1
|
Årnes AP, Fjeld MK, Stigum H, Nielsen CS, Stubhaug A, Johansen A, Hopstock LA, Morseth B, Wilsgaard T, Steingrímsdóttir ÓA. Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? The Tromsø Study. Pain 2024; 165:2011-2023. [PMID: 38442413 DOI: 10.1097/j.pain.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
ABSTRACT Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromsø Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain.
Collapse
Affiliation(s)
- Anders Pedersen Årnes
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mats Kirkeby Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Norway
| | - Christopher Sivert Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Aslak Johansen
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | |
Collapse
|
2
|
Xue H, Zou Y, Zhang S. The best modality and dose of physical activity to improve sleep quality in older adults: A Bayesian dose-response meta-analysis. Sleep Med 2024; 122:113-127. [PMID: 39154572 DOI: 10.1016/j.sleep.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/27/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The beneficial effects of physical activity on sleep quality in older adults are well-established. However, determining the optimal dose of physical activity remains unclear. This study aimed to investigate the dose-response relationship between physical activity and sleep quality in older adults. METHODS A comprehensive search was conducted across six electronic databases from inception to May 2024. Included were randomized controlled trials assessing the impact of physical activity on sleep quality in older adults. Changes in sleep quality scores were analyzed using a normal-likelihood model with an identity link function. RESULTS Fifty-one studies involving 5890 participants met the inclusion criteria. The dose-response relationship was best described by a "J" shaped curve. The minimum significant dose was 195 metabolic equivalents of tasks (METs)-min/week (Hedges'g = -0.39, SE: 0.27, 95%CrI: -0.82 to 0), with the optimum dose identified as 440 METs-min/week (Hedges'g = -0.85, SE: 0.26, 95%CrI: -1.24 to -0.37). The tolerated dose was also 820 METs-min/week (Hedges'g = -0.85, SE: 0.26, 95%CrI: -1.24 to -0.37). The optimal dose of 440 METs/min/week consistently improved sleep quality across various physical activities. Additionally, participant characteristics such as age, sex, and exercise intensity may moderate the effects of different physical activities. CONCLUSION This study identified the optimal weekly dose of physical activity to enhance sleep quality in older adults, highlighting the effectiveness of various physical activities. It also explored moderating factors affecting intervention outcomes. These findings provide valuable insights for tailoring personalized physical activity programs in clinical settings.
Collapse
Affiliation(s)
- Han Xue
- College of Sports Science, Nantong University, China.
| | - Yuehui Zou
- College of Sports Science, Nantong University, China.
| | - Shijie Zhang
- College of Sports Science, Nantong University, China.
| |
Collapse
|
3
|
Patel A, Cheung J. The effect of exercise on daytime sleepiness in healthy individuals. Sleep Med 2024; 120:10-14. [PMID: 38824847 DOI: 10.1016/j.sleep.2024.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024]
Abstract
The effects of exercise on daytime sleepiness remain unclear, with conflicting findings in the literature. We reviewed the existing literature on the relationship between exercise and daytime sleepiness in healthy individuals. We conducted a systematic search of PubMed and Google Scholar (1991 to present) for interventional studies that used the Epworth Sleepiness Scale (ESS) to measure change in self-reported degree of sleepiness before and after an exercise regimen. Seven studies were included in the review. Exercise significantly improved self-reported sleepiness after the intervention, as measured by ESS, in 4 of the 7 studies; the other studies indicated no significant difference. Additionally, exercise interventions enhanced sleep quality, evident in lower Pittsburgh Sleep Quality Index scores in 4 of 5 studies, thus indirectly alleviating daytime sleepiness. Results were variable and influenced by exercise type, intensity, and timing, as well as participant adherence. Factors that may contribute to the effect of exercise on daytime sleepiness include improved sleep quality, regulation of circadian rhythms, neurotransmitter release, stress reduction, increased energy levels, and weight reduction. This review suggests benefits of exercise for reducing daytime sleepiness and improving sleep quality. Future research is essential for assessing the mechanisms of these effects.
Collapse
Affiliation(s)
- Anshum Patel
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - Joseph Cheung
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic Jacksonville, Florida, USA.
| |
Collapse
|
4
|
Shi B, Li G, Wu S, Ge H, Zhang X, Chen S, Pan Y, He Q. Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58174. [PMID: 39083787 PMCID: PMC11325121 DOI: 10.2196/58174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/24/2024] [Accepted: 06/01/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. OBJECTIVE The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. METHODS The literature search was conducted in 6 electronic databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus-from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. RESULTS A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD -0.23, 95% CI -0.33 to -0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. CONCLUSIONS eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult-oriented research is needed to develop eHealth interventions that can change multiple behaviors. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418.
Collapse
Affiliation(s)
- Beibei Shi
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Hongli Ge
- School of Physical Education, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yang Pan
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
| |
Collapse
|
5
|
Schmidt LI, Rupprecht FS, Gabrian M, Jansen CP, Sieverding M, Wahl HW. Feeling Younger on Active Summer Days? On the Interplay of Behavioral and Environmental Factors With Day-to-Day Variability in Subjective Age. Innov Aging 2024; 8:igae067. [PMID: 39139382 PMCID: PMC11319866 DOI: 10.1093/geroni/igae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Indexed: 08/15/2024] Open
Abstract
Background and Objectives Subjective age, that is, how old people feel in relation to their chronological age, has mostly been investigated from a macro-longitudinal, lifespan point of view and in relation to major developmental outcomes. Recent evidence also shows considerable intraindividual variations in micro-longitudinal studies as well as relations to everyday psychological correlates such as stress or affect, but findings on the interplay with physical activity or sleep as behavioral factors and environmental factors such as weather conditions are scarce. Research Design and Methods We examined data from 80 recently retired individuals aged 59-76 years (M = 67.03 years, 59% women) observed across 21 days. Daily diary-based assessments of subjective age, stress, affect, and sleep quality alongside physical activity measurement via Fitbit (steps, moderate-to-vigorous physical activity) and daily hours of sunshine were collected and analyzed using multilevel modeling. Results Forty-four percent of the overall variance in subjective age was due to intraindividual variation, demonstrating considerable fluctuation. Affect explained the largest share in day-to-day fluctuations of subjective age, followed by stress and steps, whereas sunshine duration explained the largest share of variance in interindividual differences. Discussion and Implications In our daily diary design, subjective age was most strongly related to self-reported affect as a psychological correlate. We, however, also found clear associations with objective data on daily steps and weather. Hence, our study contributes to contextualizing and understanding variations in subjective age in everyday life.
Collapse
Affiliation(s)
- Laura I Schmidt
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Fiona S Rupprecht
- Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria
| | - Martina Gabrian
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Carl-Philipp Jansen
- Robert Bosch Hospital, Clinic for Geriatric Rehabilitation, Stuttgart, Germany
- Geriatric Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hans-Werner Wahl
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| |
Collapse
|
6
|
Castelli L, Ciorciari AM, Galasso L, Mulè A, Fornasini F, Montaruli A, Roveda E, Esposito F. Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay. Front Public Health 2024; 12:1339689. [PMID: 39050610 PMCID: PMC11267379 DOI: 10.3389/fpubh.2024.1339689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background In modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality. Methods To assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings. Results Participants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. -0.34 ± 0.31%, p = 0.007). Conclusion Our findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.
Collapse
Affiliation(s)
- Lucia Castelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Letizia Galasso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonino Mulè
- Free University of Bozen-Bolzano, Faculty of Education, Bolzano, Italy
| | | | - Angela Montaruli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Eliana Roveda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
7
|
Delbari A, Ahmadi F, Zar A, Zandvakili A, Sadeghipour HR, Sims J. Living in urban or rural environments affect the sleep quality of the elderly in Bushehr (Southern Iran): emphasizing the active and inactive of the elderly. BMC Public Health 2024; 24:1340. [PMID: 38760757 PMCID: PMC11102227 DOI: 10.1186/s12889-024-18747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Sleep disorders have a significant negative impact on mental and physical health, especially among the elderly. Various factors can affect the sleep quality of elderly people. The aim of this research to investigate the effect of urban and rural environments on the sleep quality of elderly people with emphasis on physical activity. METHOD Four hundred and thirty-nine elderly people (226 city residents and 213 village residents) in urban and rural areas of Bushehr (Southern Iran), volunteered to participate in the present study. Information was collected via the General information questionnaire and Petersburg Sleep Questionnaire. RESULT The results showed that active elderly women (p < 0.001), and total active elderly (male + female) (p < 0.001) living in urban areas compared to inactive elderly and also in rural areas active elderly women (p < 0.001), active elderly men (p < 0.001) and total active elderly (male + female) (p < 0.001) had better overall sleep quality in compared to inactive elderly. Also, elderly men (p < 0.001) and the total elderly (male + female) (p < 0.001) living in urban areas had better sleep quality than the elderly in rural areas. CONCLUSION Based on the findings, it can be concluded that the way of life (being active) as well as the living environment can affect the sleep quality of elderly people, so that active elderly people and also elderly people living in urban environments had better sleep quality.
Collapse
Affiliation(s)
- Ahmad Delbari
- Research Center on Aging, University of social Welfare and Rehabilitation Sciense, Tehran, Iran
| | - Fatemeh Ahmadi
- Research Center of Persian Gulf Sports, Nutrition and Health, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran
- Department of Sport Science, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran
| | - Abdossaleh Zar
- Research Center of Persian Gulf Sports, Nutrition and Health, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran.
- Department of Sport Science, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran.
| | - Atousa Zandvakili
- Research Center of Persian Gulf Sports, Nutrition and Health, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran
| | - Hamid Reza Sadeghipour
- Research Center of Persian Gulf Sports, Nutrition and Health, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran
- Department of Sport Science, School of Literature and Humanities, Persian Gulf University, Boushehr, Iran
| | - Jamie Sims
- Department of Sport, Health Sciences, and Social Work, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK
| |
Collapse
|
8
|
Chen JH, Chen JY, Wang YC. The effects of exercise programs on sleep architecture in obstructive sleep apnea: a meta-analysis of randomized controlled trials. J Sci Med Sport 2024; 27:293-301. [PMID: 38365534 DOI: 10.1016/j.jsams.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Exercise is an effective intervention for obstructive sleep apnea (OSA). However, the effects of exercise on objective sleep architecture in patients with OSA remain unknown. This meta-analysis aimed to collect data from randomized controlled trials of exercise interventions in patients with OSA, with a specific focus on objective sleep parameters derived from polysomnography. METHODS Randomized control trials that targeted patients with OSA aged >18 years, measured sleep using polysomnography after exercise programs, and reported the proportion of sleep stages were included for meta-analysis. Bias was assessed using the revised Cochrane risk-of-bias tool and funnel plots. The random effects model was applied. RESULTS Six studies with a total of 236 patients were included in the meta-analysis. There were no significant differences in the total sleep time (TST), sleep efficiency, sleep onset latency, stage N1 sleep, or rapid eye movement sleep between the exercise and control groups. Participation in an exercise program lasting >12 weeks significantly decreased stage N2 and increased stage N3 sleep as observed in the subgroup analysis. Although this tendency did not reach statistical significance in the total-group analysis, it was significant after excluding the possible confounding effects of heart disease. CONCLUSIONS The exercise program decreased N2 and increased N3 proportions over the TST among patients with OSA, which may correspond to subjective sleep quality. The beneficial effects were significant when the program lasted >12 weeks and after excluding the confounding effects of heart disease. Exercise program duration should be considered when providing clinical advice.
