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Allgood KL, Whittington B, Xie Y, Hirschtick JL, Ro A, Orellana RC, Fleischer NL. Social vulnerability and new mobility disability among adults with polymerase chain reaction (PCR)-confirmed SARS-CoV-2: Michigan COVID-19 Recovery Surveillance Study. Prev Med 2023; 177:107719. [PMID: 37788721 DOI: 10.1016/j.ypmed.2023.107719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Understanding the relationship between social factors and persistent COVID-19 health outcomes, such as onset of a disability after a SARS-CoV-2 (the virus that causes COVID-19) infection, is an increasingly important public health issue. The purpose of this paper is to examine associations between social vulnerability and new onset of a mobility disability post-COVID-19 diagnosis. METHODS We used data from the Michigan COVID-19 Recovery Surveillance Study, a population-based probability survey of adults with PCR-confirmed SARS-CoV-2 infection in Michigan between January 2020-May 2022 (n = 4295). We used the Minority Health Social Vulnerability Index (MHSVI), with high county-level social vulnerability defined at or above the 75th percentile. Mobility disability was defined as new difficulty walking or climbing stairs. We regressed mobility disability on the overall MHSVI, as well as sub-themes of the index (socioeconomic status, household composition/disability, minority and language, housing type, healthcare access, and medical vulnerability), using multivariable logistic regression, adjusting for age, race, sex, education, employment, and income. RESULTS Living in a county with high (vs. low) social vulnerability was associated with 1.38 times higher odds (95% confidence interval [CI]:1.18-1.61) of reporting a new mobility disability after a COVID-19 diagnosis after adjustment. Similar results were observed for the socioeconomic status and household composition/disability sub-themes. In contrast, residents of highly racially diverse counties had lower odds (odds ratio 0.74, 95% CI: 0.61, 0.89) of reporting a new mobility disability compared to low diversity counties. CONCLUSIONS Mitigating the effects of social vulnerabilities requires additional resources and attention to support affected individuals.
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Affiliation(s)
- Kristi L Allgood
- University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population Health. 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI 48109, USA; Texas A&M University School of Public Health, Department of Epidemiology & Biostatistics, USA.
| | - Blair Whittington
- University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population Health. 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI 48109, USA
| | - Yanmei Xie
- University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population Health. 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI 48109, USA
| | - Jana L Hirschtick
- University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population Health. 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI 48109, USA
| | - Annie Ro
- University of California - Irvine, Department of Health, Society, & Behavior. UCI Health Sciences Complex, 856 Health Sciences Quad, Suite 3600, Irvine, CA 92617, USA
| | - Robert C Orellana
- CDC Foundation, 600 Peachtree St NE #1000, Atlanta, GA 30308, USA; Bureau of Infectious Disease Prevention, Michigan Department of Health and Human Services, 333 S Grand Ave, P.O. Box 30195, Lansing, MI 48933, USA
| | - Nancy L Fleischer
- University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population Health. 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI 48109, USA
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Newman AB. The Epidemiology and Societal Impact of Aging-Related Functional Limitations: A Looming Public Health Crisis. J Gerontol A Biol Sci Med Sci 2023; 78:4-7. [PMID: 37325965 PMCID: PMC10272977 DOI: 10.1093/gerona/glad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Indexed: 06/17/2023] Open
Abstract
Functional impairment and disability become increasingly common with aging. As more people are reaching old age, the number of people needing care will rise, creating a crisis of need for care. Population studies and clinical trials have demonstrated the importance of the detection of early loss of strength and walking speed in predicting disability and in designing interventions to prevent functional decline. There is a large societal burden linked to age-related disorders. Physical activity is to date the only intervention that has prevented disability in a long-term clinical trial, but is difficult to sustain. Novel interventions are needed to maintain function in late life.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania,USA
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Smith RG, Thorner MO. Growth Hormone Secretagogues as Potential Therapeutic Agents to Restore Growth Hormone Secretion in Older Subjects to Those Observed in Young Adults. J Gerontol A Biol Sci Med Sci 2023; 78:38-43. [PMID: 37325967 PMCID: PMC10272984 DOI: 10.1093/gerona/glad022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 06/17/2023] Open
Abstract
The discovery of the growth hormone secretagogues (GHS) and the reverse pharmacology leading to the discovery of GHS receptor which enabled the identification of ghrelin as the natural ligand for the receptor have opened a new horizon in growth hormone (GH) physiology, pathophysiology, and therapeutics. Major progress has been made and we now have orally active GHS which are able to restore optimal pulsatile GH secretion which cannot be overstimulated as insulin-like growth factor feedback regulates the peaks to the optimum level. This enables GH to be restored in the older to levels normally seen in 20- to 30-year-old people; this leads to an increase in fat-free mass and redistribution of fat to the limbs. As these agents are ultimately approved and investigated further, it is likely that they will be shown to restore growth in children with moderate-to-mild GH deficiency; their benefits will be investigated in other indications such as nonalcoholic fatty liver disease, frailty, anemia, osteoporosis, and immune compromise in older subjects. The exquisite regulation of GH secretion reflects the importance of GH pulsatility in the regulation of somatotroph action of GH.
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Affiliation(s)
- Roy G Smith
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael O Thorner
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Lumos Pharma, Austin, Texas, USA
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Chen C, Cao X, Xu J, Jiang Z, Liu Z, McGoogan J, Wu Z. Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020. BMC Public Health 2023; 23:814. [PMID: 37142969 PMCID: PMC10157932 DOI: 10.1186/s12889-023-15538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups. METHODS We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors. RESULTS The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection. CONCLUSIONS In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.
