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Popelsky BK, Pettee Gabriel K, Dooley EE, Ylitalo KR. Physical Activity Fragmentation and Falls in Older Adults: Findings From the National Health and Aging Trends Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae129. [PMID: 38733095 PMCID: PMC11157969 DOI: 10.1093/gerona/glae129] [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: 10/05/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (ie, more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults. METHODS Participants (n = 685, 54.3% women, 61.5% aged 70-79 years) from the National Health and Aging Trends Study with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls. RESULTS Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR = 0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR = 1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning. CONCLUSIONS PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life course.
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Affiliation(s)
- Braden K Popelsky
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
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Oliveira JS, Sherrington C, Rissel C, Howard K, Tong A, Merom D, Wickham J, Bauman AE, Lord SR, Lindley RI, Simpson JM, Allman-Farinelli M, Kirkham C, Ramsay E, O'Rourke S, Tiedemann A. Effect of a coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years: a cluster randomised controlled trial. Br J Sports Med 2024; 58:382-391. [PMID: 38253435 PMCID: PMC10982628 DOI: 10.1136/bjsports-2023-107027] [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] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years. DESIGN Cluster randomised controlled trial. SETTING Community-dwelling older people. PARTICIPANTS 72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control. INTERVENTION Intervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months. OUTCOMES The co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability. RESULTS The mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI -21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes. CONCLUSION A physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. TRIAL REGISTRATION NUMBER ACTRN12615001190594.
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Affiliation(s)
- Juliana S Oliveira
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - James Wickham
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, New South Wales, Australia
| | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Richard I Lindley
- Sydney Medical School, Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics, School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Kirkham
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elisabeth Ramsay
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra O'Rourke
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Tiedemann
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Liang C, Shi L, Li B, He Z. The Mediating Role of Sarcopenia in the Association between Physical Activity and Falls among Chinese Older Adults: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:3146. [PMID: 38132036 PMCID: PMC10743279 DOI: 10.3390/healthcare11243146] [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: 08/23/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
Physical inactivity and sarcopenia are potentially modifiable risk factors for falls in older adults, but the strength of the association between physical activity (PA), sarcopenia, and falls in Chinese older adults is unclear. This study sought to investigate the potential mediation mechanism relationship in the connection between PA, sarcopenia, including its elements (muscle strength, physical performance, and skeletal muscle mass), and falls among Chinese older people. The subjects were 3592 community-dwelling Chinese aged 60 or over, selected from the China Health and Retirement Longitudinal Study (CHARLS). PA was evaluated through the International Physical Activity Questionnaire (IPAQ), and sarcopenia was determined through the Asian Working Group on Sarcopenia (AWGS) 2019 guidelines. We employed logistic regression to explore the link between physical activity, sarcopenia, and falls. Additionally, we applied Karlson, Holm and Breen's (KHB) method to estimate two different mediation models. The results demonstrated that PA lowers the risk of falls [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.48-0.61], whereas sarcopenia increases the risk of falls (OR 1.34, 95% CI 1.16-1.55). Sarcopenia mediated the association between PA and falls, explaining a total of 2.69% of the association (indirect effect = -0.02). PA also had a significant mediating effect on the association between sarcopenia and falls, explaining a total of 20.12% of the association (indirect effect = 0.06). The proportion mediated by sarcopenia was 2.69% for PA and falls (indirect effect = -0.02). Our findings suggest that PA and sarcopenia have a direct effect on falls as well as an indirect effect through each other. Enhancing PA levels and preventing sarcopenia may help prevent falls in older adults.
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Affiliation(s)
| | - Lei Shi
- Sports Centre, Xi’an Jiaotong University, Xi’an 710049, China; (C.L.); (B.L.); (Z.H.)
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Roe LS, Harrison S, Cawthon PM, Ensrud K, Gabriel KP, Kado DM, Cauley JA. Breaking Up Sedentary Time Reduces Recurrent Fall Risk, but Not Incident Fracture Risk in Older Men. JBMR Plus 2023; 7:e10803. [PMID: 38130765 PMCID: PMC10731095 DOI: 10.1002/jbm4.10803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 12/23/2023] Open
Abstract
Apart from physical activity volume, frequent breaks from sedentary bouts and active bouts may differentially reduce fall and fracture risk. We assessed the longitudinal relationship between frequency of breaks from time spent sedentary and frequency of active bouts with recurrent falls and fractures. The sample included 2918 men aged 79.0 ± 5.1 years with free-living activity (SenseWear Armband) at the Osteoporotic Fractures in Men Study (MrOS) year 7 (2007-2009) visit. Men were divided into quartiles by the number of breaks from sedentary bouts (sedentary bout: 5+ minutes sedentary; <1.5 metabolic equivalents of task [METS]) and separately by active bout frequency (active bout: 5+ minutes of activity; ≥1.5 METS). Recurrent falls (2+ falls/year) and fractures were ascertained by self-report; fractures were radiographically confirmed. Generalized estimating equations estimated the recurrent fall odds, with restricted cubic splines applied to assess nonlinear relationships. Cox proportional hazards models estimated fracture risk. Over 4 years of follow-up after year 7, 1025 (35.1%) men were fallers. Over 8.40 ± 4.10 years of follow-up, 640 (21.9%) men experienced a fracture. There was a significant nonlinear U-shaped relationship between number of breaks from sedentary bouts and recurrent falls (p < 0.001); compared with men with few breaks from sedentary bouts (1.4-<13.6), the odds of recurrent falls were lower with a moderate number (13.6-<17.0, odds ratio [OR] = 0.82, 95% confidence interval [CI] 0.66, 1.01; 17.0-<20.4, OR = 0.79, 95% CI 0.64, 0.99), but not with the highest number of breaks from sedentary bouts (20.4-34.6, OR = 1.01, 95% CI 0.81, 1.27). Results remained borderline significant after adjusting for total sedentary time. Men with the highest compared with the lowest number of breaks from sedentary bouts had a lower fracture risk, but the association was attenuated after adjustment for total sedentary time. No associations were observed for active bout frequency. In conclusion, breaking up extended periods of sedentary time reduces fall risk regardless of total sedentary time. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Lauren S. Roe
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPAUSA
| | | | - Peggy M. Cawthon
- California Pacific Medical CenterResearch InstituteSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Kristine Ensrud
- Division of Epidemiology and Community Health, Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Health Care SystemMinneapolisMNUSA
| | | | - Deborah M. Kado
- Stanford University Department of MedicinePalo AltoCAUSA
- Geriatric Research Education and Clinical Center (GRECC)Veterans Administration Health SystemPalo AltoCAUSA
| | - Jane A. Cauley
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPAUSA
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Endress C, Schwenk M, Werner C, Becker C, Jansen CP. [Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?]. Z Gerontol Geriatr 2023; 56:464-469. [PMID: 37676321 DOI: 10.1007/s00391-023-02230-y] [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: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. OBJECTIVE The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6‑month follow-up and to determine which factors are associated with these changes. MATERIAL AND METHODS This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6‑month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression. RESULTS The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance. CONCLUSION The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).
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Affiliation(s)
- Christoph Endress
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Schwenk
- Human Performance Research Centre, Abteilung für Sportwissenschaft, Universität Konstanz, Konstanz, Deutschland
| | - Christian Werner
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Clemens Becker
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Unit Digitale Geriatrie, Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Carl-Philipp Jansen
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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6
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Wang Y, Chen Q, Liu L, He Q, Cheung JCW, Wong DWC, Liu Y, Lam WK. Training effects of set- and repetition-interval rest time on recumbent-boxing exercise: Could virtual reality improve further? iScience 2023; 26:107399. [PMID: 37575198 PMCID: PMC10415930 DOI: 10.1016/j.isci.2023.107399] [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: 02/06/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
This study examined the influence of set-interval and repetition-interval rest time of virtual reality (VR) boxing game in supine-lying posture. Fifty healthy middle-aged adults were randomly assigned into VR and non-VR groups to perform six different exercise protocols with varying set-interval and repetition-interval rest times (S0R0, S0R1/3, S0R2/3, S40R0, S40R1/3, and S40R2/3). Analysis on the non-VR group showed significant differences between exercise protocols for average heart rate (p < 0.001), maximum ventilation volume (p < 0.001), respiratory quotient (p < 0.001), oxygen pulse (p < 0.001), and excess post-exercise oxygen consumption (EPOC) (p = 0.003). VR appeared to have no further improvement on physical training effects in middle-aged adults, while the participants reported negative experience that might be associated with the over-exertion. Future study might need to explore game design elements that can accommodate high-exertion exercises.
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Affiliation(s)
- Yi Wang
- Department of Physical Education, Renmin University of China, Beijing 100872, China
- Sports and Social Development Research Center, Renmin University of China, Beijing 100872, China
| | - Qi Chen
- Physical Education Department, University of International Business and Economics, Beijing 100029, China
| | - Liangchao Liu
- Physical Education Department, University of International Business and Economics, Beijing 100029, China
| | - Qiuhong He
- School of Physical Education, Changzhou University, Changzhou 213164, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Yang Liu
- L&L Technology PTY Company Limited, Cheltenham, VIC 3192, Australia
- School of Mechanics and Safety Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Wing-Kai Lam
- Sports Information and External Affairs Center, Hong Kong Sports Institute, Hong Kong 999077, China
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Mandal B, Pradhan KC, Mohanty P, Muhammad T. Migration status, physical limitations and associated self-rated health: a study of older Indian adults. BMC Geriatr 2023; 23:316. [PMID: 37217859 DOI: 10.1186/s12877-023-04002-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults. METHODS This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives. RESULTS Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems. CONCLUSIONS The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.