Collapse
Affiliation(s)
- Jian-Hong Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; School of Medicine, Chang Gung University, Taiwan; National Taiwan Sport University, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Taiwan
| | - Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Taiwan.
| |
Collapse
|
9
|
Milot E, Rehel S, Langeard A, Bigot L, Pasquier F, Matveeff L, Gauthier A, Bessot N, Quarck G. Effectiveness of multi-modal home-based videoconference interventions on sleep in older adults: study protocol for a randomized controlled trial. Front Public Health 2024; 12:1326412. [PMID: 38686035 PMCID: PMC11057197 DOI: 10.3389/fpubh.2024.1326412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Aging is characterized by substantial changes in sleep architecture that negatively impact fitness, quality of life, mood, and cognitive functioning. Older adults often fail to reach the recommended level of physical activity to prevent the age-related decline in sleep function, partly because of geographical barriers. Implementing home-based interventions could surmount these obstacles, thereby encouraging older adults to stay active, with videoconference administration emerging as a promising solution. Increasing the availability of biological rhythms synchronizers, such as physical activity, light exposure, or vestibular stimulation, represents a viable non-pharmacological strategy for entraining circadian rhythms and potentially fortifying the sleep-wake cycle, thereby enhancing sleep in aging. This study aims to (1) assess the impact of remote physical exercise training and its combination with bright light exposure, and (2) investigate the specific contribution of galvanic vestibular stimulation, to sleep quality among healthy older adults with sleep complaints. One hundred healthy older adults aged 60-70 years with sleep complaints will be randomly allocated to one of four groups: a physical exercise training group (n = 25), a physical exercise training combined with bright light exposure group (n = 25), a galvanic vestibular stimulation group (n = 25) or a control group (i.e., health education) (n = 25). While physical exercise training and health education will be supervised via videoconference at home, bright light exposure (for the physical exercise training combined with bright light exposure group) and vestibular stimulation will be self-administered at home. Pre-and post-tests will be conducted to evaluate various parameters, including sleep (polysomnography, subjective questionnaires), circadian rhythms (actigraphy, temperature), fitness (physical: VO2 peak, muscular function; and motor: balance, and functional mobility), cognition (executive function, long-term memory), quality of life and mood (anxiety and depression). The findings will be anticipated to inform the development of recommendations and non-pharmaceutical preventive strategies for enhancing sleep quality in older adults, potentially leading to improvements in fitness, cognition, quality of life, and mood throughout aging.
Collapse
Affiliation(s)
- Emma Milot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Stéphane Rehel
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Antoine Langeard
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | | | - Florane Pasquier
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Laura Matveeff
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Antoine Gauthier
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Nicolas Bessot
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| | - Gaëlle Quarck
- Université de Caen Normandie, INSERM, COMETE U1075, CYCERON, CHU de Caen, Normandie Université, Caen, France
| |
Collapse
|
10
|
Lyu L, Li Y, Fan X, Seo J, Eunna O. The effect of Tai Chi exercise intervention on sleep quality in community residing older adults: a systematic review and meta-analysis. Eur Geriatr Med 2024; 15:381-396. [PMID: 38227110 DOI: 10.1007/s41999-023-00923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE While clinical research has shown that Tai Chi exercise may improve the sleep quality of older adults, there is a lack of robust evidence-based verification. Therefore, this study conducted a systematic review of published research on the effect of Tai Chi exercise on the sleep quality of community-dwelling older adults, aiming to provide solid evidence-based medicine to enhance their sleep quality. METHODS A systematic search was conducted on PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed databases from their inception to December 9, 2022. The Cochrane risk of bias assessment tool 2.0 was used to assess the risk of bias in the included studies. RESULTS This systematic review included 12 original articles, involving a total of 1,058 community-dwelling older adults, with 553 in the Tai Chi group and 505 in the control group. The meta-analysis results revealed a significant improvement in the sleep quality of community-dwelling older adults who practiced Tai Chi compared to the control group [WMD = - 1.96 (95% CI: - 3.02 to - 0.90, z = 3.62, P < 0.001)]. Subgroup analysis showed that Tai Chi had significantly beneficial effects regardless of age, country/region, intervention time, and Tai Chi type. CONCLUSIONS Tai Chi exercise can serve as an effective non-medication approach for addressing sleep problems in this demographic. Among the various types of Tai Chi exercises, the 24-form Tai Chi exercise emerges as a preferred option. Moreover, Tai Chi exercise proves to be an excellent choice for older people in their later years, promoting their overall well-being and health.
Collapse
Affiliation(s)
- Linyu Lyu
- College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
| | - Yuelin Li
- College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Xing Fan
- College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Jisu Seo
- College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Oh Eunna
- College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| |
Collapse
|
11
|
Zhou L, Suwa S. Association among cognitive function, daytime activities, and nighttime sleep in older adults in a long-term care facility. Jpn J Nurs Sci 2024; 21:e12571. [PMID: 37937410 DOI: 10.1111/jjns.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
AIM To determine how the nighttime sleep patterns of older adults in a long-term care facility vary according to cognitive function and participation in daytime activities. METHODS This observational study was conducted with older adults aged ≥65 years who are residents of a long-term care facility. Nighttime sleep was monitored using a non-wearable sleep monitor for 8 weeks. Based on the Mini-Mental State Examination scores for assessment of cognitive function, participants were classified into non-dementia, mild-to-moderate dementia, and severe dementia groups. The Mann-Whitney U test and Kruskal-Wallis test were used to analyze the data. RESULTS Twenty three older adults were included in this study. Sleep onset latency was significantly longer in the severe dementia group than in the non-dementia (p = .027) and mild-to-moderate dementia (p = .041) groups. Sleep efficiency was significantly lower in the severe dementia group than in the mild-to-moderate dementia group (p = .003), whereas wakefulness after sleep onset was significantly longer in the severe dementia group than in the mild-to-moderate dementia group (p = .011). The number of days spent engaging in recreational activities was <50%, whereas those spent taking a nap was >60% in all older adults. Older adults with mild-to-moderate dementia had better sleep and participated in more daytime activities than those with severe or no dementia. Moreover, bathing in a bathtub improved sleep onset latency. CONCLUSIONS This study demonstrates that participation in daytime activities and bathing in a bathtub affect nighttime sleep in older adults.
Collapse
Affiliation(s)
- Lu Zhou
- Doctoral Program, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Sayuri Suwa
- Department of Community Health Nursing, Division of Innovative Nursing for Life Course, Graduate School of Nursing, Chiba University, Chiba, Japan
| |
Collapse
|
12
|
Wang H, Li J, Liu Q, Zhang Y, Wang Y, Li H, Sun L, Hu B, Zhang D, Liang C, Lei J, Wang P, Sheng J, Tao F, Chen G, Yang L. Physical activity attenuates the association of long-term exposure to nitrogen dioxide with sleep quality and its dimensions in Chinese rural older adults. J Affect Disord 2024; 349:187-196. [PMID: 38199389 DOI: 10.1016/j.jad.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Joint impacts of air pollution and physical activity (PA) on sleep quality remain unaddressed. We aimed to investigate whether PA attenuates the association of long-term exposure to nitrogen dioxide (NO2) with sleep quality and its dimensions in older adults. METHODS This study included 3408 Chinese rural older adults. Annual NO2 was estimated using the Space-Time Extra-Trees model. PA was assessed by International Physical Activity Questionnaire. Sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) scale. Linear regression models were used to assess the associations of long-term NO2 exposure and PA with sleep quality and its dimensions, and interaction plots were used to depict the attenuating effect of PA on associations of NO2 with sleep quality and its dimensions. RESULTS Three-year (3-y) average NO2 (per 0.64-μg/m3 increment) was positively associated with global PSQI (β = 0.41, 95 % CI: 0.23, 0.59), sleep duration (β = 0.16, 95 % CI: 0.11, 0.21), and habitual sleep efficiency (β = 0.22, 95 % CI: 0.17, 0.27), while PA was negatively associated with global PSQI (β = -0.33, 95 % CI: -0.46, -0.20) and five domains of PSQI other than sleep duration and sleep disturbances. The associations of NO2 with global PSQI, sleep duration, and habitual sleep efficiency were attenuated with increased PA (Pinteraction were 0.037, 0.020, and 0.079, respectively). CONCLUSIONS PA attenuates the adverse impacts of long-term NO2 exposure on sleep quality, especially on sleep duration, and habitual sleep efficiency, in Chinese rural elderly people. Participating in PA should be encouraged in this population, and continued efforts are still needed to reduce air pollution.
Collapse
Affiliation(s)
- Hongli Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Junzhe Li
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Qiang Liu
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Yan Zhang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Huaibiao Li
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Liang Sun
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Bing Hu
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Dongmei Zhang
- School of Health Services Management, Anhui Medical University, Hefei 230032, Anhui, China
| | - Chunmei Liang
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Jingyuan Lei
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Panpan Wang
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Jie Sheng
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Fangbiao Tao
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, Anhui, China
| | - Guimei Chen
- School of Health Services Management, Anhui Medical University, Hefei 230032, Anhui, China
| | - Linsheng Yang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China.
| |
Collapse
|
13
|
Idalino SCC, Cândido LM, Wagner KJP, de Souza Moreira B, de Carvalho Bastone A, Danielewicz AL, de Avelar NCP. Association between sleep problems and functional disability in community-dwelling older adults. BMC Geriatr 2024; 24:253. [PMID: 38481136 PMCID: PMC10938775 DOI: 10.1186/s12877-024-04822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.
Collapse
Affiliation(s)
- Stefany Cristina Claudino Idalino
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Letícia Martins Cândido
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Katia Jakovljevic Pudla Wagner
- Federal University of Santa Catarina, Campus Curitibanos, Rod. Ulysses Gaboardi, 300, Curitibanos, Santa Catarina, 89520-000, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil.
| |
Collapse
|
14
|
Páez A, Frimpong E, Mograss M, Dang-Vu TT. The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis. J Sleep Res 2024:e14189. [PMID: 38462491 DOI: 10.1111/jsr.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.
