Exploring patterns of accelerometry-assessed physical activity in elderly people

Associations Between Wearable-Specific Indicators of Physical Activity Behaviour and Insulin Sensitivity and Glycated Haemoglobin in the General Population: Results from the ORISCAV-LUX 2 Study

BACKGROUND

Parameters derived from an acceleration signal, such as the time accumulated in sedentary behaviour or moderate to vigorous physical activity (MVPA), may not be sufficient to describe physical activity (PA) which is a complex behaviour. Incorporating more advanced wearable-specific indicators of PA behaviour (WIPAB) may be useful when characterising PA profiles and investigating associations with health. We investigated the associations of novel objective measures of PA behaviour with glycated haemoglobin (HbA1c) and insulin sensitivity (Quicki index).

METHODS

This observational study included 1026 adults (55% women) aged 18-79y who were recruited from the general population in Luxembourg. Participants provided ≥ 4 valid days of triaxial accelerometry data which was used to derive WIPAB variables related to the activity intensity, accumulation pattern and the temporal correlation and regularity of the acceleration time series.

RESULTS

Adjusted general linear models showed that more time spent in MVPA and a higher average acceleration were both associated with a higher insulin sensitivity. More time accumulated in sedentary behaviour was associated with lower insulin sensitivity. With regard to WIPAB variables, parameters that were indicative of higher PA intensity, including a shallower intensity gradient and higher average accelerations registered during the most active 8 h and 15 min of the day, were associated with higher insulin sensitivity. Results for the power law exponent alpha, and the proportion of daily time accumulated in sedentary bouts > 60 min, indicated that activity which was characterised by long sedentary bouts was associated with lower insulin sensitivity. A greater proportion of time spent in MVPA bouts > 10 min was associated with higher insulin sensitivity. A higher scaling exponent alpha at small time scales (< 90 min), which shows greater correlation in the acceleration time series over short durations, was associated with higher insulin sensitivity. When measured over the entirety of the time series, metrics that reflected a more complex, irregular and unpredictable activity profile, such as the sample entropy, were associated with lower HbA1c levels and higher insulin sensitivity.

CONCLUSION

Our investigation of novel WIPAB variables shows that parameters related to activity intensity, accumulation pattern, temporal correlation and regularity are associated with insulin sensitivity in an adult general population.

Agreement of Step-Based Metrics From ActiGraph and ActivPAL Accelerometers Worn Concurrently Among Older Adults

Purpose

Our study evaluated the agreement of mean daily step counts, peak 1-min cadence, and peak 30-min cadence between the hip-worn ActiGraph GT3X+ accelerometer, using the normal filter (AG_N) and the low frequency extension (AG_LFE), and the thigh-worn activPAL3 micro (AP) accelerometer among older adults.

Methods

Nine-hundred and fifty-three older adults (≥65 years) were recruited to wear the ActiGraph device concurrently with the AP for 4-7 days beginning in 2016. Using the AP as the reference measure, device agreement for each step-based metric was assessed using mean differences (AG_N - AP and AG_LFE - AP), mean absolute percentage error (MAPE), and Pearson and concordance correlation coefficients.

Results

For AG_N - AP, the mean differences and MAPE were: daily steps -1,851 steps/day and 27.2%, peak 1-min cadence -16.2 steps/min and 16.3%, and peak 30-min cadence -17.7 steps/min and 24.0%. Pearson coefficients were .94, .85, and .91 and concordance coefficients were .81, .65, and .73, respectively. For AG_LFE - AP, the mean differences and MAPE were: daily steps 4,968 steps/day and 72.7%, peak 1-min cadence -1.4 steps/min and 4.7%, and peak 30-min cadence 1.4 steps/min and 7.0%. Pearson coefficients were .91, .91, and .95 and concordance coefficients were .49, .91, and .94, respectively.

Conclusions

Compared with estimates from the AP, the AG_N underestimated daily step counts by approximately 1,800 steps/day, while the AG_LFE overestimated by approximately 5,000 steps/day. However, peak step cadence estimates generated from the AG_LFE and AP had high agreement (MAPE ≤ 7.0%). Additional convergent validation studies of step-based metrics from concurrently worn accelerometers are needed for improved understanding of between-device agreement.