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Affiliation(s)
- Bittu Mandal
- School of Humanities and Social Sciences, Indian Institute of Technology Indore, Khandwa Road, Simrol, 453552, Indore, India.
| | - Kalandi Charan Pradhan
- School of Humanities and Social Sciences, Indian Institute of Technology Indore, Khandwa Road, Simrol, 453552, Indore, India
| | - Parimala Mohanty
- Institute of Medical Sciences & Sum Hospital, Siksha "O" Anusandhan, Bhubaneswar, 751030, Odisha, India
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
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Jansen CP, Gottschalk S, Nerz C, Labudek S, Kramer-Gmeiner F, Klenk J, Clemson L, Todd C, Dams J, König HH, Becker C, Schwenk M. Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program: final results from the LiFE-is-LiFE non-inferiority trial. Age Ageing 2023; 52:6998047. [PMID: 36702515 DOI: 10.1093/ageing/afac331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, considering higher risk of falling due to possible PA enhancement. OBJECTIVE to investigate non-inferiority in terms of PA-adjusted fall risk and cost-effectiveness of gLiFE at 12-month follow-up. DESIGN single-blinded, randomised, multi-centre non-inferiority trial. SETTING community. SUBJECTS in total, 309 adults aged 70+ years at risk of or with history of falling; n = 153 in gLiFE, n = 156 in LiFE. METHODS LiFE was delivered one-to-one at the participants' homes, gLiFE in a group. PA-adjusted fall risk was analysed using negative binomial regression to compare incidence rate ratios (IRR). Cost-effectiveness was presented by incremental cost-effectiveness ratios and cost-effectiveness acceptability curves, considering quality-adjusted life years, PA and falls as effect measures. Secondary analyses included PA (steps/day) and fall outcomes. RESULTS non-inferiority was inconclusive (IRR 0.96; 95% confidence interval, CI 0.67; 1.37); intervention costs were lower for gLiFE, but cost-effectiveness was uncertain. gLiFE participants significantly increased PA (+1,090 steps/day; 95% CI 345 and 1.835) versus insignificant increase in LiFE (+569, 95% CI -31; 1,168). Number of falls and fallers were reduced in both formats. CONCLUSION non-inferiority of gLiFE compared with LiFE was inconclusive after 12 months. Increases in PA were clinically relevant in both groups, although nearly twice as high in gLiFE. Despite lower intervention costs of gLiFE, it was not clearly superior in terms of cost-effectiveness.
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Affiliation(s)
- Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
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Jiang Y, Wang M, Liu S, Ya X, Duan G, Wang Z. The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis. Front Public Health 2022; 10:1019551. [PMID: 36438277 PMCID: PMC9691853 DOI: 10.3389/fpubh.2022.1019551] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background It is generally believed that sedentary behavior (SB) increases the risk of falls among older adults, but the evidence for it remains inconsistent and scarce. Purpose Our study aims to provide a systematic review and meta-analysis of available evidence regarding the association of SB with falls in older adults. Method A comprehensive search strategy was conducted using several online databases from 1906 to March 2022. Cohort studies both concerning the association between SB and falls and involving participants over 60 years old were regarded as eligible for inclusion. Evidence was pooled by a random-effects meta-analysis. Quality assessment for individual studies was performed with the Newcastle-Ottawa Scale (NOS). Results Altogether seven publications were identified, and the age of the 24,750 individuals involved ranging from 60 to 99 years old. Overall quality of the included studies was rated as moderate-to-high quality. We found that SB was significantly associated with increased risk of falls compared with non-SB among older adults [Odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.07-1.28; I 2 = 46.90%, P heterogeneity = 0.07, random model]. Subgroup analyses that stratified the studies according to NOS score showed significant differences between groups. Subgroup analysis stratified by SB measurement, sample size, region, publication year, and follow-up duration showed no significant differences between groups. Conclusion The findings provide reliable support for the hypothesis that sedentary lifestyles are strong predictors of falls among older adults, offering critical indications to develop strategies for fall prevention.
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Affiliation(s)
- YueShuai Jiang
- School of Sports Management and Communication, Capital Institute of Physical Education and Sports, Beijing, China
| | - Mei Wang
- School of Dance and Martial Arts, Capital Institute of Physical Education and Sports, Beijing, China
| | - Shuang Liu
- Department of Physical Education, Beijing International Studies University, Beijing, China
| | - Xiao Ya
- Department of Physical Education, Beijing No. 2 Middle School, Beijing Economic-Technological Development Area School, Beijing, China
| | - GuanTing Duan
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - ZiPu Wang
- School of Sports Management and Communication, Capital Institute of Physical Education and Sports, Beijing, China,*Correspondence: ZiPu Wang
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10
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Suri A, VanSwearingen J, Dunlap P, Redfern MS, Rosso AL, Sejdić E. Facilitators and barriers to real-life mobility in community-dwelling older adults: a narrative review of accelerometry- and global positioning system-based studies. Aging Clin Exp Res 2022; 34:1733-1746. [PMID: 35275373 PMCID: PMC8913857 DOI: 10.1007/s40520-022-02096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/01/2022]
Abstract
Real-life mobility, also called "enacted" mobility, characterizes an individual's activity and participation in the community. Real-life mobility may be facilitated or hindered by a variety of factors, such as physical abilities, cognitive function, psychosocial aspects, and external environment characteristics. Advances in technology have allowed for objective quantification of real-life mobility using wearable sensors, specifically, accelerometry and global positioning systems (GPSs). In this review article, first, we summarize the common mobility measures extracted from accelerometry and GPS. Second, we summarize studies assessing the associations of facilitators and barriers influencing mobility of community-dwelling older adults with mobility measures from sensor technology. We found the most used accelerometry measures focus on the duration and intensity of activity in daily life. Gait quality measures, e.g., cadence, variability, and symmetry, are not usually included. GPS has been used to investigate mobility behavior, such as spatial and temporal measures of path traveled, location nodes traversed, and mode of transportation. Factors of note that facilitate/hinder community mobility were cognition and psychosocial influences. Fewer studies have included the influence of external environments, such as sidewalk quality, and socio-economic status in defining enacted mobility. Increasing our understanding of the facilitators and barriers to enacted mobility can inform wearable technology-enabled interventions targeted at delaying mobility-related disability and improving participation of older adults in the community.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela Dunlap
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- The Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada.
- North York General Hospital, Toronto, ON, Canada.
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11
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Wallbank G, Sherrington C, Hassett L, Kwasnicka D, Chau JY, Phongsavan P, Grunseit A, Martin F, Canning CG, Baird M, Shepherd R, Tiedemann A. Acceptability and feasibility of an online physical activity program for women over 50: a pilot trial. Transl Behav Med 2022; 12:225-236. [PMID: 35020938 DOI: 10.1093/tbm/ibab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Regular physical activity benefits health across the lifespan. Women in middle-age often juggle carer and work responsibilities, are often inactive, and may benefit from tailored support to increase physical activity. Establish the acceptability, feasibility, and impact on physical activity of a scalable program for women 50+ years. This pilot trial randomized participants to immediate program access, or to a wait-list control. [Active Women over 50 Online] program included: (1) study-specific website, (2) 8 emails or 24 SMS motivation-based messages, (3) one telephone health-coaching session. Outcomes, at 3 months, were acceptability (recommend study participation, intervention uptake), feasibility (recruitment, reach, completion), intervention impact (physical activity), intervention impressions. At baseline, 62 participants of mean (SD) age 59 (±7) years took 7459 (±2424) steps/day and most (92%) reported ≥2 medical conditions. At 3 months, acceptability and impact data were available for 52 (84%) and 57 (92%) participants, respectively. Study participation was recommended by 83% of participants. Participants mostly agreed to receive health coaching (81%) and messages (87%: email = 56%, SMS = 44%), opened 82% of emails and accessed the website 4.8 times on average. Respondents reported the intervention supported their physical activity. Intervention participants were more likely to increase steps from baseline by 2000+/day (OR: 6.31, 95% CI: 1.22 to 32.70, p = .028) than controls, and trended toward more light-intensity (p = .075) and moderate-vigorous intensity physical activity (p = .11). The [Active Women over 50 Online] program demonstrated acceptability and feasibility among the target population, and effectiveness in some domains in the short term. Results warrant further testing in a full-scale RCT.
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Affiliation(s)
- Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Josephine Y Chau
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Grunseit
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fiona Martin
- Department of Media and Communications, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marian Baird
- Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Roberta Shepherd
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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12
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The Role of Daily Step Count in Determining Risk Factors for Falls. J Aging Phys Act 2022; 31:400-407. [DOI: 10.1123/japa.2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Falls risk is often assessed without considering exposure to risk. We examined the risk factors associated with falls in those with greater and lower levels of daily step count. Falls were recorded over 12 months using bimonthly calendars in community-dwelling older people (mean age 72.0, SD 6.9). Daily step count was measured using a pedometer worn consecutively for 7 days. A cut score of <5,575.5 steps/day was used to identify people with lower step count. Negative binominal models were used to identify cognitive, medical, and sensorimotor factors associated with falls in those with higher versus lower levels of daily step count. In those with lower daily step count, poorer executive function, slower gait speed, and lower steps per day were associated with increased falls risk. In those with higher step count, only mood was associated with increased falls risk. Considering daily step count is important when assessing falls risk in older people.
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13
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Thalmann M, Ringli L, Adcock M, Swinnen N, de Jong J, Dumoulin C, Guimarães V, de Bruin ED. Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413422. [PMID: 34949028 PMCID: PMC8705921 DOI: 10.3390/ijerph182413422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.