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Affiliation(s)
- Chen Chen
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
- National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xingqi Cao
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Zhen Jiang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
| | - Zuyun Liu
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
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Jayakody O, Breslin M, Ayers E, Verghese J, Barzilai N, Weiss E, Milman S, Blumen HM. Age-related changes in gait domains: Results from the LonGenity study. Gait Posture 2023; 100:8-13. [PMID: 36463714 PMCID: PMC9974801 DOI: 10.1016/j.gaitpost.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/30/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Impairment in gait domains such as pace, rhythm, and variability are associated with falls, cognitive decline, and dementia. However, the longitudinal changes in these gait domains are poorly understood. The aim of this study was to examine age-related changes in gait domains overall and in those with cognitive impairment and mobility disability. METHODS Participants were from the LonGenity study (n = 797; M Age=75.1 SD 6.5 years; 58.2% female) and were followed up to 12 years (Median=3.3; IQR: 1.1; 6.3). Gait speed and absolute values of step length, step time, cadence and, variability (standard deviation) of step length and step time during usual pace walking were assessed. Principal components analysis was used to obtain weighted combinations of three gait domains: pace (velocity, step length), variability (step length variability, step time variability) and rhythm (step time). Linear mixed effect models were used to examine age-related changes in gait domains overall, and in those with cognitive impairment and mobility disability at baseline. RESULTS Pace declined, and rhythm increased (worsened) in an accelerating non-linear fashion. Variability gradually increased with age. Those with cognitive impairment had faster rates of change in pace and rhythm. Those with mobility disability had faster increases in rhythm. CONCLUSIONS Age-related changes in gait domains are not uniform. Individuals with cognitive and mobility impairments are particularly vulnerable to accelerated change in pace and or rhythm.
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Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
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Greiman L, Ravesloot C, S Goddard K, Ward B. Effects of a consumer driven home modification intervention on community participation for people with mobility disabilities. Disabil Health J 2022; 15:101210. [PMID: 34521604 PMCID: PMC10798581 DOI: 10.1016/j.dhjo.2021.101210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community participation has become a key outcome measure for people with disabilities. This has resulted in a shift in researchers focus from the individual to the environment. However, research has focused primarily on participation barriers in the community with limited research examining the role of the home environment. For people with mobility disabilities the home environment is the starting place for community participation and research is needed to understand the relationship between the home and participation outcomes. OBJECTIVE This study explores the effects of a consumer-driven home modification intervention on community participation for people with mobility disabilities. METHODS We conducted a randomized control trial (from June 2017-April 2019) of the effects of a consumer-directed home modification intervention on community participation. The intervention, the Home Usability Program, was implemented with consumers at two different Centers for Independent Living (N = 195) and included a self-assessment of their home environment and implementation of a home usability change. RESULTS The Home Usability program positively affected the community participation of people with mobility disabilities. Overall, intervention participants reported a 39.5% (p < .05) increase in social and recreational activities immediately following the intervention relative to the control group after controlling for health status and month when outcome data were collected. Six months after the intervention, this effect returned to baseline. CONCLUSIONS Community-based, consumer-driven home modification programs show promise for improving community participation outcomes among people with disabilities, however, more research is needed to understand why results did not persist.
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Affiliation(s)
- Lillie Greiman
- The University of Montana Research and Training Center on Disability in Rural Communities, United States.
| | - Craig Ravesloot
- The University of Montana Research and Training Center on Disability in Rural Communities, United States
| | - Kelsey S Goddard
- The University of Kansas Research and Training Center on Independent Living (KU-RTCIL), United States
| | - Bryce Ward
- The University of Montana Research and Training Center on Disability in Rural Communities, United States
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Smith J, Ylitalo KR. Physical activity recommendation by health care providers to adults with and without functional limitations. Prev Med 2021; 153:106730. [PMID: 34284001 PMCID: PMC8595525 DOI: 10.1016/j.ypmed.2021.106730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations. Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n = 23,540; weighted N = 170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design. One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p < 0.001), even after adjusting for covariates and current activity level (aOR = 1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65-75 years (57.01%) but declined substantially for adults ≥75 years. Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.
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Affiliation(s)
- Jordan Smith
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA.
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Ipsen C, Hall JP. Dimensions of community participation. Disabil Health J 2021;:101208. [PMID: 34481735 DOI: 10.1016/j.dhjo.2021.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022]
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Hansen RK, Samani A, Laessoe U, Larsen RG, Cowan RE. Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users. Disabil Health J 2021; 14:101119. [PMID: 34099418 DOI: 10.1016/j.dhjo.2021.101119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers. OBJECTIVE We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics. METHODS Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers. RESULTS Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r2≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r2=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064). CONCLUSIONS Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.
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Affiliation(s)
- Rasmus K Hansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Department of Research and Development, University College of Northern Jutland (UCN), Aalborg, Denmark.
| | - Afshin Samani
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Uffe Laessoe
- Department of Research and Development, University College of Northern Jutland (UCN), Aalborg, Denmark; Physical Therapy Department, University College of Northern Jutland (UCN), Aalborg, Denmark
| | - Ryan G Larsen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Rachel E Cowan
- Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham, Birmingham, AL, USA
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Chua KY, Lin X, Wang Y, Chong YS, Lim WS, Koh WP. Visceral fat area is the measure of obesity best associated with mobility disability in community dwelling oldest-old Chinese adults. BMC Geriatr 2021; 21:282. [PMID: 33910516 PMCID: PMC8082923 DOI: 10.1186/s12877-021-02226-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background Although obesity can be clinically defined by body mass index (BMI), waist circumference, percent body fat, or visceral fat area, it is unclear which specific measure is best associated with mobility disability in oldest-old adults. Methods Among 589 Chinese participants aged 85 years and older in a population-based cohort in Singapore, we measured waist circumference, computed BMI, estimated appendicular skeletal muscle mass, percent body fat, and visceral fat area using bioelectrical impedance analysis, and evaluated mobility disability using the Loco-Check questionnaire. We computed areas under the receiver operating characteristic curves (AUCROC) to compare how well these measures discriminated between those with and without mobility disability. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity defined by these measures and mobility disability. Results Compared to BMI, which had an AUCROC (95% CI) of 0.68 (0.64–0.72) for the discrimination of mobility disability, only visceral fat area had a significantly higher discriminative performance [AUCROC (95% CI) of 0.71 (0.67–0.75) (Padjusted = 0.002)]. The optimal cut-offs of visceral fat area for the discrimination of mobility disability were ≥ 104 cm2 in men and ≥ 137 cm2 in women. In fully adjusted models, only obesity defined by visceral fat area was significantly associated with mobility disability [OR (95% CI) of 2.04 (1.10–3.77)]; obesity defined by the other measures were not associated with mobility disability after adjusting for visceral fat. Conclusion In oldest-old adults, visceral fat area was the best discriminator for obesity associated with mobility disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02226-6.
