D. Moored
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
| | - Jacek K. Urbanek
- Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Robert M. Boudreau
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
| | - Pamela Toto
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA
| | - Marquis Hawkins
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
| | - Adam J. Santanasto
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | | | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, PA
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21
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Kim S, Kim I, Glynn NW, Jang MK. Translation and linguistic validation of the Pittsburgh Fatigability Scale for Korean breast cancer survivors: A cognitive interviewing study. CANCER CARE RESEARCH ONLINE 2022; 2:e029. [PMID: 36798429 PMCID: PMC9928162 DOI: 10.1097/cr9.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Fatigability-the perception of fatigue contextualized to activities of fixed intensity and duration-has received growing attention in oncology research. Objectives This study aimed to translate and linguistically validate a Korean-language version of the Pittsburgh Fatigability Scale. Methods Following the Linguistic Validation Manual for Health Outcome Assessment, we applied a multi-stage cognitive interviewing (CI) method to ensure accurate translation and interpretation of the Pittsburgh Fatigability Scale. After forward- and backward-translation were completed, three rounds of CI regarding the translated instrument were performed with 18 participants having or not having breast cancer. Results The first round of CI showed that seven items of the 10-item Korean-language instrument required revision to reflect the physical abilities of breast cancer patients with similar levels of physical activity. After the second round, two additional items were revised to reflect the cultural context and gender roles. During the third round, all participants exhibited full understanding of the Korean-language instrument. Conclusions The translated instrument, its quality enriched by cross-cultural linguistic validation in combination with CI, can be effectively used to assess perceived physical and mental fatigability. Implications for Practice Use of the Pittsburgh Fatigability Scale can facilitate oncology nurses' assessment of perceived fatigue levels in cancer patients and can expand understanding of how patients' fatigue perceptions are related to their exercise capacity. Foundational This study is valuable as an example of how a multi-stage CI process can be effectively applied in cross-cultural oncology research.
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Affiliation(s)
- Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Inah Kim
- School of Nursing, Duquesne University, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Min Kyeong Jang
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
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22
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Allen HL, Gmelin T, Moored KD, Boudreau RM, Smagula SF, Cohen RW, Katz R, Stone K, Cauley JA, Glynn NW. Relationship Between Personality Measures and Perceived Mental Fatigability. J Aging Health 2022; 34:750-760. [PMID: 34821521 PMCID: PMC9130341 DOI: 10.1177/08982643211055032] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Examine the association between personality measures and perceived mental fatigability. METHODS We performed a cross-sectional analysis in N=1670 men, age 84.3±4.1 years. Multivariable linear regression models were used to examine the covariate adjusted association between personality measures (conscientiousness, optimism, goal reengagement, and goal disengagement) and perceived mental fatigability (measured with the validated 10-item Pittsburgh Fatigability Scale, PFS). RESULTS One standard deviation lower conscientiousness (β=-0.91, p<.0001) and optimism (β=-0.63, p<.0001), and higher goal reengagement (β=0.51, p=.01) scores were independently associated with higher PFS Mental scores adjusted for age, cognitive function, self-reported health status, depressive symptoms, sleep disturbance, physical activity, and goal disengagement. DISCUSSION Lower conscientiousness, optimism, and higher goal reengagement were linked with more severe perceived mental fatigability in older men. Personality traits may potentially contribute to early risk assessment for fatigability in later life. Future work should be longitudinal in nature and include personality assessments to confirm the temporality of the relationships observed.
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Affiliation(s)
- Hannah L. Allen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Kyle D. Moored
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen F. Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rebecca W. Cohen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Rain Katz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nancy W. Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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23
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Lin C, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Validation of the Traditional Chinese Version of the Pittsburgh Fatigability Scale for Older Adults. Clin Gerontol 2022; 45:606-618. [PMID: 33934690 PMCID: PMC10155380 DOI: 10.1080/07317115.2021.1914258] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Pittsburgh Fatigability Scale (PFS) is a self-administered 10-item tool to measure physical and mental fatigability in older adults. The aim of the current study was to validate the psychometric properties of the traditional Chinese version of PFS (TC-PFS). METHODS We recruited 114 community-dwellingolder adults, where 35 were diagnosed with late-life depression (LLD), 26 with mild cognitive impairment (MCI), and 53 were cognitively normal (CN) from a larger community study of older adults. Statistical analyses were done separately for TC-PFS Physical and Mental subscales. Factor analysis was used for reliability, Cronbach's alpha for internal consistency, Pearson's correlation for construct validity, and group comparison for discriminative validity. RESULTS Factor analysis revealed a two-factor structure for both the TC-PFS Physical and Mental subscales with high reliability (α = 0.89 and 0.89, respectively). Patients with LLD had the highest PFS scores, with 80.0% and 82.9% classified as having greater physical and mental fatigability. For concurrent validity, we found moderate associations with the vitality and physical functioning subscales of the 36-Item Short Form Health Survey. For convergent validity, TC-PFS showed moderate association with emotional-related psychometrics, particularly for the Physical subscale in those with LLD. In contrast, TC-PFS Mental subscale showed correlations with cognitive function, particularly in the MCI group. CONCLUSIONS Our results indicate that the TC-PFS is a valid instrument to measure perceived physical and mental fatigability in older Taiwanese adults.Clinical implications: Perceived fatigability reflects the underlying physical, mental or cognitive function in older adults with or without depression.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