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Affiliation(s)
- Melanie Thalmann
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Lisa Ringli
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Manuela Adcock
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Nathalie Swinnen
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium;
- University Psychiatric Centre, KU Leuven, 3070 Kortenberg, Belgium
| | | | - Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | | | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 171 77 Stockholm, Sweden
- Department of Health, OST—Eastern Swiss University of Applied Sciences, 9001 St. Gallen, Switzerland
- Correspondence: ; Tel.: +41-44-632-40-18
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14
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Honda K, Sekiguchi Y, Sasaki A, Shimazaki S, Suzuki R, Suzuki T, Kanetaka H, Izumi SI. Effects of seat height on whole-body movement and lower limb muscle power during sit-to-stand movements in young and older individuals. J Biomech 2021; 129:110813. [PMID: 34666246 DOI: 10.1016/j.jbiomech.2021.110813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 08/20/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
Sit-to-stand (STS) movements from low seat height are not easily executed by older individuals. Although young individuals increase their lower limb muscle power (LLMP) based on the product of the ground reaction force (GRF) and center of mass velocity (CoMv) during STS movement from a low seat height, it remains unclear whether seat height has an effect on LLMP during STS movement in older individuals. The present study aimed to investigate differences in the LLMP during STS movements when seat height is lowered between young and older individuals. Twelve older and twelve height-matched young individuals were instructed to perform STS movements from low (20 cm), middle (40 cm), and high (60 cm) seat heights. STS movement and GRF were obtained by a motion analysis system and force plates. In the low-seat-height condition, the forward and upward LLMPs and the upward CoMv were significantly lower in older individuals than those in young individuals, but the forward CoMv was not. The completion time of STS movement from a low seat height was significantly longer in older individuals than in young individuals. Our findings suggest that the slower upward CoMv due to the lower upward LLMP extends the completion time of STS movement from a low seat height in older individuals. Furthermore, in the low-seat-height condition, older individuals may move their center of mass (CoM) forward in a different way when compared with young individuals, and they may not use forward LLMP for moving CoM forward.
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Affiliation(s)
- Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Akiko Sasaki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | | | - Rie Suzuki
- TOTO Ltd., 2-8-1 Honson, Chigasaki 253-8577, Japan.
| | | | - Hiroyasu Kanetaka
- Laison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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15
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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study. J Aging Phys Act 2021; 30:635-645. [PMID: 34627127 DOI: 10.1123/japa.2021-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63-97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.
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16
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Gottschalk S, König HH, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, Dams J. Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years. J Am Med Dir Assoc 2021; 23:736-742.e6. [PMID: 34626579 DOI: 10.1016/j.jamda.2021.08.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program compared with an individually delivered program version. DESIGN An economic evaluation conducted alongside the LiFE-is-LiFE randomized non-inferiority trial. INTERVENTIONS Group and individually delivered version of a program consisting of strength and balance exercises integrated into everyday activities to prevent falls. SETTING AND PARTICIPANTS 309 community-dwelling older adults (aged ≥70 years) at risk of falling recruited around Heidelberg and Stuttgart (Germany). METHODS Cost-effectiveness of the group program was assessed over 6 months using different effect measures [quality-adjusted life years (QALYs, EQ-5D-5L), physical activity (mean number of steps/day), and falls] and cost perspectives (societal and payer's). Incremental cost-effectiveness ratios were determined, and cost-effectiveness acceptability curves were constructed. RESULTS From a societal perspective, mean costs, the number of falls, and the number of steps/day were somewhat higher in the group program, whereas QALYs were almost identical between the 2 interventions. From the payer's perspective, the incremental cost-effectiveness ratio for the group compared to the individual program were €56,733 per QALY and €4755 per fall prevented. Based on the cost-effectiveness acceptability curves, the cost-effectiveness of the group program had to be rated as uncertain for both effect measures and perspectives. In contrast, it demonstrated cost-effectiveness for increasing physical activity at willingness-to-pay values per additional 1000 steps/day of €1600 (societal perspective) or €600 (payer's perspective). CONCLUSIONS AND IMPLICATIONS Compared to the individual program, the group program might be cost-effective for increasing physical activity in older adults but was unlikely to be cost-effective with regard to QALY or for preventing falls. The cost-effectiveness should be evaluated long-term and compared to a regular care group.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Heidelberg, Germany; Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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17
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Ramsey KA, Zhou W, Rojer AGM, Reijnierse EM, Maier AB. Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: a systematic review. Ann Phys Rehabil Med 2021; 65:101571. [PMID: 34530151 DOI: 10.1016/j.rehab.2021.101571] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Higher physical activity (PA) and lower sedentary behaviour (SB) are associated with better muscle strength, balance, and functional ability, which are imperative for avoiding falls. This systematic review aimed to describe the association between objectively measured PA and SB with falls, fear of falling, and fractures. METHODS Six databases were searched from inception to July 21, 2020 for articles reporting the association of objectively measured PA/SB with falls, fear of falling, and/or fractures in community-dwelling older adults ≥60 years old. Results were synthesized in effect-direction heat maps and albatross plots expressed as Pearson's correlation coefficients (R). RESULTS A total of 43 articles were included, representing 27,629 (range 26 to 5,545) community-dwelling older adults (mean [SD] age 76.6 [8.4] years, 47% female). Longitudinal associations were reported in 13 articles and cross-sectional associations in 30. Falls were reported in 11 articles, fear of falling in 18 and fractures in 2. Higher PA and lower SB were associated with less fear of falling (median [interquartile range] Rs = steps: -0.214 [0.249; -0.148], total PA: -0.240 [0.267; -0.144], and moderate-to-vigorous PA: -0.180 [0.382; -0.121]), but these associations did not extend to falls or fractures, which showed inconsistent effect directions. CONCLUSION Fear of falling is associated with less engagement in PA and more SB, thus indicating that it is a psychological barrier to an active lifestyle. Varying effect directions for associations between PA and SB with falls and fractures may provide evidence for non-linear associations and require further research considering details of the fall or fracture incident. PROSPERO REGISTRATION NUMBER CRD42018103910.
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Affiliation(s)
- Keenan A Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Waner Zhou
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Anna G M Rojer
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore.
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18
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Jansen CP, Klenk J, Nerz C, Todd C, Labudek S, Kramer-Gmeiner F, Becker C, Schwenk M. Association between everyday walking activity, objective and perceived risk of falling in older adults. Age Ageing 2021; 50:1586-1592. [PMID: 33710267 PMCID: PMC8437067 DOI: 10.1093/ageing/afab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into 'vigorous' (low ORF/PRF), 'anxious' (low ORF/high PRF), 'stoic' (high ORF/low PRF) and 'aware' (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet. OBJECTIVE we examined everyday walking activity in those four groups and its association with ORF and PRF. DESIGN cross-sectional. SETTING community. SUBJECTS N = 294 participants aged 70 years and older. METHODS ORF was determined based on multiple independent risk factors; PRF was determined based on the Short Falls Efficacy Scale-International. Subjects were allocated to the four groups accordingly. Linear regression was used to quantify the associations of these groups with the mean number of accelerometer-assessed steps per day over 1 week as the dependent variable. 'Vigorous' was used as the reference group. RESULTS average number of steps per day in the four groups were 6,339 ('vigorous'), 5,781 ('anxious'), 4,555 ('stoic') and 4,528 ('aware'). Compared with the 'vigorous', 'stoic' (-1,482; confidence interval (CI): -2,473; -491) and 'aware' (-1,481; CI: -2,504; -458) participants took significantly less steps, but not the 'anxious' (-580 steps; CI: -1,440; 280). CONCLUSION we have integrated a digital mobility outcome into a fall risk categorisation based on ORF and PRF. Steps per day in this sample of community-dwelling older persons were in accordance with their ORF rather than their PRF. Whether this grouping approach can be used for the specification of participants' needs when taking part in programmes to prevent falls and simultaneously promote physical activity remains to be answered in intervention studies.
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Affiliation(s)
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Chris Todd
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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19
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Jansen CP, Nerz C, Labudek S, Gottschalk S, Kramer-Gmeiner F, Klenk J, Dams J, König HH, Clemson L, Becker C, Schwenk M. Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial. Int J Behav Nutr Phys Act 2021; 18:115. [PMID: 34479573 PMCID: PMC8414469 DOI: 10.1186/s12966-021-01190-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The 'Lifestyle-integrated Functional Exercise' (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. METHODS Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant's home (LiFE), followed by two "booster" phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. RESULTS Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under "real world" assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. CONCLUSIONS Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. TRIAL REGISTRATION The study was preregistered under clinicaltrials.gov (identifier: NCT03462654 ) on March 12th 2018.
