Device‐measured light‐intensity physical activity and mortality: A meta‐analysis

Association between profiles of accelerometer-measured daily movement behaviour and mortality risk: a prospective cohort study of British older adults

Objectives

We identified profiles of wake-time movement behaviours (sedentary behaviours, light intensity physical activity and moderate-to-vigorous physical activity) based on accelerometer-derived features among older adults and then examined their association with all-cause mortality.

Methods

Data were drawn from a prospective cohort of 3991 Whitehall II accelerometer substudy participants aged 60-83 years in 2012-2013. Daily movement behaviour profiles were identified using k-means cluster analysis based on 13 accelerometer-assessed features characterising total duration, frequency, bout duration, timing and activity intensity distribution of movement behaviour. Cox regression models were used to assess the association between derived profiles and mortality risk.

Results

Over a mean follow-up of 8.1 (SD 1.3) years, a total of 410 deaths were recorded. Five distinct profiles were identified and labelled as 'active' (healthiest), 'active sitters', 'light movers', 'prolonged sitters', and 'most sedentary' (most deleterious). In model adjusted for sociodemographic, lifestyle, and health-related factors, compared with the 'active' profile, 'active sitters' (HR 1.57, 95% CI 1.01 to 2.44), 'light movers' (HR 1.75, 95% CI 1.17 to 2.63), 'prolonged sitters' (HR 1.67, 95% CI 1.11 to 2.51), 'most sedentary' (HR 3.25, 95% CI 2.10 to 5.02) profiles were all associated with a higher risk of mortality.

Conclusion

Given the threefold higher mortality risk among those with a 'most sedentary' profile, public health interventions may target this group wherein any improvement in physical activity and sedentary behaviour might be beneficial.

Combining diaries and accelerometers to explain change in physical activity during a lifestyle intervention for adults with pre-diabetes: A PREVIEW sub-study

Self-report and device-based measures of physical activity (PA) both have unique strengths and limitations; combining these measures should provide complementary and comprehensive insights to PA behaviours. Therefore, we aim to 1) identify PA clusters and clusters of change in PA based on self-reported daily activities and 2) assess differences in device-based PA between clusters in a lifestyle intervention, the PREVIEW diabetes prevention study. In total, 232 participants with overweight and prediabetes (147 women; 55.9 ± 9.5yrs; BMI ≥25 kg·m-2; impaired fasting glucose and/or impaired glucose tolerance) were clustered using a partitioning around medoids algorithm based on self-reported daily activities before a lifestyle intervention and their changes after 6 and 12 months. Device-assessed PA levels (PAL), sedentary time (SED), light PA (LPA), and moderate-to-vigorous PA (MVPA) were assessed using ActiSleep+ accelerometers and compared between clusters using (multivariate) analyses of covariance. At baseline, the self-reported "walking and housework" cluster had significantly higher PAL, MVPA and LPA, and less SED than the "inactive" cluster. LPA was higher only among the "cycling" cluster. There was no difference in the device-based measures between the "social-sports" and "inactive" clusters. Looking at the changes after 6 months, the "increased walking" cluster showed the greatest increase in PAL while the "increased cycling" cluster accumulated the highest amount of LPA. The "increased housework" and "increased supervised sports" reported least favourable changes in device-based PA. After 12 months, there was only minor change in activities between the "increased walking and cycling", "no change" and "increased supervised sports" clusters, with no significant differences in device-based measures. Combining self-report and device-based measures provides better insights into the behaviours that change during an intervention. Walking and cycling may be suitable activities to increase PA in adults with prediabetes.

The Impact of Light Physical Activity, Sedentary Behavior and Cardiorespiratory Fitness in Extending Lifespan and Healthspan Outcomes: How Little is Still Significant? A Narrative Review

To describe the relationship between mortality and measures of low intensity physical activity (LIPA) as well as sedentary behavior (SB), and cardiorespiratory fitness (CRF). Study selection was performed through multiple database searches from January 1, 2000 until May 1, 2023. Seven LIPA studies, 9 SB studies, and 8 studies CRF studies were selected for primary analysis. LIPA and non-SB follow a reverse J shaped curve with mortality. The greatest benefits occur initially, and the rate of mortality reduction slows with increasing physical activity. Increasing CRF reduces mortality although the dose response curve is uncertain. For special populations such as individuals with, or at high risk of developing cardiovascular disease the benefit from exercise is heightened. LIPA, decreased SB and higher CRF lead to reductions in mortality and improved quality of life. Individualized counseling on the benefits of any amount of physical activity may increase compliance and serve as a starting point for lifestyle modifications.

Relationship between moderate-to-vigorous, light intensity physical activity and sedentary behavior in a prospective cohort of older French adults: a 18-year follow-up of mortality and cardiovascular events ─ the PROOF cohort study

Background

It is well documented that moderate-to-vigorous intensity physical activity (MVPA) is effective in the prevention of major chronic diseases. Even though the current international physical activity (PA) guidelines still mainly focus on MVPA, the topic of the most recent epidemiological studies has shifted from MVPA to light intensity physical activity (LPA), owing to the necessity of promoting all activities vs. sedentary behavior (SB). However, the evidence remains currently limited. Thus, the clarification of the effects of LPA and the close relationship with SB is crucial to promote public health.

Method

PA and SB were assessed by a validated self-administered questionnaire (POPAQ) investigating 5 different types of PA during the 7 previous days. PA was measured in metabolic equivalent of task (MET)-h, which refers to the amount of energy (calories) expended per hour of PA. SB was measured in hour/day. Medical histories and examinations were taken during each clinical visit to determine clinical events. All-cause mortality was established using the same procedure and by checking local death registries. The relationships between the intensity of PA (light, moderate to vigorous) and mortality and between the periods of SB and mortality or CV events were analyzed by splines and COX models, adjusted for sex and year of birth.

Results

From the 1011 65-year-old subjects initially included in 2001 (60% women), the last 18-year follow-up has been currently completed since 2019. A total of 197 deaths (19.2%, including 77 CV deaths) and 195 CV events (19.3%) were reported. Averages (standard deviation) of MVPA, LPA and SB were, respectively, 1.2 h/d (0.3), 5.8 h/d (1.1), and 6.6 h/d (2.3). For all-cause deaths, as well as CV deaths, the splines were significant for LPA (p = 0.04 and p = 0.01), and MVPA (p < 0.001 and p < 0.001), but not for SB (p = 0.24 and p = 0.90). There was a significant reduction in CV events when SB was decreasing from 10.9 to 3.3 h/d.

Conclusion

The PROOF cohort study shows a clear dose-response between the dose of LPA, MVPA, SB and risk of mortality. These findings provide additional evidence to support the inclusion of LPA in future PA guidelines.

Effect of isotemporal substitution of sedentary behavior with different intensities of physical activity on the muscle function of older adults in the context of a medical center

BACKGROUND

Engaging in physical activity and reducing sedentary time in daily life may enable older individuals to maintain muscle mass. This study aimed to investigate the effects of replacing sedentary behavior with light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the muscle function of older adults at a medical center in Taiwan.

METHODS

We recruited 141 older adults (51.1% men; 81.1 ± 6.9 years old) and asked them to wear a triaxial accelerometer on the waist to measure their sedentary behavior and physical activity. Functional performance was assessed based on handgrip strength, Timed Up and Go (TUG) test, gait speed, and five-times-sit-to-stand test (5XSST). Isotemporal substitution analysis was performed to examine the effect of substituting 60 min of sedentary time with 60 min of LPA, MVPA, and combined LPA and MVPA in different proportions.

RESULTS

Reallocating 60 min of sedentary behavior per day to LPA was associated with better handgrip strength (Beta [B] = 1.587, 95% confidence interval [CI] = 0.706, 2.468), TUG test findings (B = -1.415, 95% CI = -2.186, -0.643), and gait speed (B = 0.042, 95% CI = 0.007, 0.078). Reallocating 60 min of sedentary behavior per day to MVPA was associated with better gait speed (B = 0.105, 95% CI = 0.018, 0.193) and 5XSST findings (B = -0.060, 95% CI = -0.117, -0.003). In addition, each 5-min increment in MVPA in the total physical activity replacing 60 min of sedentary behavior per day resulted in greater gait speed. Replacing 60 min of sedentary behavior with 30-min of LPA and 30-min of MVPA per day significantly decreased the 5XSST test time.

CONCLUSION

Our study indicates that introducing LPA and a combination of LPA and MVPA to specifically replace sedentary behavior may help maintain muscle function in older adults.

Device-Measured Physical Activity and Sedentary Behavior in Relation to Cardiovascular Diseases and All-Cause Mortality: Systematic Review and Meta-Analysis of Prospective Cohort Studies

Introduction

This review synthesized evidence from prospective cohort studies on the association of device-measured physical activity and sedentary behavior with cardiovascular disease and all-cause mortality among adults.

Methods

Five databases were searched from 2000 through April 29, 2020. Study quality was appraised using the NIH Quality Assessment Tool. Pooled hazard ratio and 95% CI were obtained from random-effects meta-analyses. Subgroup analyses by age and sex were conducted for studies on all-cause mortality.

Results

Of 29 articles included in the systematic review, 5 studies on cardiovascular disease mortality and 15 studies on all-cause mortality were included in meta-analyses. Comparing the highest with the lowest exposure categories, the pooled hazard ratios (95% CIs) for cardiovascular disease mortality were 0.29 (CI=0.18, 0.47) for total physical activity, 0.37 (CI=0.25, 0.55) for moderate-to-vigorous physical activity, 0.62 (0.41-0.93) for light physical activity, and 1.89 (CI=1.09, 3.29) for sedentary behavior. The pooled hazard ratios (95% CIs) for all-cause mortality were 0.42 (CI=0.34, 0.53) for total physical activity, 0.43 (CI=0.35, 0.53) for moderate-to-vigorous physical activity, 0.58 (CI=0.43, 0.80) for light physical activity, and 1.58 (CI=1.19, 2.09) for sedentary behavior. The pooled hazard ratio (95% CI) for all-cause mortality was 0.35 (CI=0.29, 0.42) for steps per day, but the studies available for analysis were conducted in older adults. The results of subgroup analyses were consistent with the main results.

Discussion

Rapidly accumulating evidence suggests that more physical activity and less sedentary behavior are associated with a lower risk of cardiovascular disease and all-cause mortality. Similar beneficial relationships were found for step counts and all-cause mortality among older adults. Future studies employing standardized research methodologies and up-to-date data processing approaches are warranted to recommend specific amounts of physical activity and limits to sedentary behavior.

