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Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study
Abstract
The aims of the study were to describe the prevalence of physical activity in a sample of older adults in home care in Europe and to examine the relationship between physical activity and incident disability.
Study population consisted of a random sample of 2,005 subjects aged 65 or older admitted to home care programs in 11 European Home Health Agencies who participated in AgeD in HOme Care project. Participants who reported spending 2 or more hours of physical activities in last 3 days were defined physically active. Disability performing activities of daily living was defined as the need of assistance in one or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting.
More than 50% of participants were physically active. During a median follow-up of 12 months, 370 subjects (15%) became disabled. After adjusting for age, gender, and other possible confounding variables, active subjects were significantly less likely to become disabled compared to those reporting no or very low-intensity physical activity (OR, 0.67; 95% CI 0.53-0.84).
These findings support the possibility that physical activity has an independent effect on functional autonomy among frail and old people.
... There is growing evidence regarding the role of regular physical activity in the improvement and preservation of functional autonomy and in the prevention of many diseases and disorders [1][2][3][4][5]. For example, it has been shown that regular practice of physical activity contributes in preventing recurrent stroke [1,5], obesity [1,4], cardiovascular diseases [1][2][3], and cancer [1]. ...
... There is growing evidence regarding the role of regular physical activity in the improvement and preservation of functional autonomy and in the prevention of many diseases and disorders [1][2][3][4][5]. For example, it has been shown that regular practice of physical activity contributes in preventing recurrent stroke [1,5], obesity [1,4], cardiovascular diseases [1][2][3], and cancer [1]. Physical activity can be defined as any bodily movement produced by skeletal muscles resulting in energy expenditure [6]. ...
... There is growing evidence regarding the role of regular physical activity in the improvement and preservation of functional autonomy and in the prevention of many diseases and disorders [1][2][3][4][5]. For example, it has been shown that regular practice of physical activity contributes in preventing recurrent stroke [1,5], obesity [1,4], cardiovascular diseases [1][2][3], and cancer [1]. Physical activity can be defined as any bodily movement produced by skeletal muscles resulting in energy expenditure [6]. ...
With the growing interest in daily activity monitoring, several insole designs have been developed to identify postures, detect activities, and count steps. However, the validity of these devices is not clearly established. The aim of this systematic review was to synthesize the available information on the criterion validity of instrumented insoles in detecting postures activities and steps. The literature search through six databases led to 33 articles that met inclusion criteria. These studies evaluated 17 different insole models and involved 290 participants from 16 to 75 years old. Criterion validity was assessed using six statistical indicators. For posture and activity recognition, accuracy varied from 75.0% to 100%, precision from 65.8% to 100%, specificity from 98.1% to 100%, sensitivity from 73.0% to 100%, and identification rate from 66.2% to 100%. For step counting, accuracies were very high (94.8% to 100%). Across studies, different postures and activities were assessed using different criterion validity indicators, leading to heterogeneous results. Instrumented insoles appeared to be highly accurate for steps counting. However, measurement properties were variable for posture and activity recognition. These findings call for a standardized methodology to investigate the measurement properties of such devices.
... An increase in PA in older adults is associated with improved muscular strength [2], lower risk of disability [3], and may also protect against cognitive decline [4]. The beneficial effects of PA on functional tasks such as walking in older adults have also been reported [5,6], which is important given that loss of functional ability is associated with functional dependence [7,8] and can lead to social isolation [9] and malnutrition among older adults [10]. ...
... Fitbit-step counts per day estimated based on proprietary algorithm; ActiGraph-step counts in 60 s epochs and Freesdon Adult (1998) 10 [47]. 3 TUG-Timed Up and Go assessment. 4 A step was defined as a forward displacement of the foot together with a forward displacement of the trunk. 5 Walking was defined when the person was moving the feet forward in a walking pattern with the trunk in a forward displacement, from when the heel of the foot cleared the ground for the initial step until the foot of the closing step made complete contact with the floor, with a minimum of 2 steps. 6 Only data from the extended protocol group is discussed. ...
Measurement of real-world physical activity (PA) data using accelerometry in older adults is informative and clinically relevant, but not without challenges. This review appraises the reliability and validity of accelerometry-based PA measures of older adults collected in real-world conditions. Eight electronic databases were systematically searched, with 13 manuscripts included. Intraclass correlation coefficient (ICC) for inter-rater reliability were: walking duration (0.94 to 0.95), lying duration (0.98 to 0.99), sitting duration (0.78 to 0.99) and standing duration (0.98 to 0.99). ICCs for relative reliability ranged from 0.24 to 0.82 for step counts and 0.48 to 0.86 for active calories. Absolute reliability ranged from 5864 to 10,832 steps and for active calories from 289 to 597 kcal. ICCs for responsiveness for step count were 0.02 to 0.41, and for active calories 0.07 to 0.93. Criterion validity for step count ranged from 0.83 to 0.98. Percentage of agreement for walking ranged from 63.6% to 94.5%; for lying 35.6% to 100%, sitting 79.2% to 100%, and standing 38.6% to 96.1%. Construct validity between step count and criteria for moderate-to-vigorous PA was rs = 0.68 and 0.72. Inter-rater reliability and criterion validity for walking, lying, sitting and standing duration are established. Criterion validity of step count is also established. Clinicians and researchers may use these measures with a limited degree of confidence. Further work is required to establish these properties and to extend the repertoire of PA measures beyond “volume” counts to include more nuanced outcomes such as intensity of movement and duration of postural transitions.
... F RAILTY level has been a standard scale for evaluating the ageing process of older adults [1]. One of its essential components is physical frailty, which is relevant to the ability to live independently [2], [3]. The assessment of physical frailty is normally dependent on the performance of physical activities (PAs) [4]. ...