Advanced analytical methods to assess physical activity behavior using accelerometer time series: A scoping review

Physical activity (PA) is a complex human behavior, which implies that multiple dimensions need to be taken into account in order to reveal a complete picture of the PA behavior profile of an individual. This scoping review aimed to map advanced analytical methods and their summary variables, hereinafter referred to as wearable‐specific indicators of PA behavior (WIPAB), used to assess PA behavior. The strengths and limitations of those indicators as well as potential associations with certain health‐related factors were also investigated. Three databases (MEDLINE, Embase, and Web of Science) were screened for articles published in English between January 2010 and April 2020. Articles, which assessed the PA behavior, gathered objective measures of PA using tri‐axial accelerometers, and investigated WIPAB, were selected. All studies reporting WIPAB in the context of PA monitoring were synthesized and presented in four summary tables: study characteristics, details of the WIPAB, strengths, and limitations, and measures of association between those indicators and health‐related factors. In total, 7247 records were identified, of which 24 articles were included after assessing titles, abstracts, and full texts. Thirteen WIPAB were identified, which can be classified into three different categories specifically focusing on (1) the activity intensity distribution, (2) activity accumulation, and (3) the temporal correlation and regularity of the acceleration signal. Only five of the thirteen WIPAB identified in this review have been used in the literature so far to investigate the relationship between PA behavior and health, while they may provide useful additional information to the conventional PA variables.

Objectively Measured Physical Activity in Patients with Coronary Artery Disease: A Cross-Validation Study

Physical activity (PA) and sedentary behavior (SB) levels in healthy adults are predominately based on self-reporting measures, which generally overestimate PA but underestimate SB. Patients with coronary artery disease (CAD) eligible for cardiac rehabilitation (CR) follow an individualized program; thus, objective assessment of physical performance and regular daily activity is required. This study aimed to compare self-reported and objectively measured PA and SB in patients with CAD prior to out-patient CR. We included 91 patients with CAD and assessed their PA with an accelerometer for 8 days prior to CR, along with the short form of the international physical activity questionnaire. We found that most patients were sedentary (61%, ~8 h/day), and on average performed 63 min/day of moderate-to-vigorous-intensity physical activity (MVPA). Males performed less daily light-intensity physical activity (−5%, p = 0.011) and performed more MVPA (+2%, p = 0.002) compared to females. Maximal aerobic capacity was significantly associated with MVPA (Spearman rho = 0.483, p < 0.001) and MVPA > 10 min bouts (Spearman rho = 0.391, p < 0.001). Self-reported measures overestimated MVPA (total MVPA, +108 min/day, p < 0.001; MVPA > 10 min bouts, +152 min, p < 0.001) and underestimated SB (−174 min/day, p < 0.001) compared to objective measures. There was no significant correlation between methods in MVPA (Spearman rho = 0.147, p = 0.165)), MVPA > 10 min bouts (Spearman rho = −0.059, p = 576), and SB (Spearman rho = 0.139, p = 0.187). Quantitative analysis demonstrated the huge proportional bias for MVPA, MVPA > 10 min bouts, and SB. Our findings demonstrate that self-reported physical activity provides inaccurate estimates of MVPA and SB in patients with CAD entering the ambulatory CR. This strongly supports the more objective assessments of daily PA, preferably using an accelerometer.

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

BACKGROUND

Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.

METHODS

This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council's Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis.

RESULTS

A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs' adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients' treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.

CONCLUSION

Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT.

TRIAL REGISTRATION

Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

Associations between physical function and device-based measures of physical activity and sedentary behavior patterns in older adults: moving beyond moderate-to-vigorous intensity physical activity

Background

Research supports that moderate-to-vigorous intensity physical activity (MVPA) is key to prolonged health and function. Among older adults, substantial changes to MVPA may be infeasible, thus a growing literature suggests a shift in focus to whole-day activity patterns.