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Affiliation(s)
- Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
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20
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Taniguchi M, Sawano S, Maegawa S, Ikezoe T, Ichihashi N. Physical Activity Mediates the Relationship between Gait Function and Fall Incidence after Total Knee Arthroplasty. J Knee Surg 2021; 34:1205-1211. [PMID: 32131104 DOI: 10.1055/s-0040-1702165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present study aims to examine (1) the preoperative factors that can predict postoperative falls, (2) whether postoperative physical activity (PA) mediates the relationship between fall incidence and gait function, and (3) whether postoperative PA levels are associated with fall risk in total knee arthroplasty (TKA) patients. Ninety-six patients (mean age: 72.0 ± 6.1 years) who were observed postoperatively for 6 months were selected. Timed up and go (TUG) was assessed as an indicator of gait function. Fall incidence and PA were investigated for 6 months post-TKA. The body mass index, history of preoperative falls, knee pain, knee extensor strength, range of motion in knee flexion, and modified gait efficacy scale were evaluated. Additionally, postoperative PA levels were categorized into three groups-low: <3,000, moderate: 3,000 to 4,000, and high: ≥4,000 steps/day. The relative fall incidence rate was calculated according to the total number of falls normalized for every 1,000 steps/day for 6 months postoperatively. Twenty-five (26.0%) of the 96 patients had at least one fall. The TUG, knee pain, and knee extensor strength were identified preoperatively as significant variables affecting postoperative falls. The mediated effects model revealed that postoperative fall incidence was predicted by preoperative TUG and postoperative PA. Postoperative PA was significantly associated with preoperative TUG. Moreover, both the preoperative TUG and postoperative PA were selected as significant variables for predicting fall incidence. Thus, postoperative PA mediates the relationship between gait function and fall incidence after TKA. Furthermore, the relative fall incidence rate associated with a low PA level was significantly higher than that associated with moderate and high PA levels. In conclusion, preoperative assessments of TUG performance, muscle strength, and knee pain were effective in predicting fall risk. Additionally, an increase in PA could contribute to reducing fall risk in TKA patients. Therefore, our results suggest that preoperative screening for fall predictors and managing postoperative PA could reduce the fall incidence in TKA patients.
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Affiliation(s)
- Masashi Taniguchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Sawano
- Rehabilitation Units, Shiga University of Medical Science Hospital, Tsukinowa-cho, Seta, Otsu City, Shiga, Japan
| | - Shoji Maegawa
- Rehabilitation Units, Shiga University of Medical Science Hospital, Tsukinowa-cho, Seta, Otsu City, Shiga, Japan
| | - Tome Ikezoe
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
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21
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Mobility impact and well-being in later life: A multidisciplinary systematic review. RESEARCH IN TRANSPORTATION ECONOMICS 2021; 86:100975. [PMCID: PMC7547325 DOI: 10.1016/j.retrec.2020.100975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/19/2020] [Accepted: 10/02/2020] [Indexed: 06/01/2023]
Abstract
In modern societies, the understanding of how active mobility affects the elderly's psycho-physical well-being is crucial to design ageing-friendly transport measures. From a multidisciplinary perspective, this systematic review points out the mobility impact on three elements of the EU Active Ageing Index: health, independence and social connectedness. By scanning four databases (Scopus, Web of Science, PubMed, and TRID), 3727 peer-reviewed papers published in the last decade were found, of which 57 met the inclusion criteria. The screening process was conducted following the PRISMA protocol and registered to the database PROSPERO, while the quality assessment was done using the Mixed Methods Appraisal Tool. More than 80% of the papers showed that an active mobility prevents psycho-physical harms, while only few papers study the relation of mobility with independence and social inclusion, to reduce the need for assistance and the related public expenditures. The findings of this review give important information both to transportation researchers and policymakers and companies, underlining the need for further research as well as investments in targeted age-friendly transport systems. The Covid-19 emergency has further underlined the importance of this issue, being the elderly one of the more disadvantaged and frailer social group.
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22
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Rosenberg DE, Rillamas-Sun E, Bellettiere J, LaMonte M, Buchner DM, Di C, Hunt J, Marshall S, Stefanick M, Zhang Y, LaCroix AZ. Accelerometer-Measured Sedentary Patterns are Associated with Incident Falls in Older Women. J Am Geriatr Soc 2021; 69:718-725. [PMID: 33252141 PMCID: PMC8020891 DOI: 10.1111/jgs.16923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Falls cause significant problems for older adults. Sedentary time is associated with lower physical function and could increase the risk for falls. DESIGN Prospective study. SETTING Sites across the United States. PARTICIPANTS Older women (N = 5,545, mean age 79 years) from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS Accelerometers worn at the hip for up to 1 week collected measures of daily sedentary time and the mean sedentary bout duration, a commonly used metric for sedentary accumulation patterns. For up to 13 months after accelerometer wear, women reported daily whether they had fallen on monthly calendars. RESULTS In fully adjusted models, the incident rate ratios (95% confidence interval) for quartiles 1 (lowest), 2, 3, and 4 of sedentary time respectively were 1.0 (ref.), 1.07 (0.93-1.24), 1.07 (0.91-1.25), and 1.14 (0.96-1.35; P-trend = .65) and for mean sedentary bout duration was 1.0 (ref.), 1.05 (0.92-1.21), 1.02 (0.88-1.17), and 1.17 (1.01-1.37; P-trend = .01), respectively. Women with a history of two or more falls had stronger associations between sedentary time and falls incidence compared with women with a history of no or one fall (P for interaction = .046). CONCLUSIONS Older women in the highest quartile of mean sedentary bout duration had a significantly increased risk of falling. Women with a history of frequent falling may be at higher risk for falling if they have high sedentary time. Interventions testing whether shortening total sedentary time and/or sedentary bouts lowers fall risk are needed to confirm these observational findings.
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Affiliation(s)
- Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - John Bellettiere
- Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Michael LaMonte
- Department of Epidemiology and Environmental health, State University of New York, Buffalo, New York, USA
| | - David M Buchner
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julie Hunt
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Stephen Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marcia Stefanick
- Medicine - Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Yuzheng Zhang
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Family Medicine and Public Health, University of California, San Diego, California, USA
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23
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To Q, Huynh VA, Do D, Do V, Congdon N, Meuleners L, Vandelanotte C, Hong H, Nguyen H, To K. Falls and Physical Activity among Cataract Patients in Vietnam. Ophthalmic Epidemiol 2021; 29:70-77. [PMID: 33627039 DOI: 10.1080/09286586.2021.1893341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the relationship between falls, physical activity, and other socio-demographic and visual factors among cataract patients in Ho Chi Minh City, Vietnam. METHODS A cross-sectional study was conducted between April and November 2018. Patients presenting to two hospitals with age-related unilateral or bilateral cataract, aged ≥50 years, literate, and scheduled for a first-eye cataract surgery were recruited. The International Physical Activity Questionnaires short form was used to measure physical activity. Visual disability score was self-reported using the Catquest-9SF. The number of falls in the last 12 months prior to data collection were self-reported. Visual acuity and contrast sensitivity were measured using standard protocols. RESULTS A total of 340 patients had complete data, the majority of whom were women (62.4%), living with a spouse (66.5%), had an education level of Grade 5 or below (68.2%), and a monthly income from medium to high (58.5%). Average age was 65.7 years. A total of 135 falls were reported in the last 12 months with 27.6% reporting ≥1 fall and 7.1% ≥2 falls. Persons with high (adjusted Prevalence Ratio (aPR) = 2.4, 95%CI = 1.2, 4.7) and low (aPR = 2.4, 95%CI = 1.2, 4.6) physical activity levels had more falls compared to those with moderate levels. Women (aPR = 1.7, 95%CI = 1.04, 2.7) and those with medium income (aPR = 2.9, 95%CI = 1.2, 6.9) were more likely to fall. Poor binocular logMAR visual acuity with habitual correction (aPR = 2.3, 95%CI = 1.1, 4.6) and poor visual disability scores (aPR = 1.4, 95%CI = 1.02, 2.0) were associated with falling. CONCLUSION Patients with a moderate level of physical activity were less likely to fall compared to those with low or high levels although this U-shape relationship needs to be further investigated in prospective interventional trials. Men and those with high monthly income, better visual acuity and visual disability score were also less likely to fall. Cataract patients might be advised to maintain a moderate level of physical activity while waiting for surgery. Strategies to prevent falls may also prioritise cataract surgery for women and those with lower income.
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Affiliation(s)
- Quyen To
- Postdoctoral Research Fellow, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Physical Activity Research Group, Appleton Institute, Central Queensland University, Australia
| | - Van-Anh Huynh
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Dung Do
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Vu Do
- Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lynn Meuleners
- School of Population and Global Health, University of Western, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Australia.,Research Professor, Physical Activity Research Group Leader, Appleton Institute School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Hiep Hong
- University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ho Nguyen
- Trung Vuong Hospital, Ho Chi Minh City, Vietnam
| | - Kien To
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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24
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Klima DW, Davey A. Screening Gait Performance, Falls, and Physical Activity among Benedictine and Trappist Monks. J Prim Care Community Health 2021; 12:2150132721990187. [PMID: 33522368 PMCID: PMC8772351 DOI: 10.1177/2150132721990187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background and Objective: Physical performance in older men has been reported in analyses with veterans and in disease-based cohort research. Studies examining gait performance among older monks, however, are narrow. The purpose of this study was to analyze the impact of a recent fall on gait ability in a cohort of Benedictine and Trappist monks in 4 US monastic communities. The second aim was to analyze physical activity and a recent fall as predictive markers of 2 constructs of gait performance. Methods: In this cross-sectional study, 53 Benedictine and Trappist monks over 60 (x = 74.7 ± 7.6; range: 61-94 years) completed a basic sociodemographic and fall history profile, the Timed Up and Go (TUG) Test, Dynamic Gait Index (DGI) and the Physical Activity Scale for the Elderly (PASE). Results: Demographic profiles revealed that 10% of participants had fallen over the past 3 months; in addition, those who had fallen were more likely to limit activities because of fear of falling (P = .005). Monks who had fallen over the past 3 months demonstrated significantly poorer TUG (12.6 ± 2.1 vs 10.5 ± 1.8; P = .01) and DGI (17.2 ± 5.3 vs 22.3 ± 2.3; P < .001) scores. There was a significant association between physical activity and both the TUG (–0.55; P < .001) and DGI (64; P < .001). Multiple regression models demonstrated that physical activity and a fall in the past 3 months predicted 24% of the variance in the TUG (P < .001) and 46% of the variance in the DGI (P < .001). Conclusions: Gait performance is linked to a recent fall episode among older monks. Predictive determinants of functional mobility (TUG) and superimposing tasks on the gait cycle (DGI) include recent fall history and physical activity. Appropriate health promotion activities can be aligned with these lifestyle attributes in monastic communities.