... The assessment of physical frailty is normally dependent on the performance of physical activities (PAs) [4]. Furthermore, monitoring the performance of PA is beneficial for 1) older adults to maintain their physical health and prevent or postpone frailty; 2) doctors and physiotherapists to decide on physical treatments; 3) healthcare providers to personalize services; 4) governments to arrange health service resources [1], [2], [5]. ...
Assessment of physical performance is essential to predict the frailty level of older adults. The modified Physical Performance Test (mPPT) clinically assesses the performance of nine activities:
standing balance
,
chair rising up & down
,
lifting a book
,
putting on and taking off a jacket
,
picking up a coin
,
turning 360°
,
walking
,
going upstairs
, and
going downstairs
. The activity performing duration is the primary evaluation standard. In this study, wearable devices are leveraged to recognize and predict mPPT items’ duration automatically. This potentially allows frequent follow up of physical performance, and facilitates more appropriate interventions. Five devices, including accelerometers and gyroscopes, were attached to the waist, wrists and ankles of eight younger adults. The system was experimented within three aspects: machine learning models, sensor placement, and sampling frequencies, to which the non-causal six-stages temporal convolutional network using 6.25 Hz signals from the left wrist and right ankle obtained the optimal performance. The duration prediction error ranged from 0.63±0.29 s (
turning 360°
) to 8.21±16.41 s (
walking
). The results suggest the potential for the proposed system in the automatic recognition and segmentation of mPPT items. Future work includes improving the recognition performance of
lifting a book
and implementing the frailty score prediction.
... figura 37). L'analyse des perspectives personnelles dans notre revue a mis en évidence l'importance de la réalisation d'objectifs personnels, souvent liés à la famille (conjoint, enfants et fratrie), à la pratique d'activités (principalement de loisirs)[148,149,150,151]. De plus, des facteurs externes, l'environnement (sécurité financière, un logement approprié, l'accès aux soins de santé)[107,150] par exemple les revenus, sont généralement exclus des modèles biomédicaux[152].En revanche, les ressources internes qui contribuent à faire face et à accepter les défis et les changements qui surviennent dans le processus de vieillissement ont été prises en compte, comme la résilience ou les stratégies d'adaptation aux changements du vieillissement. ...
... flexibilité, de coordination et de vitesse de réponse ont des avantages pour augmenter la vélocité de mouvement (comme réduire la perte de vitesse dans la marche) et la performance dans les activités de la vie quotidienne[143]. En outre, chez les personnes âgées fragiles, la pratique régulière de 30 minutes de tâches physiques à domicile, comme le nettoyage, le travail manuel ou les courses, s'est avérée fortement associée à un niveau de incapacité plus faible[149]. À cet égard, un objectif spécifique d'intervention pourrait être de promouvoir ces comportements à partir d'activités récréatives régulières à la maison[150,151,152], afin qu'ils deviennent des activités de routine agréables et accessibles, plutôt qu'un entraînement traditionnel pour les personnes âgées fragiles, dont l'état de santé a tendance à être complexe et qui ont des mode de vie malsain.En conclusion, nos travaux réalisés sur 3C et confirmés sur AMI sont les premiers à considérer la fragilité comme composante à part entière du processus de dépendance. ...
La population vieillissante actuelle aura plus que doublé entre 2020 et 2050, alors que les plus âgés (les 80 ans et plus) devraient être cinq fois plus nombreux à l’issue de cette même période. Les problématiques liées au vieillissement sont progressivement devenues des défis sociétaux majeurs, que ce soit sur le plan clinique, économique, politique et de santé publique. Dans ce contexte, bien vieillir est devenu un enjeu crucial pour les sociétés modernes. L'objectif de cette thèse était 1) d'une part, l’étude théorique du concept de vieillissement réussi dans une perspective d’application sur données de cohortes épidémiologiques populationnelles et dans le cadre d’intervention en santé publique; et 2) d'autre part, de mieux décrire le continuum de dépendance, en explorant plus particulièrement la phase précoce du processus : la question posée en toile de fond étant de déterminer si la fragilité pourrait avoir une place dans le processus continu de dépendance.Nous avons tout d'abord réalisé une revue de la littérature permettant d’étudier le concept de vieillissement réussi et d’en comparer les différentes approches. Trois grandes approches peuvent être distinguées : la plus classique et la plus ancienne, l’approche biomédicale, celle incluant des facteurs psychosociaux et environnementaux et enfin celle basée sur le point de vue subjectif personnel de l’individu vieillissant. Sur les 1057 articles initialement sélectionnés, 43 articles ont été retenus. Les résultats ont confirmé que le vieillissement réussi était un processus multidimensionnel profondément hétérogène et interdépendant, avec une variabilité substantielle des expériences individuelles vécues par une personne âgée. Une définition optimale devrait combiner des marqueurs de la capacité fonctionnelle, des facteurs psychosociaux, mais aussi des évaluations subjectives de son vieillissement, propres à chaque individu. Dans l'histoire naturelle de la dépendance, la perte d'une fonction précède souvent la perte d’autres, selon un ordre souvent hiérarchisé. Cette relation hiérarchique a été identifiée dans de précédents travaux entre les domaines de dépendance [mobilité, Activités instrumentés de la vie quotidienne (AIVQ) et Activités de base (AVQ)]. Dans la continuité de ces recherches, nous avons poursuivi cette approche en nous intéressant plus particulièrement aux stades plus précoces du processus. Nous sommes ainsi partis de l’hypothèse selon laquelle la fragilité faisait partie de l'histoire naturelle du processus de dépendance et qu’elle avait sa place en amont de ce continuum. Sur les données de la cohorte populationnelle 3Cités (3C), nous avons défini un indicateur hiérarchisé allant de la robustesse à la dépendance sévère, en passant par la fragilité physique et la dépendance modérée. Afin de valider la pertinence de cette approche, nous avons étudié les risques de décès à 4 ans associés à cet indicateur hiérarchisé. Les résultats confirment l’intérêt d’introduire la fragilité pour décrire l'ensemble du processus de dépendance chez les personnes âgées vivant à domicile. Enfin dans la continuité de ce travail, ces résultats ont été confirmés sur une seconde cohorte populationnelle : la cohorte AMI. De plus, afin d’affiner encore l’analyse de la phase précoce du processus de dépendance, l’état de pré-fragilité a été distingué de l’état de robustesse. Ces travaux, menés sur 3C et AMI (données fusionnées offrant une taille d’échantillon plus conséquente), confirment que les sujets pré-fragiles ont bien un risque significativement accru de décès par rapport aux robustes et un risque moindre par rapport aux autres états analysés. Enfin, dans une démarche plus interventionnelle, nous avons construit un programme (SoBeezy) visant à promouvoir le bien-vieillir à l’aide d’une plateforme numérique ayant pour principe l’entraide citoyenne.
