Dietary and physical activity strategies to prevent type 2 diabetes in South Asian adults: protocol for a systematic review

INTRODUCTION

Type 2 diabetes (T2D) is a major health concern among populations of South Asian ethnicity. Although dietary and physical activity interventions may reduce the risk of T2D, the effectiveness has been moderate among South Asians. This might (in part) be because this subgroup follows strategies that were originally developed for interventions among other populations. Therefore, this review aims to assess the evidence for the current dietary and physical activity strategies recommended in T2D prevention intervention studies and guidelines for South Asians.

METHODS AND ANALYSIS

Included will be all studies and guidelines on dietary and/or physical activity strategies to prevent T2D in adult South Asians. Two reviewers will search online databases from their start until the present date for published and unpublished experimental/quasiexperimental studies, with at least an abstract in English. References of identified articles and key reviews will be screened for additional studies. Guidelines will be identified by searches in online databases and websites of public organisations. Finally, expert consultations will be held to supplement any missing information. Trial quality will be assessed with the Quality Assessment Tool for Quantitative Studies Data, and guidelines with the Appraisal of Guidelines for Research & Evaluation II. Data on the strategies recommended, targeting and evidence on effectiveness will be extracted by two reviewers and presented in tabular and narrative forms. Recommendations will be compared with the National Institute for Health and Care Excellence guidelines [PH35]. Overall findings on dietary and physical activity recommendations, as well as findings for specific subgroups (eg, by sex), will be discussed.

ETHICS AND DISSEMINATION

Ethics assessment is not required. Start date: 1 January 2016, finishing and reporting date 31 July 2016. Results will be published in a peer-reviewed scientific journal, the project report of EuroDHYAN (www.eurodhyan.eu) and in a PhD dissertation.

TRIAL REGISTRATION NUMBER

The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015027067.

Geriatric syndromes and functional status in NSHAP: rationale, measurement, and preliminary findings

INTRODUCTION

The geriatric functional measures and syndromes collected 5 years apart in Waves 1 and 2 of the National Social Life, Health, and Aging Project (NSHAP) data set included: difficulty with activities of daily living and instrumental activities of daily living, the timed up and go, a 3-m timed walk, repeated chair stands, self-reported physical activity, accelerometry-assessed (in)activity, falls, fractures, and frailty. The purpose of this paper was to describe the data collection methods and report preliminary population estimates for each measures.

METHOD

Frequencies, means, or medians were estimated for each measure stratified by age and gender, using the age-eligible samples in Wave 1 (n = 3,005) and Wave 2 (n = 3,196). An adapted phenotypic frailty scale was constructed in the sample common to both waves (n = 2,261). Changes over 5 years were reported for four measures common to both waves.

RESULTS

The functional measures worsened with age (p < .001). The syndromes were more prevalent with age except "all fractures" (p value range < .001-.03). Functional measures were worse among females than males except chair stand performance and the accelerometry-assessed (in)activity measures (p value range < .001-.01). The syndromes were more common among females than males except Wave 2 falls and Wave 2 hip fractures (p value range < .001-.03). Changes from Wave 1 to 2 revealed 11.5%-25.2% of individuals reported better health and 21.3%-44.7% reported worse health.

DISCUSSION

The NSHAP provides a comprehensive assessment of geriatric health. Our findings are consistent with the literature and support the construct of the study measures.

Physical behavior and function early after hip fracture surgery in patients receiving comprehensive geriatric care or orthopedic care--a randomized controlled trial

BACKGROUND

This study is a part of the randomized controlled trial, the Trondheim Hip Fracture Trial, and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care (CGC) with those managed with orthopedic care (OC).

METHODS

Treatment comprised CGC with particular focus on mobilization, or OC. A total of 397 hip fracture patients, age 70 years or older, home dwelling, and able to walk 10 m before the fracture, were included. Primary outcome was measurement of upright time (standing and walking) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor. Secondary outcomes were number of upright events on Day 4, need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1-3, and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery.

RESULTS

A total of 317 (CGC n = 175, OC n = 142) participants wore the activity monitor for a 24-hour period. CGC participants had significantly more upright time (mean 57.6 vs 45.1 min, p = .016), higher number of upright events (p = .005) and better Short Physical Performance Battery scores (p = .002), than the OC participants. Cumulated Ambulation score did not differ between groups (p = .234).

CONCLUSIONS

When treated with CGC, compared with OC, older persons suffering a hip fracture spent more time in upright, had more upright events, and had better lower limb function early after surgery despite no difference in their need for assistance during ambulation.

Concordance of physical activity trajectories among middle-aged and older married couples: impact of diseases and functional difficulties

OBJECTIVES

This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'.

METHOD

Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members.

RESULTS

In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships.

DISCUSSION

Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples.