Does physical activity reduce seniors' need for healthcare?: a study of 24 281 Canadians

Impact of the medical fitness model on long term health outcomes in older adults

BACKGROUND

Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.

METHODS

A propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.

RESULTS

Among 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 - 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 - 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 - 0.77), lower risk of a major adverse cardiovascular event. A dose-response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 - 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 - 0.92).

CONCLUSIONS

Membership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.

The influence of the Covid-19 pandemic on municipal meeting places arranging group exercise for older persons

PURPOSE

Many municipalities today, together with other stakeholders, offer group exercises for the older population via municipal meeting places, focusing on promoting good health. During the Covid-19 pandemic, these group exercises either continued in a modified form or ceased. The aim of this study was to explore involved stakeholders' experiences of group exercises for older persons arranged via municipal meeting places during the Covid-19 pandemic.

METHODS

Six online focus group interviews were conducted with 25 stakeholders, such as decision-makers and representatives from the non-profit sector, from seven municipalities in Sweden. Data were analysed using thematic analysis.

FINDINGS

The collaboration around the group exercises was challenged due to affected communication and decision-making. The stakeholders described the importance of adapting and finding new ways to offer group exercise. Furthermore, the re-arranging of group exercises created concerns about the well-being of the older persons but also happiness with the older persons ability to act for their own well-being during the pandemic.

CONCLUSIONS

This study highlights the importance of the municipalities exchanging experiences, making the older persons more involved in the decision-making process, enabling a person-centred encounter with the older persons when exercising in groups, and strengthening supportive environments by sharing the ownership of arranging the group exercises with the older persons.

Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014

Background

A growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population.

Methods

The data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models.

Results

Our findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services.

Conclusions

This study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13479-0.

The influence of physical activity level on the length of stay in hospital in older men survivors of COVID-19

The purpose of this study was to verify the influence of physical activity level on the length of hospital stay in older men recovered from COVID-19. In total, 126 older men diagnosed with COVID-19 were admitted to the hospital between September and December 2020. Among them, 70 survived, of which 39 older men were included in the study. Within 30 days after discharge, patients answered the International Physical Activity Questionnaire to measure their physical activity level through phone contact, with questions corresponding to the week before symptom onset. Clinical and laboratorial data from admission, days between onset of symptoms and admission, length of stay, computed tomography abnormalities, and the need for the intensive care unit were collected. The groups (active × sedentary) were compared using the Student t test or Mann-Whitney test for quantitative data and chi-square test was used for categorical data. There is no difference between the groups in characteristics of admission (p > 0.05), except by potassium level. Active older men had a shorter length of stay (6.50 ± 3.46 vs 11.48 ± 7.63 days; p = 0.03), disease duration (15.71 ± 4.84 vs 21.09 ± 7.69 days; p = 0.02), and lower frequency of lung damage when compared to their sedentary counterparts. In conclusion, being physically active prior to infection can attenuate length of hospital stay in older men with COVID-19.

No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

BACKGROUND

Regular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease 2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.

METHODS

Hospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.

RESULTS

The median hospital length of stay was 7.0 ± 4.0 days, median ± IQR; 3.3% of patients died, 13.8% were admitted to the ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = -0.57 (95% confidence interval (95%CI): -1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: -0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: -0.22 to 2.59), p = 0.099; and total activity index: β = 0.20 (95%CI: -0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to the ICU, or mechanical ventilation requirement (all p > 0.050).

CONCLUSION

Among hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.

