Correlates of physical activity among community-dwelling adults aged 50 or over in six low- and middle-income countries

Associations between sociodemographic and clinical characteristics and adherence to self-management behaviours among community-dwelling older adults with mild cognitive impairment

BACKGROUND

Self-management is vital for individuals with mild cognitive impairment (MCI) to enhance cognitive health and mitigate the risk of dementia. However, maintaining consistent engagement in self-management strategies can be challenging for older adults with MCI. This study aimed to explore the associations between sociodemographic and clinical characteristics and adherence to self-management behaviours among community-dwelling older adults with MCI.

METHODS

A cross-sectional study involving 467 community-dwelling older adults with MCI was conducted from July to November 2022 across Nanjing, Xuzhou, and Lianyungang in Jiangsu Province, China. Data on sociodemographic and clinical characteristics, as well as self-management behaviours for MCI, were collected. Multiple linear and binary logistic regressions were employed to identify factors influencing self-management behaviours.

RESULTS

Among the four recommended self-management behaviours for MCI, participants adopted an average of 1.37 ± 1.202 behaviours. Physical exercise (n = 239; 51.2%) was the most prevalent behaviour, followed by modifiable risk factors management (n = 156; 33.4%), cognitive training (n = 144; 30.8%), and cognitive function monitoring (n = 103; 22.1%). Higher education level (B = 0.286, P < 0.001), urban employee medical insurance (B = 0.621, P < 0.001), and non-smoking status (B = 0.389, P = 0.002) positively correlated with aggregate MCI self-management behaviours, while older age (B = -0.295, P < 0.001) had a negative association. Marital status, monthly income, employment status, gender, residence, and family history of cognitive disorders were also found to be associated with specific self-management behaviours for MCI.

CONCLUSIONS

Enhancing adherence to self-management among community-dwelling older adults with MCI is critical. Sociodemographic and clinical factors should be considered to pinpoint at-risk populations and accordingly tailor support strategies.

Prevalence of physical inactivity and associated factors among older adults in Gondar town, Northwest Ethiopia: a community-based cross-sectional study

INTRODUCTION

Older adults are increasing in number in both developed and developing countries. However, as the world's aging population grows, the burden of diseases among older people also increases. Despite this, co-occurring health problems due to physical inactivity in older adults have become a concern, and physical inactivity can be caused by different conditions. As a result, for older adults to have better health outcomes, early diagnosis of physical activity status and prevention of non-communicable diseases are crucial. There is a lack of data on the prevalence and associated factors of physical inactivity among older adults that is scarce in sub-Saharan Africa, particularly in the study area, Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of physical inactivity among older adults in Gondar town, Northwest Ethiopia, in 2022.

METHODS

A community-based cross-sectional study was conducted from April 1st to June 30th, 2022, in Gondar town, Northwest Ethiopia. The data was collected by the Global Physical Activity Questionnaire, Volume 2 through face-to-face interviews among 838 participants. Data were entered into Epinfo version 7.1, then exported and analysed using the Statistical Package of Social Science version 25. A binary logistic regression model was performed to identify factors associated with physical inactivity. The result was considered statistically significant based on an adjusted odds ratio of 95% and a p-value less than 0.05.

RESULT

The prevalence of physical inactivity was 65.6% (95% CI: 62.1-68.9). Being female (AOR: 3.053, 95% CI:1.487-6.267), age group > = 80 (AOR: 4.082, 95% CI:1.234-13.497), primary school level (AOR: 3.020, 95% CI:1.433-6.367), no formal education (AOR: 8.573, 95% CI:2.843-25.847), unemployed (AOR: 10.273, 95% CI:5.628-18.753), and symptoms of depression (AOR: 7.152, 95% CI: 4.786-17.965) were significantly associated with physical inactivity.

CONCLUSION

Physical inactivity was relatively high among older adults in Gondar town. Being female, older age, having low levels of education, being unemployed, and having depression symptoms were associated with physical inactivity. We suggest promoting the health benefits of physical activity among females by reducing their burden, older age groups, and unemployed older adults, and avoiding depression among individuals.