Collapse
Affiliation(s)
- Arsenio Páez
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Nuffield Department for Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| | - Emmanuel Frimpong
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Melodee Mograss
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| |
Collapse
|
15
|
Callow DD, Zipunnikov V, Spira AP, Wanigatunga SK, Pettigrew C, Albert M, Soldan A. Actigraphy Estimated Sleep Moderates the Relationship between Physical Activity and Cognition in Older Adults. Ment Health Phys Act 2024; 26:100573. [PMID: 38264712 PMCID: PMC10803079 DOI: 10.1016/j.mhpa.2023.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background and Aims Physical inactivity and poor sleep are common in older adults and may interact to contribute to age- and disease-related cognitive decline. However, prior work regarding the associations among physical activity, and cognition in older adults is primarily limited to subjective questionnaires that are susceptible to inaccuracies and recall bias. Therefore, this study examined whether objectively measured physical activity and sleep characteristics, each estimated using actigraphy, are independently or interactively associated with cognitive performance. Methods The study included 157 older adults free of dementia (136 cognitively unimpaired; 21 MCI; M age = 71.7) from the BIOCARD cohort. Results Using multiple linear regression, cognition was regressed on estimated total volume of physical activity (TVPA), sleep efficiency (SE), wake after sleep onset (WASO), and total sleep time (TST) (adjusted for age, sex, education, diagnosis, vascular risk factors, and Apolipoprotein E (APOE)-e4 genetic status). Models were also run for domain-specific cognitive composite scores. TVPA and SE each were positively associated with a global cognitive composite score. TVPA was positively associated with executive function and language composites, and SE was positively related to executive function, visuospatial, and language composites. Importantly, a TVPA by SE interaction (p = 0.015) suggested that adults with the poorest SE experienced the greatest benefit from physical activity in relation to global cognition. The other sleep metrics were unrelated to cognitive performance. Conclusion These results suggest that TVPA and SE may synergistically benefit cognition in older adults.
Collapse
Affiliation(s)
- Daniel D Callow
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Sarah K Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anja Soldan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Derbey L, Charlois AL, Buisson A, Roblin X, Mathieu N, Danion P, Gay C, Nancey S, Boschetti G. Physical Activity and IBD: State of Art and Knowledge, Patients and Healthcare Professionals Points of View, A French Multicenter Cross Sectional Study. Inflamm Bowel Dis 2024:izae009. [PMID: 38330214 DOI: 10.1093/ibd/izae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Several studies have reported low levels of physical activity (PA) in patients with inflammatory bowel diseases (IBD), possibly related to a lack of information and support, despite the many recognized benefits such as cardiovascular prevention or quality of life (QoL) improvement. METHODS The purpose of our study was to identify challenges faced by patients and to evaluate IBD impact on PA and QoL by using the International Physical Activity Questionnaire short form and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32) questionnaire, respectively. We also assessed the expectations and knowledge of patients and healthcare professionals using the MICI-Active questionnaire that we developed. RESULTS We included 298 IBD patients in 4 French hospitals, with a mean age of 38 years. We found a decrease in training frequency since IBD diagnosis, regardless of age, gender, symptom intensity, or type of disease. Moreover, there was an increase in low intensity activities like walking and a decrease in competitions and sports club registrations. Intensity of symptoms has a negative impact on QoL, as evidenced by the worsening of IBDQ score. Conversely, a higher PA intensity was correlated with a higher IBDQ score, regardless of symptoms intensity. The main barrier to PA was fatigue (56%), and the main fear was diarrhea (42%). Furthermore, 75% of patients did not feel sufficiently informed, and 61% were interested in coaching. A total of 112 healthcare professionals were interviewed, 62.5% said they had already discussed of PA with their patients, but 98% felt that they lacked knowledge. CONCLUSIONS Inflammatory bowel disease constraints and symptoms have a strong impact on PA. Work needs to be done to better train practitioners to improve IBD patient management, who have much to gain from better PA.
Collapse
Affiliation(s)
- Lea Derbey
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Laure Charlois
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Nicolas Mathieu
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France
| | - Pauline Danion
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Gay
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Nancey
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Gilles Boschetti
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
| |
Collapse
|
17
|
Loewenthal JV, Farkas EJ, McGough K, Tomita B, Wayne PM, Orkaby AR. The impact of yoga on aging physiology: A review. J Nutr Health Aging 2024; 28:100005. [PMID: 38388108 DOI: 10.1016/j.jnha.2023.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 02/24/2024]
Abstract
Frailty represents diminished reserve across multiple physiologic systems, accompanied by increased vulnerability to stressors and increased morbidity and mortality. With population aging, strategies to prevent and manage frailty are priorities in clinical medicine and public health. Current evidence-based approaches to frailty management are multimodal in nature. Yoga, an increasingly popular and highly adaptable mind-body practice, is multi-component, incorporating physical postures, breathing practices, meditation, and other elements, and may be a strategy for frailty management. Here, we summarize the evidence linking yoga practice to mitigation of age-related degradation across multiple physiologic systems, including cardiovascular, pulmonary, musculoskeletal, and nervous systems. We discuss putative mechanisms of action including modulation of the hypothalamic-pituitary-adrenal axis. Finally, we consider implications for clinical practice and future research.
Collapse
Affiliation(s)
- Julia V Loewenthal
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Eva J Farkas
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine McGough
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | | | - Peter M Wayne
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA; Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ariela R Orkaby
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
18
|
Kong X, Qi W, Xing F, Zhu S, Sun Y, Duan H, Wu Y. Association of Abnormal Sleep Duration and Sleep Disturbance with Physical Activity in Older Adults: Between- and within-Person Effects. J Am Med Dir Assoc 2024; 25:368-374. [PMID: 37931896 DOI: 10.1016/j.jamda.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Sleep is associated with physical activity (PA), yet the nature and directions of this association are less understood. This study aimed to disentangle the long-term temporal sequences between sleep duration/disturbance and PA in older adults, distinguishing between- and within-person effects. DESIGN Longitudinal panel study. SETTING AND PARTICIPANTS We conducted a longitudinal study using 3 waves of data collected in 2008/09 (T1), 2012/13 (T2), and 2016/17(T3) from adults aged ≥50 years in the English Longitudinal Study of Ageing (N = 10,749 individuals). MEASURES Sleep duration, sleep disturbance, and PA were assessed by self-reported questionnaires. We used cross-lagged panel models (CLPMs) to examine between-person effects and random intercept cross-lagged panel models (RI-CLPMs) to examine within-person effects. RESULTS Our analyses revealed a reciprocal relationship between abnormal sleep duration and low PA levels at between-person level (abnormal sleep duration to PA: βT1-T2 = -0.053, βT2-T3 = -0.058, all P < .001; PA to abnormal sleep duration: βT1-T2 = -0.040, βT2-T3 = -0.045, all P < .05), with abnormal sleep duration being the driving force in the dynamic association. In addition, there was a unidirectional effect of more severe sleep disturbance on lower levels of PA at both between- and within-person levels (between-person level: βT1-T2 = -0.032, βT2-T3 = -0.028, all P < .001; within-person level: βT1-T2 and T2-T3 = -0.031, all P = .011). CONCLUSIONS AND IMPLICATIONS This study adds novel insights into the temporal directionality of sleep and PA among community-dwelling older adults and highlights poor sleep as a potential risk factor for PA. Intervention strategies should aim to improve sleep to promote PA levels and successful aging.
Collapse
Affiliation(s)
- Xiangjie Kong
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Weifeng Qi
- Zibo Centre for Disease Control and Prevention, Zibo, Shandong, China
| | - Fangjie Xing
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Shuai Zhu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Yanping Sun
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haiping Duan
- Qingdao Municipal Centre for Disease Control and Prevention/Qingdao Institute of Preventive Medicine, Qingdao, Shandong, China
| | - Yili Wu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China.
| |
Collapse
|
19
|
Anderson VR, Kakuske K, Thompson C, Ivanova MV. Pilot study of a high-intensity interval training program in older adults: Safety, feasibility, functional fitness and cognitive effects. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.23299774. [PMID: 38260605 PMCID: PMC10802633 DOI: 10.1101/2024.01.09.23299774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Exercise can boost physical and cognitive health in older adults. However, there are a lack of accessible exercise programs that foster adherence among older adults. In this study, we aimed to establish the safety and feasibility of APEX, a new exercise program designed to optimize fitness and cognitive gains for older adults, in addition to evaluating its acute physiological effects, and assessing its possible effects on functional fitness and cognition among healthy older adults. APEX utilizes a multimodal progressive high-intensity interval training (HIIT) design, with high-intensity intervals focused on enhancing cardiovascular fitness and muscle strength, and recovery intervals that incorporate balance and mobility exercises. The APEX training was tested in healthy older adults (n=4) over the course of four weeks. Ultimately, APEX was found to be safe and feasible, with no adverse events and high adherence. Participants met heart rate targets for all of the high-intensity exercises, and all intervals had a significant difference in heart rates between high-intensity and recovery periods in linear effects models (p<0.001). Improvements in functional fitness were observed in aerobic endurance, lower body strength, and balance. The intervention was also associated with positive trends in the cognitive domains of information processing, working memory, executive control, and attention. APEX offers a promising alternative to traditional cardiovascular exercise modalities for older adults with additional benefits for functional fitness and cognition. These results encourage further testing of the APEX program in older adults and different clinical populations.
Collapse
|
20
|
Rai A, Aldabbas M, Veqar Z. Effect of physical activity on sleep problems in sedentary adults: a scoping systematic review. Sleep Biol Rhythms 2024; 22:13-31. [PMID: 38476845 PMCID: PMC10899995 DOI: 10.1007/s41105-023-00494-w] [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: 11/03/2022] [Accepted: 10/06/2023] [Indexed: 03/14/2024]
Abstract
This systematic review was steered forward with the aim of analyzing how different forms of exercise could influence the objective and subjective sleep outcome among sedentary adults with sleep problems. A pre-detailed study protocol (PROSPERO ID: CRD42021229649) was used to search for RCTs through five databases. The methodological quality of the included RCTs was assessed by PEDro and studies were included if they scored > 5. Effect size of all outcome measures were calculated using Cohen's d. Of the 4154 studies, 19 studies met the inclusion criteria and underwent quality assessment using 11-point PEDRO scale. 9 studies with PEDro score > 5 were finally included in this systematic review out of which, participants of 4 studies had insomnia (nrange = 37-48, agerange = 44-60 years), 3 studies had poor sleep quality (nrange = 80-275, agerange = 52-70 years) and 2 studies had obstructive sleep apnea syndrome (nrange = 26-68, agerange = 51 years). Majority of studies revealed that physical activity seems to have greater improvement with a large effect size on subjective sleep outcomes among sedentary adults with sleep problems like insomnia, poor sleep quality and OSAS, whereas limited studies and non-significant results were observed on objective sleep outcomes. Physical activity improves sleep outcomes especially among sedentary middle-aged and older adults. More research is needed to examine the effect of physical activity programs on objective sleep outcomes especially in younger sedentary adults with different sleep problems. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-023-00494-w.
Collapse
Affiliation(s)
- Anushree Rai
- SGT University, Gurugram, Haryana 110025 India
- Al-Azhar University, Faculty of Applied Medical Sciences, Department of Physical Therapy, Gaza, Palestine
| | - Mosab Aldabbas
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025 India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025 India
| |
Collapse
|
21
|
Choi NG, Choi BY, Marti CN. Mediation of the Association Between Physical Exercise and Depressive/Anxiety Symptoms by Pain and Sleep Problems Among Older Adults. Gerontol Geriatr Med 2024; 10:23337214241241397. [PMID: 38525486 PMCID: PMC10960979 DOI: 10.1177/23337214241241397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
In this study, based on the 2022 National Health and Aging Trend Study (N = 5,593, age 65+), we examined direct associations between moderate and vigorous physical exercise (PE) and depressive/anxiety symptoms as well as bothersome pain and sleep problems. We then examined if the association between PE and depressive/anxiety symptoms would be partially mediated by the effects of PE on bothersome pain and sleep problems. Results from a path model showed that controlling for sociodemographic and health statuses, PE was negatively associated with depressive/anxiety symptoms and bothersome pain, but it was not significantly associated with sleep problems. The mediation analysis showed that 10% of the total effects of PE on depressive/anxiety symptoms was indirect effects of PE on bothersome pain. This study is important as it examined the associations among PE, pain, sleep, and depression/anxiety in community-dwelling older adults in their natural environments. Healthcare and social service providers for older adults need to emphasize the importance and benefits of PE for older adults' physical and mental health. Easy access to venues for PE is also important.