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

Background

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

Methods

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

Results

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

Conclusion

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

Comparison of Prevalence of Hyperlipidemia, Medical Expenses, Inpatient, Emergency and Outpatient According to the Level of Physical Activity of Korean Adults: A Cross-Sectional Study of 2018 Korea Medical Panel

OBJECTIVES The purpose of this study is to compare the difference in the prevalence of hyperlipidemia according to the level of physical activity in adults, and to compare the difference between annual personal medical expenses, hospitalization, emergency and outpatient use depending on the level of physical activity for hyperlipidemia patients.METHODS The 2018 Korea medical panel data was used (14,489 adults and 2,559 Hyperlipidemia). Physical activity was measured with short form of IPAQ and converted to MET-minutes per week. The days of hospitalization, and personal medical expenses were compared, and frequency analysis, logistic regression, ANOVA and chi-square were performed.RESULTS The prevalence of hyperlipidemia based on the inactive group were decreased both minimally active group (OR = 0.94) and the active group (OR = 0.74, p<0.01). Annual personal medical expenses I (p<.01) and II (p<.01) with hyperlipidemia were all showed significant differences depending on the level of physical activity. On active group basis, medical expenses showed slight differences of 3.0 to 3.2% with the minimally activity group, but that of the inactive group were 19.3 ~ 21.7% higher. The annual days of hospitalization were 6.8 ± 7.2 days in activity group, minimally activity group 7.1 ± 7.2 days, inactive group 11.7 ± 26.0 days. There was no significant difference in the annual days of hospitalization and emergency between the three groups. In particular, the annual days of outpatient increased sharply at the inactive group. Participation in physical activity has been shown to have a significant effect on hospitalization and decreasing use of emergency rooms.CONCLUSIONS Hyperlipidemia prevalence was similar to inactive groups and minimally activity groups, and that of activity groups was 0.74. On medical expenses of hyperlipidemia, the activity and minimally activity group was similar, the inactivity group was 19.3 to 21.7% higher. Physical activity was found to have a positive effect on hospitalization and emergency use reduction.

Application of Activity Trackers among Nursing Home Residents-A Pilot and Feasibility Study on Physical Activity Behavior, Usage Behavior, Acceptance, Usability and Motivational Impact

The aim of this study was to assess physical activity and sedentary behavior, as well as the usage behavior, usability, acceptance, and motivational impact of an applied activity tracker among nursing home residents. Physical activity and usage behavior were measured among 22 residents (68 to 102 years) by use of a commercial activity tracker worn during waking hours for 77 days on average. Usability, acceptance, and motivational impact of the tracker were examined using an adapted questionnaire. Participants walked, on average, 1007 ± 806 steps per day and spent, on average, more than 9 h (77.2% of their waking time) sedentary. The average steps/day increased significantly within the first five weeks of wearing the activity tracker. The acceptance rate was high (94.4%). The tracker was used for 65.4% of the individual study period, and usage behavior did not significantly change during the first five wearing weeks. Participants with a usage time of ≥50% walked significantly more steps per day than those with a lower usage. Overall, we were able to reveal that the residents were highly inactive and sedentary. The results support the feasibility of a long-term application of activity trackers to assess or even increase physical activity behavior.

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

Background

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

Methods

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

Results

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

Conclusion

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

Subjective reports of physical activity levels and sedentary time prior to hospital admission can predict utilization of hospital care and all-cause mortality among patients with cardiovascular disease

Background

In prevention, sedentary behaviour and physical activity have been associated with risk of cardiovascular disease and mortality. Less is known about associations with utilization of hospital care.

Aim

To investigate whether physical activity level and sedentary behaviour prior to cardiac ward admission can predict utilization of hospital care and mortality among patients with cardiovascular disease.

Methods

Longitudinal observational study including 1148 patients admitted and treated in cardiac wards in two hospitals. Subjective reports of physical activity levels and sedentary time prior to admission were collected during inpatient care and categorized as low, medium or high. The associations between physical activity level and sedentary time with hospital stay, readmission and mortality were analysed using linear, logistic and Cox regressions.

Results

Median hospital stay was 2.1 days. One higher step in the physical activity level, or lower sedentary time, was related to an approximately 0.9 days shorter hospital stay. Sixty per cent of patients were readmitted to hospital. The risk of being readmitted was lower for individuals reporting high physical activity and low sedentary time (odds ratios ranging between 0.44 and 0.91). A total of 200 deaths occurred during the study. Mortality was lower among those with high and medium physical activity levels and low sedentary time (hazard ratios ranging between 0.36 and 0.90).

Conclusion

Both physical activity level and sedentary time during the period preceding hospitalization for cardiac events were predictors of hospital utilization and mortality. This highlights the prognostic value of assessing patients’ physical activity and sedentary behaviour.

Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

Socio-demographic correlates of physical activity among European older people

From a public health perspective, identifying factors related to attaining the physical activity (PA) recommendations is important in order to identify subgroups for intervention programs. The aim of this study is to identify the socio-demographic correlates of attaining the recommended levels of PA in the older European population. Using data from the European Social Survey round 6, PA and socio-demographic characteristics were collected from 10,148 participants (4556 men, 5592 women), aged 65 years and over, from 28 countries in 2012. PA was accessed using the question "On how many of the last seven days did you walk quickly, do sports, or other PA for 30 min or longer?" and meeting PA guidelines was assessed using World Health Organization criteria. Overall, 59.7% of the participants attained the PA-recommended levels. The likelihood of attaining PA recommendations was higher among older people with higher education levels (p < 0.05; p < 0.01; p < 0.001). Men who lived in a town or small city (p < 0.05) and lived in a rural area (p < 0.001) were more likely to attain the PA recommendations. Women who lived with a partner were more likely to attain the PA recommendations (p < 0.001). Promotion of PA is critical to health among older people; therefore, intervention programs must consider these socio-demographic factors when planning an increase in PA.

Cost analysis of a peer support programme for patients with type 2 diabetes: a secondary analysis of a controlled trial

Background

This study aimed to explore if group-based peer support as an additional component to a disease management programme (DMP) in type 2 diabetes can reduce the number of prescribed drugs; hospital admissions; and length of hospital stay and therefore be a cost-effective model.

Methods

Controlled study based on a secondary data analysis of a cluster randomized trial. Our study population was general practitioners and patients in the province of Salzburg. The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters. The groups exercised together, discussed diabetes related topics, and received support by professionals. Data was anonymously collected on clusters through the statutory health insurance.

Results

Data were available of 118 (82.5%,17 clusters of the patients in the original randomized trial) participants in the intervention and 143 (77.3%,19 clusters) in the control groups. The length of hospital stay was shorter in the intervention groups compared with controls. The mean difference during the 24-month study period was -40.13 days (95% CI - 78.54 to - 1.71, P = 0.041) in favour of the intervention groups. No differences were seen in the number of prescribed drugs and hospital admission. Estimated yearly savings by reducing the length of hospital stay was €1660.60 per patient.

Conclusion

A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care. Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model.

Hospitalizations During a Physical Activity Intervention in Older Adults at Risk of Mobility Disability: Analyses from the Lifestyle Interventions and Independence for Elders Randomized Clinical Trial

OBJECTIVES

To determine whether moderate-intensity physical activity (PA) and health education (HE) are differentially associated with categories of hospitalizations or subgroups of participants.

DESIGN

Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years.

SETTING

Eight field centers.

PARTICIPANTS

Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635).

INTERVENTIONS

Structured, moderate-intensity PA (n =  818) at a center (2×/wk) and at home (3-4×/wk) that included aerobic, strength, balance, and flexibility training or HE (n =  817) of educational workshops and upper extremity stretching exercises.

MEASUREMENTS

All-cause inpatient hospitalizations ascertained at 6-month intervals.

RESULTS

There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval (CI) = -0.18-9.54; hazard ratio (HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005).

CONCLUSION

A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01072500.