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Affiliation(s)
- Kevin Yiqiang Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Xinyi Lin
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Singapore Clinical Research Institute, Singapore, Singapore
| | - Yeli Wang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Armstrong NM, Deal JA, Betz J, Kritchevsky S, Pratt S, Harris T, Barry LC, Simonsick EM, Lin FR. Associations of Hearing Loss and Depressive Symptoms With Incident Disability in Older Adults: Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2020; 75:531-536. [PMID: 30561511 DOI: 10.1093/gerona/gly251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive symptoms and hearing loss (HL) are independently associated with increased risk of incident disability; whether the increased risk is additive is unclear. METHODS Cox Proportional Hazards models were used to assess joint associations of HL (normal, mild, moderate/severe) and late-life depressive symptoms (defined by a score of ≥8 on the 10-item Center for Epidemiologic Studies-Depression scale) with onset of mobility disability (a lot of difficulty or inability to walk ¼ mile and/or climb 10 steps) and any disability in activities of daily living (ADL), among 2,196 participants of the Health, Aging and Body Composition Study, a cohort of well-functioning older adults aged 70-79 years. Models were adjusted for age, race, sex, education, diabetes, hypertension, and body mass index. RESULTS Relative to participants with normal hearing and without depressive symptoms, participants without depressive symptoms who had mild or moderate/severe HL had increased risk of incident mobility and ADL disability (hazard ratio [HR] for mobility disability, mild HL:1.34, 95% confidence interval [CI]: 1.09, 1.64 and HR for mobility disability, moderate/severe HL: 1.37, 95% CI: 1.08, 1.75 and HR for ADL disability, mild HL: 1.32, 95% CI: 1.08, 1.63, and HR for ADL disability, moderate/severe HL: 1.42, 95% CI: 1.11, 1.82). Among participants with depressive symptoms, mild HL (HR: 1.71, 95% CI: 1.09, 2.70) was associated with increased risk of incident mobility disability. CONCLUSIONS Independent of depressive symptoms, risk of incident disability was greater in older adults with HL, regardless of severity. Further research into HL interventions may delay disability onset.
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Affiliation(s)
- Nicole M Armstrong
- National Institute on Aging Intramural Research Program, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Betz
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen Kritchevsky
- Gerontology and Geriatric Medicine Center on Diabetes, Obesity, and Metabolism, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sheila Pratt
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pennsylvania.,Geriatric Research and Clinical Education Center, VA Pittsburgh Healthcare System, Pennsylvania
| | - Tamara Harris
- National Institute on Aging Intramural Research Program, Baltimore, Maryland
| | - Lisa C Barry
- Center on Aging, University of Connecticut Health Center, Farmington
| | - Eleanor M Simonsick
- National Institute on Aging Intramural Research Program, Baltimore, Maryland
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Best KL, Beaudoin M, Routhier F. Technical quality of online resources for mobility device training. Disabil Rehabil Assist Technol 2020; 17:228-233. [PMID: 32521184 DOI: 10.1080/17483107.2020.1775316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Training is recommended to improve safe and effective use of mobility aids. The internet offers a large amount of information and it can be difficult to identify resources with good quality. This project aimed to create a catalogue of online educational resources for mobility device training. The objective of this study was to identify and assess the quality of existing online educational resources for mobility device training for individuals with physical disabilities and caregivers.Methods: A Google search was conducted in October 2016 and replicated in January 2018. Resources were included if they were educational, were available in English or French, provided instruction or training in mobility aid use, were free of charge, and were targeted towards mobility device users or their caregivers. Resources were assessed using a modified version of the Journal of the American Medical Association (JAMA) benchmarks for the evaluation of technical quality.Results: Two hundred and seventy-one resources were included in the final analysis. Two resources were added by the research team for a total of 273 resources. The average JAMA quality score per mobility device varied between 3 (for crutches) and 5 (for knee scooters) out of 6, and weighted average was 3.6. The two resources added by the research team obtained a JAMA quality score of 6. 58 resources were retained for the catalogue.Conclusions: The results suggest that the technical quality of online educational resources for mobility device training could be improved. A need for higher quality resources for device users and caregivers was identified.Implications for rehabilitationThe overall technical quality of online educational resources for mobility device training for users and caregivers is low.A Mobility Device Training Catalogue is freely available and summarizes the highest quality online resources found on mobility device training.The Mobility Device Training Catalogue is intended for use by users and caregivers, but it may also provide clinicians with a tool that may be shared with their clients.