Collapse
Affiliation(s)
| | - Bryan Y. Choi
- Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
| | | |
Collapse
|
22
|
Hidaka T, Kakamu T, Endo S, Masuishi Y, Kasuga H, Hata A, Miura R, Funayama Y, Tajimi K, Fukushima T. Associations of endurance, muscle strength, and balanced exercise with subjective sleep quality in sedentary workers: A cross-sectional study. Work 2024; 78:761-770. [PMID: 38160388 PMCID: PMC11307032 DOI: 10.3233/wor-230299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The optimal exercise combination for improving sleep quality among sedentary workers is unclear. OBJECTIVE To reveal what combination of exercises contributes to good sleep quality. METHODS In this cross-sectional study, we enrolled 5,201 sedentary workers who underwent health examinations in 2019. Data on sleep quality, basic attributes, energy expenditure, and lifestyle aspects such as exercise and physical activity, supper time close to bedtime, and alcohol intake were obtained. The subjects reported their exercise habits by selecting up to three forms of exercise from a list of 182 options, which were classified into three types: endurance (e.g., jogging), muscle strength (e.g., bench pressing), and balanced types which combined both endurance and muscle strength characteristics. (e.g., walking). These forms were then categorized into eight combination patterns: endurance only; muscle strength only; balanced only; endurance and muscle strength; endurance and balanced; muscle strength and balanced; all types; and absence of any exercise habits. Binary logistic regression analysis was used to examine the associations between the exercise combination patterns and sleep quality. RESULTS Good sleep quality was significantly associated with "endurance" (OR = 1.419; 95% CI 1.110-1.814), "balanced only" (OR = 1.474; 95% CI 1.248-1.741), and "endurance and balance" (OR = 1.782; 95% CI 1.085-2.926) exercise patterns. No significant associations were found between the combinations that included muscle strength exercises and sleep quality. CONCLUSION The endurance or balanced-type exercises, or a combination of both, may help to improve the sleep quality of sedentary workers as part of occupational health management.
Collapse
Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Hata
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Rieko Miura
- Koriyama Health Promotion Foundation, Fukushima, Japan
| | | | | | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
23
|
Inyushkin AN, Poletaev VS, Inyushkina EM, Kalberdin IS, Inyushkin AA. Irisin/BDNF signaling in the muscle-brain axis and circadian system: A review. J Biomed Res 2023; 38:1-16. [PMID: 38164079 PMCID: PMC10818175 DOI: 10.7555/jbr.37.20230133] [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: 06/04/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024] Open
Abstract
In mammals, the timing of physiological, biochemical and behavioral processes over a 24-h period is controlled by circadian rhythms. To entrain the master clock located in the suprachiasmatic nucleus of the hypothalamus to a precise 24-h rhythm, environmental zeitgebers are used by the circadian system. This is done primarily by signals from the retina via the retinohypothalamic tract, but other cues like exercise, feeding, temperature, anxiety, and social events have also been shown to act as non-photic zeitgebers. The recently identified myokine irisin is proposed to serve as an entraining non-photic signal of exercise. Irisin is a product of cleavage and modification from its precursor membrane fibronectin type Ⅲ domain-containing protein 5 (FNDC5) in response to exercise. Apart from well-known peripheral effects, such as inducing the "browning" of white adipocytes, irisin can penetrate the blood-brain barrier and display the effects on the brain. Experimental data suggest that FNDC5/irisin mediates the positive effects of physical activity on brain functions. In several brain areas, irisin induces the production of brain-derived neurotrophic factor (BDNF). In the master clock, a significant role in gating photic stimuli in the retinohypothalamic synapse for BDNF is suggested. However, the brain receptor for irisin remains unknown. In the current review, the interactions of physical activity and the irisin/BDNF axis with the circadian system are reconceptualized.
Collapse
Affiliation(s)
- Alexey N. Inyushkin
- Department of Human & Animal Physiology, Samara National Research University, Samara 443011, Russia
| | - Vitalii S. Poletaev
- Department of Human & Animal Physiology, Samara National Research University, Samara 443011, Russia
| | - Elena M. Inyushkina
- Department of Human & Animal Physiology, Samara National Research University, Samara 443011, Russia
| | - Igor S. Kalberdin
- Department of Human & Animal Physiology, Samara National Research University, Samara 443011, Russia
| | - Andrey A. Inyushkin
- Department of Human & Animal Physiology, Samara National Research University, Samara 443011, Russia
| |
Collapse
|
24
|
Kochman M, Kielar A, Kasprzak M, Maruszczak K, Kasperek W. The Relationship between Self-Rated Health and Physical Fitness in Polish Youth. Healthcare (Basel) 2023; 12:24. [PMID: 38200930 PMCID: PMC10778670 DOI: 10.3390/healthcare12010024] [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: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Self-rated health (SRH) is a tool for assessing a population's health across the lifetime, and seems to be a dynamic assessment of current health status and a strong predictor of cardiovascular disease and mortality, whereas insufficient levels of physical fitness in adolescence are a significant health problem and may contribute to the development of many disorders in adulthood. In this cross-sectional study, we attempted to assess the relationship between SRH and the physical fitness of adolescents. Two hundred and thirty-five adolescents (eighty-five boys and one hundred and fifty girls) aged 16-17 were recruited for this study. The study procedures included a short author questionnaire and physical fitness assessment (Zuchora's Physical Fitness Index). Boys declared better health states and reported less frequent morbidity of seasonal diseases (p < 0.05). No differences were found in physical fitness, the incidence of postural disorders, lower limb malalignments, foot deformities, sleep duration, and perception of physical activity on physical condition and well-being in boys and girls (p > 0.05). The comparison of physical fitness levels in adolescents with different SRH, sleep duration, perceptions of physical activity on physical condition and well-being also showed significant differences (p < 0.05). Positive SRH and perception of physical activity on physical condition and well-being, proper sleep duration (7-8 h/night), and a lack of foot deformities are associated with a better physical fitness in adolescents. Physical fitness seems to be a good predictor of SRH only in Polish boys, but not girls and the entire population. The lack of significance in the entire population could be attributed to the substantial number of girls in the study group. Despite that, it is recommended to encourage adolescents to engage in regular exercises, sleep routines and healthy lifestyles. Further research should be based on a more representative group, with a comparable number of girls and boys in the study group and potential confounders, but also they should be focused on SRH predictors to improve SRH in Polish girls.
Collapse
Affiliation(s)
- Maciej Kochman
- Physiotherapy Department, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-215 Rzeszów, Poland
| | | | | | | | | |
Collapse
|
25
|
Zhou Y, Li Z, Li J, Wang X, Qi K, Zhang S, Zhou C. Sex Difference in the Association Between Sedentary Behavior and Sleep Quality: A Longitudinal Study Among Older Adults in Rural China. J Am Med Dir Assoc 2023; 24:1520-1526.e2. [PMID: 37105235 DOI: 10.1016/j.jamda.2023.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES Sleep quality plays a vital role in maintaining health in older adults. Sedentary behavior may be a risk factor for poor sleep quality in older adults. This study aimed to explore the relationship between sedentary behavior and sleep quality among older adults in rural China and determine whether there is a sex difference in this association. DESIGN A longitudinal design. The data used in this study were obtained from the Shandong Rural Elderly Health Cohort (wave 1: 2019, wave 2: 2020). SETTING AND PARTICIPANTS Data were from 2731 individuals aged ≥60 years from rural areas in China. METHODS Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sedentary behavior and control variables were measured using self-reported questions. Multivariable logistic regression and generalized estimating equations were used to assess the associations. RESULTS After full adjustment, the association between sedentary behavior and poor sleep quality was statistically significant [odds ratio (OR) 1.49, 95% CI 1.20-1.85]. Specifically, a longer sedentary time was associated with worse subjective sleep quality, less sleep latency, and lower habitual sleep efficiency (OR 1.39-1.58). A significant association was observed in women but not men. CONCLUSIONS AND IMPLICATIONS Older adults who spend more time engaging in sedentary activities have poorer sleep quality and more sleep problems. Prolonged sedentary time is more detrimentally associated with poor sleep quality in women than men. There is a need for tailored exercise prescriptions and guidelines to stimulate older adults of different sexes to change their sedentary behavior, which may improve sleep quality in older adults.
Collapse
Affiliation(s)
- Yanxin Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhixian Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Xiyuan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kaili Qi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China; Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China.
| |
Collapse
|
26
|
Yi W, Wang W, Xu Z, Liu L, Wei N, Pan R, Song R, Li X, Liu J, Yuan J, Song J, Cheng J, Huang Y, Su H. Association of outdoor artificial light at night with metabolic syndrome and the modifying effect of tree and grass cover. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 264:115452. [PMID: 37696078 DOI: 10.1016/j.ecoenv.2023.115452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Epidemiological studies show that outdoor artificial light at night (ALAN) is linked to metabolic hazards, but its association with metabolic syndrome (MetS) remains unclear. We aimed to investigate the association of outdoor ALAN with MetS in middle-aged and elderly Chinese. METHODS From 2017-2020, we conducted a cross-sectional study in a total of 109,452 participants living in ten cities of eastern China. MetS was defined by fasting blood glucose (FG), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), blood pressure (BP), and waist circumference (WC). In 2021, we followed up 4395 participants without MetS at the baseline. Each participant's five-year average exposure to outdoor ALAN, as well as their exposure to green space type, were measured through matching to their address. Generalized linear models were used to assess the associations of outdoor ALAN with MetS. Stratified analyses were performed by sex, age, region, physical activity, and exposure to green space. RESULTS In the cross-sectional study, compared to the first quantile (Q1) of outdoor ALAN exposure, the odds ratios (ORs) of MetS were 1.156 [95 % confidence interval (CI): 1.111-1.203] and 1.073 (95 %CI: 1.021-1.128) respectively in the third and fourth quantiles (Q3, Q4) of outdoor ALAN exposure. The follow-up study found that, compared to the first quantile (Q1) of outdoor ALAN exposure, the OR of MetS in Q4 of ALAN exposure was 1.204 (95 %CI: 1.019-1.422). Adverse associations of ALAN with MetS components, including high FG, high TG, and obesity, were also found. Greater associations of ALAN with MetS were found in males, the elderly, urban residents, those with low frequency of physical activity, and those living in areas with low levels of grass cover and tree cover. CONCLUSIONS Outdoor ALAN exposure is associated with an increased MetS risk, especially in males, the elderly, urban residents, those lacking physical activity, and those living in lower levels of grass cover and tree cover.
Collapse
Affiliation(s)
- Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Weiqiang Wang
- Suzhou Hospital of Anhui Medical University, China; Suzhou Municipal Hospital of Anhui Province, China
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Li Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Ning Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Xuanxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jintao Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jiajun Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China
| | - Yuee Huang
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China.