Physical activity and health services utilization and costs among U.S. adults

The objective of this study was to examine the relationship between physical activity and health services utilization and costs among adults aged 18 or older in the U.S. Data came from the Medical Expenditure Panel Survey-Household component from 2007 through 2011 (n=117,361). Regular physical activity was defined as spending half an hour or more in moderate or vigorous physical activity at least three times a week. The following categories of self-reported health services utilization and costs were examined: preventive, office-based, outpatient, inpatient, emergency department, home health, and prescription medicines. The association of physical activity and health services utilization and costs was estimated using two-part models. Adults who engaged in regular physical activity were more likely to use preventive (ORs ranged from 1.06 to 1.34, p<0.05) and office-based services (OR=1.05, 95% CI=1.01-1.10, p<0.05). Combining results from both parts of the two-part models, physically active adults incurred significantly lower utilization of inpatient (0.09 vs 0.12 visit per person), emergency room (0.18 vs 0.19 visit per person), home health care (1.21 vs 1.92 visit per person), and prescription medicines (12.66 vs 13.75 number of prescriptions per person) and spent $27 less per capita expenditures for office-based visits, $351 less for inpatient visits, and $52 less for home health care visits. Promoting regular physical activity may reduce health care costs through decreasing demand for secondary and tertiary care services.

The Frequency and Health Benefits of Physical Activity for Older Adults

The benefits of physical activity (PA) for older adults have been demonstrated in reduced prevalence of common chronic conditions, improved mental health, decreased cognitive decline, and reduced mortality rates. Less is understood concerning the health impacts of light-to-moderate intensity PA. The purpose of this study was to estimate light-to-moderate PA frequency levels-low (0-2 days/week), intermediate (3-4 days/week) and high (≥5 days/week)-among AARP Medicare Supplement insureds, identify characteristics, and estimate the association of PA levels with the prevalence of selected chronic conditions, health care utilization, and expenditures. In 2015, surveys were sent to a random sample of insureds. PA was determined from survey responses querying self-reported days per week of at least 30 minutes of light-to-moderate PA. Multivariate regression models, adjusting for confounding covariates and survey nonresponse bias, were utilized to determine the characteristics and association of intermediate and high PA levels with health outcomes. In a second analysis, results were stratified by age groups: 65-69, 70-79, and ≥80 years. Among survey respondents (n = 17,676), 23.3%, 33.9%, and 42.9% engaged in low, intermediate, and high PA, respectively. The strongest predictors of intermediate and high PA included being male, younger, self-reporting better health, using fewer prescription drugs, and being less likely to be diagnosed with common chronic conditions or depression. Those engaged in intermediate and high PA, overall and across age groups, had significantly lower health care utilization and expenditures and lower prevalence of most chronic conditions. Efforts to increase intermediate and high levels of PA among older adults should be encouraged.

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

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

Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey

Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73;  P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92;  P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82,  P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.

Measuring the implementation of a group-based Lifestyle-integrated Functional Exercise (Mi-LiFE) intervention delivered in primary care for older adults aged 75 years or older: a pilot feasibility study protocol

BACKGROUND

Declines in function and quality of life, and an increased risk of cardiovascular events, falls, and fractures occur with aging and may be amenable to exercise intervention. Primary care is an ideal setting for identifying older adults in need of exercise intervention. However, a cost-effective, generalizable model of chronic disease management using exercise in a real-world setting remains elusive. Our objective is to measure the feasibility, potential effectiveness, and implementation of an evidence-based Lifestyle-integrated Functional strength and balance Exercise (LiFE) intervention adapted as a group-based format (Mi-LiFE) for primary care to promote increased physical activity levels in older adults aged 75 years or older. We hypothesize that the intervention will be feasible without modification if ≥30 individuals are recruited over 6 months, ≥75 % of our sample is retained, and ≥50 % of our sample complete exercises ≥3 days per week.