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Affiliation(s)
- Krista L Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de service sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Maude Beaudoin
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de service sociaux de la Capitale-Nationale, Quebec City, Canada
| | - François Routhier
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de service sociaux de la Capitale-Nationale, Quebec City, Canada
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Cawthon PM, Travison TG, Manini TM, Patel S, Pencina KM, Fielding RA, Magaziner JM, Newman AB, Brown T, Kiel DP, Cummings SR, Shardell M, Guralnik JM, Woodhouse LJ, Pahor M, Binder E, D’Agostino RB, Quian-Li X, Orwoll E, Landi F, Orwig D, Schaap L, Latham NK, Hirani V, Kwok T, Pereira SL, Rooks D, Kashiwa M, Torres-Gonzalez M, Menetski JP, Correa-De-Araujo R, Bhasin S. Establishing the Link Between Lean Mass and Grip Strength Cut Points With Mobility Disability and Other Health Outcomes: Proceedings of the Sarcopenia Definition and Outcomes Consortium Conference. J Gerontol A Biol Sci Med Sci 2020; 75:1317-1323. [PMID: 30869772 PMCID: PMC7447857 DOI: 10.1093/gerona/glz081] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 03/13/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Lack of consensus on how to diagnose sarcopenia has limited the ability to diagnose this condition and hindered drug development. The Sarcopenia Definitions and Outcomes Consortium (SDOC) was formed to develop evidence-based diagnostic cut points for lean mass and/or muscle strength that identify people at increased risk of mobility disability. We describe here the proceedings of a meeting of SDOC and other experts to discuss strategic considerations in the development of evidence-based sarcopenia definition. METHODS Presentations and panel discussions reviewed the usefulness of sarcopenia as a biomarker, the analytical approach used by SDOC to establish cut points, and preliminary findings, and provided strategic direction to develop an evidence-based definition of sarcopenia. RESULTS The SDOC assembled data from eight epidemiological cohorts consisting of 18,831 participants, clinical populations from 10 randomized trials and observational studies, and 2 nationally representative cohorts. In preliminary assessments, grip strength or grip strength divided by body mass index was identified as discriminators of risk for mobility disability (walking speed <0.8 m/s), whereas dual-energy X-ray absorptiometry-derived lean mass measures were not good discriminators of mobility disability. Candidate definitions based on grip strength variables were associated with increased risk of mortality, falls, mobility disability, and instrumental activities of daily living disability. The prevalence of low grip strength increased with age. The attendees recommended the establishment of an International Expert Panel to review a series of position statements on sarcopenia definition that are informed by the findings of the SDOC analyses and synthesis of literature. CONCLUSIONS International consensus on an evidence-based definition of sarcopenia is needed. Grip strength-absolute or adjusted for body mass index-is an important discriminator of mobility disability and other endpoints. Additional research is needed to develop a predictive risk model that takes into account sarcopenia components as well as age, sex, race, and comorbidities.
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Affiliation(s)
- Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Thomas G Travison
- Department of Medicine, Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Karol M Pencina
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Jay M Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Todd Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Douglas P Kiel
- Department of Medicine, Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts,Longitudinal Studies Section, The National Institute on Aging, Baltimore, Maryland
| | - Steve R Cummings
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Michelle Shardell
- Longitudinal Studies Section, The National Institute on Aging, Baltimore, Maryland
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Ellen Binder
- Division of Geriatrics, Washington University School of Medicine, St Louis, Missouri
| | - Ralph B D’Agostino
- Department of Mathematics, Framingham Heart Study, Boston University, Massachusetts
| | - Xue Quian-Li
- Director of Biostatistics, Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Eric Orwoll
- Division of Endocrinology, Metabolism and Clinical Nutrition, Oregon Health and Sciences University, Portland
| | - Francesco Landi
- Department of Medicine and Geriatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laura Schaap
- Faculty of Science, Nutrition and Health Aging and Later Life, Free University of Amsterdam, The Netherlands
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vasant Hirani
- School of Life and Environmental Sciences, University of Sydney, Australia
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine,School of Public Health, The Chinese University of Hong Kong, China
| | | | - Daniel Rooks
- Novartis Biomedical Research Institute, Cambridge, Massachusetts
| | | | | | - Joseph P Menetski
- The Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Address correspondence to: Shalender Bhasin, MB, BS, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115. E-mail:
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14
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Hollis ND, Zhang QC, Cyrus AC, Courtney-Long E, Watson K, Carroll DD. Physical activity types among US adults with mobility disability, Behavioral Risk Factor Surveillance System, 2017. Disabil Health J 2020; 13:100888. [PMID: 32061542 DOI: 10.1016/j.dhjo.2020.100888] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Physical Activity Guidelines for Americans, second edition, recommend that all adults participate in moderate-intensity equivalent aerobic physical activity at least 150-300 min/week for substantial health benefits and muscle-strengthening activities involving all major muscle groups 2 or more days a week. The prevalence of the general population meeting the Guidelines and the types of physical activity in which they engage have been described elsewhere. Similar descriptions are lacking for individuals with mobility disability whose physical activity profiles may differ from the general population. OBJECTIVE This study examined patterns of aerobic and muscle-strengthening physical activity among US adults with mobility disability. METHODS We used 2017 Behavioral Risk Factor Surveillance System data from 66,635 adults with mobility disability. We estimated the percentage who engaged in any aerobic physical activity, met the aerobic and/or muscle-strengthening guidelines, and who participated in specific activities. RESULTS Less than half (45.2%) of US adults with mobility disability reported engaging in aerobic physical activity, and 39.5% met one or both components of the physical activity guidelines. Walking was the most commonly reported activity type (34.0%). CONCLUSIONS Walking is a common activity type among adults with mobility disability. Efforts to make walking or wheelchair rolling a safe, viable option are important to helping decrease barriers that may limit the ability of those with mobility disability to engage in walking or other physical activity types.
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Affiliation(s)
- NaTasha D Hollis
- Disability and Health Branch, Division of Human Development and Disability, National Center of Birth Defects and Developmental Disabilities, Atlanta, GA, USA; Commissioned Corps, U.S. Public Health Service, Atlanta, GA, USA.
