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Amera TG, Tefera YM, Menberu T, Yassin AM. Determinants of Type 2 Diabetes Mellitus Among Adults in Dill-Chora Referral Hospital, Dire Dawa, East Ethiopia. Diabetes Metab Syndr Obes 2022; 15:3565-3576. [PMID: 36419502 PMCID: PMC9677892 DOI: 10.2147/dmso.s384737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Ethiopia has been exhibiting trends that are shifting the populace's way of life toward urbanization. As a result, the country's primary focus is on treating infectious diseases, whereas chronic noncommunicable diseases receive less attention. Type 2 diabetes has emerged as a major noncommunicable disease that is endangering African nations' economic, social, and cultural underpinnings. There has been research mostly on prevalence, factors associated, and glycemic control of diabetes but not adequate on the causes of T2DM in Ethiopia, particularly in the study region. Objective To identify the determinants of type 2 diabetes mellitus among adults at Dill-Chora hospital, from August 30 to October 30, 2021. Methods An unmatched case-control study was carried out at Dill-Chora referral hospital using face-to-face interviews. The data was collected, cleaned, coded, and entered to epi data version 3.1 before being exported to SPSS version 23 for analysis. The analyses used were descriptive and logistic regression. Results The study included 331 individuals, 113 cases and 218 controls. Cigarette smoking (AOR: 3.15, 95% CI: 1.24-7.96), extra salt consumption (AOR: 5.52, 95% CI: 2.33-13.05), low fruit consumption (AOR: 5.28, 95% CI: 2.12-13.16), infrequent physical activity (AOR: 3.72, 95% CI: 1.65-8.39), waist to hip ratio (AOR: 18.88, 95% CI: 7.35-48.42), and triglyceride level (AOR: 2.93, 95% CI: 1.34-6.32) were strongly linked to the onset of type 2 diabetes mellitus. Conclusion and Recommendation This study discovered a variety of risk factors for type 2 diabetes, including triglyceride levels, fruit consumption, smoking, increased salt consumption, irregular exercise, and waist to hip ratio. By focusing preventative efforts on these risk factors, the occurrence of type 2 diabetes may be reduced. Furthermore, diabetes mellitus screening is crucial, particularly in those with a high waist-to-hip ratio, a smoking history, and high triglyceride levels.
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Affiliation(s)
- Tewodros Getnet Amera
- Department of Public Health, Medicine and Health Sciences College, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yibekal Manaye Tefera
- Department of Public Health, Medicine and Health Sciences College, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tameru Menberu
- Department of Medical Laboratory, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Aminu Mohammed Yassin
- Department of Midwifery, medicine and health sciences college, Dire Dawa University, Dire Dawa, Ethiopia
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Storm RK, Jakobsen TG. Does international elite sporting success or hosting major events affect self-rated health? An examination of potential positive externalities related to international sporting tournaments. MANAGING SPORT AND LEISURE 2021. [DOI: 10.1080/23750472.2021.2004914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rasmus K. Storm
- Danish Institute for Sports Studies, Århus, Denmark
- NTNU Business School, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Georg Jakobsen
- NTNU Business School, Norwegian University of Science and Technology, Trondheim, Norway
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Triaxial Accelerometry-Based Moderate to Vigorous Physical Activity in Older Adults Using Four Different Methods. J Aging Phys Act 2021; 30:473-481. [PMID: 34548421 DOI: 10.1123/japa.2020-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
The amount of physical activity reported using accelerometry can vary depending on the method used. This study examined variability in four different methods of calculating moderate to vigorous physical activity (MVPA) among older adults, as well as lifestyle correlates of physical activity. The MVPA data were captured (n = 111; Mage = 70.3 years, SDage = 6.3) using waist-worn ActiGraph wGT3X-BT monitors and examined using 10-min bouted versus sporadic methods, and with cut points calibrated to older and younger adults. The sample, on average, did not meet national guidelines of 150 min/week of MVPA when using bouted methods, irrespective of cut point used. This was not the case for sporadic MVPA. More physical activity was reported for participants with two or more physical hobbies, but no association with social behavior was found. These results demonstrate the wide variability possible in reporting methods for accelerometry data and their relation to adherence rates for national health recommendations.