... In their recent systematic review, van der Vorst et al. (2016) identified several protective factors against ADL disability in communitydwelling people aged ≥75. With regards to intervening factors, strong evidence was found for higher levels of physical activity as a protective factor against developing ADL disability (Avlund, Damsgaard, et al., 2002;Avlund, Due et al., 2002 ;Landi et al., 2007;Shah, Buchman, Leurgans, Boyle, & Bennet, 2012;Stessman et al., 2009;Sun et al., 2009). In addition, not smoking was found to be protective in one study (Sun et al., 2009). ...
... However, it could be hypothesized that physical activity is more influential than physical frailty with regards to ADL dependency. In this study, the protective effect of physical activity does not significantly differ across age groups, which is comparable with previous research (Landi et al., 2007). ...
... Research conducted by Sousa and Mendes (2013) showed that a combined exercise program can improve components of functional fitness. Physically active older adults show greater functional ability in activities of daily living than those with relatively low levels of physical activity (Landi et al., 2007). In contrast, among the elderly, limited physical activity is a major cause of reduced functional capacity (Miller et al., 2000;Nakano et al., 2014), which is significantly associated with a high mortality risk (Rakowski and Mor, 1992). ...
Abstract: The specificity of learning motor movements in artistic gymnastics is the state in which the action should
be performed automatically, in order to reduce or minimize the risk of unsuccessful performance. Properly learned
floor exercises requires technically correct movement, which is provided by the FIG Regulations for a given discipline.
All those acrobatic exercises are characterized by changes in extremely short-term, alternating support of the arms
and legs on the ground, where the body is very often in the phase without support, ie in the flight phase. The subject of
this paper are basic floor discipline exercises that are realized in the programs of the subject Gymnastics or Exercises
on apparatus in primary schools in the Republic of Serbia, while the aim of the paper is a methodical procedure of
training certain basic floor exercises, through certain phases, to a properly learned performance technique. Some
researchers have suggested that the best way to do a new exercise is through a step-by-step approach, which is known
in coaching as a progressive approach to learning. The steps taken in teaching new motor actions may vary and there
may not be a single “best way”. The basic gymnastic floor exercises that are selected from the Curriculum of primary
schools are basic forward movements. During the training process, the new student (gymnast) is enabled to develop a
proprioceptive consciousness that enables him to identify himself and correct his posture much more effectively.
Developing greater proprioceptive and kinesthetic awareness is important for gaining greater control during dynamic
work of certain phases in the training model. In the modern age of great development of information technologies,
modern electronics means such as video cameras, computers, digital cameras, etc. are of great help, but if we do not
know the models of the elements we analyze, even these are not helpful. This research examines the problems of the
learning process of some basic floor exercises and it’s modern approach, which is reflected in a faster and more efficient
learning method. The scientific approach to the evaluation of analogy is not only applicable to artistic gymnastics, but
it’s implementation is possible in all branches of sports where the goal is to achieve the desired results faster and more
successful.
Key words: training, method, artistic gymnastics, floor
... Research conducted by Sousa and Mendes (2013) showed that a combined exercise program can improve components of functional fitness. Physically active older adults show greater functional ability in activities of daily living than those with relatively low levels of physical activity (Landi et al., 2007). In contrast, among the elderly, limited physical activity is a major cause of reduced functional capacity (Miller et al., 2000;Nakano et al., 2014), which is significantly associated with a high mortality risk (Rakowski and Mor, 1992). ...
... Regular physical activity (PA), defined as physical movement involving energy expenditure during work, play, chores, travel, and recreation [1,2], is fundamental to healthy aging. Physically active older adults, defined here as people 60 years or older [3,4], retain independence and functional capacity much longer [5,6], enjoy better prevention and management of chronic diseases like diabetes and cardiovascular diseases [7,8], experience less stress, have lower rates of depression, anxiety, and social isolation [9,10], and have boosted immune responses when faced with illness compared to those who are inactive [11,12]. ...
Objectives: To present the best and most up-to-date evidence on associations between built environment (BE) attributes and overall and specific domains of physical activity (PA) (i.e., leisure, transport, walking, and cycling) in older adults (≥60 years).
Methods: An umbrella review was undertaken to compile evidence from systematic reviews using the Joanna Briggs Institute methodology. A comprehensive search (updated 16 August 2022), inclusion/exclusion of articles via title/abstract and full-text reviews, data extraction, and critical appraisal were completed. Only reviews with a good critical appraisal score were included.