| | - Qing C Zhang
- Disability and Health Branch, Division of Human Development and Disability, National Center of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Alissa C Cyrus
- Disability and Health Branch, Division of Human Development and Disability, National Center of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Elizabeth Courtney-Long
- Disability and Health Branch, Division of Human Development and Disability, National Center of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Kathleen Watson
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center of Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Dianna D Carroll
- Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, U.S. Public Health Service, Atlanta, GA, USA
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15
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Yu L, Boyle PA, Leurgans SE, Wilson RS, Bennett DA, Buchman AS. Incident Mobility Disability, Mild Cognitive Impairment, and Mortality in Community-Dwelling Older Adults. Neuroepidemiology 2019; 53:55-62. [PMID: 30986783 DOI: 10.1159/000499334] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/24/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Mobility disability and mild cognitive impairment (MCI) are common in aging and both are associated with risk of death. This study tested the hypothesis that risk of death differs by the order in which mobility disability and MCI occurred. METHODS One thousand two hundred and sixty-two community-dwelling older adults were unimpaired at baseline and followed annually. Mobility disability was based on measured gait speed, and MCI was based on cognitive performance tests. A multistate Cox model simultaneously examined incidences of mobility disability and MCI to determine whether the order of their occurrence is differentially associated with risk of death. RESULTS The average age was 75.3 years and 70% were female. While mobility disability occurred more frequently than incident MCI, the subsequent risk of death was higher in participants who developed MCI alone compared to those who developed mobility disability alone (hazard ratio [HR] 1.70, p = 0.018). Of the participants who initially developed mobility disability, about half subsequently developed MCI that doubled their risk of death (HR 2.17, p < 0.001). By contrast, over two-third who developed MCI subsequently developed mobility disability, which did not further increase their risk of death. CONCLUSION Mobility disability occurs more frequently in community-dwelling older adults, but MCI is more strongly associated with mortality.
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Affiliation(s)
- Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA, .,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA,
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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16
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Holmgren M, Sandberg M, Ahlström G. The complexity of reaching and maintaining a healthy body weight - the experience from adults with a mobility disability. BMC Obes 2018; 5:33. [PMID: 30524738 PMCID: PMC6276247 DOI: 10.1186/s40608-018-0212-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/29/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with a disability affecting their mobility are more likely to be overweight or obese than those without a mobility disability. The guidelines on how to prevent and treat overweight/obese adults in the general population have not been adapted to the needs of people with a mobility disability. A reasonable useful first step in the process of adapting such guidelines is to conduct a qualitative study of the perceived needs of these people. AIM The aim was to explore the experienced importance of body weight among adults with a mobility disability and their perceived needs and actions to reach and maintain a healthy weight. METHOD This was an explorative qualitative study based on individual interviews and qualitative content analysis. An inductive analysis of the interviews formed the basis for the establishment of sub-categories, main categories and, finally, a main theme. The twenty participants included in the study have had a mobility disability for more than two years before being recruited. RESULTS The overall theme, "The complex trajectory to a healthy weight", included four main categories. In the category (i) Vicious circle of problems, the participants perceived that everything was harder with the combination of a mobility disability and being overweight/obese with one factor making the other worse. In (ii) Strategies based on decisions and attempts, the participants talked about different ways of attempting to reach or maintain a healthy weight. In (iii) Internal resources, they spoke of awareness and motivation as contributory factors. In (iv) External resources - experienced and required, they spoke about feelings that their weight problems were not given high priority in primary health care. They found it difficult to get advice designed for persons with a mobility disability and felt that competence was lacking among health professionals. The participants asked for a team of professionals with adequate knowledge concerning mobility disabilities. CONCLUSIONS People with a mobility disability combined with being overweight/obese have a complex living situation and health needs. The experiences communicated by participants may facilitate adaption of existing intervention programs or development of a new evidence-based obesity prevention program for primary health care settings.
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Affiliation(s)
- Marianne Holmgren
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00 Lund, SE Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00 Lund, SE Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00 Lund, SE Sweden
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17
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Marzetti E, Cesari M, Calvani R, Msihid J, Tosato M, Rodriguez-Mañas L, Lattanzio F, Cherubini A, Bejuit R, Di Bari M, Maggio M, Vellas B, Dantoine T, Cruz-Jentoft AJ, Sieber CC, Freiberger E, Skalska A, Grodzicki T, Sinclair AJ, Topinkova E, Rýznarová I, Strandberg T, Schols AMWJ, Schols JMGA, Roller-Wirnsberger R, Jónsson PV, Ramel A, Del Signore S, Pahor M, Roubenoff R, Bernabei R, Landi F. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants. Exp Gerontol 2018; 113:48-57. [PMID: 30261246 DOI: 10.1016/j.exger.2018.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. METHODS The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. RESULTS During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. CONCLUSION PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
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Affiliation(s)
- Emanuele Marzetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Geriatric Rehabilitation, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Vellas
- Gérontopôle, University Hospital of Toulouse, Toulouse, France
| | | | | | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Limited, Worcestershire, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Berglind D, Nyberg G, Willmer M, Persson M, Wells M, Forsell Y. An eHealth program versus a standard care supervised health program and associated health outcomes in individuals with mobility disability: study protocol for a randomized controlled trial. Trials 2018; 19:258. [PMID: 29703242 PMCID: PMC5923004 DOI: 10.1186/s13063-018-2646-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Young adults with mobility disability (MD) are less likely to engage in regular physical activity (PA) compared with their able-bodied peers and inactive adults with a MD are more likely to report one or more chronic diseases compared to those who are physically active. Despite the vast amount of research published in the field of PA interventions over the past decades, little attention has been focused on interventions aiming to increase PA among individuals with MD. Thus, we propose to compare the effects of an eHealth program compared to a usual care supervised health program on levels of PA and other health behaviors. Methods The current intervention will use a randomized controlled trial (RCT) design with two treatment groups (an eHealth program and a usual care supervised health program) in young adults with newly acquired MD. In total, 110 young adults (aged 18–40 years) with a MD, acquired within the past 3 years, will be recruited to participate in a 12-week intervention. The primary study outcome is accelerometer-measured time spent in moderate to vigorous PA. Secondary outcomes includes health-related quality of life, depression, stress, fitness, body composition, diet, musculoskeletal pain, motivation to exercise and work ability. Discussion There is a lack of RCTs investigating effective ways to increase levels of PA in young adults with MD. Increased levels of PA among this physically inactive population have the potential to substantially improve health-related outcomes, possibly more so than in the general population. The trial will put strong emphasis on optimizing exercise adherence and investigating feasibility in the two treatment programs. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (2017/1206–31/1). Trial registration International Standard Randomised Controlled Trial Number (ISRCTN), reference number ISRCTN22387524. Prospectively registered February 4, 2018 Electronic supplementary material The online version of this article (10.1186/s13063-018-2646-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | | | - Michael Wells