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Watching sports and depressive symptoms among older adults: a cross-sectional study from the JAGES 2019 survey. Sci Rep 2021; 11:10612. [PMID: 34011984 PMCID: PMC8134456 DOI: 10.1038/s41598-021-89994-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
The current study investigated the relationship between the frequency of watching sports and depressive symptoms among older adults. This study used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide mail survey of 21,317 older adults. Depressive symptoms were defined as a Geriatric Depression Scale score of ≥ 5. Participants were queried regarding the average frequency at which they watched sports on-site and via TV/Internet over the past year. Among the 21,317 participants, 4559 (21.4%) had depressive symptoms, while 4808 (22.6%) and 16,576 (77.8%) watched sports on-site and via TV/Internet at least once a year, respectively. Older adults who watched sports on-site a few times/year (prevalence ratio, 0.70; 95% confidence interval, 0.65–0.74) or 1–3 times/month (0.66, 0.53–0.82) were less likely to have depressive symptoms compared to non-spectators after adjusting for frequency of playing sports, exercise activities, and other potential confounders. Meanwhile, a dose–response relationship was confirmed for watching via TV/Internet (prevalence ratio of 0.86, 0.79, and 0.71 for a few times/year, 1–3 times/month, and ≥ 1 time/week, respectively). This study suggested that watching sports on-site or via TV/Internet, regardless of whether they regularly engage in sports, may reduce the risk of depressive symptoms among older adults.
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Tsuji T, Kanamori S, Watanabe R, Yokoyama M, Miyaguni Y, Saito M, Kondo K. Watching sports and depressive symptoms among older adults: a cross-sectional study from the JAGES 2019 survey. Sci Rep 2021. [PMID: 34011984 DOI: 10.1038/s41598-021-89994-8[publishedonlinefirst:20210519]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
The current study investigated the relationship between the frequency of watching sports and depressive symptoms among older adults. This study used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide mail survey of 21,317 older adults. Depressive symptoms were defined as a Geriatric Depression Scale score of ≥ 5. Participants were queried regarding the average frequency at which they watched sports on-site and via TV/Internet over the past year. Among the 21,317 participants, 4559 (21.4%) had depressive symptoms, while 4808 (22.6%) and 16,576 (77.8%) watched sports on-site and via TV/Internet at least once a year, respectively. Older adults who watched sports on-site a few times/year (prevalence ratio, 0.70; 95% confidence interval, 0.65-0.74) or 1-3 times/month (0.66, 0.53-0.82) were less likely to have depressive symptoms compared to non-spectators after adjusting for frequency of playing sports, exercise activities, and other potential confounders. Meanwhile, a dose-response relationship was confirmed for watching via TV/Internet (prevalence ratio of 0.86, 0.79, and 0.71 for a few times/year, 1-3 times/month, and ≥ 1 time/week, respectively). This study suggested that watching sports on-site or via TV/Internet, regardless of whether they regularly engage in sports, may reduce the risk of depressive symptoms among older adults.
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Affiliation(s)
- Taishi Tsuji
- Faculty of Health and Sport Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo City, Tokyo, 112-0012, Japan.
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan.
| | - Satoru Kanamori
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi City, Tokyo, 173-8605, Japan
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku City, Tokyo, 160-8402, Japan
| | - Ryota Watanabe
- Department of Rehabilitation, Tsushima City Hospital, 3-73 Tachibana-cho, Tsushima City, Aichi, 496-8537, Japan
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba City, Chiba, 260-8670, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Meiko Yokoyama
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan
| | - Yasuhiro Miyaguni
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Masashige Saito
- Department of Social Welfare, Nihon Fukushi University, Okuda, Mihama-cho, Chita-gun, Aichi, 470-3295, Japan
- Center for Well-Being and Society, Nihon Fukushi University, 5-22-35 Chiyoda, Naka Ward, Nagoya City, Aichi, 460-0012, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage Ward, Chiba City, Chiba, 263-8522, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
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Physical Activity Among Urban-Living Middle-Aged and Older Japanese During the Build-Up to the Tokyo Olympic and Paralympic Games: A Population Study. J Aging Phys Act 2020; 29:308-318. [PMID: 33091871 DOI: 10.1123/japa.2020-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
This research examines physical activity (PA) parameters among urban-living middle-aged and older Japanese during the Tokyo Olympic build-up period. Population sampling was employed, and an online survey was administered with 4,000 adults across Japan's five largest cities. The International Physical Activity Questionnaire-Short Form constituted the main outcome variable, with auxiliary measures of Olympic interest and engagement, readiness for PA behavior change, perceived environmental barriers, and demographic information. Despite interest in the Olympics (>60% moderate-high interest), planned engagement with the event was low (>70% planned passive engagement). Higher levels of interest and planned engagement were both significantly correlated with greater self-reported PA participation (p < .001). Across the sample, the PA levels were in the low-moderate range (990 metabolic equivalent of task-min/week), with significant variations observed by the age-cohort and geographic area (p < .001). Age-cohort and geographic variations were also identified with regard to readiness for PA behavior change and perceived environmental barriers to activity (p < .001). Older age (65 years and above) and host city (Tokyo) residence emerged as correlates of higher levels of PA, greater readiness for behavior change, and fewer reported barriers to participation. These findings have implications for Olympic legacy management and successful transitions from middle age to later life in Japan.