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, China.
| |
Collapse
|
27
|
Ding X, Pan Y, Chen Y, Li Y. Association between dependency and long sleep duration among elderly people: a community-based study. Psychogeriatrics 2023; 23:789-799. [PMID: 37332148 DOI: 10.1111/psyg.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Long sleep duration is a common sleep disorder among elderly people. Dependency increases with increasing age. This study aimed to assess the association between dependency and long sleep duration among elderly people. METHODS This study is a population-based cross-sectional study. A total of 1152 participants aged ≥ 60 years were selected from 26 locations in China by a complex multistage sampling design. Data were collected through face-to-face interviews. Sleep duration was measured using the Pittsburgh Sleep Quality Index. Dependency was assessed using Minnesota Multiphasic Personality Inventory-II. Hierarchical multiple linear regression analysis was used to evaluate the efficacy of sleep-related factors and psychological factors for sleep duration. Analysis of covariance and logistic regression analysis were performed to evaluate the association between the dependency score and sleep duration, and the strength of dependency effect on sleep duration. RESULTS A total of 1120 participants were valid for the analysis. Among them, 15.8% of participants had a dependency score ≥60 points. The results of hierarchical multiple linear regression analysis showed that sleep duration was positively associated with dependency scores. Analysis of covariance indicated a J-shaped association between dependency scores and sleep duration. The results of logistic regression analysis showed dependency was significantly associated with long sleep duration, and the odds ratio was 3.52 (95% CI, 1.87-6.63; P < 0.001). CONCLUSION Dependency was significantly associated with long sleep duration among elderly people. The results suggested that dependent intervention may be a strategy that needs urgent implementation to reduce long sleep duration among elderly people.
Collapse
Affiliation(s)
- XiWen Ding
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - YiYang Pan
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yuan Chen
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ying Li
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
- School of medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
28
|
Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus 2023; 15:e43595. [PMID: 37719583 PMCID: PMC10503965 DOI: 10.7759/cureus.43595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Regular physical activity has several health benefits, including improved sleep quality and symptoms of sleep disorders. With the known benefits of moderate-intensity activities to sleep quality and a growing interest in using physical activity as a treatment approach for different sleep disorders, we conducted a systematic review to provide evidence-based data on the association between physical activity and sleep. A systematic search was carried out in PubMed, Embase, MEDLINE (Medical Literature Analysis and Retrieval System Online), Google Scholar, and Scopus, using predetermined search terms (Medical Subject Headings (MeSH) terms) and keywords. The included studies focused on exploring the effect of physical activity on sleep quality and sleep disorders or the association between physical activity and sleep outcomes. Relevant data were extracted, and the quality of the studies was evaluated using suitable methods. The collected findings were synthesized and discussed. The findings of this systematic review have potential implications for healthcare, public health policies, and health promotion.
Collapse
Affiliation(s)
| | | | | | - Gufran A Salem
- Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | - Abeer A Alharbi
- Pulmonary Medicine/Sleep Medicine, King Fahad Hospital, Madinah, SAU
| |
Collapse
|
29
|
Castelli L, Galasso L, Mulè A, Ciorciari A, Esposito F, Roveda E, Montaruli A. Physical activity and morningness: A helpful combination in improving the sleep quality of active Italian university students. Chronobiol Int 2023; 40:1028-1038. [PMID: 37525628 DOI: 10.1080/07420528.2023.2241906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
University students are commonly described as having worsened sleep quality, especially when inactive and Evening-type (E-type) subjects. This study aimed to examine the interactions between physical activity and chronotype on sleep quality among a sample of active Sports Science university students. In November 2019, 433 participants (mean age: 19.7 ± 1.56 years; 70% males) completed the Pittsburgh Sleep Quality Index, the Godin-Shepard Leisure-Time Physical Activity Questionnaire (tertiles categorisation), and the Morningness-Eveningness Questionnaire. Females and E-type slept significantly worse than males and Neither-(N-types) and Morning-types (M-types), respectively. However, there were no significant differences in sleep quality based on physical activity levels. The three-way ANOVA revealed that sleep quality in N- and E-types appeared to be independent of physical activity, whereas M-types showed an improvement in sleep classification with increased physical activity. Moderation analysis indicated that physical activity significantly moderated the relationship between chronotypes and sleep quality. Specifically, M-types demonstrated a more pronounced improvement in sleep quality with increasing physical activity compared to the other chronotypes. In conclusion, M-type university students derived the greatest benefits from physical activity in improving sleep quality. Conversely, physical activity seemed to have a limited impact on sleep quality among active E-type university students.
Collapse
Affiliation(s)
- Lucia Castelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Letizia Galasso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonino Mulè
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Andrea Ciorciari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- I.R.C.C.S. Ospedale Galeazzi-Sant'ambrogio, Milan, Italy
| | - Eliana Roveda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- I.R.C.C.S. Ospedale Galeazzi-Sant'ambrogio, Milan, Italy
| | - Angela Montaruli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- I.R.C.C.S. Ospedale Galeazzi-Sant'ambrogio, Milan, Italy
| |
Collapse
|
30
|
Khalesi S, Vandelanotte C, Irwin C, Vincent GE, Gupta C, Mishra GD. Symptoms of sleep problems and adherence to dietary guidelines in older women: evidence from the Australian Longitudinal Study on Women's Health. Public Health Nutr 2023; 26:1679-1685. [PMID: 37277168 PMCID: PMC10410364 DOI: 10.1017/s1368980023001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/07/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study examined adherence to dietary guidelines and symptoms of sleep problems (e.g. taking a long time to fall sleep or waking up early) and their associations in a sample of older Australian women (68-73 years of age). DESIGN This was a population-based cross-sectional study. Adherence to the dietary guidelines was measured using a validated FFQ and reported as a diet quality score. Symptoms of sleep problems were measured using five questions and a total score was derived. Multivariate linear regression was used to investigate the association between these outcomes, adjusted for the potential confounding influence of demographic (i.e. age and marital status) and lifestyle (i.e. physical activity, stress, alcohol intake, sleep medication use) variables. SETTING Respondents from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health who completed Survey 9 were included. PARTICIPANTS Data from n 7956 older women (mean age ± sd: 70·8 ± 1·5) were included. RESULTS 70·2 % reported having at least one symptom and 20·5 % had between 3 and 5 symptoms of sleep problems (mean score ± sd: 1·4 ± 1·4, range 0-5). Adherence to dietary guidelines was poor with an average diet quality score of 56·9 ± 10·7 (range 0-100). Better adherence to dietary guidelines was associated with fewer sleep problem symptoms (β: -0·065, 95 % CI: -0·012, -0·005) and remained significant after adjusting for confounding influences. CONCLUSIONS These findings support the evidence that adherence to dietary guidelines is associated with symptoms of sleep problems in older women.
Collapse
Affiliation(s)
- Saman Khalesi
- Appelton Institute and School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Brisbane & Adelaide, Australia
| | - Corneel Vandelanotte
- Appelton Institute and School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Brisbane & Adelaide, Australia
| | - Christopher Irwin
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Grace E Vincent
- Appelton Institute and School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Brisbane & Adelaide, Australia
| | - Charlotte Gupta
- Appelton Institute and School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Brisbane & Adelaide, Australia
| | - Gita D Mishra
- Australian Women and Girls’ Health Research Centre, School of Public Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
31
|
AO YAWEN, LI YUSHUANG, ZHAO YILIN, ZHANG LIANG, YANG RENJIE, ZHA YUNFEI. Hippocampal Subfield Volumes in Amateur Marathon Runners. Med Sci Sports Exerc 2023; 55:1208-1217. [PMID: 36878015 PMCID: PMC10241426 DOI: 10.1249/mss.0000000000003144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE Numerous studies have implicated the involvement of structure and function of the hippocampus in physical exercise, and the larger hippocampal volume is one of the relevant benefits reported in exercise. It remains to be determined how the different subfields of hippocampus respond to physical exercise. METHODS A 3D T1-weighted magnetic resonance imaging was acquired in 73 amateur marathon runners (AMR) and 52 healthy controls (HC) matched with age, sex, and education. The Montreal Cognitive Assessment, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Scale were assessed in all participants. We obtained hippocampal subfield volumes using FreeSurfer 6.0. We compared the volumes of the hippocampal subfield between the two groups and ascertained correlation between the significant subfield metrics and the significant behavioral measure in AMR group. RESULTS The AMR had significantly better sleep than HC, manifested as with lower score of PSQI. Sleep duration in AMR and HC was not significantly different from each other. In the AMR group, the left and right hippocampus, cornu ammonis 1 (CA1), CA4, granule cell and molecular layers of the dentate gyrus, molecular layer, left CA2-3, and left hippocampal-amygdaloid transition area volumes were significantly larger compared with those in the HC group. In AMR group, the correlations between the PSQI and the hippocampal subfield volumes were not significant. No correlations were found between hippocampal subfield volumes and sleep duration in AMR group. CONCLUSIONS We reported larger volumes of specific hippocampal subfields in AMR, which may provide a hippocampal volumetric reserve that protects against age-related hippocampal deterioration. These findings should be further investigated in longitudinal studies.
Collapse
|
32
|
M’Koma AE, Ware JN, Nabaweesi RK, Chirwa SS. Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood. MEDICAL RESEARCH ARCHIVES 2023; 11:3784. [PMID: 37492395 PMCID: PMC10367541 DOI: 10.18103/mra.v11i6.3784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Inflammatory bowel disease (IBD) is a term for two autoimmune diseases encompassing Crohn's disease (CD) and ulcerative colitis (UC) which are lifelong diseases affecting more than 3 million adults (1.3%) in the United States. IBD is characterized by chronic inflammation of the whole digestive system which results in damage to the gastrointestinal (GI) tract. IBD often emerges during adolescence and young adulthood. Maternal morbidity includes physical and psychological conditions that result from or are aggravated by pregnancy and have an adverse effect on a woman's health, the baby's health or both. Some women have health challenges that arise before or during pregnancy that could lead to complications. It is recommended for women to receive health care counseling before and during pregnancy. Compared to other developed countries, the United States has the highest rate of women dying of pregnancy related complications. During the past 25 years maternal mortality has been getting worse. African American women (AAW) with and/or without IBD are dying at significantly higher rates than other groups. This is linked to several factors, i.e., systemic, institutionalized, and structural racism in health-care delivery and subsequent toxic stress from people's lived experiences of racism, limited knowledge about healthcare system function, lack of access to healthcare, (inclusiveness and insurance policies) all of which negatively impact these patients. African Americans (AAs) are also up to three times as likely to experience severe maternal morbidity: unexpected outcomes of labor and delivery, deficient or lacking prenatal care and social determinants of health like lack of transportation, adequate employment, limited literacy, and limited healthcare access contribute to poor health outcomes. Studies on IBD patients indicate Medicaid expansion is associated with reduced rates of maternal morbidity, particularly for African American Women (AAW) and increased access to preconception and prenatal services that make pregnancy and childbirth safer for parent and baby. Herein we examine the physiological changes of pregnancy in patients diagnosed with inflammatory bowel disease and their relationship perinatal outcomes and parenthood.