Results: Across three included systematic reviews, each BE attribute category was positively associated with ≥1 PA outcome. A larger number of significant associations with BE attributes were reported for transport walking (13/26), total walking (10/25), and total PA (9/26), compared to leisure walking (4/34) and transport cycling (3/12). Fewer associations have been examined for leisure cycling (1/2).
Conclusion: Although the causality of findings cannot be concluded due to most primary studies being cross-sectional, these best and most up-to-date findings can guide necessary future longitudinal and experimental studies for the (re)design of age-friendly communities.
... Specifically, barrier-free design for housing (e.g., wide doors, sufficient space for wheelchairs, and knee spaces under the sink) and its surrounding environment (e.g., handrails, slopes, and wide hallways) can create a more accessible environment for older people's physical activities, especially for people with disabilities [14,25]. Indoor public amenities (e.g., clubs and leisure/sports centers) and outdoor public spaces (e.g., green spaces and pedestrian ways) can encourage older people to engage in more recreational activities and physical exercise, contributing to a healthy lifestyle and high quality of life [15,17,26,27]. The use of connecting corridors, elevators, and a shared area (e.g., a hall and meeting room) can support the gathering of and communication among senior residents and reinforce their social interactions within the community [16,18,28,29]. ...
Senior housing with age-friendly design and elderly care services contributes to the health and well-being of older people. Previous research has evidenced that the immediate environment factors of senior housing, such as the design of housing features and facilities, have a direct bearing on the satisfaction and quality of life of older people. However, external environment factors, such as political, economic, and social ones that affect key stakeholders’ behaviors in senior housing development, are relatively under-researched. Accordingly, this study aimed to explore the external environmental factors influencing the development of senior housing. Taking Hong Kong as case study, this study first commenced with a systematic review to identify the factors in political, economic, and social domains from global evidence. Following this, we interviewed local experts from academia, industry, and government to solicit their opinions on the relative importance of these factors. We then determined the factor rankings using the analytical hierarchy process method. The results showed that local experts perceived economic factors as the most critical ones in influencing senior housing development in Hong Kong, including land costs, funding from financial institutions, and government incentives. If policymakers tend to promote senior housing in densely populated cities like Hong Kong, the policies should be attractive for housing developers, such as land premium concessions and innovative financial channels for supporting the long-term development of senior housing.
... Research conducted by Sousa and Mendes (2013) showed that a combined exercise program can improve components of functional fitness. Physically active older adults show greater functional ability in activities of daily living than those with relatively low levels of physical activity (Landi et al., 2007). In contrast, among the elderly, limited physical activity is a major cause of reduced functional capacity (Miller et al., 2000;Nakano et al., 2014), which is significantly associated with a high mortality risk (Rakowski and Mor, 1992). ...
Aging is an inevitable and irreversible process in which changes occur that negatively affect the functional status of older people. One of the ways to positively influence these changes is the intervention of a combined exercise program that can improve more health parameters in older women. Objective: To investigate the effects of a 10-month combined exercise program on functional fitness in elderly women. Methods: Older women were randomly assigned to the experimental group (n = 30), which completed a 60-minute workout twice a week over a 10-month period. Aerobic exercise and strength training were a combination of a targeted exercise program. The aerobic program included simple choreographed steps, and the strength training was performed with the patient's own body weight. Functional status (standing up from chair 30-s, manual bending 30-s, 2-minute step test, chair recline, shoulder mobility, 8-foot test) was measured before and after the experimental treatment. Results: Statistically significant improvements were obtained for all fitness variables (t (29) =-12.120, p < 0.0005 for the 2-minute step test; t (29) =-10.09, p < 0.0005 for getting up from the chair; t (29) =-9.549, p < 0.0005 for flexion at the elbow joint; t (29) =-5.696, p < 0.0005 for chair forward; t (29) =-2602, p < 0.05 for shoulder flexibility it t (29) = 8.299, p < 0.0005 by 8 feet). Conclusion: 10 months of combined exercise training is the optimal time to improve health in older women. Motivation and regularity of participation show that the model is pragmatic to maintain a positive lifestyle.
... However, as a modifiable behavioral factor, PA is associated with improving physiological systems in frail older adults, such as sarcopenia and muscle force (Talar et al., 2021). Previous studies have also demonstrated that older adults with various risk factors who participate in moderate-to high-intensity PA exhibit a lower incidence of cardiovascular disease (Soares-Miranda et al., 2016) and that even low-intensity PA independently predicts frailty-related outcomes, such as mortality, falls, and disability (Landi et al., 2004(Landi et al., , 2007. Moreover, there is considerable evidence of the importance of PA in maintaining body weight and preventing obesity issues in older adults (Colleluori et al., 2019;Liao et al., 2017). ...
The Assessment of Physical Activity in Frail Older People (APAFOP) is a patient-reported outcome measure assessing physical activity among community-dwelling older adults. However, this instrument has not been verified in the Chinese context. Thus, we translated the APAFOP into Chinese and then linguistically validated the Chinese version of APAFOP (APAFOP-C) by following the guidelines developed by Beaton and Willis. The translation process took 6 months. We identified nine translation issues in the translation process, of which experiential equivalence issues were the most frequent. It took three rounds of cognitive interviews to achieve linguistic validity, and the most significant issues were related to the layout of the questionnaire identified during the cognitive interview. In conclusion, the items of the APAFOP-C were considered comprehensive and relevant to assessing the physical activities of frail older adults in China. This study has laid the foundation for future evaluation of its measurement properties.
... Age is also predictive of involvement in everyday and physical activities with younger elderly being more active. Older age is often associated with limited individual mobility due to poorer health, which makes it harder for older adults to be involved in various daily and physical activities (Landi et al., 2007). In addition, education has contributed to a greater engagement in everyday activities. ...
The study aimed at investigating age and gender differences in cognitive reserve (CR) and whether CR can contribute to everyday and physical activity and fluid reasoning in older adults. Participants (N = 294), categorized into three age groups: young-old, middle-old, and old-old, completed the Cognitive Reserve Index questionnaire (CRIq), the Everyday Activity Questionnaire (EAQ), the Physical Activity Scale for the Elderly (PASE), and the Unbalanced Structure Test (UST). The old-old had significantly lower scores on CRI-Total, CRI-Working activity, and CRI-Leisure time compared to young-old and middle-old. Men showed higher scores than women on all CR subscales except for CRI-Leisure time where no significant difference was found. Younger age and higher CRI-Leisure time predicted higher scores on PASE, EAQ, and UST, while higher scores on CRI-Education predicted EAQ and UST. Higher CR seems to enable a more active and healthier lifestyle, while CRIq is a useful tool in the assessment of cognitive potential in the elderly.
... More specifically, crosssectional and longitudinal data demonstrate that 1) cardiorespiratory fitness is associated with functional capacity and independence; 2) strength and power are related to the performance and activities of daily living and; 3) Balance-mobility in combination with power are important factors in preventing falls [11]. Landi et al. also support that physical activity has an independent effect on functional autonomy among frail and older people [12]. In addition, two reviews of the literature assessing the association between physical activity and physical function have shown that a physically active lifestyle reduces the risk of low physical function among older adults [13,14]. ...
Abstract Background Physical activity (PA) is recognized as important predictor of healthy aging. However, the influence of the type of voluntary PA as well as age or sex in this relationship is unclear. Thus, we assess the association between current and past PA level and physical performances among voluntary active older adults. Methods Functional capacities (timed Up and Go, sit-to-stand, alternate step test, unipodal balance, grip strength, knee extension strength, estimated muscle power and VO2 max) as well as body composition (DXA: total and appendicular lean masses (LM; kg), fat mass (FM; %)) were measured. Current and last 5-years PA level (time spent on total, aerobic, resistance and body & mind activities) were assessed using an interview. Multiple regressions, adjusted on age, sex and BMI, were performed to assess the relationship between current or past PA level and physical performances. Sub-group analysis, according to the sex (men/women) or age (
... Aging is commonly associated with loss of independence and impairment in physical functioning which is a major indicator of frailty. Physical activity plays a major role in healthy aging and is essential to maintain healthy functioning in elderly people [1]. In particular, physical activity can reduce the negative impact of frailty and reduce the risk of frailty in older adults [2]. ...
Wearable technology offers a prospective solution to the increasing demand for activity monitoring in pervasive healthcare. Feature extraction and selection are crucial steps in activity recognition since it determines the accuracy of activity classification. However, existing feature extraction and selection methods involve manual feature engineering, which is time-consuming, laborious and prone to error. Therefore, this paper proposes an unsupervised feature learning method that automatically extracts and selects the features without human intervention. Specifically, the proposed method jointly trains a convolutional denoising autoencoder with a convolutional neural network to learn the underlying features and produces a compact feature representation of the data. This allows not only more accurate and discriminative features to be extracted but also reduces the computational cost and improves generalization of the classification models. The proposed method was evaluated and compared with deep learning convolutional neural networks on a public dataset. Results have shown that the proposed method can learn a salient feature representation and subsequently recognize the activities with an accuracy of 0.934 and perform comparably well to the convolutional neural networks.
... High levels of sedentary behavior (sitting) contributes to lipid accumulation (Smith et al., 2014;Larsen et al., 2014;Manini et al., 2007), metabolic impairments (Ford et al., 2005), and loss of muscle mass during aging (Atkins et al., 2014), all of which strongly contribute to functional decline (Landi et al., 2007a;Vincent et al., 2010;Vieira et al., 2013;Botoseneanu et al., 2015). These findings are of concern as the majority of middle-age Americans spend over half their waking day (~8-9 h) engaged in sedentary pursuits (Cohen et al., 2013;Maher et al., 2013), with older adults spending an even greater proportion (75%) of their waking hours engaged in sedentary behavior (~11 h per day) (Mankowski et al., 2015). ...
Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology-or geroscience-has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world.
... La realización de cualquier tipo de práctica deportiva está directamente relacionada con el bienestar, los estilos de vida saludables, así como la mejora de la salud y calidad de vida (Landi et al., 2007;Rebollo, 2008). ...
Realizamos un análisis del estado actual de las personas mayores en relación con la actividad física y el sedentarismo, éste último aspecto convertido en la actualidad como una de las principales fuentes de amenaza para la salud pública de los países europeos y americanos. Damos a conocer los efectos negativos de la inactividad física sobre los parámetros cardiovasculares, diabetes, depresión y cáncer, entre otros. Mostramos los beneficios de la actividad física (herramienta clave para solucionar los problemas propios del sedentarismo) para la salud de este colectivo de la población; al tiempo que estudiamos las razones por las que las personas mayores acuden a los programas de actividad física. Finalmente, aportamos una serie de conclusiones.Palabras clave: Actividad Física. Calidad de Vida. Personas mayores. Salud. Sedentarismo.Abstract: We analyzed the current status of the elderly in relation to physical activity and sedentary, the latter now become a major source of threat to public health in the European and American countries. We report the negative effects of physical inactivity on cardiovascular parameters, diabetes, depression and cancer, among others. We show the benefits of physical activity (a key tool to solve the problems of the sedentary lifestyle) for the health of this group of the population while we study the reasons why older people attend physical activity programs. Finally, we provide a number of conclusions. Keywords: Physical Activity. Quality of Life. Elderly. Health. Sedentary.