Physical Activity Intervention for Leisure-Time Activity Levels Among Older Adults: A Cluster Randomized Trial

Importance

Current randomized trial evidence of the effects of physical activity interventions in older adults is mainly from developed countries, with little reliable evidence from low- and middle-income countries, such as China, where race, culture, and lifestyles differ substantially from those in Western populations.

Objective

To evaluate the effects of a multilevel intervention for increasing leisure-time activity levels in Chinese older adults.

Design, Setting, and Participants

This cluster randomized trial was conducted from May 2021 to May 2023, including an 8-week intervention period and a follow-up period of 24 months. Eight villages in China were randomly assigned to the intervention (4 villages) or the control (4 villages) group. Potentially eligible participants were 60 years or older. A total of 511 older adults from the selected 8 villages were enrolled.

Interventions

The intervention group received an 8-week socioecological model-based intervention, comprising individual, interpersonal, and community-level components, whereas the control group did not.

Main Outcome and Measure

The primary outcome was the change in leisure-time activity at 8 weeks, measured by the Physical Activity Scale for the Elderly (PASE). Possible PASE scores for leisure-time activity range from 0 to 502, with higher scores indicating higher activity levels.

Results

A total of 511 older adults from 8 villages were recruited and randomly allocated to the intervention (240 participants, 4 villages) or control (271 participants, 4 villages) groups. The mean (SD) age was 70.95 (5.72) years, and 284 (55.6%) were female participants. Seven serious adverse events (unrelated deaths) were reported. Participants in the intervention group increased leisure-time activity more than those in the control group, with a mean difference in PASE scores of 13.74 points (95% CI, 8.58-18.91 points) between the groups at 8 weeks (P < .001). Significant differences in leisure-time activity were also found over 24 months (mean difference in scores at 4 weeks, 11.66 points; 95% CI, 6.41-16.90 points; P < .001; at 6 months, 12.35 points; 95% CI, 7.19-17.50 points; P < .001; at 12 months, 11.55 points; 95% CI, 6.32-16.78 points; P < .001; and at 24 months, 14.51 points; 95% CI, 9.28-19.75 points; P < .001).

Conclusions and Relevance

In this cluster randomized trial, the multilevel intervention was effective in promoting leisure-time activity over 24 months of follow-up in older adults from China. This finding suggests that implementation of such interventions could be an important step in addressing physical inactivity in older adults in low- and middle-income countries.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2100045653.

Neighborhood safety, fall indices, physical activity level and social participation restrictions from a population of community-dwelling older adults in Nsukka, Enugu State, Nigeria

BACKGROUND

Restriction in physical activity (PA) and social participation restriction (PR) can be heightened in the presence of fear of fall (FOF), fall experience, and perceived unsafe neighborhood, particularly among older adults. Despite the enormous benefits of social participation and physical activity, many older adults remain vulnerable to participation restriction and this probably accounts for a significant proportion of health challenges for older adults.

OBJECTIVE

This study investigated the relationship between neighborhood safety (NS), fall indices, physical activity, and social participation restriction among older adults from selected communities in Nsukka, Enugu state, Nigeria.

METHODS

This was a cross-sectional survey of 170 recruited via consecutive non-probability sampling techniques. Socio-demographic variables, co-morbidities, and fall prevalence were obtained using a self-administered questionnaire. The study instruments include the PA neighborhood environment scale - Nigeria (PANES-N), PA scale for elderly (PASE), Participation scale (PS), Modified fall efficacy scale (MFES), and Fall risk assessment tool (FRAT) and fall indices.

STATISTICAL ANALYSIS

Descriptive statistics of mean and standard deviations, frequency counts, and percentages were used to analyze the socio-demographic variables, and Inferential statistics of Spearman rank order correlation were used to determine the relationship among the neighborhood safety, fall indices, physical activity level, and participation restrictions.

RESULTS

PR has a negative relationship with NS (r = -0.19, p- 0.01), and fall efficacy (r = -0.52, p- 0.001). However, PR has a positive relationship with fall risk (r = 0.36, p = 0.001).

CONCLUSION

Participation restriction is negatively correlated with neighborhood safety, fall efficacy, and PA. The PR has a positive relationship with fall risk (FR).

Physical inactivity among internally displaced persons in Nigeria

Background

Physical inactivity may complicate physical and mental health problems among internally displaced persons (IDPs). This study aimed to assess the prevalence of physical inactivity and its sociodemographic correlates among IDPs in Northeastern Nigeria.

Methods

A total of 363 participants recruited from four IDP camps were categorized into physically inactive and active using International Physical Activity Questionnaire. Multiple logistic regression was used to explore the association between physical inactivity and sociodemographic correlates.

Results

The prevalence of physical inactivity was 36.2%. Those who were males (Odd Ratio (OR) = 4.52, 95% Confidence Interval (CI) = 2.33 to 8.78) and Kanuri (OR = 2.53, 95% CI = 1.44 to 4.45) were more likely to be physically inactive. Younger participants were less likely to be physically inactive than those who were aged >49 years old.

Conclusion

There is a high prevalence of physical inactivity among IDPs in Nigeria, and we found important sociodemographic factors associated with physical inactivity.

A hierarchy of correlates for objectively measured physical activity, sedentary time, and physical fitness in older adults: A CHAID analysis

The aging process reflects, in many cases, not only a decline in physical activity (PA) and physical fitness (PF), but also an increase in overall levels of sedentary time (ST). In order to hierarchically identify the most powerful correlates related to low and high levels of objectively assessed PA, ST, and PF during the late adulthood, a total of 2666 older adults were cross-sectionally evaluated. Multidimensional correlates were obtained through interview. Using chi-squared automatic detection analysis to identify the cluster of correlates with most impact on PA (<21.4 min/day), ST (≥8 h/day), and PF (<33.3th percentile), was found that the most likely subgroup to be physically inactive consisted of widowers not owning a computer and sport facilities in the neighbourhood (94.7%), while not being widowed, reporting to have a family that exercises and a computer at home (54.3%) represented the subgroup less likely to be inactive. Widowers without sidewalks in the neighbourhood were the most sedentary group (91.0%), while being a married woman and reporting to have space to exercise at home (40%) formed the most favourable group of correlates regarding ST. Men reporting a financial income <500€ and physical problems frequently formed the group with the lowest PF level (70.3%). In contrast, the less likely subgroup to have low levels of PF level consisted of having a financial income ≥1000€ and a computer at home (3.4%). Future interventions should target widowers with limited accessibility to computer and urban/sport-related infrastructures, as well as impaired older adults with low financial income.HighlightsChi-squared automatic interaction detection was used to identify and hierarchise correlates of objectively measured physical activity, sedentary time, and fitness.Widowers not having a computer at home and sport facilities in the neighbourhood were the most likely to be physically inactive, while not being widowed, having a family that exercises and a computer at home represented the subgroup less likely to be physically inactive.The most likely to be classified as sedentary were widowers without sidewalks in the neighbourhood, while the most favourable group of correlates regarding ST was formed by married women and reporting to have space to exercise at home.Individuals with a low financial income and physical problems comprised the population subgroup with the lowest PF levels, while having a medium-high financial income and a computer at home represented the less likely subgroup to have low levels of PF.

Prevalence and associated factors of physical inactivity among middle-aged and older adults in India: results of a national cross-sectional community survey

OBJECTIVE

This study aimed to determine the prevalence and associated factors of physical inactivity in middle-aged and older adults in India.

DESIGN

Population-based cross-sectional study.

SETTING

Nationally representative sample of general community-dwelling middle-aged and older adult population in India.

PARTICIPANTS

The sample included 72 262 adults (45 years and older, mean age 58.8 years, SD=11.8), from the longitudinal ageing study in India wave 1 in 2017-2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-reported physical activity, along with physical measurements, health status and health behaviour, and sociodemographic covariates. Multivariable logistic regression calculated OR with 95% CI for physical inactivity.

RESULTS

Overall, 36.7% were physically inactive, 42.6% among men, and 32.4% among women (p<0.001). In the adjusted logistic regression analysis, among both men and women, older age (70 years and older), being Sikh, impaired vision and depressive symptoms were positively and cognitive functioning, current tobacco use and social participation were negatively associated with physical inactivity. In addition, among men, higher socioeconomic status, urban residence, functional disability and heart disease or stroke were positively associated with physical inactivity, and among women being married and higher education were negatively, and insomnia symptoms and poor or fair self-rated health status were positively associated with physical inactivity.

CONCLUSIONS

Almost 4 in 10 middle-aged and older adults in India had inadequate physical activity. Overall and gender specific risk factors for physical inactivity were identified. Interventions may operate at multiple levels and consider gender-related physical inactivity patterns.

Perceived neighborhood social cohesion and the 10-year risk of cardiovascular disease in low- and middle-income countries: The World Health Organization Study on Global Aging and Adult Health

Low- and middle-income countries (LMICs) bear the greatest burden of cardiovascular disease (CVD) worldwide. Emerging evidence, mostly from industrialized countries, suggest that neighborhood characteristics influence cardiovascular health. This study presents results from 27,797 participants living in six LMICs on the association of perceived neighborhood social cohesion, the degree of connectedness among neighbors, with 10-year risk of CVD. We observed that greater perceived neighborhood social cohesion was associated with lower odds of high (>20%) 10-year CVD risk (OR = 0.67, 95%CI: 0.53-0.86). These novel findings, suggest that interventions to enhance social cohesion may have beneficial effects on cardiovascular health in LMICs.

Systematic Review of Physical Activity, Sedentary Behaviour and Sleep Among Adults Living with Chronic Respiratory Disease in Low- and Middle-Income Countries

Abstract

Physical activity (PA), sedentary behaviour (SB) and sleep are important lifestyle behaviours associated with chronic respiratory disease (CRD) morbidity and mortality. These behaviours need to be understood in low- and middle-income countries (LMIC) to develop appropriate interventions.

Purpose

Where and how have free-living PA, SB and sleep data been collected for adults living with CRD in LMIC? What are the free-living PA, SB and sleep levels of adults living with CRD?

Patients and Methods

The literature on free-living PA, SB and sleep of people living with CRD in LMIC was systematically reviewed in five relevant scientific databases. The review included empirical studies conducted in LMIC, reported in any language. Reviewers screened the articles and extracted data on prevalence, levels and measurement approach of PA, SB and sleep using a standardised form. Quality of reporting was assessed using bespoke criteria.

Results

Of 89 articles, most were conducted in Brazil (n=43). PA was the commonest behaviour measured (n=66). Questionnaires (n=52) were more commonly used to measure physical behaviours than device-based (n=37) methods. International Physical Activity Questionnaire was the commonest for measuring PA/SB (n=11). For sleep, most studies used Pittsburgh Sleep Quality Index (n=18). The most common ways of reporting were steps per day (n=21), energy expenditure (n=21), sedentary time (n=16), standing time (n=13), sitting time (n=11), lying time (n=10) and overall sleep quality (n=32). Studies revealed low PA levels [steps per day (range 2669-7490steps/day)], sedentary lifestyles [sitting time (range 283-418min/day); standing time (range 139-270min/day); lying time (range 76-119min/day)] and poor sleep quality (range 33-100%) among adults with CRD in LMIC.

Conclusion

Data support low PA levels, sedentary lifestyles and poor sleep among people in LMIC living with CRDs. More studies are needed in more diverse populations and would benefit from a harmonised approach to data collection for international comparisons.

Physical activity and visual difficulties in 36 low- and middle-income countries

BACKGROUND

Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association.

METHODS

Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations.

RESULTS

Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA.

CONCLUSIONS

In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.

Prevalence, Sociodemographic, and Health Correlates of Insufficient Physical Activity and High Sedentary Behavior Among Older Adults in Singapore

We determined the prevalence and correlates of insufficient physical activity and high sedentary behavior among a nationally representative sample of 2,240 older adults (≥60 years) in Singapore. The Global Physical Activity Questionnaire, administered through face-to-face interviews, assessed physical activity and sedentary behavior. Logistic regression identified the correlates of insufficient physical activity (<600 metabolic equivalent of task minutes/week) and high sedentary behavior (>7 hr/day). The prevalence of insufficient physical activity and high sedentary behavior was 33.7% and 17.3%, respectively. Those older, females, Malays, residing in smaller housing, living with child but no spouse, with functional limitations and sensory impairments (vision/hearing) were more likely to have insufficient physical activity whereas those with tertiary education had lower odds. High sedentary behavior was more likely among those older, with secondary education, preobesity/obesity, and with functional limitations. While policies should encourage all older adults to be physically active, at-risk subgroups identified in our study merit greater attention.