Collapse
Affiliation(s)
- Amosy E. M’Koma
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
| | | | | | - Sanika S. Chirwa
- Departments of Biochemistry, Cancer Biology, Neuroscience and Pharmacology
| |
Collapse
|
33
|
De Baets L, Runge N, Labie C, Mairesse O, Malfliet A, Verschueren S, Van Assche D, de Vlam K, Luyten FP, Coppieters I, Babiloni AH, Martel MO, Lavigne GJ, Nijs J. The interplay between symptoms of insomnia and pain in people with osteoarthritis: A narrative review of the current evidence. Sleep Med Rev 2023; 70:101793. [PMID: 37269784 DOI: 10.1016/j.smrv.2023.101793] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
Osteoarthritis (OA) is a leading cause of disability worldwide and clinical pain is the major symptom of OA. This clinical OA-related pain is firmly associated with symptoms of insomnia, which are reported in up to 81% of people with OA. Since understanding the association between both symptoms is critical for their appropriate management, this narrative review synthesizes the existing evidence in people with OA on i) the mechanisms underlying the association between insomnia symptoms and clinical OA-related pain, and ii) the effectiveness of conservative non-pharmacological treatments on insomnia symptoms and clinical OA-related pain. The evidence available identifies depressive symptoms, pain catastrophizing and pain self-efficacy as mechanisms partially explaining the cross-sectional association between insomnia symptoms and pain in people with OA. Furthermore, in comparison to treatments without a specific insomnia intervention, the ones including an insomnia intervention appear more effective for improving insomnia symptoms, but not for reducing clinical OA-related pain. However, at a within-person level, treatment-related positive effects on insomnia symptoms are associated with a long-term pain reduction. Future longitudinal prospective studies offering fundamental insights into neurobiological and psychosocial mechanisms explaining the association between insomnia symptoms and clinical OA-related pain will enable the development of effective treatments targeting both symptoms.
Collapse
Affiliation(s)
- Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium
| | - Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium; Division of Rheumatology, University Hospitals Leuven, Belgium
| | - Olivier Mairesse
- Department of Brain Body and Cognition (BBCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Sleep Laboratory and Unit for Chronobiology U78, Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles (ULB) and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium
| | - Dieter Van Assche
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium; Division of Rheumatology, University Hospitals Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Belgium; Skeletal Biology & Engineering Research Center, Dept. of Development & Regeneration, KU Leuven, Belgium
| | - Frank P Luyten
- Skeletal Biology & Engineering Research Center, Dept. of Development & Regeneration, KU Leuven, Belgium
| | - Iris Coppieters
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; The Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal) and University of Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Faculty of Dentistry & Department of Anesthesia, McGill University, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal) and University of Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| |
Collapse
|
34
|
Bate GL, Kirk C, Rehman RZU, Guan Y, Yarnall AJ, Del Din S, Lawson RA. The Role of Wearable Sensors to Monitor Physical Activity and Sleep Patterns in Older Adult Inpatients: A Structured Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4881. [PMID: 37430796 PMCID: PMC10222486 DOI: 10.3390/s23104881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/12/2023]
Abstract
Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.
Collapse
Affiliation(s)
- Gemma L. Bate
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Rana Z. U. Rehman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Yu Guan
- Department of Computer Science, University of Warwick, Coventry CV4 7EZ, UK;
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Rachael A. Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| |
Collapse
|
35
|
Huang HH, Stubbs B, Chen LJ, Ku PW, Hsu TY, Lin CW, Weng YM, Wu SH. The effect of physical activity on sleep disturbance in various populations: a scoping review of randomized clinical trials. Int J Behav Nutr Phys Act 2023; 20:44. [PMID: 37069626 PMCID: PMC10107572 DOI: 10.1186/s12966-023-01449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed to examine the effect of various PA intervention strategies on sleep across different populations, identify key sleep outcomes, and analyze knowledge gaps by mapping the relevant literature. METHODS For this study, we systematically searched articles published till March 2022 from PubMed, Web of Science, Cochrane Library, and Embase databases for randomized clinical trials (RCTs) regarding the effect of physical activity on sleep. Two authors extracted key data and descriptively analyzed the data. Thematic analysis was used to categorize the results into themes by all authors. Arksey and O'Malley's scoping review framework was used to present the findings. RESULTS Twenty-one randomized controlled trials out of 3052 studies were finally included with 3677 participants (2852 females (78%)). Five trials were conducted in healthy working-age adults with sleep disturbance but without the diagnosis of insomnia, five in healthy older adults, two in perinatal women, four in patients with cancer, three in mental illness related subjects, and another two in other disease-related areas. PA interventions were diverse, including walking, resistance training, aerobic exercise, housework, water exercise, basketball, smartphone/tablet "apps", web, online videos or wearable actigraphy, and self-determined exercise. Three major themes were identified: (1) Sleep environment may be important to address prior to instituting PA interventions, (2) All types of PA were effective for improving sleep in all populations studied, (3) Self-tolerated PA is safe for improving sleep in the elderly and in co-morbid or perinatal populations. CONCLUSIONS PA is effective and safe for improving sleep in both healthy and co-morbid populations with sleep disturbance by increasing daily activity levels using a variety of strategies, even low intensity, such as housekeeping, sit-to-stand repetitions, along with encouraging PA through web pages, videos, and self-goal setting apps. In addition, this scoping review identifies the need for further therapeutic research and future exploration in populations with sleep initiation or sleep maintenance disturbance.
Collapse
Affiliation(s)
- Hung-Hsin Huang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, Box, UK
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, 145 Xingda Rd., South Dist, Taichung City, 402, Taiwan
- Department of Kinesiology, National Tsing Hua University, Hsinchu, 300, Taiwan
| | - Tai-Yi Hsu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Wei Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Doctoral Degree Program in Artificial Intelligence, Asia University, Taichung, Taiwan
| | - Yi-Ming Weng
- Emergency department of Taoyuan General Hospital, MOHW, Taoyuan, Taiwan
| | - Shih-Hao Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan.
- Attending Physician of Emergency Department, China Medical University Hospital, Taichung, 404, Taiwan.
| |
Collapse
|
36
|
Scott RQ, Rodríguez AJ. Improving Quality of Sleep in Healthy Adults. CURRENT PULMONOLOGY REPORTS 2023. [DOI: 10.1007/s13665-023-00304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
|
37
|
Mackey DC, Ekegren CL, Baldwin C, Young PJ, Gray SM, Ciok A, Wong A. Outcome domains measured in randomized controlled trials of physical activity for older adults: a rapid review. Int J Behav Nutr Phys Act 2023; 20:34. [PMID: 36964571 PMCID: PMC10039503 DOI: 10.1186/s12966-023-01431-3] [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: 12/22/2022] [Accepted: 03/04/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Toward development of a core outcome set for randomized controlled trials (RCTs) of physical activity (PA) interventions for older adults, the purpose of this study was to identify outcome domains and subdomains ('what' was measured) in previously published RCTs of PA for older adults. METHODS We conducted a rapid review and searched Ovid MEDLINE for recently- published (2015-2021), English-language, RCTs of PA interventions for older adults (mean age 60+ yrs). We limited to articles published in Web of Science top-10 journals in general and internal medicine, geriatrics and gerontology, rehabilitation, and sports science. Two reviewers independently completed eligibility screening; two other reviewers abstracted trial descriptors and study outcomes. We classified study outcomes according to the standard outcome classification taxonomy endorsed by the Core Outcome Measures in Effectiveness Trials Initiative. RESULTS Our search yielded 548 articles; 67 articles were eligible to be included. Of these, 82% were efficacy/effectiveness trials, 85% included both male and female participants, and 84% recruited community-dwelling older adults. Forty percent of articles reported on interventions that involved a combination of group and individual PAs, and 60% involved a combination of PA modes (e.g., aerobic, resistance). Trial sample size ranged from 14 to 2157 participants, with median (IQR) of 94 (57-517); 28,649 participants were included across all trials. We identified 21 unique outcome domains, spanning 4/5 possible core areas (physiological/clinical; life impact; resource use; adverse events). The five most commonly reported outcome domains were physical functioning (included in n=51 articles), musculoskeletal and connective tissue (n=30), general (n=26), cognitive functioning (n=16), and emotional functioning/wellbeing (n=14). Under these five outcome domains, we further identified 10 unique outcome subdomains (e.g., fall-related; body composition; quality of life). No outcome domains or subdomains were reported consistently in all RCTs. CONCLUSIONS We found extensive variability in outcome domains and subdomains used in RCTs of PA for older adults, reflecting the broad range of potential health benefits derived from PA and also investigator interest to monitor a range of safety parameters related to adverse events. This study will inform development of a core outcome set to improve outcome reporting consistency and evidence quality.
Collapse
Affiliation(s)
- Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, Building G, Moorooduc Hwy, Frankston, Victoria, 3199, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, South Australia, 5042, Australia
| | - Peter J Young
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Samantha M Gray
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Alex Ciok
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Angela Wong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| |
Collapse
|
38
|
Zhang X, Yang Z, Du L, Xiong C, Wang Z, Pan Y, He Q, Chen S, Cui L. Associations of accelerometer-measured physical activity, sedentary behavior with self-reported insomnia in older women: Does pattern matter? Sleep Med 2023; 104:58-63. [PMID: 36906996 DOI: 10.1016/j.sleep.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
AIMS Insomnia is a common sleep disorder that widely occurs in older population, especially older women. This study aims to investigate the associations between accelerometer-measured physical activity (PA) and sedentary behavior (SB) patterns with insomnia in older Chinese women. METHODS Cross-sectional data derived from the baseline survey of the Physical Activity and Health in Older Women Study were analyzed for 1112 older women aged 60 to 70. Insomnia was evaluated using Athens Insomnia Scale. PA and SB patterns were measured through an accelerometer. Multivariate logistic regression was used to investigate associations of PA and SB patterns with insomnia. RESULTS All SB variables were positively associated with insomnia, with multivariate-adjusted ORs of 1.24, 1.19 and 1.19 for 60-min increase of total SB, 10min-bouted SB and 30min-bouted SB, respectively. Total LPA and bouted LPA were negatively associated with insomnia, with multivariate-adjusted ORs of 0.90 and 0.89 for 30-min increase of total LPA and bouted LPA, respectively. CONCLUSION Avoiding SB and encouraging LPA engagement may hold promise in preventing insomnia and promoting sleep in older population. Future studies with experimental study design and follow-up periods are warranted to illustrate the causal associations.
Collapse
Affiliation(s)
- Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | - Zikun Yang
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | - Litao Du
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | | | - Ziwen Wang
- School of Physical Education, Huanggang Normal University, Huanggang, 438000, China.
| | - Yang Pan
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Lili Cui
- School of Physical Education, Shandong University, Jinan, 250061, China.
| |
Collapse
|
39
|
Health and Nutrition Analysis in Older Adults in San José de Minas Rural Parish in Quito, Ecuador. Glob Health Epidemiol Genom 2023; 2023:1839084. [PMID: 36814561 PMCID: PMC9940982 DOI: 10.1155/2023/1839084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/02/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Knowing the health and nutritional status of older adults is crucial to helping them live healthier lives and limiting the need for pharmaceuticals and complicated medical procedures. The objective of this research was to analyze the eating habits (EH), physical activity (PA), and sleep quality (SQ) of older adults in the rural parish of San José de Minas in Quito, Ecuador. Three validated questionnaires were used: the Pittsburgh PSQI for SQ, IPAQ for PA, and frequency of consumption for EH. The results revealed high consumption of refined flours and sugar (70% at least once a day), low intake of whole grains, fish, and olive oil, and considerable consumption of fruits and water. Fifty percent of respondents engage in moderate physical activity and 24% in low physical activity, while 90% of older adults have poor sleep quality. These results indicate a problem in the integral health of the population that does not allow older adults to have a good old age. Health campaigns should be developed to increase physical activity, encourage a better diet, and thus, improve the quality of sleep.