The association of subjective vision with objectively measured intensity-specific physical activity and bout-specific sedentary behavior among community-dwelling older adults in Japan

PURPOSE

Visual impairment is a possible cause of physical frailty. Reduced physical activity (PA) may be involved in the pathway from visual impairment to physical frailty, although the association between vision and objectively measured PA among older adults remains unclear. This study examined the sex-specific association of subjective vision with intensity-specific PA and bout-specific sedentary behavior (SB) among community-dwelling, older Japanese adults.

STUDY DESIGN

Cross-sectional study METHODS: This study used data from the Neuron to Environmental Impact across Generations study analyzing older adults (527 participants, aged 65-84 years) living in rural areas of Niigata Prefecture, Japan. Subjective vision was assessed by use of a questionnaire. Intensity-specific PA (light-intensity PA and moderate-to-vigorous PA [MVPA]), bout-specific SB, and daily step count were objectively evaluated by use of an accelerometer. The association of subjective vison with PA and SB, stratified by sex, was analyzed by means of general regression analyses, with adjustment for covariates.

RESULTS

The data of 512 participants (men: 46.9%; with poor subjective vision: 22.9%) were analyzed. Poor subjective vision was significantly associated with log MVPA (partial regression coefficient = -0.261, P = .013) and log steps (partial regression coefficient = -0.164; P = .021) among women, whereas a tendency of an association was observed with prolonged SB time among men (partial regression coefficient: 39.1; P = .073).

CONCLUSION

Older Japanese women with poor subjective vision performed less MVPA and had fewer step counts than those of participants with good subjective vision, and men with poor subjective vision had longer prolonged SB, which may all accelerate the process to physical frailty.

Accelerometer-measured physical activity in mid-age Australian adults

Background

Raw data from accelerometers can provide valuable insights into specific attributes of physical activity, such as time spent in intensity-specific activity. The aim of this study was to describe physical activity assessed with raw data from triaxial wrist-worn accelerometers in mid-age Australian adults.

Methods

Data were from 700 mid-age adults living in Brisbane, Australia (mean age: 60.4; SD:7.1 years). Data from a non-dominant wrist worn triaxial accelerometer (Actigraph wGT3X-BT), expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g), were used to estimate time spent in moderate-vigorous intensity physical activity (MVPA; >100 mg) using different bout criteria (non-bouted, 1-, 5-, and 10-min bouts), and the proportion of participants who spent an average of at least one minute per day in vigorous physical activity.

Results

Mean acceleration was 23.2 mg (SD: 7.5) and did not vary by gender (men: 22.4; women: 23.7; p-value: 0.073) or education (p-value: 0.375). On average, mean acceleration was 10% (2.5 mg) lower per decade of age from age 55y. The median durations in non-bouted, 1-min, 5-min and 10-min MVPA bouts were, respectively, 68 (25th -75th : 45–99), 26 (25th -75th : 12–46), 10 (25th -75th : 3–24) and 8 (25th -75th : 0–19) min/day. Around one third of the sample did at least one minute per day in vigorous intensity activities.

Conclusion

This population-based cohort provided a detailed description of physical activity based on raw data from accelerometers in mid-age adults in Australia. Such data can be used to investigate how different patterns and intensities of physical activity vary across the day/week and influence health outcomes.

The Long-Term Influence of Puppy Acquisition on Physical Activity: Results of a 3-Year, Longitudinal, Pilot Study

Dog ownership has been associated with increased levels of physical activity (PA), including increases in total PA and walking time in some but not in all studies. These earlier studies did not consider puppy acquisition, in particular, and were limited to a maximum of 10 months duration. The purpose of the current pilot study was, therefore, to analyze long-term changes in participants’ PA behavior after puppy acquisition. Participants who acquired a puppy from one of nine preselected breeds differing in size and energy level were included. PA was assessed at baseline and 6, 12, 24 and 36 months after puppy acquisition using an online questionnaire. Participants, who were initially included, did not differ in their PA at baseline (n = 38). In the group that completed the trial (n = 11) total PA, leisure time walking, total dog-related PA, and total dog walking increased within the first two years and decreased while remaining above baseline values during the last year, coinciding with the COVID-19 pandemic. Non-dog-related PA did not change over time. We conclude that the acquisition of a puppy increases PA and thus, could have a long-lasting positive effect on physical health.

Differences in Accelerometer-Measured Physical Activity and Sedentary Behavior Between Middle-Aged Men and Women in Japan: A Compositional Data Analysis

BACKGROUND

Differences in accelerometer-measured sedentary behavior and different physical activity (PA) intensities between men and women have been poorly described. The authors examined gender differences in time-use activity composition and total volume of PA.

METHODS

A cross-sectional mail survey was conducted from 2013 to 2015 with a randomized sample of 6000 middle-aged (40-64 y) community-dwelling Japanese adults living in urban and regional cities. Participants wore Active style Pro HJA-350IT on their waist for 7 consecutive days. Gender differences in activity time use was examined using compositional data analysis to control for time spent in all activity measures.

RESULTS

In total, 757 participants (303 men, 52.3 [7.1] y) with valid data were included in the analysis. Women spent on average 12.6% less time in sedentary behavior and 23.4% more time in light-intensity PA than men, whereas no significant difference was found for moderate to vigorous PA. Women accumulated a significantly greater volume of PA than men (17.8 vs 15.0 metabolic equivalent of task h/d).

CONCLUSIONS

Japanese middle-aged women showed higher levels of PA than men because they spent more time in light-intensity PA. Given the health benefits of light-intensity PA, evaluating only moderate to vigorous PA may lead to an underestimation of women's participation in PA.

Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study

Objectives

This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer.

Methods

This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%.

Results

Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3-77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4-22.4).

Conclusion

These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy.

Trial registration number

NCT03331406.

Impact of Dog’s Age and Breed on Dog Owner’s Physical Activity: A German Longitudinal Study

Dog ownership contributes positively to physical activity (PA). The impact of different dog breeds and age on PA is less investigated in longitudinal studies. This study aimed to evaluate PA changes in dog owners as their dogs’ ages increased and to explore whether there are differences in PA between owners of different breeds over a three-year period. Owners of different dog breeds were categorized into nine groups according to the perceived energy level and size of the breed. PA was monitored using an online questionnaire for three consecutive years. Linear mixed models (LMM) showed a small, but significant decrease in total PA, leisure time walking, dog-related PA and dog walking over three years. No decreases were found if only participants who attended at all time points were included. In all LMM analyses, a significant relationship between the dog breed and the outcomes of PA were shown. At baseline, dog owners performed different types of activities depending on their dog breed. In conclusion, owners of different dog breeds differ in their types of PA. The study emphasizes that age, size and energy level of the dog does not per se have an impact on dog owners PA.

Association between Accelerometer-Measured Light-Intensity Physical Activity and Cognitive Function in Older Adults

OBJECTIVES

This study aimed to investigate whether accelerometer-measured light physical activity (LPA) is associated with cognitive function and whether engaging in ≥3 h/day of LPA can reduce the chance of cognitive impairment among a sample of older adults in Taiwan.

DESIGN

Cross-sectional study.

SETTING

An outpatient department in a medical center.

PARTICIPANTS

Participants were community-dwelling older adults aged 65 years and older who were able to walk independently from September 2020 to March 2021.

MEASUREMENTS

A tri-axial accelerometer was used to measure LPA for 7 consecutive days, and the Mini-Mental State Examination (MMSE) scale was used to assess the chance of cognitive impairment. Multiple linear regression model and binary logistic regression model were performed to examine the association between LPA and MMSE scores.

RESULTS

145 older Taiwanese adults (51.7% men; 81.2±6.8 years; 6.9% at chance of cognitive impairment) were included. After adjusting for moderate-to-vigorous physical activity (MVPA) and wear time, we found that there was a significant association between LPA and cognitive function (95% confidence interval [CI]: 0.64-1.65; P<0.001), and further found that those who engaged in LPA ≥3 h/day were at reduced chance of cognitive impairment compared with people who engaged in LPA <3 h/day (odds ratio [OR]: 0.16; 95% CI: 0.03-0.80; P=0.025).

CONCLUSION

This study demonstrated that engaging in LPA ≥3 h/day could be viewed as a protective factor for maintaining cognitive function in older adults. We recommend further longitudinal research to elucidate the association between intensity-specific LPA and cognitive function.

Association of Light-Intensity Physical Activity With Mortality in the Older Population: A Nationwide Cohort Study

Background

There is a paucity of information about mortality related to light-intensity physical activity (LPA) in the older population. We examine the associations between physical activity and mortality, focusing on the effect of light-intensity physical activity and the dose-response relationship between physical activity and mortality.

Methods

We analyzed a total of 58,537 participants aged ≥ 65 years (mean age, 73.9 ± 5.8 years; male, 36.0%) in the Korean National Health Insurance Service database between 2009 and 2012. The Date of the end of follow-up was December 31, 2013. Individuals were divided into four categories according to physical activity intensity: totally sedentary (43.3%), LPA only (35.8%), LPA and moderate- to vigorous-intensity physical activity (MVPA) (16.3%), MVPA only (4.5%). Physical activity was quantified using standardized self-reported questionnaires which composed of the duration and frequency of physical activity.

Results

During a mean follow-up of 39.6 ± 14.0 months, 5,651 (9.7%) deaths occurred. Compared with totally sedentary individuals, those in the LPA only, LPA and MVPA, and MVPA only groups showed 26% [hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.68–0.82], 27% (HR 0.73, 95% CI 0.63–0.84), and 34% (HR 0.66, 95% CI 0.54–0.79) lower all-cause mortality risk, showing an inverse relationship between physical activity intensity and mortality risk. In contrast, the LPA only, LPA and MVPA, and MVPA only groups represented a stronger inverse association with CV mortality (LPA: HR 0.76, 95% CI 0.62–0.92; LPA with MVPA: HR 0.74, 95% CI 0.55–0.999; MVPA, HR 0.57, 95% CI 0.37–0.87). Among participants performing LPA alone, participants performing less than the recommended dose of physical activity had lower all-cause mortality than those with sedentary activity (1–249 MET-min/week: HR 0.74, 95% CI 0.67–0.82, 250–499 MET-min/week: HR 0.65, 95% CI 0.59–0.72).

Conclusion

Physical activity, even low doses of LPA, was associated with reduced mortality risk in the elderly population. This study may motivate sedentary individuals to engage in any physical activity for mortality benefits.

The association between Geographic Information System-based neighborhood built environmental factors and accelerometer-derived light-intensity physical activity across the lifespan: a cross-sectional study

Background

Evidence on associations between environmental factors and accelerometer-derived light-intensity physical activity (LPA) is scarce. The aim of this study was to examine associations between Geographic Information System (GIS)-based neighborhood built environmental factors and accelerometer-derived LPA, and to investigate the moderating effect of age group (adolescents, adults, older adults) on these associations.