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Slot-Heijs JJ, Collard DCM, Pettigrew S, Vinck J, Edell D, Barriguete A, Visscher TLS. The training and support needs of 22 programme directors of community-based childhood obesity interventions based on the EPODE approach: an online survey across programmes in 18 countries. BMC Health Serv Res 2020; 20:870. [PMID: 32933494 PMCID: PMC7491184 DOI: 10.1186/s12913-020-05709-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tackling childhood obesity is complex and requires a community-based approach implemented in multiple environments. It is known from literature that knowledgeable and skilled professionals are essential to implement such an approach successfully. The aim of the present study was to assess the need for training and support among a global network of programme directors implementing a Community-Based Childhood Obesity Intervention (CBCOI) based on the EPODE approach, in order to assist them in optimising the implementation process. METHODS An online survey was sent to 40 programme directors representing programmes implementing a CBCOI based on the EPODE approach. The survey consisted of statements on a 5-point Likert scale and multiple-choice questions about attitude towards and usefulness of training and support, and preferences for some predefined training types and training topics. In total, 22 programme directors responded to the survey (55% response rate). Data were analysed using descriptive statistics to describe the need for support in order to improve successful implementation. RESULTS Respondents strongly agreed that continually updating skills and learning how to make their programmes more effective and sustainable at the start and during the implementation was important. On-site training was preferred most at the commencement of a programme, while a 2-day training course was most valued during implementation. Monitoring, measuring and programme evaluation was identified as the most valuable training topic. CONCLUSIONS The results indicate a continuing and significant need for support and training among programme directors implementing a CBCOI. The findings give directions regarding topics and types of training and support in order to improve the implementation process.
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Affiliation(s)
| | - Dorine C M Collard
- Mulier Institute, Herculesplein 269, NL-3584, AA, Utrecht, The Netherlands
| | - Simone Pettigrew
- The George Institute for Global Health, Level 5/ 1 King Street, Newtown, NSW, 2042, Australia
| | - Jan Vinck
- Hasselt University, Martelarenlaan 42, BE-3500, Hasselt, Belgium
| | - Dennis Edell
- EPODE Canada, 20 Gothic Ave, Toronto, M6P 1T5, Canada
| | - Armando Barriguete
- National Institute of Medical Sciences and Nutrition, Vasco Quiroga, 14080, Tlalpan, Mexico
| | - Tommy L S Visscher
- Hanze University of Applied Sciences, Zernikeplein 7, 9747, AS, Groningen, The Netherlands
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Bagnall AM, Radley D, Jones R, Gately P, Nobles J, Van Dijk M, Blackshaw J, Montel S, Sahota P. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health 2019; 19:8. [PMID: 30606173 PMCID: PMC6318991 DOI: 10.1186/s12889-018-6274-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. METHODS Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. RESULTS Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. CONCLUSIONS Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.