Machine Learning Model for Predicting CVD Risk on NHANES Data

Cardiovascular disease (CVD) is a major health problem throughout the world. It is the leading cause of morbidity and mortality and also causes considerable economic burden to society. The early symptoms related to previous observations and abnormal events, which can be subjectively acquired by self-assessment of individuals, bear significant clinical relevance and are regularly preserved in the patient's health record. The aim of our study is to develop a machine learning model based on selected CVD-related information encompassed in NHANES data in order to assess CVD risk. This model can be used as a screening tool, as well as a retrospective reference in association with current clinical data in order to improve CVD assessment. In this form it is planned to be used for mass screening and evaluation of young adults entering their army service. The experimental results are promising in that the proposed model can effectively complement and support the CVD prediction for the timely alertness and control of cardiovascular problems aiming to prevent the occurrence of serious cardiac events.

Prevalence and factors associated with physical inactivity among older adults in Malaysia: A cross-sectional study

AIM

Physical inactivity in older adults is linked to increased risk of chronic diseases, disability and various poor health outcomes. As the aging population rises, the prevalence of diseases associated with aging also increases. Regular physical activity in older adults is important to improve overall health and promote healthy aging. This study aimed to determine the prevalence and factors associated with physical inactivity among older adults in Malaysia.

METHODS

This study was based on 3969 Malaysian older adults aged ≥60 years who completed the physical activity module in the National Health and Morbidity Survey 2018, a population-based cross-sectional survey. Physical activity was measured using the Global Physical Activity Questionnaire through a face-to-face interview. Participants were classified as physically active or inactive. Associations between physical inactivity, sociodemographic characteristics and a range of selected independent variables were examined using multivariable logistic regression.

RESULTS

Overall, three out of 10 (29.8%) Malaysian older adults were physically inactive. Results of multivariable analysis showed that older age group (≥80 years), of Bumiputera Sarawak ethnicity, unemployed/retirees/homemakers, functional limitation, diabetes mellitus and dementia were significantly associated with a higher risk of physical inactivity. Women, with secondary education level and good social support were less likely to be physically inactive.

CONCLUSIONS

The present study reported the status of physical inactivity among older adults in Malaysia. There is the need to design effective public health programs and interventions to promote active living and healthy aging among Malaysian older adults, particularly in those at-risk older population subgroups. Geriatr Gerontol Int 2020; 20: 49-56.

Physical Functioning Among Community-Dwelling Elderly in Rural Indonesia

BACKGROUND

As people live longer and the number of elderly individuals increases, caring for the elderly and increasing quality of life become important health care concerns.

OBJECTIVE

The aim of this study is to assess physical functioning among elderly people in rural Indonesia and draw conclusions about factors that might impact physical functioning.

METHODS

This study involved 412 elderly individuals aged 60 and over selected by multistage random sampling. A logistic regression was used to determine factors which associated with physical functioning.

RESULTS

Older age (75+), suffered from chronic illness, and living in low- and middle- income households tend to have limitations on physical function. Also, elderly individuals who had partner and were currently working experienced better physical function than those who did not.

CONCLUSION

This study supports other findings that say elderly people should do activities that reduce the risk of developing chronic illnesses. Having regular physical activity and routine preventive health check-ups can improve overall health, protect from having diseases and maintain the physical function of the elderly.

Factors influencing physical activity: A cross-sectional study of the community-dwelling older adults in a Portuguese rural area

BACKGROUND

There are a variety of intrinsic determinants which are key to understand the reasons for older people to stay (or not) active.

OBJECTIVES

To identify and analyse the factors underlying the physical activity engagement in older Portuguese living in a rural area.

METHODS

A total of 504 community-dwelling older adults (aged ≥65 years) were enrolled in this cross-sectional study. Sociodemographic data, physical activity levels, physical fitness and body composition were analysed.

RESULTS

Gender, age, income level, lower body strength, overweight, muscle mass and sedentarism (sitting time) were significantly associated with different physical activity levels. The multinomial logistic regression pointed out that dynamic balance, BMI and sitting time for moderate levels, as well as muscle mass for high levels, were the main independent factors that seem to influence the engagement in these levels compared to low physical activity levels. Additionally, classification tree analysis confirmed sitting time, dynamic balance and gender as discriminating factors for physical activity levels.