Methods

Objective data were used from three similar observational studies conducted in Ghent (Belgium) between 2007 and 2015. Accelerometer data were collected from 1,652 participants during seven consecutive days, and GIS-based neighborhood built environmental factors (residential density, intersection density, park density, public transport density, entropy index) were calculated using sausage buffers of 500 m and 1,000 m around the home addresses of all participants. Linear mixed models were performed to estimate the associations.

Results

A small but significant negative association was observed between residential density (500 m buffer) and LPA in the total sample (B = -0.002; SE = 0.0001; p = 0.04), demonstrating that every increase of 1,000 dwellings per surface buffer was associated with a two minute decrease in LPA. Intersection density, park density, public transport density and entropy index were not related to LPA, and moderating effects of age group were absent.

Conclusions

The small association, in combination with other non-significant associations suggests that the neighborhood built environment, as classically measured in moderate-to-vigorous intensity physical activity research, is of limited importance for LPA. More research is needed to unravel how accelerometer-derived LPA is accumulated, and to gain insight into its determinants.

Perceived Urban Environment Attributes and Device-Measured Physical Activity in Latin America: An 8-Nation Study

INTRODUCTION

Attributes of the neighborhood-built environment are associated with self-reported physical activity, but only a few studies have concentrated on device-measured physical activity in Latin America. This study examines the associations of perceived neighborhood-built environment attributes, device-measured sedentary time, and light-intensity and moderate-to-vigorous physical activity in adults from 8 Latin American countries.

METHODS

Data from Estudio Latinoamericano de Nutrición y Salud adult study, an observational multicountry study (N=2,478), were analyzed in 2020. Data were collected between 2014 and 2015. Perceived neighborhood-built environment attributes were measured using the Neighbourhood Environment Walkability Survey. Sedentary time, light-intensity physical activity, and moderate-to-vigorous physical activity data were collected using accelerometers.

RESULTS

No associations between perceived neighborhood-built environment attributes and sedentary time were found. Positive perceptions of walking/cycling facilities (β=6.50, 95% CI=2.12, 10.39) were associated with more light-intensity physical activity. Perceptions of better aesthetics (Argentina) and better walking/cycling facilities (Brazil and Ecuador) were positively associated with light-intensity physical activity. Land use mix-diversity (β=0.14, 95% CI=0.03, 0.25), walking/cycling facilities (β=0.16, 95% CI=0.05, 0.27), aesthetics (β=0.16, 95% CI=0.02, 0.30), and safety from traffic (β=0.18, 95% CI=0.05, 0.24) were positively associated with moderate-to-vigorous physical activity. Land use mix-diversity, street connectivity, and safety from traffic were positively associated with moderate-to-vigorous physical activity in Venezuela.

CONCLUSIONS

These findings have implications for policy recommendations, which can guide policies to promote physical activity in the region. Land use mix-diversity, walking/cycling facilities, aesthetics, and safety from traffic can maintain or increase the levels of light-intensity and moderate-to-vigorous physical activity among Latin American adults.

Modifiable predictive factors and all-cause mortality in the non-hospitalized elderly population: An umbrella review of meta-analyses

OBJECTIVE

This umbrella review aimed to summarize the association between modifiable predictive factors and all-cause mortality in the non-hospitalized elderly population, and estimated the credibility and strength of the current evidence.

METHODS

PubMed, Embase, Web of science, and EBSCOhost were searched up to February 28, 2022. Random-effect summary effect sizes and 95% confidence intervals (CIs), heterogeneity, small-study effect, excess significance bias, as well as 95% prediction intervals (PIs) were calculated. Methodological quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. The credibility of the included meta-analyses was graded from convincing to weak using established criteria. This umbrella review was registered with PROSPERO, CRD 42021282183.

RESULTS

In total, 32 predictive factors involving 49 associations extracted from 35 meta-analyses were analyzed. Forty-three of the 49 (87.8%) associations presented nominal significant effects by the random-effect model (P < 0.05), of which 34 had harmful associations and nine had beneficial associations with all-cause mortality. Frailty (FRAIL scale), low short physical performance battery (SPPB) score, and fewer daily steps carried a more than three-fold risk for all-cause mortality. Convincing evidence showed that weight fluctuation, prefrailty and frailty status, sarcopenia, low SPPB score, fewer daily steps, and fatigue increased the risk of all-cause mortality, while daily moderate-to-vigorous physical activity (MVPA) duration and total physical activity participation reduced the risk of death. There were twenty, nine, five, and six associations that yielded highly suggestive, suggestive, weak, and non-significant grades of evidence. Thirty-four (69.4%) of the associations exhibited significant heterogeneity. Twenty-two associations presented 95% PIs excluding the null value, two indicated small-study effects, and three had evidence for excess significance bias, respectively. The methodological quality of most meta-analyses was rated as low (37.1%) or critically low (42.9%).

CONCLUSIONS

A summary of the currently available meta-analyses suggests that a broad range of modifiable predictive factors are significantly associated with all-cause mortality risk in the non-hospitalized elderly population. The most credible evidence indicates that physical function represented by frailty and sarcopenia, as well as physical activity, are significant predictors for all-cause mortality. This umbrella review may provide prognostic information to direct appropriate diagnostic evaluation and treatment goals in the future. More solid evidence is still needed coming from moderate-to-high quality meta-analyses.