Collapse
|
40
|
dos Santos Quaresma MVL, Marques CG, Magalhães ACO, Cirillo L, Ciudi RB, Oliveira LS, dos Santos RVT, Nakamoto FP. Prevalence of dietary supplement consumption among CrossFit practitioners. NUTRIRE : REVISTA DE SOCIEDADE BRASILEIRA DE ALIMENTACAO E NUTRICAO = JOURNAL OF THE BRAZILIAN SOCIETY OF FOOD AND NUTRITION 2023; 48:9. [PMID: 38625281 PMCID: PMC9924833 DOI: 10.1186/s41110-023-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
Purpose We aimed to verify the prevalence of dietary supplements among CrossFit practitioners (CFPs), considering gender and training status. Still, we aimed to determine the type, reasons, and associated factors of dietary supplement utilization among CFPs. Methods This is a cross-sectional, exploratory, and descriptive study with the snowball sampling method. Data were collected through online questionnaires using the Google Forms® tool. We included CFPs aged 18-64 years, from Aug 1, 2020, to Sept 31, 2020. The questionnaire contained questions to assess the prevalence, type, and reasons for supplement use; also, we assessed information about sociodemographic variables and the prevalence of the main chronic morbidities. To analyze aspects of eating behavior and sleep-related parameters, we applied the three-factor eating questionnaire (TFEQ)-R21 and the Pittsburgh Sleep Quality Index questionnaire (PSQI), respectively. Results We assessed one hundred twelve (n = 112; 57 men; 55 women) CFPs (28.9 ± 7.64 years old; body mass index (BMI), 25.5 ± 4.83 kg/m2). Eighty-seven (50 men; 37 women; 28.2 ± 6.66 years old; BMI, 25.4 ± 4.55 kg/m2) reported using dietary supplements. Whey protein was the most used supplement (n = 70), followed by creatine (n = 54). Cognitive restraint (a dimension of eating behavior) score was higher in supplement users than in non-users (51.7 ± 18.6 vs. 42.6 ± 20.5; p = 0.040). Sleep-related parameters did not differ between supplement users and non-users. The most associated factors to supplement use were sex (being man; OR, 7.99; p = 0.007), sleep quality (poor; OR, 5.27; p = 0.045), CrossFit level (as prescribed (RX); OR, 4.51; p = 0.031), and cognitive restraint (OR, 1.03; p = 0.029). Conclusion The CFPs, especially RX and Elite ones, showed a higher prevalence of supplement utilization. Anabolic-related supplements (i.e., whey protein and creatine) were the most used; moreover, several CFPs used supplements not supported by scientific evidence. Cognitive restraint score was higher in supplement users than in non-users. RX level, being men, and poor sleep quality were associated with supplement utilization. These data draw attention to the necessity of nutritional education for CrossFit coaches and athletes. Broader studies are necessary to confirm our findings.
Collapse
Affiliation(s)
| | | | - Ana Carolina Oumatu Magalhães
- Centro Universitário São Camilo, Curso de Nutrição, São Paulo, SP Brazil
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Letícia Cirillo
- Centro Universitário São Camilo, Curso de Nutrição, São Paulo, SP Brazil
| | | | | | - Ronaldo Vagner Thomatieli dos Santos
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP Brazil
- Departamento de Biociências, Universidade Federal de São Paulo, Santos, SP Brazil
| | | |
Collapse
|
41
|
Gu HJ, Lee OS. Effects of Non-Pharmacological Sleep Interventions in Older Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3101. [PMID: 36833796 PMCID: PMC9966498 DOI: 10.3390/ijerph20043101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/01/2023]
Abstract
This study investigated the effects of non-pharmacological interventions on sleep in older people through a systematic review and meta-analysis. We conducted a literature search using eight electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Participant characteristics, the contents of the evaluated interventions, and the measured outcomes were systematically reviewed for 15 selected studies. We performed a meta-analysis to estimate the effect size for overall, aggregated sleep outcomes. Due to the small number of studies available for each intervention, only the overall effectiveness of non-pharmacological sleep interventions was evaluated. The evaluated interventions included exercise, aromatherapy, acupressure, cognitive behavior therapy, and meditation. Our results demonstrated that non-pharmacological interventions showed statistically significant effects on sleep (effect size = 1.00, 95% confidence interval: 0.16, 1.85, I2 = 92%, p < 0.001). After confirming publication bias and removing outliers, we found no heterogeneity (I2 = 17%, p = 0.298), with a decrease in effect size to 0.70 (95% confidence interval: 0.47, 0.93). Non-pharmacological interventions are effective for improving sleep in older adults. Future studies should continue to investigate sleep problems and interventions addressing these problems in this demographic, particularly in older women. Objective measures should be used to follow-up on the evaluated sleep interventions over the long term.
Collapse
Affiliation(s)
- Hye-Ja Gu
- Department of Nursing Science, Kyungsung University, Busan 48434, Republic of Korea
| | - Oi-Sun Lee
- Department of Nursing, Gyeongnam Geochang University, Geochang-gun 50147, Republic of Korea
| |
Collapse
|
42
|
Abstract
High-quality sleep is an important factor in sustaining health and improving well-being. Previous evidence has demonstrated the positive associations between increased physical activity and reduced sedentary behaviour (SB) with sleep quality. The substitutional relationships between SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) need to be considered when examining how a particular behaviour may impact sleep quality. No studies, to our knowledge, have explored these substitutional relationships in middle-aged adulthood. Using an isotemporal substitution approach, this study examined the associations of replacing sedentary time with physical activity on sleep quality measures in a sample of middle-aged adults in Japan. Data from 683 adults aged 40-64 living in Japan were used. The average daily time spent in SB, LPA, and MVPA was objectively assessed by accelerometers. Two self-reported sleep quality measures were obtained using questionnaires, including rest by sleep and sleep quality. Multivariable linear regression models were used to assess the associations of SB, LPA, and MVPA with the sleep quality measures stratified by gender. We found that each 60 min unit of SB or LPA replaced with MVPA was favourably associated with rest by sleep among women (β = 0.16, 95% CI 0.07, 0.28, p < 0.001; β = 0.18, 95% CI 0.07, 0.32, p < 0.05, respectively). There were no significant associations between SB, LPA, and MVPA with sleep measures in men across all three models. These findings indicate that higher MVPA has a positive association with sleep quality in middle-aged women.
Collapse
|
43
|
Carvalho KMD, Figueiredo MDLF, Galindo Neto NM, Sá GGDM, Silva CRDT, Mendes PN. Comparison of the effectiveness of two educational interventions on sleep quality in older adults: a randomized clinical trial. Rev Esc Enferm USP 2023; 56:e20220326. [PMID: 36651869 PMCID: PMC10088524 DOI: 10.1590/1980-220x-reeusp-2022-0326en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/18/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE to compare the effectiveness of an educational intervention mediated by a booklet with verbal nursing guidelines in improving sleep quality in older adults. METHOD this is a randomized, single-blind clinical trial, carried out with 126 older adults, of which 62 were allocated in group 1, who received health education using an educational booklet, and 64 in group 2, who were exposed to health education with verbal nursing guidelines. Sleep quality was verified by the Pittsburgh Index, Epworth Sleepiness Scale and variable minutes that it takes to sleep. In order to compare the pre and post-tests, within the group, the Wilcoxon and chi-square tests were used. Status change was assessed using McNemar's chi-square test. To compare groups, Mann-Whitney and chi-square were used. The significance level was 5%. RESULTS older adults in both groups showed improvement in sleep quality (p > 0.05) after the interventions. There was no statistically significant difference between the interventions. CONCLUSION the educational intervention mediated by a booklet and verbal nursing guidelines were equally effective in improving older adults' sleep quality. RBR-993xf7.
Collapse
|
44
|
Wang X, Si K, Gu W, Wang X. Mitigating effects and mechanisms of Tai Chi on mild cognitive impairment in the elderly. Front Aging Neurosci 2023; 14:1028822. [PMID: 36760710 PMCID: PMC9906996 DOI: 10.3389/fnagi.2022.1028822] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Mild cognitive impairment (MCI) is a major public health concern that endangers health and decreases the quality of life of the elderly around the world. A recent clinical guideline has recommended regular exercise (twice per week) for patients with MCI as part of an overall approach to management. Tai Chi, a form of light-to-moderate-intensity mind-body exercise, is particularly suitable for seniors. This review aims to summarize epidemiological studies related to the effects of Tai Chi on symptom remission in older adults with MCI and reveal the potential mechanisms. Evidence suggested that Tai Chi can improve cognitive functions and alleviate the accompanying symptoms of MCI in the elderly potentially by activating the expression of signals in different brain regions, altering their connectivity, increasing the brain volume, and modulating brain-derived neurotropic and inflammation factors. Studies comparing various types of Tai Chi may contribute to the identification of paradigms that have appropriate intensities and difficulty and exert good effects on older people with MCI. In addition, studies are warranted to determine the frequency and duration of training that can optimize the beneficial effects of Tai Chi on MCI.
Collapse
Affiliation(s)
- Xin Wang
- Faculty of Traditional Chinese Medicine, Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Wei Gu
- Faculty of Traditional Chinese Medicine, Naval Medical University, Shanghai, China
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| |
Collapse
|
45
|
Liu H, Liu F, Ji H, Dai Z, Han W. A bibliometric analysis of sleep in older adults. Front Public Health 2023; 11:1055782. [PMID: 36908435 PMCID: PMC9995908 DOI: 10.3389/fpubh.2023.1055782] [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: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Sleep problems severely affect the quality of life in the elderly and have gradually gained attention among scholars. As a major hot spot of current research, sleep in older adults is highly exploratory and of great significance for human health. Objective Therefore, in this study, the current state of the art of sleep research in older adults was analyzed through the visual mapping function of CiteSpace software. Using this software, we analyzed popular research questions and directions and revealed the development trends and research frontiers of this field. Methods In this paper, we searched the Web of Science database for sleep-related studies focusing on older adults and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by using CiteSpace software. Results Our results revealed that the number of publications concerning sleep in older adults has gradually increased; after 2017, this field underwent rapid development. The journal Sleep has published the majority of the articles on sleep in older adults and has the highest citation frequency. The Journal of the American Geriatrics Society has the highest impact factor and CiteScore among the top 10 journals in terms of the number of published articles. The United States has the highest number of publications and most of the leading institutions in this field are located in the United States, with the University of California, Los Angeles, and the University of Pittsburgh having the highest number of publications. Dzierzewski JM is the most published author and has played an important role in guiding the development of this field. Research in this area is focused on insomnia, sleep quality, depression, and sleep duration. Conclusion The rapid development of sleep research in older adults, which shows a yearly growth trend, indicates that this field is receiving increasing attention from researchers. Insomnia in older adults is the most concerning problem in this field. At the same time, future research should continue to focus on the impact of sleep disorders on older adults to improve sleep and quality of life in older adults.