Methods

With data from 795 older adults aged 65–100 in the Adult Changes in Thought Activity Monitoring study, we used linear regression to estimate associations between ActiGraph and activPAL measured activity patterns – including light intensity physical activity, steps, standing, and sedentary behaviors – and physical function as measured by a short Performance-based Physical Function (sPPF) score (range 0–12), a composite score based on three standardized physical performance tasks: gait speed, timed chair stands, and grip strength. We examined whether relationships persisted when controlling for MVPA or differed across age, gender, or quartiles of MVPA.

Results

In models unadjusted for MVPA, a 1-standard deviation (SD) increment of daily sitting (1.9 h more), mean sitting bout duration (8 min longer average), or time spent in sedentary activity (1.6 h more) was associated with ~ 0.3–0.4 points lower mean sPPF score (all p < 0.05). A 1-SD increment in daily steps (~ 3500 more steps) was associated with ~ 0.5 points higher mean sPPF score (95% CI: 0.22 to 0.73). MVPA adjustment attenuated all relationships. The association between physical function and steps was strongest among adults aged 75+; associations of worse function with greater sedentary behavior were more pronounced in participants with the lowest levels of MVPA.

Conclusions

We found associations between function and activity metrics other than MVPA in key subgroups, findings that support research on broader activity patterns and may offer ideas regarding practical intervention opportunities for improving function in older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02163-4.

Community participation of community dwelling older adults: a cross-sectional study

BACKGROUND

With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation.

METHODS

This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored.

RESULTS

Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48).

CONCLUSION

Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity.

TRIAL REGISTRATION

Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Instrumented measures of sedentary behaviour and physical activity are associated with mortality in community-dwelling older adults: A systematic review, meta-analysis and meta-regression analysis

BACKGROUND

Sedentary behaviour (SB) and physical activity (PA) can be objectively assessed with inertial sensors to describe bodily movement. Higher SB and lower PA is associated with higher chronological age and negative health outcomes. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and mortality in community-dwelling older adults, to subsequently compare the quantitative effect sizes and to determine the dose-response relationships.

METHODS

An electronic search in six databases from inception to 27th of June 2019 was conducted. All articles reporting on i-SB or i-PA and mortality in community-dwelling older adults aged 60 years or older were considered eligible. A meta-analysis was conducted for the association between i-SB and i-PA and mortality expressed in Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). A meta-regression analysis was performed to determine the dose-response relationship between i-SB and steps per day and mortality.

RESULTS

Twelve prospective articles representing eleven cohorts, reporting data of 38,141 participants were included. In total 2502 (6.4%) participants died during follow-up (2.0 to 9.8 years). Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled HR of 2.44 (95% CI 1.82-3.25). Comparing the least active with the most active groups of participants resulted in a pooled HR of 1.93 (95% CI 1.39-2.69); 2.66 (95% CI 2.11-3.35); 3.43 (95% CI 2.61-4.52), and 3.09 (95% CI 2.33-4.11) for light, moderate-to-vigorous-, total PA and steps per day, respectively. Meta-regression analyses showed clear dose-response relationships between i-SB and steps per day and mortality risk.

CONCLUSION

Both i-SB and i-PA are significantly associated with mortality in community-dwelling older adults, showing the largest effect size for total physical activity. Dose-response relationships could be observed for i-SB and steps per day.

Association between physical function and various patterns of physical activity in older adults: a cross-sectional analysis

BACKGROUND

To improve physical function, physical activity (PA) guidelines for older adults recommend completing PA in bouts of 10 min or more. Spontaneous PA (< 10 min) can also benefit older adults. However, a paucity of research exists examining if shorter bouts of PA are associated with greater physical function.

AIM

To determine the association between various patterns of PA and the likelihood of greater physical function in older adults.

METHODS

Older adults from the 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey were included for analysis. PA lasting 1, 5, 10, 30, and 60 min was quantified using accelerometers. Physical function was assessed using a Likert scale reflecting the self-reported capability to complete 11 tasks. A single function score was then computed using factor analysis. Logistic regression analyses calculated the association between PA bout length and the likelihood of above average function.