Leisure-Time and Transport-Related Physical Activity and the Risk of Mortality: The CRONICAS Cohort Study

BACKGROUND

The long-term health association of the leisure-time and transport-related physical activity domains of the International Physical Activity Questionnaire have not been established in Latin American settings. The authors aimed to quantify the 7-year all-cause mortality risk associated with levels of leisure-time and transport-related physical activity.

METHODS

Ongoing prospective cohort study conducted in 4 sites in Peru. People ≥35 years were randomly selected from the general population in each study site. The exposures were leisure-time and transport-related physical activity (International Physical Activity Questionnaire) at baseline. The outcome was all-cause mortality based on information retrieved from national records. Cox regression and sensitivity analyses were conducted.

RESULTS

There were 3601 people (mean age 55.8 y, 51.5% women). Greater levels of physical activity were associated with lower risk of all-cause mortality, an observation confirmed in sensitivity analyses. Compared with those with low levels of physical activity, leisure-time (≥500 metabolic equivalent of task minutes per week) and transport-related (500-1499 and ≥1500 metabolic equivalent of task minutes per week) physical activity were associated with 70% (95% confidence interval, 3%-90%), 43% (95% confidence interval, 18%-61%), and 42% (95% confidence interval, 8%-63%) lower all-cause mortality, respectively.

CONCLUSIONS

Greater levels of leisure-time and transport-related physical activity were associated with a strong reduction in the risk of all-cause mortality across different geographical sites.

A cluster analysis of device-measured physical activity behaviours and the association with chronic conditions, multi-morbidity and healthcare utilisation in adults aged 45 years and older

Most adults do not meet physical activity guidelines with negative implications for health. The aim of this study was to profile adults using multiple physical activity behaviours and to investigate associations with chronic conditions, multi-morbidity and healthcare utilisation. The study used data generated from a sample of adults aged 45 years and older (N = 485), recruited to the Move for Life randomised control trial. Participants wore an accelerometer for eight consecutive days. Hierarchical cluster analysis was conducted using the variables: moderate to vigorous intensity physical activity, light intensity physical activity, step count, waking sedentary time, standing time and bed hours. Descriptive statistics were used to investigate associations with self-reported number of chronic illnesses, multi-morbidity and healthcare utilisation. Four distinct physical activity behaviour profiles were identified: inactive-sedentary (n = 50, 10.3%), low activity (n = 295, 60.8%), active (n = 111, 22.9%) and very active (n = 29, 6%). The inactive-sedentary cluster had the highest prevalence of chronic illnesses, in particular, mental illness (p = 0.006) and chronic lung disease (p = 0.032), as well as multi-morbidity, complex multi-morbidity and healthcare utilisation. The prevalence of any practice nurse visit (p = 0.033), outpatient attendances (p = 0.04) and hospital admission (p = 0.034) were higher in less active clusters. The results have provided an insight into how physical activity behaviour is associated with chronic illness and healthcare utilisation. A group within the group has been identified that is more likely to be unwell. Provisions need to be made to reduce barriers for participation in physical activity for adults with complex multi-morbidity and very low physical activity.

Are Japanese Women Less Physically Active Than Men? Findings From the DOSANCO Health Study

BACKGROUND

Previous research has established that women accumulate less moderate-to-vigorous physical activity (MVPA) than men. To date, however, little is known about the gender differences in device-based activity patterns of sedentary behavior (SB) and light-intensity physical activity (LPA). We aimed to compare time spent in SB and different intensities of physical activity taking into account of co-dependence of time use domains.

METHODS

This cross-sectional study was conducted in Suttu town, Hokkaido, Japan. Data were analyzed from 634 Japanese adults (278 men, aged 19-92 years) who provided valid accelerometer (HJA-750C) data. Gender differences in activity behavior patterns were tested using multivariate analysis of covariance (MANCOVA) based on isometric log-ratio transformations of time use, adjusting for age. We also developed bootstrap percentile confidence intervals (CI) to support the interpretation of which behavior differed between genders.

RESULTS

Overall, participants had percent time spent in SB, LPA, MVPA during wearing time (mean, 14.8 hours) corresponding to 53.9%, 41.7%, and 4.4% of wearing time, respectively. Activity behavior patterns differed significantly between genders after controlling for time spent in all activities. Women spent relatively 13.3% (95% CI, 9.9-15.9%) less time in SB and 19.8% (95% CI, 14.9-24.6%) more time in LPA compared to men. The difference of time spent in MVPA was not statistically significant.

CONCLUSIONS

In contrast with previous studies, our findings suggest that Japanese women are more physically active than men when all intensities of activities are considered. Given the health benefits of LPA, evaluating only MVPA may disproportionately underestimate the level of physical activity of women.

Role of received social support in the physical activity of coronary heart patients: The Health Action Process Approach

Physical activity (PA) plays a crucial role in the management of coronary artery disease (CAD). The Health Action Process Approach provides a useful framework for understanding and predicting the process of health behaviors. The aim of the current study was to unveil the role of received social support in the HAPA model, concerning the physical activity of CAD patients. A longitudinal sample of 117 CAD patients filled out a questionnaire during three measurement points (baseline, 2 months, and 6 months later). The constructs within the model were measured by the previously validated HAPA scales. PA was assessed with four items, which were also included in the HAPA questionnaire. To test the direct and indirect associations between the variables, structural equation modeling with latent variables was employed. Received social support was proven to have a significant and strong effect on both action planning and action control, suggesting a synergistic effect on the individual factors, as well as increasing the explained variance of PA. Results confirmed the important role of received social support in the PA of CAD patients. It could be presumed that strengthening the social support from family and friends could support the regular physical activity of CAD patients.