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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19
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Bilzon J, Gray S, Johansen-Berg H, Sexton CE, Western MJ, de Koning JL, Bollen JC, Moorlock SJ, Demnitz N, Seager P, Guralnik JM, Jack Rejeski W, Fox KR. A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion (REACT)): study protocol for a randomised controlled trial. Trials 2018; 19:228. [PMID: 29665854 PMCID: PMC5905123 DOI: 10.1186/s13063-018-2603-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/14/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The REtirement in ACTion (REACT) study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT) with an internal pilot phase. It aims to test the effectiveness and cost-effectiveness of a community, group-based physical activity intervention for reducing, or reversing, the progression of functional limitations in older people who are at high risk of mobility-related disability. METHODS/DESIGN A sample of 768 sedentary, community-dwelling, older people aged 65 years and over with functional limitations, but who are still ambulatory (scores between 4 and 9 out of 12 in the Short Physical Performance Battery test (SPPB)) will be randomised to receive either the REACT intervention, delivered over a period of 12 months by trained facilitators, or a minimal control intervention. The REACT study incorporates comprehensive process and economic evaluation and a nested sub-study which will test the hypothesis that the REACT intervention will slow the rate of brain atrophy and of decline in cognitive function assessed using magnetic resonance imaging (MRI). Outcome data will be collected at baseline, 6, 12 and 24 months for the main study, with MRI sub-study data collected at baseline, 6 and 12 months. The primary outcome analysis (SPPB score at 24 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. DISCUSSION REACT represents the first large-scale, pragmatic, community-based trial in the UK to target the non-disabled but high-risk segment of the older population with an intervention to reduce mobility-related disability. A programme that can successfully engage this population in sufficient activity to improve strength, aerobic capacity, coordination and balance would have a major impact on sustaining health and independence. REACT is also the first study of its kind to conduct a full economic and comprehensive process evaluation alongside the RCT. If effective and cost-effective, the REACT intervention has strong potential to be implemented widely in the UK and elsewhere. TRIAL REGISTRATION ISRCTN, ID: ISRCTN45627165 . Retrospectively registered on 13 June 2016. Trial sponsor: University of Bath. Protocol Version 1.5.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Janet Withall
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Colin J. Greaves
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Janice L. Thompson
- 0000 0004 1936 7486grid.6572.6School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Gordon Taylor
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Antonieta Medina-Lara
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Colin Green
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - James Bilzon
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Selena Gray
- 0000 0001 2034 5266grid.6518.aFaculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Heidi Johansen-Berg
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, FMRIB, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Claire E. Sexton
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,0000 0001 2297 6811grid.266102.1Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Max J. Western
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jolanthe L. de Koning
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jessica C. Bollen
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Sarah J. Moorlock
- 0000 0004 1936 7486grid.6572.6School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Naiara Demnitz
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Poppy Seager
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, FMRIB, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jack M. Guralnik
- 0000 0001 2175 4264grid.411024.2Department of Epidemiology and Public Health, University of Maryland, School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201-1559 USA
| | - W. Jack Rejeski
- 0000 0001 2185 3318grid.241167.7Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC 27109 USA
| | - Ken R. Fox
- 0000 0004 1936 7603grid.5337.2Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ UK
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Gill TM, Beavers DP, Guralnik JM, Pahor M, Fielding RA, Hauser M, Manini TM, Marsh AP, McDermott MM, Newman AB, Allore HG, Miller ME. The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: secondary analysis of a randomized controlled trial. BMC Med 2017; 15:65. [PMID: 28347337 PMCID: PMC5368996 DOI: 10.1186/s12916-017-0824-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations. METHODS We analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70-89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years. RESULTS For both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58-1.1) and 0.77 (0.62-0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71-3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88-1.7), but this difference did not achieve statistical significance (P-interaction, 0.670). CONCLUSIONS Intervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01072500 .
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Affiliation(s)
- Thomas M Gill
- Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT, 06519, USA.
| | - Daniel P Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Roger A Fielding
- Tufts University, Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, USA
| | - Michelle Hauser
- Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Mary M McDermott
- Departments of Internal Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Heather G Allore
- Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT, 06519, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Botoseneanu A, Chen H, Ambrosius WT, Allore HG, Anton S, Folta SC, King AC, Nicklas BJ, Spring BJ, Strotmeyer ES, Gill TM. Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial. J Am Geriatr Soc 2017; 65:1244-1250. [PMID: 28369670 DOI: 10.1111/jgs.14793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without. DESIGN Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years). SETTING Eight U.S. centers. PARTICIPANTS Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data. INTERVENTION Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769). MEASUREMENTS MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death). RESULTS Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04). CONCLUSION Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Ann Arbor and Dearborn, Michigan.,Institute of Gerontology, University of Michigan, Ann Arbor and Dearborn, Michigan
| | - Haiying Chen
- Department of Biostatistical Sciences, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Heather G Allore
- Division of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Stephen Anton
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Abby C King
- Department of Health Research and Policy, Department of Medicine, School of Medicine, Stanford University, Stanford, California.,Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Barbara J Nicklas
- J. Paul Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Bonnie J Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Elsa S Strotmeyer
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas M Gill
- Division of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut
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Rejeski WJ, Marsh AP, Brubaker PH, Buman M, Fielding RA, Hire D, Manini T, Rego A, Miller ME. Analysis and Interpretation of Accelerometry Data in Older Adults: The LIFE Study. J Gerontol A Biol Sci Med Sci 2016; 71:521-8. [PMID: 26515258 PMCID: PMC5175451 DOI: 10.1093/gerona/glv204] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/09/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accelerometry has become the gold standard for evaluating physical activity in the health sciences. An important feature of using this technology is the cutpoint for determining moderate to vigorous physical activity (MVPA) because this is a key component of exercise prescription. This article focused on evaluating what cutpoint is appropriate for use with older adults 70-89 years who are physically compromised. METHODS The analyses are based on data collected from the Lifestyle Interventions and Independence for Elders (LIFE) study. Accelerometry data were collected during a 40-minute, overground, walking exercise session in a subset of participants at four sites; we also used 1-week baseline and 6-month accelerometry data collected in the main trial. RESULTS There was extreme variability in median counts per minute (CPM) achieved during a controlled bout of exercise (n = 140; median = 1,220 CPM (25th, 75th percentile = 715, 1,930 CPM). An equation combining age, age(2), and 400 m gait speed explained 61% of the variance in CPM achieved during this session. When applied to the LIFE accelerometry data (n = 1,448), the use of an individually tailored cutpoint based on this equation resulted in markedly different patterns of MVPA as compared with using standard fixed cutpoints. CONCLUSIONS The findings of this study have important implications for the use and interpretations of accelerometry data and in the design/delivery of physical activity interventions with older adults.