RESULTS

PA performed in 1-min (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03), 5-min (OR 1.02; CI 1.01-1.03), or 10-min bouts (OR 1.02; CI 1.01-1.03) was associated with greater physical function following adjustment for confounders. When scaled to represent an accumulation of 10 min of MVPA, likelihoods increased for both 1-min ([OR] 1.25; 95% [CI] 1.11-1.39) and 5-min (OR 1.22; 95% CI 1.08-1.37) bouts.

DISCUSSION/CONCLUSIONS

Our findings suggest bouts of PA lasting 10 min or shorter in duration are associated with greater physical function in older adults.

Pattern measures of sedentary behaviour in adults: A literature review

Objective

With sensors, we are increasingly able to assess sitting behaviour during the day. However, there is no consensus among researchers on the best outcome measures for representing the accumulation of sedentary time during the day.

Methods

We analysed the pattern measures of sedentary behaviour. Articles reporting patterns measures in adults, in which behaviour data was collected with a sensor were included. We discuss the strengths and weaknesses of the pattern measures of sedentary behaviour and provide recommendations for choosing objective measures of sedentary behaviour.

Results

Most studies report the number of sitting bouts during the day. Others focus on the number of breaks and/or periods of physical activity. Simple measures of sedentary behaviour were most popular. More complex pattern measures, such as the Gini index or the half-life bout duration, that capture the distribution of lengths of sitting periods in a single number, were reported sparsely. The sedentary patterns that were reported in the various studies were difficult to compare, due to the differences among measurement devices, data analysis protocols and a lack of basic outcome parameters such as total wear-time and total sedentary time.

Conclusions

Objective sedentary measures can be grouped into simple and complex measures of sedentary time accumulation during the day. These measures serve different goals. The answer to the question as to which measures are most suitable to report, is strongly dependent on the research question. We have shown that the reported measures were dependent on (a) the sensing method, (b) the classification method, (c) the experimental and data cleaning protocol and (d) the applied definitions of bouts and breaks. We recommend that studies should always report total wear-time, total sedentary time, number of bouts and at least one measure describing the diversity of bout lengths in the sedentary behaviour such as the half-life bout duration. Additionally, we recommend reporting the measurement conditions and data processing steps.

Physical Activity and Sedentary Time in Active and Non-Active Adults with Intellectual Disability: A Comparative Study

This study describes and compares physical activity (PA) levels and sedentary time (ST) of active (AG) and a non-active (NAG) groups of adults with intellectual disability (ID) versus a group of adults without ID. Thirty-seven participants from the AG, 29 from the NAG, and 31 adults without ID participated in this study. Height and weight were obtained to calculate body mass index (BMI). PA levels and ST were assessed with GT3X Actigraph accelerometers for 7 days. Results revealed that the AG engaged in higher values of moderate to vigorous PA compared with the NAG (all p < 0.05), but were similar to adults without ID. Adults without ID performed less ST and more light PA than the ID groups (all p < 0.05). The participants of the AG did not demonstrate less ST than the NAG. It is concerning that adults with ID (AG or NAG) are spending a higher time in ST and less time in light PA than adults without ID. Our results suggest that integrated, well-designed PA programmes into the ID population workdays can lead to increased PA levels. Nevertheless, these interventions and exercise programmes implemented for adults with ID should be tailored to also reduce ST.

Objective evaluation of physical activity pattern using smart devices

Physical activity session frequency and distribution over time may play a significant role on survival after major cardiovascular events. However, the existing amount-based metrics do not account for these properties, thus the physical activity pattern is not fully evaluated. The aim of this work is to introduce a metric which accounts for the difference between the actual and uniform distribution of physical activity, thus its value depends on physical activity aggregation over time. The practical application is demonstrated on a step data from 40 participants, half of them diagnosed with chronic cardiovascular disease (CVD). The metric is capable of discriminating among different daily patterns, including going to and from work, walking in a park and being active the entire day. Moreover, the results demonstrate the tendency of CVD patients being associated with higher aggregation values, suggesting that CVD patients spend more time in a sedentary behaviour compared to healthy participants. By combining the aggregation with the intensity metric, such common weekly patterns as inactivity, regular activity and “weekend warrior” can be captured. The metric is expected to have clinical relevance since it may provide additional information on the relationship between physical activity pattern and health outcomes.