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24
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Renner SW, Qiao Y(S, Gmelin T, Santanasto AJ, Boudreau RM, Walston JD, Perls TT, Christensen K, Newman AB, Glynn NW. Association of fatigue, inflammation, and physical activity on gait speed: the Long Life Family Study. Aging Clin Exp Res 2022; 34:367-374. [PMID: 34196949 PMCID: PMC8864668 DOI: 10.1007/s40520-021-01923-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue, inflammation, and physical activity (PA) are all independently associated with gait speed, but their directionality is not fully elucidated. AIMS Evaluate the bidirectional associations amongst fatigue, inflammation, and PA on gait speed. METHODS This cross sectional study included probands (n = 1280, aged 49-105) and offspring (n = 2772, aged 24-88) in the Long Life Family Study. We assessed gait speed, fatigue with the question "I could not get going", inflammation using fasting interleukin-6 (IL-6) and high sensitivity C-reactive protein (CRP), and self-reported PA as walking frequency in the past two weeks. The two generations were examined separately using linear mixed modeling. RESULTS Lower fatigue, lower IL-6, and greater PA were all associated with faster gait speed in both generations (all p < 0.05); lower CRP was only associated with faster gait speed in the offspring. PA explained the association of fatigue and gait speed via a 16.1% (95% CI 9.7%, 26.7%) attenuation of the direct associations for the probands and 9.9% (95% CI 6.3%, 18.8%) in the offspring. In addition, IL-6 explained more of the association of fatigue and gait speed than the association between PA and gait speed, via a 14.9% (95% CI 9.2%, 23.4%) attenuation of the direct association in the offspring only. DISCUSSION Results revealed a potential directionality from fatigue to IL-6 to PA that may lead to faster gait speed. Future work should examine these relationships longitudinally to establish temporality and causality. CONCLUSIONS Our findings support a signal that lowering fatigue and inflammation and increasing physical activity may delay functional decline.
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Affiliation(s)
- Sharon W. Renner
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Yujia (Susanna) Qiao
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Adam J. Santanasto
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Robert M. Boudreau
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Jeremy D. Walston
- Johns Hopkins School of Medicine, Division of Geriatrics and Gerontology, Baltimore, Maryland
| | - Thomas T. Perls
- Boston University School of Medicine, Department of Medicine, Geriatrics Section, Boston, Massachusetts
| | - Kaare Christensen
- University of Southern Denmark, Department of Public Health, Unit of Epidemiology, Biostatistics and Biodemography, Odense, Denmark
| | - Anne B. Newman
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Nancy W. Glynn
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
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25
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Glynn NW, Gmelin T, Renner SW, QiaoScM YS, Boudreau RM, Feitosa MF, Wojczynski MK, Cosentino S, Andersen SL, Christensen K, Newman AB. Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:837-841. [PMID: 34908118 PMCID: PMC8974332 DOI: 10.1093/gerona/glab374] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Perceived physical fatigability is highly prevalent in older adults and associated with mobility decline and other health consequences. We examined the prognostic value of perceived physical fatigability as an independent predictor of risk of death among older adults. METHODS Participants (N = 2,906), mean age 73.5 [SD, 10.4] years, 54.2% women, 99.7% white enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017) with 2.7 [SD, 1.0] years follow-up. The Pittsburgh Fatigability Scale (PFS), a 10-item, self-administered validated questionnaire (score range 0-50, higher=greater fatigability) measured perceived physical fatigability at Visit 2. Deaths post-Visit 2 through December 31, 2019 were identified by: family members notifying field centers, reporting during another family member's annual phone follow-up, an obituary, or Civil Registration System (Denmark). We censored all other participants at their last contact. Cox proportional hazard models predicted mortality by fatigability severity, adjusted for family relatedness and other covariates. RESULTS Age-adjusted PFS Physical scores were higher for those who died (19.1 [SE, 0.8]) compared to alive (12.2, [SE, 0.4]) overall, as well as across age strata (P<.001), except for those 60-69 years (P=.79). Participants with the most severe fatigability (PFS Physical scores ≥25) were over twice as likely to die (HR, 2.33 [95% CI, 1.65 to 3.28]) compared to those with less severe fatigability (PFS Physical scores <25) after adjustment. CONCLUSIONS This work underscores the utility of the PFS as a novel patient-reported prognostic indicator of phenotypic aging that captures both overt and underlying disease burden that predicts death.
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Affiliation(s)
- Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon W Renner
- Department of Kinesiology and Health Sciences, Columbus State University, Columbus, GA, USA
| | - Yujia Susanna QiaoScM
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary F Feitosa
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mary K Wojczynski
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Jang MK, Kim S, Park CG, Collins EG, Quinn LT, Glynn NW, Ferrans CE. Psychometric properties of the Korean version of the Pittsburgh Fatigability Scale in breast cancer survivors. Health Qual Life Outcomes 2021; 19:179. [PMID: 34247645 PMCID: PMC8274048 DOI: 10.1186/s12955-021-01815-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.
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Affiliation(s)
- Min Kyeong Jang
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Chang Gi Park
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Eileen G Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lauretta T Quinn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carol Estwing Ferrans
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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27
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Cohen RW, Meinhardt AJ, Gmelin T, Qiao YS, Moored KD, Katz RD, Renner SW, Glynn NW. Prevalence and severity of perceived mental fatigability in older adults: The Long Life Family Study. J Am Geriatr Soc 2021; 69:1401-1403. [PMID: 33675035 DOI: 10.1111/jgs.17075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Rebecca W Cohen
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexa J Meinhardt
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yujia Susanna Qiao
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan D Katz
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharon W Renner
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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