... 2 Logically lower physical performance is accompanied with a higher rate of sarcopenia, body fat, impairment of cardiovascular and metabolic systems, and neurocognitive functions, which results in a general decrease of overall quality of life in elderly. [3][4][5][6] This progressive deterioration of physical performance and neurocognitive functions is even more significant in the elderly with cognitive impairment and early stages of dementia. Therefore, the increase of muscle mass, strength, flexibility, endurance and cardiorespiratory fitness, as essential components of physical performance, is very important, since when reduced, they can significantly contribute to the limited mobility, physical performance and cognitive state. ...
Introduction:
The objective of the study was to examine the relationship between the values of selected parameters of physical function, body composition, body mass index (BMI) and biochemical markers of metabolic health with the total testosterone (TT) levels in adult males. We aimed to analyse the correlation between these values and variations in the TT levels.
Methods:
A total of 17 subjects (age = 50.2 ± 8.1 years, TT = 11.4 ± 3.8nmol/l) were included in the study. Subjects were tested on physical function (1RM on leg press, bench-press, handgrip, VO2max), body composition (DXA), biochemical parameters (morning fasting blood samples).
Results:
TT was inversely correlated with abdominal circumference (AC) (p.
... Since disability is difficult to reverse at older age, frailty has been considered as a window of opportunity to prevent disability. For instance, promoting physical activity and participation in social activities among frail older adults can help them to slow down the process towards disability [11,12]. Transport disadvantage is relevant in this context. ...
This study examined differences in older adults’ travel behaviours by frailty status in metropolitan, suburban, and rural areas of Japan. Data were collected from 9104 older adults (73.5 ± 5.7 years; 51% women; 19% frail) living in metropolitan (n = 5032), suburban (n = 2853), and rural areas (n = 1219) of Japan. Participants reported if they walked, cycled, drove a car, rode a car as a passenger, and used public transportation (PT) once per week or more. A standardised questionnaire was used to assess frailty status. We conducted logistic regression analysis to calculate the odds ratios of using each travel mode by frailty status stratified by locality. Relative to non-frail participants, frail participants were less likely to walk and drive a car in all three areas. Frail participants had significantly higher odds of being a car passenger in the suburban (OR = 1.73 (95% CI: 1.32, 2.25)) and rural areas (OR = 1.61 (1.10, 2.35)) but not in the metropolitan area (OR = 1.08 (0.87, 1.33)). This study found that frail older adults living in suburban and rural areas tended to rely more on cars driven by someone else, suggesting that transport disadvantage is more pronounced in suburban and rural areas than in metropolitan areas.
... 2 Logically lower physical performance is accompanied with a higher rate of sarcopenia, body fat, impairment of cardiovascular and metabolic systems, and neurocognitive functions, which results in a general decrease of overall quality of life in elderly. [3][4][5][6] This progressive deterioration of physical performance and neurocognitive functions is even more significant in the elderly with cognitive impairment and early stages of dementia. Therefore, the increase of muscle mass, strength, flexibility, endurance and cardiorespiratory fitness, as essential components of physical performance, is very important, since when reduced, they can significantly contribute to the limited mobility, physical performance and cognitive state. ...
The study compared the effect of 12-week multimodal training programme performed twice a week at the regular exercise facility (REF) with the 12-week multimodal training programme performed three times per week as a part of the research programme (EX). Additionally, the study analysed how the experimental training programme affect the physical performance of cognitive healthy and mild cognitive impaired elderly (MCI). The REF training group included 19 elderly (65.00±3.62 years). The experimental training programme combined cognitively healthy (EXH: n=16; 66.3±6.42 years) and age-matched individuals with MCI (EXMCI: n=14; 66.00±4.79 years). 10m maximal walking speed (10mMWS), Five Times Sit-to-Stand Test (FTSS), maximal and relative voluntary contraction (MVC & rel. MVC) were analysed. The REF group improved in 10mMWS (t=2.431, p=.026), the MVC (t=-3.528, p=.002) and relative MVC (t=3.553, p=.002). The EXH group improved in FTSS (t=5.210, P=.000), MVC (t=2.771, p=.018) and relative MVC (t=-3.793, p=.004). EXMCI improved in FTSS (t=2.936, p=.012) and MVC (t=-2.276, p=.040). According to results, both training programmes sufficiently improved walking speed and muscle strength in cognitively healthy elderly. Moreover, the experimental training programme improved muscle strength in MCI elderly.
... Evidence suggests that health-related quality of life is improved by psychological well-being with better physical activity [11]. Although some age-related physical and mental declines are undeniable but physically active older adults retain healthy functioning for a longer time than sedentary peers [12]. Socio economic status (SES) refers to an individual's position within a hierarchical social structure, which is one of the important enticements of health status [13][14][15][16][17][18]. ...
... 79 This benefit extends to frail elderly populations where physical activity can prevent a loss of functional autonomy (odds ratio 0.67). 80 On the other hand, falls are not benign events. In addition to the physical consequences, falls in older adults are associated with significant anxiety 81,82 and a reduced quality of life. ...
Background:
Despite falls being an almost universal clinical feature and central to the presentation and diagnostic criteria of progressive supranuclear palsy, our understanding of falls is surprisingly limited and there are few effective treatment options.
Objectives:
To provide an overview of the topic of the impact, assessment, mechanism, and management of falls in progressive supranuclear palsy.