CONCLUSION

Physical fitness-related variables seem to mainly determine the levels of physical activity in the studied population. Thus, nursing care must promote the integration of physical activity into daily life routines of community-dwelling older adults, especially in rural areas.

IMPLICATIONS FOR PRACTICE

The diverse nature of factors influencing physical activity must be taken into account in primary health care, particularly in rural areas. Nursing care for older people must promote the integration of physical activity into daily life routines of community-dwelling older adults.

Self-Reported Physical Activity in Middle-Aged and Older Adults in Rural South Africa: Levels and Correlates

Little is known about physical activity (PA) levels and correlates in adults from rural settings in South Africa, where a rapid increase in the number of older people and marked disparities in wealth are evident, particularly between those living in rural and urban areas. This paper describes levels of self-reported PA in rural South African men and women and examines factors associated with meeting PA guidelines. Global Physical Activity Questionnaire (GPAQ) data from the Health and Aging in Africa: Longitudinal studies of INDEPTH communities (HAALSI) survey of 5059 adults aged over 40 years were assessed. Logistic regression analyses were used to assess socio-demographic, functional and cognitive capacity, and chronic disease measures associated with PA. In addition, 75.4% (n = 3421) of the participants with valid GPAQ data (n = 4538 of 5059) met the PA guidelines. Factors associated with not the meeting PA guidelines were being male, over the age of 80 years, being in a higher wealth category, obesity, and poorer functional capacity. These findings highlight worthwhile targets for future interventions to maintain or improve PA levels in this population and suggest that intervening earlier within this age range (from 40 years) may be crucial to prevent the ‘spiral of decline’ that characterizes the frailty syndrome.

Meeting Physical Activity Guidelines by Walking in Older Adults From Three Middle-Income Countries: A Cross-Sectional Analysis From the International Mobility in Aging Study

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Membership in Sport or Exercise Groups Predicts Sustained Physical Activity and Longevity in Older Adults Compared to Physically Active Matched Controls

Background

Physical activity tends to decline in older age, despite being key to health and longevity. Previous investigations have focused on demographic and individual factors that predict sustained physical activity.

Purpose

To examine whether engaging in physical activity in the context of sport or exercise group membership can protect against age-related physical activity decline.

Methods

Drawn from the English Longitudinal Study of Ageing, participants were members of sport or exercise groups aged 50 and over (N = 2015) as well as nonmember controls, who were matched at baseline for age, sex, and physical activity levels (N = 1881). Longitudinal mixed effects models were used to assess the effect of sport or exercise group membership on physical activity and longevity across a 14-year follow-up.

Results

Members of sport or exercise groups experienced an attenuated decline in both moderate and vigorous physical activity over a 14-year follow-up compared to physically active matched controls. Sport or exercise group members were also less likely to have died at follow-up, an effect that was mediated through sustained physical activity.

Conclusions

Promoting membership in sport and exercise groups may be a beneficial strategy for supporting sustained physical activity and health among older people.

Physical activity and loneliness among adults aged 50 years or older in six low- and middle-income countries

INTRODUCTION

Loneliness is widespread and associated with deleterious outcomes in middle-aged and older age people in low- and middle-income countries (LMICs). Physical activity is one potential psychosocial strategy with the potential to reduce loneliness in this population. Thus, the aim of this study was to explore associations between physical activity (PA) and loneliness in middle-aged and older people from six LMICs.

MATERIALS AND METHODS

Data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Self-reported data on loneliness and PA (as assessed by the Global Physical Activity Questionnaire) were collected. Participants were dichotomized into those who do and do not meet the international recommendation of 150 minutes of moderate to vigorous PA per week. Associations between loneliness and PA were examined using logistic regressions.

RESULTS

Among 34 129 individuals aged 50 years or older, the prevalence of loneliness was higher among those not meeting the PA guidelines in all countries, although this difference was not significant in Mexico and South Africa. After full adjustment, not meeting PA guidelines was positively associated with loneliness in the meta-analysis based on country-wise estimates, with a moderate level of between-country heterogeneity being observed (OR = 1.31; 95% CI, 1.07-1.61; I2 = 48.7%). At an individual country level, statistical significance was only reached in Ghana (OR = 1.89; 95% CI = 1.44-2.49).

DISCUSSION

Our data suggest that physical inactivity and loneliness commonly co-occur in adults aged 50 years or older in LMICs overall but that this association differs by country. Longitudinal studies are required to confirm these findings and investigate potential mechanisms that may inform future interventions.

Level of physical activity among urban adults and the socio-demographic correlates: a population-based cross-sectional study using the global physical activity questionnaire

BACKGROUND

Globally, in 2016, 23.3% of adult populations were physically inactive, and it accounts for 9% of the global premature mortality. However, evidence on the level of physical activity was limited in resource-poor settings. This study, therefore, assessed the adult's level of physical activity and its correlates among the urban population in Dire Dawa, eastern Ethiopia.

METHODS

A total of 872 randomly selected adults of age 25-64 years in Dire Dawa city, eastern Ethiopia, are included in this analysis. The Global Physical Activity Questionnaire (GPAQ) is used to measure physical activity. Individuals are considered physically active when they achieved metabolic equivalent tasks (MET) minutes of 600 or more per week, and otherwise inactive. A binary logistic regression is used to identify the correlates of physical activity.

RESULTS

54.9% (95% confidence interval (CI) 51.6 to 58.2) of adults were physically active, with a higher proportion of men being physically active than women, 63.9% (95% CI 58.1 to 69.3) versus 50.6% (95% CI 46.5 to 54.6). Among the adults who reported doing physical activity, the highest domain-specific contribution to the total physical activity was from activities at workplaces, and leisure-time activities contributed the least. The proportion of adults who engaged in a high-level physical activity was 37.0% (95% CI 33.9 to 40.3). Male adults were 1.45 times (aOR (adjusted odds ratio) =1.45; 95% CI 1.05 to 1.99) more likely to achieve the recommended level of physical activity. In contrary, unemployed adults (aOR = 0.51; 95% CI 0.35 to 0.75) were less likely to perform the recommended level of physical activity to accrue health benefits.

CONCLUSION

Interventions aimed at promoting physical activity should target unemployed and female adults. We recommend further study to explore the contextual factors that hinder physical activity in the study setting.

Associations of physical activity with anxiety symptoms and status: results from The Irish longitudinal study on ageing

AIMS

Anxiety is debilitating and associated with numerous mental and physical comorbidities. There is a need to identify and investigate low-risk prevention and treatment strategies. Therefore, the purpose of this study was to investigate cross-sectional and longitudinal associations between different volumes of moderate-to-vigorous physical activity (PA) and anxiety symptoms and status among older adults in Ireland.

METHODS

Participants (n = 4175; 56.8% female) aged ⩾50 years completed the International PA Questionnaire (IPAQ) at baseline, and the anxiety subscale of the Hospital Anxiety and Depression Scale at baseline and follow-up (2009-2013). Participants were classified according to meeting World Health Organisation PA guidelines, and divided into IPAQ categories. Respondents without anxiety at baseline (n = 3165) were included in prospective analyses. Data were analysed in 2017.

RESULTS

Anxiety symptoms were significantly higher among females than males (p < 0.001). Models were adjusted for age, sex, waist circumference, social class, smoking status and pain. In cross-sectional analyses, meeting PA guidelines was associated with 9.3% (OR = 0.91, 95% confidence interval 0.78-1.06) lower odds of anxiety. Compared with the inactive group, the minimally- and very-active groups were associated with 8.4% (OR = 0.92, 0.76-1.10) and 18.8% (OR = 0.81, 0.67-0.98) lower odds of anxiety, respectively. In prospective analyses, meeting guidelines was associated with 6.3% (OR = 0.94, 0.63-1.40) reduced odds of anxiety. Compared with the inactive group, the minimally and very-active groups were associated with 43.5% (OR = 1.44, 0.89-2.32) increased, and 4.3% (OR = 0.96, 0.56-1.63) reduced odds of anxiety. The presence of pain, included in models as a covariate, was associated with a 108.7% (OR = 2.09, 1.80-2.42) increase in odds of prevalent anxiety, and a 109.7% (OR = 2.10, 1.41-3.11) increase in odds of incident anxiety.