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Affiliation(s)
- W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Matthew Buman
- SNHP Exercise Science & Health, Arizona State University, Tempe
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Don Hire
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Todd Manini
- Department of Aging and Geriatric Research. University of Florida, Gainesville
| | - Alvito Rego
- General Internal Medicine and Geriatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Pérez-Zepeda MU, Gutiérrez-Robledo LM. Calf circumference predicts mobility disability: A secondary analysis of the Mexican health and ageing study. Eur Geriatr Med 2016; 7:262-266. [PMID: 27656259 DOI: 10.1016/j.eurger.2016.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Calf circumference is a surrogate measurement of muscle mass. However, there is scarce evidence on its validity in predicting adverse outcomes such as mobility disability. The aim of this report is to determine if calf circumference could predict incident mobility disability in Mexican 60-year or older adults. METHODS This is a secondary analysis of the Mexican Health and Aging Study and in particular of its two first waves. Sixty-year or older adults without mobility disability in the first assessment were included and followed-up for two years. Calf circumference quartile groups were compared to test the difference of incident mobility disability. Logistic regression models were fitted to test the independent association when including confounding variables. RESULTS A total of 745 older adults were assessed, from which 24.4% of the older adults developed mobility disability at follow-up. A calf circumference > 38 cm was associated with a higher risk of developing mobility disability, even after adjustment in the multivariate model, with an odds ratio 0.55 (95% confidence interval 0.31-0.99, P = 0.049). CONCLUSIONS High calf circumference in Mexican older adults is independently associated with incident mobility disability. This could reflect the impact of adverse health conditions such as obesity (with high fat tissue) or edema. Further research should aim at testing these results in different populations.
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Affiliation(s)
- M U Pérez-Zepeda
- Geriatric Epidemiology Department at National Institute of Geriatrics, Mexico City, Mexico
| | - L M Gutiérrez-Robledo
- Head Office of the National Institute of Geriatrics, Periférico Sur 2767, colonia San Jerónimo Lídice, delegación Magdalena Contreras, 10200 México Distrito Federal, Mexico City, Mexico
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Norrbäck M, De Munter J, Tynelius P, Ahlström G, Rasmussen F. The association of mobility disability, weight status and job strain: A cross-sectional study. Scand J Public Health 2015; 44:311-9. [PMID: 26674491 DOI: 10.1177/1403494815618112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 01/21/2023]
Abstract
AIMS The study investigated whether people with mobility disability (MD) and/or obesity had higher job strain than people without it, and whether social support at work modifies this association. METHODS The study included 35,160 individuals (25-64 years of age) from the Stockholm Public Health Surveys of 2006 and 2010. Data on MD and obesity (BMI ⩾ 30 kg/m(2)calculated from weight (kg) and height (m)) were self-reported. According to the Demand-Control-Support theory job strain, collective strain, and isolated strain were calculated for six groups of people based on the presence of MD and obesity, using the subtraction approach (demand minus control). Differences in job strain mean scores were estimated by multivariate linear regression. Social support at work was analyzed as a potential effect modifier (high/low). RESULTS Obese people with MD had the highest job strain (β = 0.92, 95% CI 0.64-1.19), compared to normal weight people without MD (reference group). We found that social support at work significantly (p<0.001) modifies the association between job strain, MD and obesity. Obese people with MD had the highest isolated strain (β = 2.92, 95% CI 2.52-3.31), and the highest collective strain, although of smaller magnitude (β = 0.34, 95% CI 0.05-0.63), compared to the reference group. CONCLUSIONS Obese people with MD perceive higher job strain than non-disabled people of normal weight. Strategies aiming to increase the social support at work may be important for this group of people to prevent them from experiencing unhealthy job strain.
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Affiliation(s)
- Mattias Norrbäck
- Child and Adolescent Public Health Epidemiology, Department of Public Health Science, Karolinska Institutet, Sweden
| | - Jeroen De Munter
- Child and Adolescent Public Health Epidemiology, Department of Public Health Science, Karolinska Institutet, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology, Department of Public Health Science, Karolinska Institutet, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology, Department of Public Health Science, Karolinska Institutet, Sweden
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25
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Ezeugwu V, Klaren RE, A Hubbard E, Manns PT, Motl RW. Mobility disability and the pattern of accelerometer-derived sedentary and physical activity behaviors in people with multiple sclerosis. Prev Med Rep 2015; 2:241-6. [PMID: 26844077 PMCID: PMC4721432 DOI: 10.1016/j.pmedr.2015.03.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Low physical activity and high sedentary behavior levels are major concerns in persons with multiple sclerosis (MS) and these differ depending on the level of mobility disability. However, the manner in which daily activity is accumulated is currently unknown in this population. Methods A secondary analysis was performed on a combined data set of persons with MS from two previous investigations of physical activity and symptomatic or quality of life outcomes in the United States over a two year period (2007–2009). Mobility disability status was determined using the Patient Determined Disease Steps (PDDS) while activity behavior was objectively monitored using an ActiGraph accelerometer for 7 days. Results Persons with MS who have mobility disability were involved in sedentary behavior, light and moderate intensity activity for 65%, 34% and 1% of the day, respectively compared to 60%, 37%, and 3%, respectively in those without mobility disability (p < 0.05). Breaks in sedentary time did not differ by mobility disability status. Compared to those without mobility disability, the average number of sedentary bouts longer than 30 min was greater in those with mobility disability (p = 0.016). Conclusion Persons with MS with mobility disability are less active, engage in more sedentary behavior and accumulate prolonged sedentary bouts. MS patients with mobility disability had more daily sedentary time (65% vs. 60%). MS patients with mobility disability had less time in light activity (34% vs. 37%). MS patients with mobility disability had less time in MVPA (1% vs. 3%). MS patients with mobility disability engage more in prolonged sedentary bouts (5.1 vs. 4.3).