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Affiliation(s)
- Dennis W Klima
- University of Maryland Eastern Shore, Princess Anne, MD, USA
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25
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Del Din S, Galna B, Lord S, Nieuwboer A, Bekkers EMJ, Pelosin E, Avanzino L, Bloem BR, Olde Rikkert MGM, Nieuwhof F, Cereatti A, Della Croce U, Mirelman A, Hausdorff JM, Rochester L. Falls Risk in Relation to Activity Exposure in High-Risk Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:1198-1205. [PMID: 31942969 PMCID: PMC7243591 DOI: 10.1093/gerona/glaa007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 11/27/2022] Open
Abstract
Background Physical activity is linked to many positive health outcomes, stimulating the development of exercise programs. However, many falls occur while walking and so promoting activity might paradoxically increase fall rates, causing injuries, and worse quality of life. The relationship between activity exposure and fall rates remains unclear. We investigated the relationship between walking activity (exposure to risk) and fall rates before and after an exercise program (V-TIME). Methods One hundred and nine older fallers, 38 fallers with mild cognitive impairment (MCI), and 128 fallers with Parkinson’s disease (PD) were randomly assigned to one of two active interventions: treadmill training only or treadmill training combined with a virtual reality component. Participants were tested before and after the interventions. Free-living walking activity was characterized by volume, pattern, and variability of ambulatory bouts using an accelerometer positioned on the lower back for 1 week. To evaluate that relationship between fall risk and activity, a normalized index was determined expressing fall rates relative to activity exposure (FRA index), with higher scores indicating a higher risk of falls per steps taken. Results At baseline, the FRA index was higher for fallers with PD compared to those with MCI and older fallers. Walking activity did not change after the intervention for the groups but the FRA index decreased significantly for all groups (p ≤ .035). Conclusions This work showed that V-TIME interventions reduced falls risk without concurrent change in walking activity. We recommend using the FRA index in future fall prevention studies to better understand the nature of intervention programs.
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Affiliation(s)
- Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Lord
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Esther M J Bekkers
- KU Leuven, Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Belgium
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genova, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Freek Nieuwhof
- Radboud University Medical Center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Radboud University Medical Center, Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Andrea Cereatti
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, Bioengineering Unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration, Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel.,Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Choi P, Wei T, Motl RW, Agiovlasitis S. Risk factors associated with history of falls in adults with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 106:103748. [PMID: 32911340 DOI: 10.1016/j.ridd.2020.103748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/17/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adults with intellectual disability (ID) have a higher risk for falls than the general population. AIM The purpose of this study was to identify risk factors for falls in adults with ID using objective measurements. METHODS Eighty adults with ID (men 36 women 44 age 43 ± 13 years) provided data on falls history, health problems or limitations in daily life, physical activity (PA), and physical performance. We conducted independent-samples t-tests, and Chi-square (χ2) tests to examine the difference between fallers and non-fallers. Multivariate logistic regressions were performed to identify the independent effects of risk factors for falls in adults with ID. RESULTS Fallers had significantly lower SPPB, mobility, and moderate PA than non-fallers (p < .05). Fallers were more likely to be older, need support with activities of daily living (ADLs), and have arthritis or rheumatism, walking problem, and limitations to participating in PA than non-fallers (p < .05). Among these variables, only needing support with ADLs remained a significant independent predictor of falls in a multivariate model. CONCLUSION Support need for ADLs can predict falls in individuals with ID. Caregivers may need to closely monitor adults with ID who need support for ADLs.
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Affiliation(s)
- Poram Choi
- Mississippi State University, Department of Kinesiology, McCarthy Gym, MS, 39762, United States.
| | - Tianlan Wei
- Mississippi State University, Department of Counseling, Educational Psychology and Foundation, 175 Presidents Circle, MS, 39762, United States.
| | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, School of Health Professions Bldg. Room 360X, 1716 9th Avenue South, Birmingham, AL, 35233, United States.
| | - Stamatis Agiovlasitis
- Mississippi State University, Department of Kinesiology, McCarthy Gym, MS, 39762, United States.
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Association between accelerometer-measured physical activity and falls among community-dwelling older people living in cold, snowy areas. Eur Geriatr Med 2020; 12:91-98. [PMID: 32975746 DOI: 10.1007/s41999-020-00398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present study was to investigate the association between falls, including falls on frozen roads, and physical activity among older people living in cold, snowy regions in Japan. METHODS Participants were subjects of the Japan Gerontological Evaluation Study 2016 who had agreed to the Hokkaido additional visit survey in winter 2017/18 and lived in cold, snowy regions in Japan. The analysis included 461 participants (mean age 74.7 years; standard deviation 2.8 years; 46.5% male). Sociodemographic characteristics, physical activity (min/day of moderate-to-vigorous intensity physical activity [MVPA] and light intensity physical activity, and walking steps/day) measured by accelerometer, cognitive function, depression, visual impairment, and history of stroke were surveyed. Poisson regression analyses were performed to clarify the association between prevalence of falls and physical activity. RESULTS Of those who reported a fall with location, 86 (69.9%) fell on frozen roads, 24 (19.5%) fell on unfrozen roads and 13 (10.6%) fell indoors. There were significant positive associations between MVPA (adjusted prevalence ratio [aPR] Tertile [T] 3 vs T1, 1.73; 95% confidence interval [CI], 1.04-2.87) and all falls. When limited to falls on frozen roads, higher MVPA levels and walking steps were associated with falls on frozen roads (MVPA, aPR T3 vs T1, 2.16; 95% CI, 1.19-3.94; walking steps, aPR T3 vs T1, 2.49; 95%CI 1.33-4.68). CONCLUSION The risk of falls, especially on frozen roads, increased among active older people living in cold, snowy regions, and environmental factors should be considered when determining prevention strategies.
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Lu Z, Lam FMH, Leung JCS, Kwok TCY. The U-Shaped Relationship Between Levels of Bouted Activity and Fall Incidence in Community-Dwelling Older Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 75:e145-e151. [PMID: 32115656 PMCID: PMC7518560 DOI: 10.1093/gerona/glaa058] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It remains uncertain whether the association between physical activity (PA) and falls is U-shaped, and few studies have explored the potential mediation of PA accumulation pattern. METHODS We measured PA in 671 community-dwelling older adults (82.7 ± 3.8 years) using wrist-worn accelerometer for 7 days. PA was further classified to bouted PA (≥10 minutes bout length) and sporadic PA (<10 minutes bout length) for subanalysis. Fall incidence in the following 12-month was recorded through tri-monthly telephone interviews. Classification and Regression Tree analysis was used to identify two optimal cutoff values of each PA measurement to predict falls. Participants were then divided into "inactive," "moderately active," and "highly active" groups accordingly. Negative binomial regression models were used to estimate the association between the PA measures and fall incidence. RESULTS Six hundred and thirty-nine participants completed 12-month follow-up. Ninety-three (14.6%) experienced a total of 118 falls. Inactive and highly active older adults had higher falls per person month relative to the moderately active group (inactive: incidence rate ratios [IRR] = 2.372, 95% confidence interval [CI] = 1.317-4.271; highly active: IRR = 2.731, 95% CI = 1.196-6.232). Subanalyses found similar significant finding with bouted PA (p < .001) but not sporadic PA (p ≥ .221). The association between bouted PA and falls remained significant even after adjusting fall incidence for bouted activity time (inactive: IRR = 3.636, 95% CI = 2.238-5.907; highly active: IRR = 1.823, 95% CI = 1.072-3.1). Further adjustments for fall-related risk factors did not meaningfully change the results. CONCLUSION A U-shaped relationship was identified between bouted but not sporadic PA and fall incidence. There is an approximately twofold increase in fall rate in highly active older adults even after adjusting for activity time.
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Affiliation(s)
- Zhihui Lu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Freddy M H Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
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Rosenberg D, Walker R, Greenwood-Hickman MA, Bellettiere J, Xiang Y, Richmire K, Higgins M, Wing D, Larson EB, Crane PK, LaCroix AZ. Device-assessed physical activity and sedentary behavior in a community-based cohort of older adults. BMC Public Health 2020; 20:1256. [PMID: 32811454 PMCID: PMC7436994 DOI: 10.1186/s12889-020-09330-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Few studies characterize older adult physical activity and sitting patterns using accurate accelerometer and concurrent posture measures. In this descriptive paper, we report accelerometer data collection protocols, consent rates, and physical behavior measures from a population-based cohort study (Adult Changes in Thought, ACT). METHODS The ACT study holds enrollment steady at approximately 2000 members of Kaiser Permanente Washington aged 65+ without dementia undergoing detailed biennial assessments. In 2016 the ACT-Activity Monitor (ACT-AM) sub-study was initiated to obtain data from wearing activPAL and ActiGraph devices for 7 days following regular biennial visits. We describe the methods protocol of ACT-AM and present characteristics of people who did and did not consent to wear devices. We compute inverse probability of response weights and incorporate these weights in linear regression models to estimate means and 95% confidence intervals (CI) of device-based pattern metrics, adjusted for wear time and demographic factors, and weighted to account for potential selection bias due to device-wear consent. RESULTS Among 1885 eligible ACT participants, 56% agreed to wear both devices (mean age 77 years, 56% female, 89% non-Hispanic white, 91% with post-secondary education). On average, those who agreed to wear devices were younger and healthier. Estimated mean (95% CI) activPAL-derived sitting, standing, and stepping times were 10.2 h/day (603-618 min/day), 3.9 h/day (226-239 min/day), and 1.4 h/day (79-84 min/day), respectively. Estimated mean ActiGraph derived sedentary (Vector Magnitude [VM] < =18 counts/15 s), light intensity (VM 19-518 counts/15 s), and moderate-to-vigorous intensity (VM > 518 counts/15 s) physical activity durations were 9.5 h/day (565-577 min/day), 4.5 h/day (267-276 min/day), and 1.0 h/day (59-64 min/day). Participants who were older, had chronic conditions, and were unable to walk a half-mile had higher sedentary time and less physical activity. CONCLUSIONS Our recruitment rate demonstrates the feasibility of cohort participants to wear two devices that measure sedentary time and physical activity. Data indicate high levels of sitting time in older adults but also high levels of physical activity using cut-points developed for older adults. These data will help researchers test hypotheses related to physical behavior and health in older adults in the future.
