The Impact of Leisure and Social Activities on Activities of Daily Living of Middle-Aged Adults: Evidence from a National Longitudinal Survey in Japan

Association between daily step counts and healthy life years: a national cross-sectional study in Japan

BACKGROUND

Despite accumulating evidence concerning the association between daily step counts and mortality or disease risks, it is unclear whether daily step counts are associated with healthy life years.

METHODS

We used the combined dataset of the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey conducted for a randomly sampled general population in Japan, 2019. Daily step counts were measured for 4957 adult participants. The associations of daily step counts with activity limitations in daily living and self-assessed health were evaluated using a multivariable logistic regression model. The bootstrap method was employed to mitigate uncertainties in estimating the threshold of daily step counts.

RESULTS

The median age was 60 (44-71) years, and 2592 (52.3%) were female. The median daily step counts were 5650 (3332-8452). The adjusted OR of activity limitations in daily living for the adjacent daily step counts was 0.27 (95% CI 0.26 to 0.27) for all ages and 0.25 (95% CI 0.25 to 0.26) for older adults at the lowest, with the thresholds of significant association at 9000 step counts. The OR of self-assessed unhealthy status was 0.45 (95% CI 0.44 to 0.46) for all ages and 0.42 (95% CI 0.41 to 0.43) for older adults at the lowest, with the thresholds at 11 000 step counts.

CONCLUSION

Daily step counts were significantly associated with activity limitations in daily living and self-assessed health as determinants of healthy life years, up to 9000 and 11 000 step counts, respectively. These results suggest a target of daily step counts to prolong healthy life years within health initiatives.

Sports activity participation and subjective health status of patients after total hip arthroplasty via the anterolateral-supine approach: a case series study

Background

No reports have been published about participation in sports activity and subjective health status after total hip arthroplasty via the anterolateral approach in the supine position (ALS-THA) in Japanese patients. This study assessed sports activity participation and subjective health status, as well as factors potential associated with these variables, in patients who underwent ALS-THA.

Methods

Of 698 patients who underwent total hip arthroplasty at our institution between 2013 and 2018, questionnaires were sent to 355 patients under 80 years old who had undergone ALS-THA and 242 responded. Patients were asked about their subjective health status, participation in sports activity, the EuroQol 5-dimensions 5-level (EQ-5D-5L), the University of California Los Angeles (UCLA) activity scale score and the Forgotten Joint Score (FJS). Patient characteristics and hospitalization information were also collected. Patients’ subjective health status was categorized as “healthy” or “unhealthy”. Univariate and multivariate logistic regression analyses were performed to determine factors associated with participation in sports activity after ALS-THA and a “healthy” status.

Results

The pre- and postoperative sports activity participation rates were 54.0% and 57.8%, respectively. Most patients (76.8%, n = 182) were considered “healthy”. Age (P = .019) and UCLA activity score (P < .001) were significantly associated with sports activity after ALS-THA. FJS (P = .002) and EQ-5D-5L (P = .004) were significantly associated with a “healthy” status.

Conclusion

Patients participating in sports activity after ALS-THA are older and have higher UCLA activity scores and patients considered “healthy” have higher FJS and EQ-5D-5L scores.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05886-6.

Interpretable classifiers for prediction of disability trajectories using a nationwide longitudinal database

OBJECTIVES

To explore the heterogeneous disability trajectories and construct explainable machine learning models for effective prediction of long-term disability trajectories and understanding the mechanisms of predictions among the elderly Chinese at community level.

METHODS

This study retrospectively collected data from the Chinese Longitudinal Healthy Longevity and Happy Family Study between 2002 and 2018. A total of 4149 subjects aged 65 + in 2002 with completed activities of daily living (ADL) information for at least three waves were included. The mixed growth model was used to identify disability trajectories, and five machine learning models were further established to predict disability trajectories using epidemiological variables. An explainable approach was deployed to understand the model's decisions.

RESULTS

Three distinct disability trajectories, including normal class (77.3%), progressive class (15.5%), and high-onset class (7.2%), were identified for three-class prediction. The latter two were further merged into abnormal class, accompanied by normal class for two-class prediction. Machine learning, especially random forest and extreme gradient boosting achieved good performance in both two tasks. ADL, age, leisure activity, cognitive function, and blood pressure were key predictors.

CONCLUSION

The findings suggest that machine learning showed good performance and maybe of additional value in analyzing quality indicators in predicting disability trajectories, thereby providing basis to personalize intervention measures.