Collapse
Affiliation(s)
- Haitao Liu
- College of Physical Education, Henan University, Kaifeng, Henan, China.,Research Center of Sports Reform and Development, Henan University, Kaifeng, Henan, China.,Institute of Physical Fitness and Health, Henan University, Kaifeng, Henan, China
| | - Feiyue Liu
- College of Physical Education, Henan University, Kaifeng, Henan, China
| | - Haoyuan Ji
- College of Physical Education, Henan University, Kaifeng, Henan, China
| | - Zuanqin Dai
- College of Physical Education, Henan University, Kaifeng, Henan, China
| | - Wenxiu Han
- College of Physical Education, Henan University, Kaifeng, Henan, China
| |
Collapse
|
46
|
Efendi F, Tonapa SI, Has EMM, Ho KHM. Effects of chair-based resistance band exercise on physical functioning, sleep quality, and depression of older adults in long-term care facilities: Systematic review and meta-analysis. Int J Nurs Sci 2022; 10:72-81. [PMID: 36860706 PMCID: PMC9969069 DOI: 10.1016/j.ijnss.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
Objective Chair-based resistance band exercise (CRBE) is a simple and safe physical activity for persons with limited mobility. This study aimed to review and analyze CRBE effects on physical functioning, sleep quality, and depression among older adults in long-term care facilities (LTCF). Method A systematic search guided by the PRISMA 2020 approach was performed on specific databases: AgeLine, CINAHL, PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The randomized controlled trial studies that trialed CRBE for older adults in LTCF, peer-reviewed articles published in the English language from inception to March 2022 were retrieved. Methodological quality was established using the Physiotherapy Evidence Database scale. The random and fixed effects model were used to generate the pooled effect size. Results Nine studies met the eligibility criteria and were synthesized. The results revealed that CRBE significantly promoted the activity of daily living (six studies; SMD = 0.30, P = 0.001), lung capacity (three studies; MD = 40.35, P < 0.001), handgrip strength (five studies; MD = 2.17, P < 0.001), upper limb muscle endurance (five studies; MD = 2.23, P = 0.012), lower limb muscle endurance (four studies; MD = 1.32, P < 0.001), upper body flexibility (four studies; MD = 3.06, P = 0.022), lower body flexibility (four studies; MD = 5.34, P < 0.001), dynamic balance (three studies; MD = -0.35, P = 0.011), sleep quality (two studies; MD = -1.71, P < 0.001), and reduced depression (two studies; SMD = -0.33, P = 0.035). Conclusion The evidence suggests that CRBE improved physical functioning parameters, and sleep quality, and lowers depression among older adults in LTCF. This study could be used to persuade long-term care facilities to allow people with limited mobility to engage in physical activity.
Collapse
Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia,School of Nursing & Midwifery, La Trobe University, Melbourne, Australia,Corresponding author. Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
| | | | | | - Ken Hok Man Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
47
|
Le Cornu Q, Chen M, van Hees V, Léger D, Fayosse A, Yerramalla MS, Sabia S. Association of physical activity, sedentary behaviour, and daylight exposure with sleep in an ageing population: findings from the Whitehall accelerometer sub-study. Int J Behav Nutr Phys Act 2022; 19:144. [PMID: 36494722 PMCID: PMC9733167 DOI: 10.1186/s12966-022-01391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ageing is accompanied by changes in sleep, while poor sleep is suggested as a risk factor for several health outcomes. Non-pharmacological approaches have been proposed to improve sleep in elderly; their impact remains to be investigated. The aim of this study was to examine the independent day-to-day associations of physical behaviours and daylight exposure with sleep characteristics among older adults. METHODS Data were drawn from 3942 participants (age range: 60-83 years; 27% women) from the Whitehall II accelerometer sub-study. Day-to-day associations of objectively-assessed daytime physical behaviours (sedentary behaviour, light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA), mean acceleration, physical activity chronotype) and daylight exposure (proportion of waking window with light exposure > 1000 lx and light chronotype) with sleep characteristics were examined using mixed models. RESULTS A 10%-increase in proportion of the waking period spent sedentary was associated with 5.12-minute (4.31, 5.92) later sleep onset and 1.76-minute shorter sleep duration (95%confidence interval: 0.86, 2.66). Similar increases in LIPA and MVPA were associated with 6.69 (5.67, 7.71) and 4.15 (2.49, 5.81) earlier sleep onset respectively and around 2-minute longer sleep duration (2.02 (0.87, 3.17) and 2.23 (0.36, 4.11), respectively), although the association was attenuated for MVPA after adjustment for daylight exposure (1.11 (- 0.84, 3.06)). A 3-hour later physical activity chronotype was associated with a 4.79-minute later sleep onset (4.15, 5.43) and 2.73-minute shorter sleep duration (1.99, 3.47). A 10%-increase in proportion of waking period exposed to light> 1000 lx was associated with 1.36-minute longer sleep (0.69, 2.03), independently from mean acceleration. Associations found for sleep duration were also evident for duration of the sleep windows with slightly larger effect size (for example, 3.60 (2.37, 4.82) minutes for 10%-increase in LIPA), resulting in associations with sleep efficiency in the opposite direction (for example, - 0.29% (- 0.42, - 0.16) for 10%-increase in LIPA). Overall, associations were stronger for women than for men. CONCLUSIONS In this study, higher levels of physical activity and daylight exposure were associated with slightly longer sleep in older adults. Given the small effect sizes of the associations, increased physical activity and daylight exposure might not be enough to improve sleep.
Collapse
Affiliation(s)
- Quentin Le Cornu
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Mathilde Chen
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | | | - Damien Léger
- Department of Epidemiology and Public Health, University College London, London, UK.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France
| | - Aurore Fayosse
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Manasa S Yerramalla
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Séverine Sabia
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France. .,Department of Epidemiology and Public Health, University College London, London, UK.
| |
Collapse
|
48
|
Aliabadi S, Zarghami F, Farhadi A, Sharifi F, Moodi M. Effect of Physical Activity on Sleep Outcomes among Iranian Older Adults: A Cross-Sectional Study. ADVANCES IN GERONTOLOGY 2022. [DOI: 10.1134/s2079057022040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
49
|
Ai JY, Kuan G, Juang LYT, Lee CH, Kueh YC, Chu IH, Geng XL, Chang YK. Effects of Multi-Component Exercise on Sleep Quality in Middle-Aged Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15472. [PMID: 36497548 PMCID: PMC9737228 DOI: 10.3390/ijerph192315472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
Sleep is a crucial factor in healthy aging. However, most middle-aged adults experience high levels of sleep disorders. While previous findings have suggested exercise training could benefit the quality of sleep, the effects of multi-component exercise on sleep quality are less examined. Accordingly, the current study aimed to assess the effectiveness of a multi-component exercise program on the quality of sleep among middle-aged adults. Twenty-four middle-aged adults were randomly assigned either to a multi-component exercise (MCE) group or a control group. The participants in the MCE group attended a 90-min session per week for 12 weeks. The control group was instructed to maintain their daily routine for 12 weeks. The primary outcome was the sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was physical fitness, including muscular strength and endurance, balance, and flexibility. Regarding sleep quality, the global mean score (p = 028), sleep disturbances (p = 011), and sleep efficiency (p = 035) of the PSQI scores were significantly reduced in the MCE group after the 12-week intervention. Regarding physical fitness, the flexibility of the MCE group improved significantly after the intervention (p = 028), yet, no significant change was observed in the control group. Additionally, the muscular strength of the control group declined significantly after the 12-week period (p = 034). Our results revealed the effectiveness of the MCE intervention in improving sleep quality and physical fitness in middle-aged adults. Further studies using larger sample sizes, objective measures of sleep quality, different types of exercise training, as well as different populations, are warranted to extend our current findings.
Collapse
Affiliation(s)
- Jing-Yi Ai
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei 106209, Taiwan
| | - Garry Kuan
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Linda Ya-Ting Juang
- Lifestyles of Health and Sustainability Executive Master of Business Administration, National Taiwan Normal University, Taipei 106209, Taiwan
| | - Ching-Hsiu Lee
- Lifestyles of Health and Sustainability Executive Master of Business Administration, National Taiwan Normal University, Taipei 106209, Taiwan
| | - Yee-Cheng Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - I-Hua Chu
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Xiao-Ling Geng
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei 106209, Taiwan
- Department of Wushu, Hong Kong Sports Institute, Hong Kong 999077, China
| | - Yu-Kai Chang
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei 106209, Taiwan
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei 106209, Taiwan
| |
Collapse
|
50
|
Wu W, Sun L, Li H, Zhang J, Shen J, Li J, Zhou Q. Approaching person-centered clinical practice: A cluster analysis of older inpatients utilizing the measurements of intrinsic capacity. Front Public Health 2022; 10:1045421. [PMID: 36438281 PMCID: PMC9692078 DOI: 10.3389/fpubh.2022.1045421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Maintaining the intrinsic capacity (IC) of older inpatients is a novel view in providing person-centered treatments in clinical practice. Uncertainty remains regarding the primary nature of IC among older hospitalized patients. Objectives We aimed to understand the status of IC among older inpatients by a cluster analysis based on IC measurements. Methods This is a cross-sectional study conducted in the geriatric department of Beijing Hospital in China. Older inpatients who were older than 60 years and who underwent comprehensive geriatric assessments were included. The inpatients were classified into subgroups based on 13 measurements of IC according to unsupervised methods (K-means cluster analysis and t-SNE). Subgroup differences were investigated for domains of IC, age, sex, frailty, activities of daily living, and falls. Results A total of 909 inpatients with a mean age of 76.6 years were included. Almost 98% of the inpatients showed IC impairment. Locomotion impairment was the most prevalent problem (91.1%), followed by sensory impairment (61.4%), psychological impairment (57.3%), cognition decline (30.7%), and vitality problem (29.2%). A total of five clusters were obtained by classification: Cluster 1 (56.6% of the participants) showed high IC with fair impairment of locomotion and vision; clusters 2 and 3 (37.8 % of the participants) had additional impairment of sleep in the psychological domain; clusters 4 and 5 (5.6% of the participants) represented a severe loss of all the IC domains; and clusters 1-5 showed a gradual decline in the IC score and were significantly associated with increased age, frailty, decreased activities of daily living, and falls. Significant correlations among the domains were observed; the locomotion domain showed the strongest links to the others in network analysis. Conclusions Great declines in IC and disparities between IC domains were found in older inpatients. IC-based primary assessment and classification enabled us to identify the variation of functional abilities among the older inpatients, which is pivotal for designing integrated treatment or care models in clinical practice.
Collapse
Affiliation(s)
- Wenbin Wu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Wenbin Wu
| | - Liang Sun
- The Key Laboratory of Geriatrics, National Center of Gerontology of National Health Commission, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Li
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Zhang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ji Shen
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- The Key Laboratory of Geriatrics, National Center of Gerontology of National Health Commission, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|