A dose response relationship between accelerometer assessed daily steps and depressive symptoms in older adults: a two-year cohort study

OBJECTIVES

this study investigated the prospective associations of accelerometer assessed daily steps with subsequent depressive symptoms in older adults.

METHODS

a 2-year prospective study was performed in the community. A total of 285 older adults ≥65 years (mean age = 74.5) attended the baseline assessment in 2012. The second wave of assessment was carried out in 2014 including 274 (96.1%) participants. Daily step counts were measured with a triaxial accelerometer (ActiGraph GT3X+), and participants were divided into three categories (<3,500, 3,500-6,999 and ≥ 7,000 steps/day). The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Negative binomial regression models with multivariable adjustment for covariates (baseline depressive symptoms, accelerometer wear time, age, gender, education, chronic disease, activities of daily living) were conducted to examine the association between daily steps and subsequent depressive symptoms.

RESULTS

each 1,000-step increase in daily walking was linearly associated with a reduced rate of subsequent depressive symptoms (rate ratio [RR] = 0.95, 95% confidence interval [CI] = 0.92-0.98). Participants with daily step count in 3,500-6,999 (RR = 0.84, 95% CI = 0.70-0.99) and ≥7,000 steps (RR = 0.71, 95% CI = 0.55-0.92) per day had fewer depressive symptoms at follow-up. Sensitivity analyses assessing confounding and reverse causation provided further support for the stability of our findings.

CONCLUSION

older adults engaging in more daily steps had fewer depressive symptoms after 2 years. Even as few as 3,500-6,999 steps a day was associated with a protecting effect. Accumulating ≥7,000 steps a day could provide the greatest protection against depressive symptoms.

The prediction of mortality by quality of life assessed with the WHOQOL-BREF: a longitudinal analysis at the domain and item levels using a seven-year follow-up period

PURPOSE

To determine the predictive value of quality of life for mortality at the domain and item levels.

METHODS

This longitudinal study was carried out in a sample of 479 Dutch people aged 75 years or older living independently, using a follow-up of 7 years. Participants completed a self-report questionnaire. Quality of life was assessed with the WHOQOL-BREF, including four domains: physical health, psychological, social relationships, and environment. The municipality of Roosendaal (a town in the Netherlands) indicated the dates of death of the individuals.

RESULTS

Based on mean, all quality of life domains predicted mortality adjusted for gender, age, marital status, education, and income. The hazard ratios ranged from 0.811 (psychological) to 0.933 (social relationships). The areas under the curve (AUCs) of the four domains were 0.730 (physical health), 0.723 (psychological), 0.693 (social relationships), and 0.700 (environment). In all quality of life domains, at least one item predicted mortality (adjusted).

CONCLUSION

Our study showed that all four quality of life domains belonging to the WHOQOL-BREF predict mortality in a sample of Dutch community-dwelling older people using a follow-up period of 7 years. Two AUCs were above threshold (psychological, physical health). The findings offer health care and welfare professionals evidence for conducting interventions to reduce the risk of premature death.

Pace of life and perceived stress in international students

An accelerated pace of life greatly impacts individuals' health and lifestyles. However, this imposition has not been systematically researched within a culturally diverse sample. Thus, this study aimed to explore the subjective experience of the pace of life and its correlates in a culturally diverse sample within a German university context. This was done to test whether students (N = 156) with a migration background from other countries (n = 105) differ from students without migration background (n = 51). The pace of life, life satisfaction, stress, work-life balance, and health were measured on an individual level along with sociodemographic variables through online questionnaires. The pace of life was found to be invariant across students from different cultural backgrounds and unrelated to the length of stay at the current university. Interrelations were found between pace of life and work-life balance, r = .21, p < .05. While this study revealed perceived stress to be generally prevalent among students, the relationship between a slower pace of life and increased stress levels, ß = -.17, p < .05, disappears when controlling for health, ß = -.26, p < .01, work-life balance, ß = -.28, p < .01, and life satisfaction, ß = -.25, p < .01, as well as sociodemographic variables (only gender and medium length of stay were significant.) Furthermore, a mediation effect, b = -1.89, 95% CI [-3.598, -0.463], revealed that students cope with a faster pace of life by effective time management, which also leads to better work-life balance and in turn reduces the experienced level of stress. Future research should examine psychological mechanisms more extensively in longitudinal research and apply interventional designs to help students prevent and manage stress in the era of a fast-paced life.

The Association Between Light Physical Activity and Cognition Among Adults: A Scoping Review

Background

The physical and cognitive benefits of moderate-vigorous intensity physical activity (MVPA) for adults have been well documented. Recently, there has been increasing interest in the independent health benefits of light-intensity physical activity (LPA). This research has primarily focused on the relationship between LPA and morbidity and mortality risk, with few studies investigating cognitive associations. The purpose of this scoping review was to catalog existing evidence on the association between device-based or technologically measured LPA and cognition among adults, identify trends in the literature, and recommend future areas for research.

Methods

Six electronic databases were searched between January and June 2020. Forty published studies met the inclusion criteria, which included both healthy and clinical young and older adult populations. Among the 40 articles were 14 acute exercise studies, 4 randomized control trials (RCTs), 18 cross-sectional studies, and 4 longitudinal studies.