Methods:
We performed a literature search for "falls" and "progressive supranuclear palsy" and included additional relevant literature known to us. We synthesized this literature with experience from clinical practice.
Results:
We review current understanding of the pathophysiology of falls, highlighting the roles of the indirect pathway and the pedunculopontine nucleus. We go on to identify shortcomings in commonly used assessments to measure falls. We discuss medical and nonmedical fall prevention strategies, and finally we discuss balancing falls risk against promoting independence.
Conclusion:
Falls are central to progressive supranuclear palsy presentation and diagnosis. Indirect locomotor and pedunculopontine nucleus dysfunction are thought to be the neural substrate of falls in this condition. Attempts to measure and prevent falls, by medical and nonmedical means, are currently limited. A personalized approach is advocated in the management of falls.
... Well-being in older people is often not satisfactory due to health limitations such as psychological and functional problems [16]. The association between PA practice and HRQoL provides a multitude of health benefits for older people [17]. Moreover, physical inactivity and sedentary lifestyles are both causes of negative health consequences [18], such as decreasing cognitive and functional capacity [3]. ...
This study (1) analyzes the differences between non-participating and participating older women in terms of clinical characteristics, pain coping strategies, health-related quality of life and physical activity (PA); (2) studies the associations between non-participants and participants, clinical characteristics, pain coping strategies, HRQoL and bodily pain and PA; and (3) determines whether catastrophizing, physical role, behavioural coping, social functioning and emotional role are significant mediators in the link between participating in a Pilates-aerobic program (or not) and bodily pain. The sample comprised 340 older women over 60 years old. Participants of the present cross-sectional study completed measures of clinical characteristics: HRQoL using the SF-36 Health Survey, pain-coping strategies using the Vanderbilt Pain Management Inventory (VPMI) and PA using the International Physical Activity Questionnaire (IPAQ). Significant differences between non-participants and participants, were found in clinical characteristics, pain-coping strategies (both, p < 0.05), HRQoL (p < 0.01), and PA (p < 0.001). Moreover, catastrophizing support mediated the link between non-participants and participants and bodily pain by 95.9% of the total effect; 42.9% was mediated by PA and 39.6% was mediated by behavioural coping. These results contribute to a better understanding of the link between PA and bodily pain.
... This conclusion is supported not only by studies [8] but also by public administrations [9]. Taking part in a PA has a direct association with well-being and healthy lifestyle as well as improved health and quality of life [10][11][12]. ...
The aim of this study was to analyze the level of satisfaction in three municipal sports centers in the city of Malaga and to learn and analyze the characteristics of users older than 40 years of age in these centers. A total of 303 persons (123 men and 180 women) from three sports centers in the city of Malaga participated in this study (M = 58.14, SD = 7.16 years). The Evaluation of Perceived Quality in Sports Services test (CECASDEP) was used, and the results demonstrated that the different dimensions studied-sports center, activity space, locker rooms, program of activities, and trainer-were very positively correlated. The level of customer loyalty increased with user satisfaction and perceived quality of services as well as the age of the person. Users were also found to be more motivated to take part in physical activities due to greater satisfaction. The highest scores were given to the trainers, who played a key role in all three sports centers. In conclusion, we gathered important insights into perceived quality in different sports centers. This information can be used by sports managers to strengthen dimensions with lower scores and improve those with higher scores. In addition, the study confirms that the level of customer loyalty is related to the perceived quality scores. Therefore, the use of measuring instruments is recommended to optimize the quality of sports services.
... It is common of having elderly population who were having low level of physical activity (Logan et al, 2013). A study found majority of the participants who were involved in the physical activity had low rate of physical activity (Landi et al, 2007). Elderly were highly inactive in physical activity. ...
Background: Aging will cause loss of physical and mental function, loss of family and also loss of spouse. These type of loses gradually affect quality of life among elderly. Therefore, it is important to increase awareness among people in the community to understand about the benefits of doing physical activities regularly.
Materials and Methods: The aim of study is to assess whether physical and mental activity may improve the quality of life among elderly. A cross sectional study using a convenience sampling was conducted on 380 elderly aged 60 years and above in Kuantan, Pahang. The instruments used in this study were WHOQOL-BREF and GPAQ. The descriptive analysis and Mann Whitney test were carried out.
Result: There is zero number of respondents classified under high level of physical activity. A total number of 23 respondents were group among medium level and the rest were having low level of physical activity. There was no association between psychological healths; social relationship and environment domain as p-value for the test were ≥0.05 while the p-value for physical domain was ≤0.05. There was also no association between the mental activity and quality of life. It also identified no association between physical activity or mental activity and quality of life.
Conclusion: Majority of the elderly had low level of physical activity, however those engaged in medium level of physical activity has a significantly higher level of quality of life. We identify the findings benefits to inform health care providers in emphasizing their health advice towards keeping the elderly physically active to maintain an optimal quality of life and healthy aging.
Keywords: Quality of Life, Physical Activity, Mental Activity, Elderly
... Physical frailty encompasses a number of indicators. Well-established indicators of physical frailty are gait speed, (13) physical activity, (14) hand grip strength, and balance. (15) A proper understanding of the contribution of individual indicators of frailty in the prediction of disability is a requisite for preventive interventions. ...
Background: Balance disorders are a major cause of falls and the most common geriatric syndromes
threatening the independence and affecting the health outcome of elderly people and it reduced level
of function.
Objective: The study aimed to assess the effects of balance disorders on health outcomes of elderly
people. A cross-sectional study was conducted and comprised 114 elderly (60 years and above) from
the elderly home, Damanhur. Their demographic characteristics, balance measurements and health
outcomes have been evaluated. Data was collected according to the Arabic version of 12-item short
form of health outcomes. The Berg Balance Scale (BBS) was used to evaluate balance. The Timed
Up and Go (TUG) test was used to measure basic functional mobility. Flexibility was assessed by a
sit and reach test, to determine the level of fear of falling in daily life by the visual analogue scale
(VAS) was used.