CONCLUSION

High volumes of PA are cross-sectionally associated with lower anxiety symptoms and status, with a potential dose-response apparent. However, significant associations were not observed in prospective analyses. The low absolute number of incident anxiety cases (n = 109) potentially influenced these findings. Further, as older adults may tend to experience and/or report more somatic anxiety symptoms, and the HADS focuses primarily on cognitive symptoms, it is plausible that the HADS was not an optimal measure of anxiety symptoms in the current population.

Effects of hospital–community integrated transitional care on quality of life in patients with chronic obstructive pulmonary disease†

Objective

To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD).

Methods

A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital–community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire.

Results

For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05)

Conclusions

Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.

Testing the deconditioning hypothesis of low back pain: A study in 1182 older women

This study assessed the deconditioning hypothesis of low back pain (LBP) by examining physical function in relation to LBP and self-reported physical activity in women. This cross-sectional study recruited a representative population-based sample of females aged greater than 60 years. In total, 1182 women were included in the study and completed questionnaires (physical activity and LBP intensity) and functional testing (countermovement jump, chair rise, gait speed and grip strength). Individuals were stratified into four groups based on physical activity and LBP status and analysed via a two-way ANOVA. Most participants (87%) reported current LBP and 25% were physically active. Countermovement jump height, chair rise and grip strength were lower in physically inactive women (p ≤ 0.005), but not women with LBP (p ≥ 0.21). Gait speed was not associated with physical activity or LBP status. There was no association between LBP and physical activity status. Whilst LBP was associated with lower physical activity, contrary to the deconditioning hypothesis, LBP status itself was not associated with reduced physical function in community-dwelling women 60 years and older. This implies that LBP may not be related to physical function in this population group, but rather to their physical activity levels.

Global physical activity levels - Need for intervention

Substantial evidence shows that physical inactivity (PI) and sedentary behavior (SB) increases the risk of many chronic diseases and shortens life expectancy. We describe evidence that certain domains of physical activity (PA) in the United States (US) population have declined substantially over 5 decades. The prevalence of PI is very high worldwide, which has contributed to 6%-10% of the burden of many chronic diseases and premature mortality. Reduction or elimination of PI would likely produce substantial increases in life expectancy of the world's population. Great efforts are needed to reduce PI and SB and increase levels of PA in the US and worldwide.

Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (<5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia.

Self-reported pain in patients with schizophrenia. Results from the national first-step FACE-SZ cohort

INTRODUCTION

Little is known about perception of physical pain in schizophrenia (SZ). Some studies have suggested that patients with SZ may have an increased pain threshold, while others have suggested that patients with SZ may suffer from undetected and untreated high physical pain levels. The objectives of this study were (i) to investigate the prevalence of self-reported physical pain in stabilized SZ subjects, and (ii) to determine whether physical pain was associated with psychiatric characteristics and somatic comorbidities (iii) to determine whether antidepressants and benzodiazepine administration were associated with lower self-reported pain.

METHOD

468 community-dwelling stable SZ subjects (73% men, mean aged 32 years) were recruited in the Schizophrenia Expert Center national network. Patients with moderate to extreme pain, assessed with the EQ5D-5L questionnaire, were classified as belonging to the "pain group".

RESULTS

104 (22.2%) reported moderate to extreme pain levels. In multivariate analysis, pain has been associated with headache (OR = 2.63 [1.04-6.63], p = 0.04), higher anxiety (OR = 1.61 [1.18-2.21], p = 0.003), higher current depressive symptoms (OR = 1.09 [1.01-1.17], p = 0.03), history of childhood trauma (1.03 [1.01-1.06], p = 0.01) and older age (OR = 1.04 [1.01-1.07], p = 0.03), independently of current psychotic severity, sociodemographic variables, antipsychotic, antidepressant and benzodiazepine treatments. No association with addictive behaviors or illness characteristics has been found.

CONCLUSION

The present findings suggest that community-dwelling SZ outpatients report a high rate of self-reported physical pain, associated with headache, depression and anxiety and history of childhood trauma. Physical pain should be systematically assessed and specifically treated, when needed, in patients with SZ.