Relationships of leisure activities with physical and cognitive functions among Chinese older adults: A prospective community-based cohort study

OBJECTIVES

Based on a prospective design, this study aimed to investigate the relationships of leisure activities with physical and cognitive functions among Chinese older adults.

METHODS

The respondents aged 65 years or more were selected from the 2014-2018 of the Chinese Longitudinal Healthy Longevity Survey. Physical function measurement indicators were reflected by activities of daily living (ADL), instrumental activities of daily living (IADL), and physical performance (PP), while cognitive function was assessed by Mini-Mental State Examination. Fine-Gray competing risk regression models were used to analyze the data.

RESULTS

Using the figures for 2014 as a baseline for the study, we included 6047, 6216, 5951, and 5916 respondents in the ADL, IADL, PP, and cognitive function analyses, respectively. The prospective results showed that keeping domestic animals or pets was related to a lower risk of ADL disability of respondents after adjustment (SHR: 0.619, 95% CI: 0.486, 0.788). Similarly, taking part in social activities (SHR: 0.781, 95%CI: 0.658, 0.929) and reading books or newspapers (SHR: 0.793, 95% CI: 0.656, 0.958) were associated with a lower risk of IADL disability. Playing cards or mahjong was correlated with a lower risk of cognitive impairment (SHR: 0.669, 95% CI: 0.507, 0.882), while keeping domestic animals or pets was related to a higher risk of cognitive impairment (SHR: 1.279, 95% CI: 1.047, 1.562).

CONCLUSION

Participation in leisure activities moderately may decrease the risk of a decline in physical and cognitive functions among Chinese older adults.

Frequency-Response Relationship Between Exercise and Locomotive Syndrome Across Age Groups: Secondary Analysis of a Nationwide Cross-Sectional Study in Japan

OBJECTIVES

This study aimed to clarify the frequency-response relationship between exercise habits and locomotive syndrome in different age groups.

METHODS

We analyzed 8,681 independent community dwellers who participated in a nationwide cross-sectional locomotive syndrome study. Participants were divided into young (20-39 years), middle (40-64 years), and old (≥ 65 years) groups. The presence of locomotive syndrome was evaluated using the locomotive syndrome risk tests. Exercise habits were assessed by exercise frequency (almost every day/sometimes/occasionally/never). The association between locomotive syndrome and exercise was assessed using the multiple logistic regression analysis adjusted for participant characteristics for each age category.

RESULTS

Overall, 3,528 (41%) participants had locomotive syndrome. In the old group, the risk of locomotive syndrome was lower with an increased exercise frequency. However, this dose-response relationship was not found in the young group. The proportion of locomotive syndrome was lower even in participants who occasionally exercised (1-3 days/month) than those who never exercise in the young and middle age groups.

CONCLUSIONS

Regular exercise reduced the risk of locomotive syndrome not only in middle and older adults but also in young adults. Moreover, increasing exercise frequency may provide benefits for locomotive syndrome prevention, especially among older adults.

Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management

PURPOSE OF REVIEW

We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. We further address available management and therapeutic strategies.

RECENT FINDINGS

Vascular and neurodegenerative pathologies often co-occur and share similar risk factors. The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. Aggressive blood pressure control and multidomain lifestyle interventions are associated with decreased risk of cognitive impairment, but disease-modifying treatments are still lacking. Recent research has led to a better understanding of mechanisms leading to SVD-related cognitive decline, such as blood-brain barrier dysfunction, reduced cerebrovascular reactivity and impaired perivascular clearance.

SUMMARY

SVD is the leading cause of VCI and is associated with substantial morbidity. Tackling cardiovascular risk factors is currently the most effective approach to prevent cognitive decline in the elderly. Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. Designing and testing disease-modifying interventions for VCI remains a key priority in healthcare.

The interaction effect between physical and cultural leisure activities on the subsequent decline of instrumental ADL: the Fujiwara-kyo study

Background

Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown.

Methods

We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index).

Results

The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004).

Conclusions

We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.

Association between intelligence quotient and disability: The role of socioeconomic status

BACKGROUND

No study has investigated the association between intelligence quotient (IQ) and disability (i.e., difficulties in activities of daily living [ADL] or instrumental activities of daily living [IADL]) in the general population.

OBJECTIVE

The goal of this nationally representative study was to analyse the potential IQ-disability association in England and identify influential factors in this association.