Results

7/14 (50%) acute, 3/4 (75%) RCT, 10/18 (56%) cross-sectional, and 2/4 (50%) longitudinal studies reported a significant, positive relationship between LPA and one or more cognitive outcomes. These heterogeneous findings can largely be attributed to the diverse study designs and populations, as well as the numerous assessments used to test the cognitive domains.

Conclusion

These collective findings suggest LPA may be a potential lifestyle intervention to improve cognition across adulthood. However, the inconsistent approaches used among these studies suggest a more concerted, unified scientific approach is needed to further understand the LPA-cognition relationship.

Mental Health and Psychological Wellbeing in Rheumatoid Arthritis during COVID-19 - Can Physical Activity Help?

In response to the COVID-19 pandemic, many countries have adopted community containment to manage COVID-19. These measures to reduce human contact, such as social distancing, are deemed necessary to contain the spread of the virus and protect those at increased risk of developing complications following infection with COVID-19. People with rheumatoid arthritis (RA) are advised to adhere to even more stringent restrictions compared to the general population, and avoid any social contact with people outside their household. This social isolation combined with the anxiety and stress associated with the pandemic, is likely to particularly have an impact on mental health and psychological wellbeing in people with RA. Increasing physical activity and reducing sedentary behaviour can improve mental health and psychological wellbeing in RA. However, COVID-19 restrictions make it more difficult for people with RA to be physically active and facilitate a more sedentary lifestyle. Therefore, guidance is necessary for people with RA to adopt a healthy lifestyle within the constraints of COVID-19 restrictions to support their mental health and psychological wellbeing during and after the COVID-19 pandemic.

Initial impact of the COVID-19 pandemic on physical activity and sedentary behavior in hypertensive older adults: An accelerometer-based analysis

Background

This study reports the accelerometer-based physical activity (PA) and sedentary behavior (SB) before and during the COVID-19 pandemic in hypertensive older adults.

Methods

Thirty-five hypertensive older adults were included in this observational study. Accelerometer-based PA and SB measures were assessed before (January to March 2020) and during (June 2020) the COVID-19 pandemic. Linear mixed models were used to assess within-group changes in PA and SB measures, adjusted by accelerometer wear time.

Results

Before COVID-19 pandemic participants presented: 5809 steps/day (SE = 366), 303.1 min/day (SE = 11.9) of light PA, 15.5 min/day (SE = 2.2) of moderate-vigorous PA, and 653.0 min/day (SE = 12.6) of SB. During COVID-19 pandemic there was a decrease in steps/day (β = −886 steps/day, SE = 361, p = 0.018), in moderate-vigorous PA (β = −2.8 min/day, SE = 2.4, p = 0.018), and a trend in light PA (β = −26.6 min/day, SE = 13.4, p = 0.053). In addition, SB increased during the COVID-19 pandemic (β = 29.6 min/day, SE = 13.4, p = 0.032). The magnitude of changes was greater on the weekend, mainly for steps/day (β = −1739 steps/day, SE = 424, p < 0.001) and the SB pattern (more time spent in bouts of ≥10 and 30 min, less breaks/day and breaks/h).

Conclusions

The COVID-19 pandemic may elicit unhealthy changes in movement behavior in hypertensive older adults. Lower PA, higher and more prolonged SB on the weekend are the main features of the behavioral changes.

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Unhealthy changes in movement behavior were observed during the COVID-19 pandemic.

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Hypertensive older adults decreased steps/day and time spent in physical activities.

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An increase in time spent in sedentary behavior (SB) was observed.

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The time spent in prolonged SB increased and the breaks in SB decreased.

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Greater unhealthy changes in movement behavior occurred on weekend.

Twenty-Four Hour Activity and Sleep Profiles for Adults Living with Arthritis: Habits Matter

OBJECTIVE

To identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership.

METHODS

Our study comprised a cross-sectional cohort and used baseline data from 2 randomized trials studying activity counseling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or knee osteoarthritis (OA). Participants wore activity monitors for 1 week and completed surveys for demographic information, mood (Patient Health Questionnaire 9), and sitting and walking habits (Self-Reported Habit Index). A total of 1,440 minutes/day were stratified into minutes off body (activity unknown), sleeping, resting, nonambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership.

RESULTS

Our cohort included 172 individuals, including 51% with RA, 30% with OA, and 19% with SLE. We identified 4 activity-sleep profiles (clusters) that were characterized primarily by differences in time in nonambulatory activity: high sitters (6.9 hours sleep, 1.6 hours rest, 13.2 hours nonambulatory activity, and 1.6 hours intermittent and 0.3 hours purposeful walking), low sleepers (6.5 hours sleep, 1.2 hours rest, 12.2 hours nonambulatory activity, and 3.3 hours intermittent and 0.6 hours purposeful walking), high sleepers (8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory activity, and 2.5 hours intermittent and 0.3 hours purposeful walking), and balanced activity (7.4 hours sleep, 1.5 hours sleep, 9.4 hours nonambulatory activity, and 4.4 hours intermittent and 0.8 hours purposeful walking). Younger age (odds ratio [OR] 0.95 [95% confidence interval (95% CI) 0.91-0.99]), weaker occupational sitting habit (OR 0.55 [95% CI 0.41-0.76]), and stronger walking outside habit (OR 1.43 [95% CI 1.06-1.91]) were each associated with balanced activity relative to high sitters.

CONCLUSION

Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.