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Affiliation(s)
- Anne-Marie Bagnall
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Duncan Radley
- School of Sport, Leeds Beckett University, Leeds, UK
| | - Rebecca Jones
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Paul Gately
- School of Sport, Leeds Beckett University, Leeds, UK
| | - James Nobles
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Margie Van Dijk
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Jamie Blackshaw
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Sam Montel
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Pinki Sahota
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, UK
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Javadipoor M, Zareian H, Parsaju A. Identifying the Contexts of Social Participation in Sport for all in Iran: A Qualitative Study. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2018. [DOI: 10.21859/jech.5.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Storm RK, Nielsen CG, Jakobsen TG. Can international elite sport success trickle down to mass sport participation? Evidence from Danish team handball. Eur J Sport Sci 2018; 18:1139-1150. [PMID: 29944458 DOI: 10.1080/17461391.2018.1489000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Many scholars do not find evidence of a trickle-down effect from elite sport success to mass sport participation. Contrary to what is assumed by the trickle-down effect "theorem", successful elite sportspeople do not seem to inspire amateurs to take up sport themselves. However, recent studies present evidence that elite sport can have an influence. In this article, we apply regression models on time series data from one of the most successful Danish sports, team handball. Our findings are mixed, but lean towards supporting scholars who argue that trickle-down effects are not necessarily an inherent part of international sporting success. Further studies should examine more sports to identify where trickle-down effects occur and why.
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Affiliation(s)
- Rasmus K Storm
- a Danish Institute for Sports Studies , København K , Denmark.,b NTNU Business School , Norwegian University of Science and Technology , Trondheim , Norway
| | | | - Tor Georg Jakobsen
- b NTNU Business School , Norwegian University of Science and Technology , Trondheim , Norway
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Valiani V, Sourdet S, Schoeller DA, Mackey DC, Bauer DC, Glynn NW, Yamada Y, Harris TB, Manini TM. Surveying predictors of late-life longitudinal change in daily activity energy expenditure. PLoS One 2017; 12:e0186289. [PMID: 29040301 PMCID: PMC5645098 DOI: 10.1371/journal.pone.0186289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/23/2017] [Indexed: 12/21/2022] Open
Abstract
Background Total daily energy expenditure (TEE) is composed of resting metabolic rate (RMR), post-prandial thermogenesis and activity energy expenditure (AEE). Higher AEE is strongly associated with lower mortality and physical limitations among older adults, but factors that predict changes in AEE in septu and octogenarians are not clearly understood. Objective To identify factors associated with late-life longitudinal change in AEE. Design Energy expenditure was re-assessed in 83 participants (average age at baseline, 74.4±3.2 years)—an average of 7.5±0.54 years since the baseline measure. RMR was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of TEE. AEE was calculated as: TEE(0.9)-RMR. Participants were categorized into two groups according to the estimated day-to-day precision of the doubly-labeled water technique. Those who were within 10% or increased relative to their initial AEE measurement were categorized as having preserved AEE. Participants who declined greater than 10% of their initial measurement were categorized as having reduced AEE. A variety of socio-demographic, functional and mental factors, body composition, community and personal behaviors, blood measurements and health conditions were evaluated between groups at baseline and changes during follow-up. Results Daily AEE declined 106.61±293.25 kcal, which equated to a 14.63±40.57 kcal/d decrease per year. Fifty-nine percent (n = 49) preserved their AEE and 41% (n = 34) declined. Those who demonstrated a decline in AEE were older, had lower walking speed at baseline and showed a higher lean mass loss during follow up. Otherwise, groups were similar for socio-demographic characteristics, body composition, mental and physical function, health conditions and community and personal behaviors at baseline and change in these factors during follow-up. Conclusions This study demonstrates that AEE declines through the 8th decade of life and is associated with age, lower walking speed at baseline and lean mass loss. Additionally, there are a significant number of individuals who appear to be resilient to these declines despite having health events that are expected to have a negative impact on their physical activity.
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Affiliation(s)
- Vincenzo Valiani
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Forida, United States of America
- Dipartimento Interdisciplinare di Medicina, Clinica Medica Cesare Frugoni, University of Bari Aldo Moro, Bari, Italy
- * E-mail: ,
| | | | - Dale A. Schoeller
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Dawn C. Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Douglas C. Bauer
- Division of General Internal Medicine, University of California, San Francisco, California, United States of America
| | - Nancy W. Glynn
- Department of Epidemiology, Center for Aging and Population Health, Univeristy of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yosuke Yamada
- Deparment of Nutritional Science, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, IRP, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Forida, United States of America
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