METHODS

Cross-sectional data were analyzed from the 2007 Adult Psychiatric Morbidity Survey (n=6872). IQ was assessed by using the National Adult Reading Test, which consists of a list of 50 words and is scored by counting the number of errors in reading the words aloud. Disability was defined as difficulties in at least 1 of the 7 domains of ADL and IADL. Regression and mediation analyses were conducted to analyze the association between IQ and disability and identify potential factors involved in this relationship, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among the 6872 participants, the mean (SD) age was 46.9 (18.9) years; 51.8% were women. The prevalence of disability increased from 27.7% with IQ 120-129 to 51.0% with IQ 70-79. After adjusting for sex, age and ethnicity, as compared with IQ 120-129, with IQ 110-119, 100-109, 90-99, 80-89, and 70-79, the probability of disability was increased (OR 1.22 [95% CI 1.01-1.48], 1.42 [1.16-1.72], 1.86 [1.54-2.25], 2.41 [1.92-3.03], and 4.71 [3.56-6.17], respectively). In addition, we found a positive association between a 1-SD decrease in IQ and disability (OR 1.53, 95% CI 1.43-1.63). Finally, income (mediated percentage 26.9%), social class (18.0%) and education (11.6%) strongly affected the IQ-disability association, and these socioeconomic factors collectively explained 37.1% of the association.

CONCLUSIONS

Low IQ was positively associated with disability in England, and socioeconomic status explained more than one-third of this relationship.

Exercise or sports in midlife and healthy life expectancy: an ecological study in all prefectures in Japan

BACKGROUND

With the increase of overall life expectancy in Japan, effective and beneficial lifestyle approaches and practices are crucial for individuals to have a long, productive and healthy life. Although previous studies suggest that exercise or sports, especially when performed with others, from midlife level have a positive impact on enhancing healthy life expectancy, there is paucity of information regarding these contexts and possible associations. The present study intends to clarify the relationship between engagement in exercise or sports among middle-aged persons and healthy life expectancy through an ecological study in all prefectures in Japan.

METHODS

We tabulated (1) the ratios of middle-aged individuals engaged in exercise or sports and (2) the different methods by which they are engaged in exercise or sports for each prefecture by using data from the 2005-2010 Longitudinal Survey of Middle-aged and Elderly Persons by the Ministry of Health, Labour and Welfare of Japan. Weighted multiple linear regression analyses were performed by sex, using healthy life expectancy in 2010 of each prefecture calculated by Hashimoto (2013) as a criterion variable; indices of (1) and (2) of each year as explanatory variables; and age, living conditions, employment, and chronic diseases as adjusted variables.

RESULTS

For middle-aged males, the ratio of those engaged in exercise or sports in each year from 2005 to 2010 was positively correlated with healthy life expectancy; this relationship was found in the ratio of middle-aged engaging in exercise or sports "with families or friends". For females, such a relationship could only be found in the ratio of middle-aged females engaged in exercise or sports in 2008 and 2010, and those engaging in exercise or sports "with families or friends" in 2008.

CONCLUSION

Prefectures with a higher ratio of middle-aged individuals engaging in exercise or sports, especially when done with families or friends, have longer healthy life expectancies. This was particularly evident for males. Thus, exercise or sports with families or friends in midlife seems to be more effective in promoting healthy life expectancy for males than females in Japan.

Frequency and pattern of exercise and depression after two years in older Japanese adults: the JAGES longitudinal study

Few have clarified what exercise frequencies and patterns (e.g. alone or with others) are effective for preventing depression in older adults. We examined the relationship between total frequency and/or pattern of exercise and the risk of depression after two years in older Japanese adults. We used a sub-sample of the Japan Gerontological Evaluation Study (JAGES) performed in 2011 and 2013. The sample for analysis was 1,422 adults aged 65 years or older without depression and low physical strength in 2011. All variables were assessed with a questionnaire including the geriatric depression screening scale (GDS-15). Binomial logistic regression analysis was used to examine the relationships between exercise in 2011 and depression in 2013 (0 = non-depression, 1 = depression). The adjusted odds ratio (OR) for later depression was 0.52 (95% confidence intervals: 0.33–0.81) for exercise two or more times a week compared to non-exercisers. The OR for exercisers who exercise with others even a little (Ewo) was 0.53 (0.34–0.84) compared to non-exercisers. Among combinations of frequency and pattern, the OR for Ewo who exercise two or more times a week was 0.40 (0.24–0.68) compared to non-exercisers. Exercising at least twice a week and/or with others may be useful in preventing depression in older adults.