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Affiliation(s)
- Victor Ezeugwu
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Rachel E Klaren
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | - Elizabeth A Hubbard
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
| | | | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
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26
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Rejeski WJ, Rushing J, Guralnik JM, Ip EH, King AC, Manini TM, Marsh AP, McDermott MM, Fielding RA, Newman AB, Tudor-Locke C, Gill TM. The MAT-sf: identifying risk for major mobility disability. J Gerontol A Biol Sci Med Sci 2015; 70:641-6. [PMID: 25680917 DOI: 10.1093/gerona/glv003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The assessment of mobility is essential to both aging research and clinical geriatric practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations as an innovative method to improve measurement accuracy/precision. The primary aim of the current study was to evaluate whether MAT-sf scores can be used to identify risk for major mobility disability (MMD). METHODS This article is based on data collected from the Lifestyle Interventions and Independence for Elders study and involved 1,574 older adults between the ages of 70-89. The MAT-sf was administered at baseline; MMD, operationalized as failure to complete the 400-m walk ≤ 15 minutes, was evaluated at 6-month intervals across a period of 42 months. The outcome of interest was the first occurrence of MMD or incident MMD. RESULTS After controlling for age, sex, clinic site, and treatment arm, baseline MAT-sf scores were found to be effective in identifying risk for MMD (p < .0001). Partitioning the MAT-sf into four groups revealed that persons with scores <40, 40-49, 50-59, and 60+ had failure rates across 42 months of follow-up of 66%, 52%, 35%, and 22%, respectively. CONCLUSIONS The MAT-sf is a quick and efficient way of identifying older adults at risk for MMD. It could be used to clinically identify older adults that are in need of intervention for MMD and provides a simple means for monitoring the status of patients' mobility, an important dimension of functional health.
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Affiliation(s)
- W Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
| | - Julia Rushing
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Edward H Ip
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Abby C King
- Department of Health Research and Policy and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, California
| | - Todd M Manini
- Department of Aging & Geriatric Research, College of Medicine, University of Florida, Gainesville
| | - Anthony P Marsh
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Mary M McDermott
- Department of Internal Medicine, Northwestern University, Chicago, Illinois
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | | | - Thomas M Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Abstract
OBJECTIVE Despite theoretical advances in our conceptualization of disability, the "environment" remains a largely unspecified term in disablement models. The purpose of this research is to draw upon on a unique state-of-the-art nationally representative data set with innovative measures that provide the opportunity to tease apart and specify the role of different environmental factors in the disablement process. METHOD Using multinomial logistic regression with data from the first round of the recently launched National Health and Aging Trends Study (N = 6,578 community-dwelling Americans age 65+), this paper examines the role of the built environment (e.g., stairs or ramps leading up to the home) and mobility devices on reported difficulty going outside by oneself. RESULTS Almost three quarters of community-dwelling older Americans live in a residence that has stairs at the entrance. Older adults who use a walker to help them get around are adversely affected by stairs at the entrance to their home, effectively doubling the odds of reporting difficulty going outside independently. Roughly 10% of community-dwelling older Americans live in a residence with a ramp at the entryway, which reduces the odds of outdoor mobility difficulty threefold among those using wheeled mobility devices. However, ramps at the entryway are associated with a higher likelihood of reporting difficulty going outdoors among those who do not use any type of mobility device. DISCUSSION A better understanding of the complexities of the environment in the disablement process is critical for the planning and development of age-friendly environments allowing older adults to age in place.
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Onadja Y, Atchessi N, Soura BA, Rossier C, Zunzunegui MV. Gender differences in cognitive impairment and mobility disability in old age: a cross-sectional study in Ouagadougou, Burkina Faso. Arch Gerontol Geriatr 2013; 57:311-8. [PMID: 23827740 DOI: 10.1016/j.archger.2013.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022]
Abstract
This study aims to examine differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions. Data were collected on 981 men and women aged 50 and older in a 2010 cross-sectional health survey conducted in the Ouagadougou Health and Demographic Surveillance System. Cognitive impairment was assessed using the Leganés cognitive test. Mobility disability was self-reported as having any difficulty walking 400 m without assistance. We used logistic regression to assess gender differences in cognitive impairment and mobility disability. Prevalence of cognitive impairment was 27.6% in women and 7.7% in men, and mobility disability was present in 51.7% of women and 26.5% of men. The women to men odds ratio (95% confidence interval) for cognitive impairment and mobility disability was 3.52 (1.98-6.28) and 3.79 (2.47-5.85), respectively, after adjusting for the observed life course social and health conditions. The female excess was only partially explained by gender inequalities in nutritional status, marital status and, to a lesser extent, education. Among men and women, age, childhood hunger, lack of education, absence of a partner and being underweight were independent risk factors for cognitive impairment, while age, childhood poor health, food insecurity and being overweight were risk factors for mobility disability. Enhancing nutritional status and education opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities.
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Affiliation(s)
- Yentéma Onadja
- Département de démographie, Université de Montréal, 3150 rue Jean-Brillant, Montréal, Québec H3T 1N8, Canada.
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