Accelerometer-Measured Physical Activity and Sedentary Behavior: A Cross-Sectional Study of Brazilian Older Adults

BACKGROUND

To examine the level of physical activity and sedentary behavior (SB), measured with accelerometers, in older adults from a city in southern Brazil according to sociodemographic and health characteristics.

METHODS

The sample consisted of 425 older adults (≥63 y) from the EpiFloripa Aging Study. Light physical activity (LPA), moderate to vigorous physical activity (MVPA), and SB were measured with accelerometers over a period of 7 days.

RESULTS

The older adults spent two-thirds of the time of use in SB, one-third in LPA, and only 2.1% (95% confidence interval, 1.8-2.2) in MVPA. In the final adjusted model, lower levels of MVPA were observed for women, as well as higher SB and lower LPA and MVPA for those with higher age. There were also trends toward prolonged SB and lower LPA when participants had a higher educational level and toward lower MVPA with higher body mass index.

CONCLUSIONS

Constant monitoring of physical activity levels and SB using objective measures is recommended and interventions should be directed at the groups most exposed to excessive SB and low levels of MVPA.

Objectively Assessed Physical Activity in the Oldest Old Persons With Coronary Artery Disease

BACKGROUND AND PURPOSE

Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for ActiGraph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons.

METHODS

In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity.

RESULTS AND DISCUSSION

The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation.

CONCLUSIONS

The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.

Do weather changes influence physical activity level among older adults? - The Generation 100 study

Introduction

Understanding how individual and environmental factors impact physical activity (PA) level is important when building strategies to improve PA of older adults. No studies have examined how hour-to-hour weather changes influence PA in older adults or how the association between weather and PA eventually is related to cardiorespiratory fitness (CRF) measured as peak oxygen uptake. The aim of this study was therefore to examine how hour-to-hour changes in weather effects hour-to-hour PA in a cohort of Norwegian older adults across CRF levels, gender and seasons.

Methods

PA was assessed objectively in 1219 older adults (70–77 years, 51% females) using the Actigraph GT3X+ accelerometer, and quantified as counts·min^-1 (CPM). Weather (Norwegian meteorological Institute) and CRF (MetaMax II) were measured objectively. Panel data analysis added a longitudinal dimension when 110.888 hours of weather- and PA data were analyzed.

Results

Older adults had a higher PA level in warmer (597 CPM) than colder months (556 CPM) (p<0.01). Fixed effects regression-models revealed that increasing temperatures (per hour) influenced PA positively in both colder and warmer months (all, p<0.01), with greater influence in fitter vs. less fit participants (p<0.01). In warmer months, increasing precipitation negatively influenced PA in both unfit females and unfit males (p<0.01). In colder months, increasing precipitation positively influenced PA for moderately fit to fit males (p<0.01), but not for females and unfit males.

Conclusion

To the best of our knowledge, this is the first study to examine the association between weather conditions and objectively-measured-PA among Norwegian older adults. Our findings demonstrates that unfit older adults will be less likely to participate in PA when the weather is unpleasant, compared to those highly fit. The data suggests that the impact of weather should not be ignored when planning public health strategies for increasing PA among older adults.

Objective Measures of Activity in the Elderly: Distribution and Associations With Demographic and Health Factors

BACKGROUND

Little is known about the distribution of activity over the full 24-hour spectrum in late old age and its association with demographic and health factors. Therefore, we aimed to evaluate the distribution of physical activity (PA), sedentary behavior, and sleep, and associated factors in the elderly population.

METHODS

Our study included 1210 participants (51.9% women) aged 70-94 years [mean age 77.5 years, standard deviation (SD) 5.0] from the population-based Rotterdam Study. Participants wore a triaxial accelerometer (GENEActiv) around the wrist for 7 days between July 2014 and June 2016. We examined if PA, sedentary behavior, and sleep differed by age, sex, body mass index (BMI), smoking status, alcohol consumption, education, season, functional capacity, marital status, presence of chronic disease, and use of sleep medication.