METHODS/DESIGN

A pre-post pilot study design will be used to evaluate feasibility, potential effectiveness, and implementation outcomes over a 6-month period in physically inactive older adults ≥75 years recruited from a local family health team practice. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework will be applied to evaluate the public health effects of the intervention including outcomes both at the individual and organizational levels. A physical therapist will teach participants how to integrate strength and balance activities into their daily lives over one individual and four group-based sessions, and two phone calls. Assessments will be completed at baseline and 6 months. Feasibility outcomes include recruitment over 6 months, retention at follow-up, and adherence measured by activity diaries. Change in patient-centered and implementation outcomes that will be evaluated include physical activity levels using accelerometers and International Physical Activity Questionnaire, physical performance using short physical performance battery, quality of life using EQ5D questionnaire, falls and harms using daily calendar diaries and self-report, fidelity using descriptive feedback, barriers and facilitators to implementation using thematic content analysis, and process outcomes.

DISCUSSION

The feasibility and implementation of the Mi-LiFE intervention in primary care for older adults will be evaluated, as well as the effects of the intervention on secondary outcomes. If the intervention appears feasible, we will use the resultant information to design a larger trial.

TRIAL REGISTRATION

ClinicalTrials.gov: NCTO2266225.

Prevalence and correlates of physical inactivity among older adults in Rio Grande do Sul, Brazil

Background

Current information on the epidemiology of physical inactivity among older adults is lacking, making it difficult to target the inactive and to plan for interventions to ameliorate adverse effects.

Objectives

To present statewide representative findings on the prevalence of physical inactivity among older community residents, its correlates and associated health service use.

Methods

A representative non-institutionalized random sample of 6963 individuals in Rio Grande do Sul, Brazil, aged ≥60 years, was interviewed face-to-face. Information was obtained on demographic characteristics, social resources, health conditions and behaviors, health service use, and physical inactivity. Controlled logistic regression was used to determine the association of physical inactivity with these characteristics.

Results

Overall, 62% reported no regular physical activity. Physical inactivity was significantly more prevalent among women, older persons, those with lower education and income, Afro-Brazilians (73%; White: 61%; “other”: 64%), those no longer married, and was associated with multiple individual health conditions and impaired activities of daily living (ADL). In adjusted analyses, associations remained for sociodemographic characteristics, social participation, impaired self-rated health, ADL, vision, and depression (odds ratios (OR) 1.2–1.7). Physically inactive respondents were less likely to report outpatient visits (OR 0.81), but more likely to be hospitalized (OR 1.41).

Conclusions

Physical inactivity is highly prevalent, particularly among Afro -Brazilians. It is associated with adverse sociodemographic characteristics; lack of social interaction; and poor self-rated health, ADL, vision, and depression; although not with other health conditions. Self-care may be neglected, resulting in hospitalization.

Health care costs associated with prolonged sitting and inactivity

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Adherence to physical exercise recommendations in people over 65--the SNAC-Kungsholmen study

BACKGROUND

There is limited knowledge regarding to what extent the older population meet the recommendations of physical exercise, especially fitness-enhancing exercise. This study assessed participation in health- and fitness-enhancing exercises in people aged >65, and explored to what extent the possible differences in meeting current recommendations differs by age, gender and education.

METHODS

The study population was derived from the Swedish National study on Aging and Care, and consisted of a random sample of 2593 subjects, aged 65+ years. Participation in health- and fitness-enhancing exercise according to the WHO and the American College of Sports Medicine's recommendations in relation to age, gender and education was evaluated using multinomial logistic regression adjusted for health indicators and physical performance.

RESULTS

According to the recommendations, 46% of the participants fulfilled the criteria for health-enhancing and 16% for fitness-enhancing exercises. Independent of health indicators and physical performance, women <80 years of age were less likely than men to participate in fitness-enhancing exercise, but they participated more in health-enhancing exercise. In the advanced age group (80+ years), women were less likely to participate both in fitness- and health-enhancing exercise. Advanced age and low education were negatively related to participation in both health- and fitness-enhancing exercise independent of health indicators, but the association was not observed among people with fast walking speed.

CONCLUSION

Promoting physical exercise and encouraging participation among older adults with lower education, especially among those with initial functional decline, may help to reduce adverse health outcomes.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A model to estimate the potential for a physical activity-induced reduction in healthcare costs for the elderly, based on pedometer/accelerometer data from the Nakanojo Study

The rising healthcare costs associated with an aging population have become an urgent fiscal problem. However, evidence of the efficacy of preventive programmes is limited, since almost all studies have involved only small numbers of highly selected participants. This article examines potential physical activity-induced decreases in healthcare expenses, applying a theoretical model to the Nakanojo Study of habitual physical activity and health in an entire elderly community. The Nakanojo Study has shown substantial associations of health with both step count and the duration of moderate effort (intensity >3 metabolic equivalents [METs]). Participants are classed as 'dependent' (n = 800) or 'independent' (n = 4400); the latter category is divided arbitrarily into quartiles, based on physical activity patterns (Q1-Q4; n = 1100 for each quartile). The five groups show a graded prevalence of various morbidities, including dependency, depression, osteoporosis, fractures, hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart diseases, cerebrovascular diseases, cancer and dementia. Consequently, annual healthcare expenditures (based on 2009 published Japanese costs associated with each of these conditions) differ by about yen (¥)197 900 ($US1979) per person between dependent individuals and those in group Q1, ¥20 700 ($US207) between Q1 and Q2, ¥14 600 ($US146) between Q2 and Q3, and ¥5300 ($US53) between Q3 and Q4. Accepting a causal relationship between physical activity and health, and assuming that an increase in physical activity induces a benefit that is uniform across conditions and diseases, respective morbidity prevalences and associated healthcare costs seem likely to decrease as physical activity increases. Thus, if the physical activity of only 5% of each group could be increased by a single ranking (pedometer/accelerometer scores of 2000 steps/day and 5-10 min/day at >3 METs and/or an adjusted questionnaire score of 10 MET hours/week), one might predict average savings across this population of about ¥12 600 ($US126) per person, or 3.7%, of total medical expenses, including ¥9800 ($US98) of public nursing care insurance costs and an additional ¥2800 ($US28) of national health insurance expenditures. The impact of various changes in the prevalence of physical activity can be simulated using our model. In principle, savings should increase if more people increase their physical activity, and/or the magnitude of individual increases in physical activity is greater. Nevertheless, our analysis suggests that if even a small fraction of individuals in the three least active groups were to make a single-rank increase in their habitual physical activity as a result of focused health support and the promotion of physical activity, a significant reduction in medical expenses might be anticipated, justifying investment in preventive programmes. We now propose to test the validity of the present simulations on a national basis, obtaining accurate and objective evidence of change in individual physical activity patterns using an advanced design of pedometer/accelerometer.

Physical and leisure activity in older community-dwelling canadians who use wheelchairs: a population study

Background. Physical and leisure activities are proven health promotion modalities and have not been examined in older wheelchair users. Main Objectives. Examine physical and leisure activity in older wheelchair users and explore associations between wheelchair use and participation in physical and leisure activity, and wheelchair use, physical and leisure activity, and perceived health. Methods. 8301 Canadians ≥60 years of age were selected from the Canadian Community Health Survey. Sociodemographic, health-related, mobility-related, and physical and leisure activity variables were analysed using logistic regression to determine, the likelihood of participation in physical and leisure activity, and whether participation in physical and leisure activities mediates the relationship between wheelchair use and perceived health. Results. 8.3% and 41.3% older wheelchair users were physically and leisurely active. Wheelchair use was a risk factor for reduced participation in physical (OR = 44.71) and leisure activity (OR = 10.83). Wheelchair use was a risk factor for poor perceived health (OR = 10.56) and physical and leisure activity negatively mediated the relationship between wheelchair user and perceived health. Conclusion. There is a need for the development of suitable physical and leisure activity interventions for older wheelchair users. Participation in such interventions may have associations with health benefits.