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Affiliation(s)
- Dori Rosenberg
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
| | - Rod Walker
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | | | - John Bellettiere
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Yunhua Xiang
- University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - KatieRose Richmire
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Michael Higgins
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - David Wing
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Paul K Crane
- University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
| | - Andrea Z LaCroix
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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Lawal TA, Todd JJ, Elliott JS, Linton MM, Andres M, Witherspoon JW, Collins JP, Chrismer IC, Tounkara F, Waite MR, Nichols C, Bönnemann CG, Vuillerot C, Bendixen R, Jain MS, Meilleur KG. Assessing Motor Function in Congenital Muscular Dystrophy Patients Using Accelerometry. J Neurosci Nurs 2020; 52:172-178. [PMID: 32511172 PMCID: PMC10449085 DOI: 10.1097/jnn.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND When tested in a controlled clinic environment, individuals with neuromuscular-related symptoms may complete motor tasks within normal predicted ranges. However, measuring activity at home may better reflect typical motor performance. The accuracy of accelerometry measurements in individuals with congenital muscular dystrophy (CMD) is unknown. We aimed to compare accelerometry and manual step counts and assess free-living physical activity intensity in individuals with CMD using accelerometry. METHODS Ambulatory pediatric CMD participants (n = 9) performed the 6-minute walk test in clinic while wearing ActiGraph GT3X accelerometer devices. During the test, manual step counting was conducted to assess concurrent validity of the ActiGraph step count in this population using Bland-Altman analysis. In addition, activity intensity of 6 pediatric CMD participants was monitored at home with accelerometer devices for an average of 7 days. Cut-point values previously validated for neuromuscular disorders were used for data analysis. RESULTS Bland-Altman and intraclass correlation analyses showed no concurrent validity between manual and ActiGraph-recorded step counts. Fewer steps were recorded by ActiGraph step counts compared with manual step counts (411 ± 74 vs 699 ± 43, respectively; P = .004). Although improved, results were in the same direction with the application of low-frequency extension filters (587 ± 40 vs 699 ± 43, P = .03). ActiGraph step-count data did not correlate with manual step count (Spearman ρ = 0.32, P = .41; with low-frequency extension: Spearman ρ = 0.45, P = .22). Seven-day physical activity monitoring showed that participants spent more than 80% of their time in the sedentary activity level. CONCLUSIONS In a controlled clinic setting, step count was significantly lower by ActiGraph GT3X than by manual step counting, possibly because of the abnormal gait in this population. Additional studies using triaxial assessment are needed to validate accelerometry measurement of activity intensity in individuals with CMD. Accelerometry outcomes may provide valuable measures and complement the 6-minute walk test in the assessment of treatment efficacy in CMD.
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Villumsen M, Grarup B, Christensen SWMP, Palsson TS, Hirata RP. "Study protocol for the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (the NOCfao study)". BMC Geriatr 2020; 20:198. [PMID: 32513121 PMCID: PMC7278063 DOI: 10.1186/s12877-020-01535-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 03/25/2020] [Indexed: 01/06/2023] Open
Abstract
Background Accidental falls are common among community-dwellers, probably due to the level of physical activity and impaired postural stability. Today, fall risk prediction tools’ discriminative validity are only moderate. In order to increase the accuracy, multiple variables such as highly validated objective field measurements of physical activity and impaired postural stability should be adressed in order to predict falls. The main aim of this paper is to describe the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (NOCfao) investigating the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. Methods The study consists of a baseline session where the participants are asked to respond to three questionnaires, perform physical tests (i.e., measuring strength in the upper and lower extremities, balance, and walking speed), participate in an assessment of pain sensitivity, and to wear an ankle mounted pedometer for measuring physical activity for 5 days. Subsequently, the fall incidences and the circumstances surrounding the falls during the previous 1 to 2 months will be recorded throughout a one-year follow-up period. Discussion This study will add to the present-day understanding of the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. These data will provide valid and reliable information on the relationship between these variables and their significance for community-dwelling older adults. Trial registration ClinicalTrials.gov identifier: NCT2995317. Registered December 13th, 2016.
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Affiliation(s)
- Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark
| | - Bo Grarup
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark.
| | - Steffan Wittrup Mc Phee Christensen
- Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark
| | | | - Rogerio Pessoto Hirata
- Performance and Technology, Department of Health Science and Technology Aalborg University, Niels Jernes Vej 12, 9220, Aalborg East, Denmark
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Physical performances show conflicting associations in aged manual workers. Sci Rep 2020; 10:2254. [PMID: 32042126 PMCID: PMC7010773 DOI: 10.1038/s41598-020-59050-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022] Open
Abstract
Ageing is associated with a decrease in physical performance implying that aged manual workers may be unable to match the physical requirements of their jobs. In this cross-sectional study, 96 male manual workers aged 51–72 years were recruited. Outcomes included handgrip strength (HGS), fat-free mass (FFM), fat percentage, cardiorespiratory fitness (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{{\rm{V}}}$$\end{document}V˙O2max), forced vital capacity (FVC), forced expiratory volume after 1 s (FEV1), spinal flexibility, sit-to-stand test performance and static balance. Covariates included height, smoking habits, leisure-time physical activity and systemic inflammation from blood samples. Outcomes were also compared with general populations. Age was negatively related to FFM and FEV1, whereas static balance (velocity of displacement) was positively associated with age. Greater HGS, but poorer \documentclass[12pt]{minimal}
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\begin{document}$$\dot{{\rm{V}}}$$\end{document}V˙O2max and FEV1/FEV ratio were found compared with general populations. Age was negatively related with physical performances although a large part of the variance in performance could be explained by factors other than age such as smoking and systemic inflammation. The manual workers had greater muscle strength but had poorer cardiorespiratory fitness and lung function when compared with general populations. Specific health interventions targeting specifically cardiorespiratory fitness, lung function, and balance may be needed to maintain physical performances among manual workers.
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Taylor L, Parsons J, Taylor D, Binns E, Lord S, Edlin R, Rochester L, Del Din S, Klenk J, Buckley C, Cavadino A, Moyes SA, Kerse N. Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial. Trials 2020; 21:46. [PMID: 31915043 PMCID: PMC6950827 DOI: 10.1186/s13063-019-3949-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/02/2019] [Indexed: 01/30/2023] Open
Abstract
Background Falls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively. Methods/design This is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period. Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs. The trial commenced recruitment on 30 November 2018. Discussion This study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.
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Affiliation(s)
- Lynne Taylor
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand. .,Auckland University of Technology, Health and Rehabilitation Research Institute, Auckland, New Zealand.
| | - John Parsons
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Denise Taylor
- Auckland University of Technology, Health and Rehabilitation Research Institute, Auckland, New Zealand
| | - Elizabeth Binns
- Auckland University of Technology, Health and Rehabilitation Research Institute, Auckland, New Zealand
| | - Sue Lord
- Auckland University of Technology, Health and Rehabilitation Research Institute, Auckland, New Zealand
| | - Richard Edlin
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry Ulm, Ulm University, Ulm, Germany.,Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Stuttgart, Germany
| | - Christopher Buckley
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alana Cavadino
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Simon A Moyes
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Ngaire Kerse
- The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
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Mazo GZ, Lima RE, Franco PS, Hoffmann L, Menezes EC. Components of physical fitness as prognostic factors for falls in elderly female exercise practitioners: a longitudinal study. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.032.ao59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Physical exercise is used as a strategy for the prevention of falls because it improves the physical fitness of older adults. Objective: To determine which components of physical fitness are predictors of falls in elderly female exercise practitioners. Method: Longitudinal, descriptive, comparative study. The components of physical fitness (upper and lower limb strength and flexibility, agility, aerobic endurance, and hand grip strength) and the occurrence or not of falls in the last 12 months were analyzed in 80 older women practitioners of exercise from 2013 to 2016. Descriptive analysis, ROC curve attributing cut-off points, and binary logistic regression for the prediction of falls were used. Results: The mean age of the participants was 67.46 years (SD=7.65). Over the years, a significant difference between elderly fallers and non-fallers was observed for right hand grip strength (2013 and 2015), left hand grip strength (2014 and 2015), lower limb flexibility (2013, 2014 and 2015), agility (2015), and aerobic endurance (2015). In adjusted analysis, older women with poor lower limb flexibility in 2013 had a higher risk of falls in 2016 (OR=4.98; 95%CI 1.12 - 22.1). Older women with poor flexibility in 2015 also had a higher risk of falls (OR= 6.08; 95%CI 1.06 - 34.67). Conclusion: Poor performance in the lower limb flexibility, right and left hand grip strength, agility and aerobic endurance tests was associated with falls and these components are predictors of future falls in elderly exercise practitioners.