RESULTS

Mean total PA, expressed in milli-gravity (mg) units, was slightly higher for women (20.3, SD 5.6) than for men (19.3, SD 5.2, P < .01). Mean (SD) daily duration spent in sedentary behavior and light and moderate-to-vigorous PA was 13.3 (1.5) h/d, 147.5 (31.5) min/d, and 75.0 (25.5) min/d, respectively, among women; and 13.8 (1.6) h/d, 140.5 (31.1) min/d, and 71.5 (24.5) min/d, respectively, among men. Women spent on average 6.7 (SD 1.1) h/d sleeping and men 6.6 (1.4) h/d. Across increasing categories of age and BMI and in participants with chronic disease and disability, time spent in light and moderate-to-vigorous PA was decreased. Higher age and BMI were associated with more sedentary time. In addition, obese men spent slightly more time sleeping than their normal weight counterparts and women spent slightly less time sleeping in the summer than in spring.

CONCLUSIONS

PA and sedentary behavior in the elderly differed by sex, age, BMI, prevalence of chronic disease, and disability, whereas there were no clear patterns for sleep. On average, our participants spent up to 79.5% of their time awake being sedentary and 7%-8% in moderate-to-vigorous PA. Replacing sedentary behavior with light PA would be a good starting point for those with the lowest level of PA. Older adults, those with high BMI and worse health could benefit from targeted interventions to increase PA.

Sedentary Time in Male and Female Masters and Recreational Athletes Aged 55 and Older

The purpose of this study was to quantify sedentary time among recreational and Masters (competitive) athletes aged 55 and older. A cross-sectional survey including questions on demographics, sport participation, as well as a short form of the International Physical Activity Questionnaire, and the Measure of Older Adult’s Sedentary Time questionnaire was administered (n = 203). Male Masters athletes reported more time spent in vigorous intensity physical activity and less time watching TV than recreational athletes. Among females, being a Masters athlete was associated with being more sedentary than being a recreational athlete, while among males, being a recreational athlete was associated with being more sedentary. The intensity and duration that older Masters and recreational athletes spent in their sport was inversely associated with the amount of sedentary time accumulated. Future research using inclinometers is needed to further elucidate sedentary time in older male and female athletes.

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults.

METHODS

A trained librarian created a search strategy that was peer reviewed for completeness.

RESULTS

Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry

The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future.

Short- and long-term effects of a need-supportive physical activity intervention among patients with type 2 diabetes mellitus: A randomized controlled pilot trial

Objective

This pilot trial evaluated the short- and long-term effects of a six-week need-supportive physical activity (PA) intervention among patients with type 2 diabetes mellitus, on health-related (HbA1c and physical fitness) and behavioral (objectively-measured and self-reported PA) outcomes.

Methods

To support the basic psychological needs for autonomy, relatedness and competence, the intervention included one in- and outtake session with a PA coach, an individualized PA program and a weekly PA group session. The intervention was set up in collaboration with a health insurance fund and with general practitioners. A total of forty-eight patients participated in the study and were randomly assigned to an intervention (n = 27) or a waiting-list control condition (n = 21).

Results

Linear mixed models did not reveal any significant interaction effects between time and condition (ps > .05). However, significant time effects across conditions were found: a decrease in HbA1c at short term and increases in self-reported PA at both short and long term and in physical fitness at long term (ps < .05).

Conclusion

Although the intervention as a whole did not produce the expected impact, there seems a potential for brief but regular expert visit and measurement.

Objective Sedentary Time, Moderate-to-Vigorous Physical Activity, and Physical Capability in a British Cohort

Supplemental digital content is available in the text.

Purpose

Sedentariness has been proposed as an independent risk factor for poor health. However, few studies have considered associations of sedentary time (ST) with physical functional health independent of time spent in moderate-to-vigorous physical activity (MVPA).

Methods

Community-based men and women (n = 8623, 48–92 yr old) in the European Prospective Investigation of Cancer—Norfolk study attended a health examination for objective measurement of physical capability, including grip strength (Smedley dynamometer (kg)), usual walking speed (UWS (cm·s⁻¹)), and timed chair stand speed (TCSS (stands per minute)). Of these, 4051 participants wore an accelerometer (GT1M ActiGraph) for 7 d to estimate time spent in MVPA (MVPA, ≥1952 counts per minute) and ST (ST, <100 counts per minute). Relations between physical capability outcomes and both MVPA and ST were explored using linear regression. The mutual independence of associations was also tested, and ST-MVPA interactions were explored using fractional polynomial models to account for nonlinear associations.

Results

Men in the highest compared with those in the lowest sex-specific quartile of MVPA were stronger (1.84 kg; 95% confidence interval (CI), 0.79–2.89), had faster UWS (11.7 cm·s⁻¹; 95% CI, 8.4–15.1) and faster TCSS (2.35 stands per minute; 95% CI, 1.11–3.59) after multivariable adjustment. Similarly, women in the highest quartile of MVPA were stronger (2.47 kg; 95% CI, 1.79–3.14) and had faster UWS (15.5 cm·s⁻¹; 95% CI, 12.4–18.6) and faster TCSS (3.27 stands per minute; 95% CI, 2.19–4.25). Associations persisted after further adjustment for ST. Associations between higher ST and lower physical capability were also observed, but these were attenuated after accounting for MVPA. Furthermore, no MVPA–ST interactions were observed (P_interactions > 0.05).

Conclusions

More time spent in MVPA was associated with higher physical capability, but there were no independent ST associations.

Challenges and Opportunities for Harmonizing Research Methodology: Raw Accelerometry

OBJECTIVES

Raw accelerometry is increasingly being used in physical activity research, but diversity in sensor design, attachment and signal processing challenges the comparability of research results. Therefore, efforts are needed to harmonize the methodology. In this article we reflect on how increased methodological harmonization may be achieved.

METHODS

The authors of this work convened for a two-day workshop (March 2014) themed on methodological harmonization of raw accelerometry. The discussions at the workshop were used as a basis for this review.

RESULTS

Key stakeholders were identified as manufacturers, method developers, method users (application), publishers, and funders. To facilitate methodological harmonization in raw accelerometry the following action points were proposed: i) Manufacturers are encouraged to provide a detailed specification of their sensors, ii) Each fundamental step of algorithms for processing raw accelerometer data should be documented, and ideally also motivated, to facilitate interpretation and discussion, iii) Algorithm developers and method users should be open about uncertainties in the description of data and the uncertainty of the inference itself, iv) All new algorithms which are pitched as "ready for implementation" should be shared with the community to facilitate replication and ongoing evaluation by independent groups, and v) A dynamic interaction between method stakeholders should be encouraged to facilitate a well-informed harmonization process.

CONCLUSIONS

The workshop led to the identification of a number of opportunities for harmonizing methodological practice. The discussion as well as the practical checklists proposed in this review should provide guidance for stakeholders on how to contribute to increased harmonization.

Differences between work and leisure in temporal patterns of objectively measured physical activity among blue-collar workers

Background

Leisure time physical activity (LTPA) is generally associated with favorable cardiovascular health outcomes, while occupational physical activity (OPA) shows less clear, or even opposite, cardiovascular effects. This apparent paradox is not sufficiently understood, but differences in temporal patterns of OPA and LTPA have been suggested as one explanation. Our aim was to investigate the extent to which work and leisure (non-occupational time) differ in temporal activity patterns among blue-collar workers, and to assess the modification of these patterns by age and gender.

Methods

This study was conducted on a cross-sectional sample of male (n = 108) and female (n = 83) blue-collar workers, aged between 21 and 65 years. Physical activity and sedentary behavior were assessed using accelerometers (Actigraph GT3X+) worn on the thigh and trunk for four consecutive days. Temporal patterns of OPA and LTPA were retrieved using Exposure Variation Analysis (EVA), and expressed in terms of percentage of work and leisure time spent in uninterrupted periods of different durations (<1 min, 1–5 min, 5–10 min, 10–30 min, 30–60 min and > 60 min) of sitting, standing, and walking. Repeated measures ANOVA and linear regression analyses were used to test a) possible differences between OPA and LTPA in selected EVA derivatives, and b) the modification of these differences by age and gender.