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Effect of a Comprehensive Health Care Program on Blood Pressure, Blood Glucose, Body Composition, and Depression in Older Adults Living Alone: A Quasi-Experimental Pretest-Posttest Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010220. [PMID: 31892263 PMCID: PMC6982085 DOI: 10.3390/ijerph17010220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 12/02/2022]
Abstract
This study explored the effects of a comprehensive health-care program (CHCP) on blood pressure, blood glucose, body composition, and depression in older adults living alone. We used a quasi-experimental, two-group, pretest–posttest design. The CHCP consisted of open lectures, health counseling, exercise classes, nutrition counseling, and self-help group meetings at a local senior welfare center. Fifty-eight subjects participated in this study, with thirty subjects in the experimental group and twenty-eight subjects in the control group. Data were analyzed by using the descriptive statistics, χ2-test, and t-test. Comparisons of the pretest and posttest systolic blood pressure (t = −2.530, p < 0.016) and blood glucose (t = 3.089, p < 0.004) between the experimental and control groups showed significant differences. In both the experimental (t = 3.949, p < 0.001) and control groups (t = 3.816, p < 0.002), depression symptoms showed a significant decrease posttest, compared with pretest. Our findings infer that older adults require physical and psychosocial health care and that more efforts must be made to improve the general health and well-being of this population group.
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Abstract
Besides its known function as a transport protein for testosterone and other steroid hormones, sex hormone-binding globulin (SHBG) is a biomarker associated with many adverse health effects. The aim of this study was to investigate the association of physical activity with SHBG serum levels in older adults. The physical activity and SHBG values for 1,259 older adults (43.4% female; 56.6% male) with a mean age of 75.6 ± 6.5 years were included in the analysis. The average daily walking duration was 104.2 ± 40.4 (mean ± SD) min. A positive dose-response relationship of daily walking duration with quartiles of SHBG was seen after adjustment for age, sex, history of cardiovascular diseases, diabetes, smoking, γ-glutamyl transferase, and C-reactive protein (p for trend = .010). However, this relationship disappeared after adjustment for body mass index (p for trend = .977). Body mass index seems to be an important determinant of SHBG and a possible confounding factor in the relationship of physical activity and SHBG.
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Duck AA, Stewart MW, Robinson JC. Physical activity and postural balance in rural community dwelling older adults. Appl Nurs Res 2019; 48:1-7. [PMID: 31266601 PMCID: PMC6690351 DOI: 10.1016/j.apnr.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was two-fold: 1) identify the types of physical activity being done among rural community dwelling older adults; and 2) determine the relationship between amount of physical activity and postural balance in that population. BACKGROUND Balance impairment coupled with other fall risk factors pose a formidable challenge for aging adults. This study identified types of physical activity rural-community dwelling older adults do and explored the relationship between amount (in minutes) of physical activity and balance. METHODS A cross sectional, correlational design was used to recruit rural community-dwelling older adults. Data were collected using the Jackson Heart Study Physical Activity Survey, Berg Balance Scale, and Timed Up and Go Test; ActiGraph accelerometers were worn to objectively measure physical activity. RESULTS One hundred and one participants enrolled. Most were female (78%), White (74%), and between 65 and 91 years old. Berg Balance Scale scores positively correlated with average minutes of light (r = 0.262) and moderate (r = 0.276) physical activity; and the Jackson Heart Study Physical Activity Survey active living index (r = 0.320) and home and garden index (r = 0.324). In regression models, age and sex were the strongest predictors of Berg Balance Scale (adjusted r2 = 0.313, F(6, 89) = 8.203, P ≤ 0.001). Physical activity was not associated. CONCLUSIONS Minutes of light or moderate physical activity were not associated with balance. However, investigating factors such as physical activity that influence health functional status and balance deserve continuous attention.
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Affiliation(s)
- Angela A Duck
- University of Mississippi Medical Center, Jackson, MS, United States of America.
| | - Mary W Stewart
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Jennifer C Robinson
- University of Mississippi Medical Center, Jackson, MS, United States of America
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Taheri-Kharameh Z, Poorolajal J, Bashirian S, Heydari Moghadam R, Parham M, Barati M, Rásky É. Risk factors for falls in Iranian older adults: a case-control study. Int J Inj Contr Saf Promot 2019; 26:354-359. [PMID: 31195925 DOI: 10.1080/17457300.2019.1615958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Falls are an important cause of morbidity and mortality in older adults. Identifying potential risk factors would provide a considerable public health benefit. The objective of this retrospective study was to determine the risk factors for falling among Iranian older adults. Two hundred eighty community-dwelling elders, with and without a history of falls, participated in the study. Elders aged 60 or over referred to retirement centres completed a multi-section questionnaire on demographic information, behavioural, environmental, and medical factors of fall from May to September 2018. Data analysis was performed with descriptive statistics and logistic regression using the Stata version 14 software. Sedentary activity level (OR: 2.14; 95% CI: 1.85, 3.23), hearing loss (OR: 2.17; 95% CI: 1.23, 3.83), vertigo or dizziness (OR: 2.24; 95% CI: 1.02, 4.91) and visual impairment (OR: 1.63; 95% CI: 1.01, 2.67) were important predictors of falls. No significant associations were observed between falls with demographic factors and medication. This study indicates several modifiable risk factors may be associated with falls that affect the health of older adults. Appropriate interventions are necessary to reduce modifiable risk factors of falls of high-risk elders.
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Affiliation(s)
- Zahra Taheri-Kharameh
- Students Research committee, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Bashirian
- Department of Public Health, School of Health, Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rashid Heydari Moghadam
- Department of Ergonomics, School of Health, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahmoud Parham
- Clinical Research Development Center, Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Majid Barati
- Department of Public Health, School of Health, Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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Pettee Gabriel K, Griswold ME, Wang W, Conway SH, Windham BG, Palta P, Kucharska-Newton A, Pompeii LA. Physical activity trajectories and subsequent fall risk: ARIC Study. Prev Med 2019; 121:40-46. [PMID: 30742870 PMCID: PMC6448408 DOI: 10.1016/j.ypmed.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/25/2018] [Accepted: 02/08/2019] [Indexed: 01/17/2023]
Abstract
To examine the impact of moderate to vigorous intensity physical activity (MVPA) trajectories during midlife and older adulthood with subsequent fall risk in later life. Cross-temporal analyses were conducted in 15,792 participants (27% black, 55% women) aged 45 to 64 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. MVPA was collected at Exams 1 (1987-89), 3 (1993-95) and 5 (2011-13) using the ARIC/Baecke questionnaire. Latent class growth analysis was used to identify the MVPA trajectory groups. Reported falls outcomes were collected in 2013-14, 2015-16, and 2016-17. Generalized Linear Models were used to estimate associations of baseline predictors with trajectory class membership, as well as associations of trajectory classes with any falling (adjusted incident relative risks, aIRR) and with number of falls (adjusted relative rates, aRR). Four primary trajectory classes emerged, reflecting longitudinal patterns of maintained high (48%), maintained low (22%), increasing (14%) and decreasing (15%) MVPA. After adjustment for covariates, the decreasing MVPA trajectory group had a 14% higher risk of reporting any falling compared to the maintained high MVPA group [aIRR = 1.14 (1.01, 1.28)]. When compared to the maintained high MVPA group, the maintained low and decreasing group had a 28% [aRR = 1.28 (1.14, 1.44)] and 27% [aRR = 1.27 (1.17, 1.38)] higher rate in the reported number of falls, respectively. Findings support public health campaigns targeting habitual MVPA or exercise for fall prevention and suggest that interventions should be initiated in midlife; a time when individuals may be more able and willing to change behavior.
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Affiliation(s)
- Kelley Pettee Gabriel
- UTHealth School of Public Health - Austin Campus, Department of Epidemiology, Human Genetics, and Environmental Sciences, Austin, TX, USA; The University of Texas at Austin, Dell Medical School, Department of Women's Health, Austin, TX, USA; The University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, USA.
| | - Michael E Griswold
- The University of Mississippi Medical Center, Department of Data Science, Jackson, MS, USA
| | - Wanmei Wang
- The University of Mississippi Medical Center, Department of Data Science, Jackson, MS, USA
| | - Sadie H Conway
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Houston, TX, USA
| | - B Gwen Windham
- The University of Mississippi Medical Center, Department of Medicine, Division of Geriatrics, Jackson, MS, USA
| | - Priya Palta
- Columbia University, Department of Medicine, Division of General Medicine, New York, NY, USA
| | - Anna Kucharska-Newton
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Lisa A Pompeii
- Baylor College of Medicine, Department of Pediatrics, Center for Epidemiology & Population Health, Houston, TX USA
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Smith L, Stubbs B, Hamer M. Changes in Physical Activity Behavior and Risk of Falls Over 8 Years' Follow-Up: English Longitudinal Study of Aging. Mayo Clin Proc 2019; 94:365-367. [PMID: 30711135 DOI: 10.1016/j.mayocp.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/25/2018] [Accepted: 11/13/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Brendon Stubbs
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, De Crespigny Park, London, UK
| | - Mark Hamer
- School Sport, Exercise Health Sciences, Loughborough University, Loughborough, UK
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Oliveira AEPD, Ostolin TLVDP, Vieira WDO, Arantes RL, Gagliardi ARDT, Sperandio EF, Dourado VZ. The association between physical activity, sedentary behavior and the occurrence of falls in asymptomatic adults over 40 years old. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Sedentary behavior (SB) has been described as an independent risk factor for health, regardless of the recommended amount of moderate-to-vigorous physical activity (MVPA). However, SB and MVPA as predictors of falls have been poorly investigated. Objective: To compare the associations between SB and MVPA and the occurrence of falls in middle-aged and older adults. Method: The participants wore a triaxial accelerometer over the dominant hip for seven days to measure SB and MVPA. The occurrence of falls and cardiovascular risk factors were assessed by self-report. Isokinetic peak torque (PT) of knee extension, peak oxygen uptake (V’O2) in a ramp treadmill protocol, and lean (LBM) body mass and body fat (BFM) (bioelectrical impedance) were also assessed. The critical roles of SB and MVPA on the occurrence of falls were compared by multiple logistic regression adjusted for age, sex, cardiovascular risk factors, LBM, peak V’O2, and PT of knee extension. Results: 379 participants were evaluated, aged 40-80 years. Forty-eight participants reported at least one fall in the previous 12 months (14.5%). Fallers presented lower SB and higher MVPA. They were predominantly women and older adults with lower physical fitness. After multivariate analysis, MVPA, but not SB, was selected as an independent predictor of falls, increasing the odds ratio of having a fall (1.184, 95% confidence interval, 1.016 - 1.378). Conclusion: Episodes of falls in predominantly middle-aged and women subjects were associated with a higher amount of MVPA, not the opposite, indicating an adverse effect of MVPA in these subjects.
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Kihara Y, Yamaguchi R, Makino K, Shimizu K, Ito K, Furuna T. Relationship between the occurrence of falls by season and physical functions of community-dwelling old-old people living in cold, snowy areas. Geriatr Gerontol Int 2018; 19:124-129. [PMID: 30565831 DOI: 10.1111/ggi.13566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 12/01/2022]
Abstract
AIM To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons. METHODS Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χ2 -test, Student's t-test and Mann-Whitney U-test. Logistic regression analysis was carried out. spss version 25 was used for the statistical analysis. The level of significance was set at 5%. RESULTS No differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy. CONCLUSIONS When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.
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Affiliation(s)
- Yuriko Kihara
- Department of Physical Therapy, Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan.,Department of Rehabilitation, Japan Health Care College, Eniwa, Japan
| | - Ryo Yamaguchi
- Department of Physical Therapy, Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kotaro Shimizu
- Department of Physical Therapy, Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kazunari Ito
- Department of Physical Therapy, Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Taketo Furuna
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
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Jansen CP, Nerz C, Kramer F, Labudek S, Klenk J, Dams J, König HH, Clemson L, Becker C, Schwenk M. Comparison of a group-delivered and individually delivered lifestyle-integrated functional exercise (LiFE) program in older persons: a randomized noninferiority trial. BMC Geriatr 2018; 18:267. [PMID: 30400832 PMCID: PMC6219201 DOI: 10.1186/s12877-018-0953-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Lifestyle-Integrated Functional Exercise (LiFE) program is effective in improving strength, balance, and physical activity (PA) while simultaneously reducing falls in older people by incorporating exercise activities in recurring daily tasks. However, implementing the original LiFE program includes substantial resource requirements. Therefore, as part of the LiFE-is-LiFE project, a group format (gLiFE) of the LiFE program has been developed, which will be tested regarding its noninferiority to the individually delivered LiFE in terms of PA-adjusted fall incidence and overall cost-effectiveness. METHODS In a multi-centre, single-blinded noninferiority trial, an envisaged sample of N = 300 participants (> 70 years; faller and/or confirmed falls risk; community-dwelling) will be randomized in either LiFE or gLiFE. Both groups will undergo the same strength and balance activities as well as PA promotion activities and habitualization strategies as described in the LiFE programme, however, based on different approaches of delivery: During the 6-month intervention phase, LiFE participants will receive seven home visits and two telephone calls; in gLiFE, the program will be delivered in seven group sessions and also two telephone calls. Main outcomes are a) fall incidence per PA and b) incremental cost-effectiveness ratio comparing costs and quality-adjusted life years between the two interventions. Secondary outcomes include PA behaviour, motor performance, health status, psychosocial status, program evaluation, and adherence. Measurements will be conducted at baseline, 6-month and 12-month follow-up; evaluation of intervention sessions and assessment of psychosocial variables related to execution and habitualization of LiFE activities will be made during the intervention period as well. DISCUSSION Compared to LiFE, we expect gLiFE to (a) reduce falls per PA by a similar rate; (b) be more cost-effective; (c) comparably enhance physical performance in terms of strength and balance as well as PA. By investigating the economic and societal benefit, this study will be of high practical relevance as noninferiority of gLiFE would facilitate large-scale implementation due to lower resource usage. This would result in better reach and increased accessibility, which is important for subjects with a history of falls and/or being at risk of falls. TRIAL REGISTRATION ClinicalTrials.gov NCT03462654 . Registered on March 12, 2018.
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Affiliation(s)
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Franziska Kramer
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB Hochschule Berlin, Studienzentrum Stuttgart, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Soares WJS, Lopes AD, Nogueira E, Candido V, de Moraes SA, Perracini MR. Physical Activity Level and Risk of Falling in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. J Aging Phys Act 2018; 27:1-10. [PMID: 29543113 DOI: 10.1123/japa.2017-0413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This systematic review examines the association between physical activity (PA) level and risk of falling in community-dwelling older adults. A search of PubMed, Embase, CINAHL, SPORTDiscus, and Web of Science was performed in January 2017. Four prospective cohort studies investigating the incidence of falls in a period of at least 12 months and its association with the level of PA in people aged 60 years and older were reviewed and pooled for meta-analysis. The pooled risk ratio (RR) for being a recurrent faller (2,420 participants) was 39% higher among those who were in the lowest PA level (RR = 1.39; 95% confidence interval [1.17, 1.65]; I2 = 0%, p = .43; p < .0001). The association between being a faller (7,927 participants) and PA level was inconclusive. This review identified that the benefit of general PA for preventing falls is associated with the adopted PA level.
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Li J, Zhang Q, Wang Q. Reply to letter to the editor: fracture risk after bariatric surgery: a possible involvement of physical activity. Obes Rev 2018; 19:1315-1316. [PMID: 30051960 DOI: 10.1111/obr.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Q Zhang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Q Wang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 370] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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Enhancing Physical Activity as Lifestyle Behavior in Older Persons: The Rome Statement. J Aging Phys Act 2018; 26:345-351. [DOI: 10.1123/japa.2017-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Musich S, Wang SS, Ruiz J, Hawkins K, Wicker E. The impact of mobility limitations on health outcomes among older adults. Geriatr Nurs 2018; 39:162-169. [DOI: 10.1016/j.gerinurse.2017.08.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
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Perry B, Herrington W, Goldsack JC, Grandinetti CA, Vasisht KP, Landray MJ, Bataille L, DiCicco RA, Bradley C, Narayan A, Papadopoulos EJ, Sheth N, Skodacek K, Stem K, Strong TV, Walton MK, Corneli A. Use of Mobile Devices to Measure Outcomes in Clinical Research, 2010-2016: A Systematic Literature Review. Digit Biomark 2018; 2:11-30. [PMID: 29938250 PMCID: PMC6008882 DOI: 10.1159/000486347] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023] Open
Abstract
Background The use of mobile devices in clinical research has advanced substantially in recent years due to the rapid pace of technology development. With an overall aim of informing the future use of mobile devices in interventional clinical research to measure primary outcomes, we conducted a systematic review of the use of and clinical outcomes measured by mobile devices (mobile outcomes) in observational and interventional clinical research. Method We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles on clinical research published between January 2010 and May 2016 in which mobile devices were used to measure study outcomes. We screened each publication for specific inclusion and exclusion criteria. We then identified and qualitatively summarized the use of mobile outcome assessments in clinical research, including the type and design of the study, therapeutic focus, type of mobile device(s) used, and specific mobile outcomes reported. Results The search retrieved 2,530 potential articles of interest. After screening, 88 publications remained. Twenty-five percent of the publications (n = 22) described mobile outcomes used in interventional research, and the rest (n = 66) described observational clinical research. Thirteen therapeutic areas were represented. Five categories of mobile devices were identified: (1) inertial sensors, (2) biosensors, (3) pressure sensors and walkways, (4) medication adherence monitors, and (5) location monitors; inertial sensors/accelerometers were most common (reported in 86% of the publications). Among the variety of mobile outcomes, various assessments of physical activity were most common (reported in 74% of the publications). Other mobile outcomes included assessments of sleep, mobility, and pill adherence, as well as biomarkers assessed using a mobile device, including cardiac measures, glucose, gastric reflux, respiratory measures, and intensity of head-related injury. Conclusion Mobile devices are being widely used in clinical research to assess outcomes, although their use in interventional research to assess therapeutic effectiveness is limited. For mobile devices to be used more frequently in pivotal interventional research – such as trials informing regulatory decision-making – more focus should be placed on: (1) consolidating the evidence supporting the clinical meaningfulness of specific mobile outcomes, and (2) standardizing the use of mobile devices in clinical research to measure specific mobile outcomes (e.g., data capture frequencies, placement of device). To that aim, this manuscript offers a broad overview of the various mobile outcome assessments currently used in observational and interventional research, and categorizes and consolidates this information for researchers interested in using mobile devices to assess outcomes in interventional research.
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Affiliation(s)
- Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
| | - Will Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer C Goldsack
- Clinical Trials Transformation Initiative, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Cheryl A Grandinetti
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kaveeta P Vasisht
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Martin J Landray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York, USA
| | | | - Corey Bradley
- Duke University Hospital, Durham, North Carolina, USA
| | | | - Elektra J Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nirav Sheth
- MicroMedicine, Watertown, Massachusetts, USA
| | - Ken Skodacek
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Marc K Walton
- Janssen Research and Development, Titusville, New Jersey, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Clinical Trials Transformation Initiative, Durham, North Carolina, USA
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