Results

OPA showed a larger percentage time walking in brief (<5 min) periods [mean (SD): 33.4 % (12.2)], and less time in prolonged (>30 min) sitting [7.0 % (9.3)] than LTPA [walking 15.4 % (5.0); sitting 31.9 % (15.3)], even after adjustment for the difference between work and leisure in total time spent in each activity type. These marked differences in the temporal pattern of OPA and LTPA were modified by gender, but not age.

Conclusion

We found that the temporal patterns of OPA and LTPA among blue-collar workers were markedly different even after adjustment for total physical activity time, and that this difference was modified by gender. We recommend using EVA derivatives in future studies striving to disentangle the apparent paradoxical cardiovascular effect of physical activity at work and during leisure.

Using activity triggered e-diaries to reveal the associations between physical activity and affective states in older adult's daily living

Background

Evidence suggests that older adults show positive affects after participating in exercise bouts. However, it is less clear, if and how physical activities in daily living enhance affective states, too. This is dissatisfying, as most of older adults’ physical activities are part of their daily living. To answer these questions we used activity-triggered e-diaries to investigate the within-subject effects of physical activity on three dimensions of affective states (valence, energetic arousal, calmness) during everyday life.

Methods

Older adults (N = 74) between 50 and 70 years took part in the study during three consecutive days. Physical activity in daily living was objectively assessed using accelerometers. Affects were measured 10 min after a study participant surpassed a predefined threshold for activity or inactivity. The participants were prompted by an acoustic signal to assess their momentary affective states on an e-diary. Data were analyzed with hierarchical multilevel analyses.

Results

Whenever older individuals were more physically active, they felt more energized (energetic arousal) and agitated (calmness). However, they did not feel better (valence). Interestingly, body mass index (BMI) and valence were associated in a significant cross-level interaction. BMI acts as a moderating variable in the way that lower BMI scores were associated with higher levels of valence scores after being physically active.

Conclusions

The innovative ambulatory assessment used here affords an interesting insight to the affective effects of daily activity of older adults. These effects are no simple and no linear ones, i.e. physical activity is not associated with positive affects per se as shown several times in experimental studies with single activity bouts. Rather there is a differentiating association seen as an enhanced feeling of energy and agitation, which is not accompanied by a better feeling. Socio-emotional selectivity theory may support the finding that older individuals are emotionally more stable during their day-to-day life, which might explain the non-significant effect on the affect dimension valence.

Associations between multiple accelerometry-assessed physical activity parameters and selected health outcomes in elderly people--results from the KORA-age study

Introduction

Accelerometry is an important method for extending our knowledge about intensity, duration, frequency and patterns of physical activity needed to promote health. This study has used accelerometry to detect associations between intensity levels and related activity patterns with multimorbidity and disability. Moreover, the proportion of people meeting the physical activity recommendations for older people was assessed.

Methods

Physical activity was measured in 168 subjects (78 males; 65–89 years of age), using triaxial GT3X accelerometers for ten consecutive days. The associations between physical activity parameters and multimorbidity or disability was examined using multiple logistic regression models, which were adjusted for gender, age, education, smoking, alcohol consumption, lung function, nutrition and multimorbidity or disability.

Results

35.7% of the participants met the physical activity recommendations of at least 150 minutes of moderate to vigorous activity per week. Only 11.9% reached these 150 minutes, when only bouts of at least 10 minutes were counted. Differences in moderate to vigorous activity between people with and without multimorbidity or disability were more obvious when shorter bouts instead of only longer bouts were included. Univariate analyses showed an inverse relationship between physical activity and multimorbidity or disability for light and moderate to vigorous physical activity. A higher proportion of long activity bouts spent sedentarily was associated with higher risk for multimorbidity, whereas a high proportion of long bouts in light activity seemed to prevent disability. After adjustment for covariates, there were no significant associations, anymore.

Conclusions

The accumulated time in moderate to vigorous physical activity seems to have a stronger relationship with health and functioning when shorter activity bouts and not only longer bouts were counted. We could not detect an association of the intensity levels or activity patterns with multimorbidity or disability in elderly people after adjustment for covariates.