Results: One-third of the participants (33.3%) had a history of falls once or more. The most reported
morbidities were hypertension and diabetes mellitus (43.9% and 26.3%, respectively).The BBS
scores were significantly associated with physical and social health domains, (r = 0.625,p=0.042, and
r =0.19, p =0.048).While it was negatively correlated with the psychological health domain (r = -
0.16,p =0.087). A positive correlation was observed between the health outcome (SF-12 scores) and
BBS, flexibility (r =0.016, 0.082, and 0.119).Whereas, fear of falling was negatively associated with
all measured parameters except the flexibility (r = 0.063). The majority of the participants, (80.7%)
had moderate health-related quality of life.
Conclusion: The assessment of falling risks and body balance of the elderly in elderly homes will
guide the implementation of suitable intervention programs to improve body balance, reduce falling
and its consequences among elderly.
... Knowledge about this association is useful in addressing cases where older adults exercise less than daily. This is important as lesser physical activity can lead to functional and cognitive decline in the long term (Landi et al., 2007;Sofi et al., 2011). ...
There is a large body of literature about the determinants of exercising regularly in older adults. However, to date, there is limited evidence showing that self-regulation is associated with exercising regularly. Existing studies are mostly restricted to rather specific or small samples. Thus, the purpose of this study was to examine whether self-regulation is associated with daily sports activities among older adults. For the current study, cross-sectional data were used from the German Ageing Survey (n = 7,757), a nationally representative sample of community-dwelling individuals aged 40 and over in Germany. Logistic regression analysis showed that daily sports activities is positively associated with self-regulation [OR: 1.32 (95%-CI: 1.11–1.58)]. The present study highlights the importance of an association between daily sports activities and self-regulation. Knowledge about this association is useful in addressing cases where older adults exercise less than daily.
... Las participantes las superarían tanto en tiempo de práctica física ligera como en la frecuencia y tiempo de actividades físicas a una intensidad moderadaintensa. Esto conlleva a que la práctica física a altas intensidades en el medio natural y a través de entrenamientos específicos (Binder et al., 2002) como pueden ser rutas de senderismo, propicie mejoras en la capacidad física (Takata et al., 2002) y en el desarrollo psicológico de las participantes (Landi et al., 2007). Por consiguiente, las participantes podrían desear la práctica de actividad física frecuente de alta intensidad. ...
El envejecimiento es un proceso natural e inevitable con cambios
degenerativos en la mayoría de las funciones físicas, fisiológicas, psicológicas y
sociales. El presente trabajo estudia la relación establecida entre aspectos de la
práctica de ejercicio físico moderado/intenso tales como la frecuencia semanal y
tiempo dedicado, con la capacidad física de las participantes. La muestra se
compone de 43 mujeres mayores de 60 años (66.4+5.3), que forman parte de un
programa de condición física. La frecuencia de las rutas de senderismo es de una
vez a la semana y 50 minutos de duración. La frecuencia semanal de práctica física
extra y el tiempo empleado para cada ocasión, además de la duración de las
clases de condición física e intensidad percibida fueron evaluadas. Los resultados
muestran una relación significativa entre los días a la semana que las participantes
practican ejercicio físico moderado/intenso a través de rutas de senderismo y la
flexibilidad del tren inferior (back scratch test) (p>0.05); tiempo dedicado a las
sesiones de capacidad física con la flexibilidad del tren inferior (back scratch test) y
agilidad/equilibrio dinámico (8-ft up and go test) (ambos, p<0.05). Las personas más
activas físicamente, y que practican ejercicio físico asiduamente, presentan
mejores capacidades físicas.
... Physical activity provides health benefits for older adults and is directly correlated to reduction in mortality, morbidity, and disability (Gorman et al., 2014;Healy, Winkler, Owen, Anuradha, & Dunstan, 2015;Landi et al., 2007;Nied & Franklin, 2002). Physical activity is important to maintain physical fitness of the body and also for mental health (Chodzko-Zajko, 2014;Taraldsen, Chastin, Riphagen, Vereijken, & Helbostad, 2012). ...
This paper presents the overall design of a prototype home-based system aimed to reduce sedentary behavior of older adults. Quantitative performance indicators were developed to measure the sedentary behavior and daily activities of an older adult. The sedentary behavior is monitored by identifying individual positions (standing, sitting, and lying) within the field of view of a Microsoft Kinect sensor, using a custom designed algorithm. The physical activity of the older adult when outside the field of view of the Microsoft Kinect sensor, is monitored by counting the number of steps using a Fitbit Charge HR watch, which the older adult is equipped with. A user interface was developed on a PC platform to interact with the older adult. The user interface is automatically operated and includes several modules. It displays the activity level, and provides feedbacks, alerts, and reminders to reduce sedentary behavior. Evaluations using a mixed methods approach that included a focus group, interviews, and observations were conducted to examine the integrated system, evaluate the users’ experience with the system, and compare different types of feedbacks and alerts. The analyses indicated the feasibility of the proposed SIT LESS system along with recommendations for improving the system in future research.
... Según los resultados del presente estudio, el 63,84% de los mayores de 70 años que viven en la comunidad necesitan prescripción del ejercicio como tratamiento de la prefragilidad o de su limitación funcional, con el objetivo de mejorar su función física y evitar los eventos adversos asociados al declive funcional. La edad superior a 80 años (OR = 4,65; IC del 95%, 2,60-8,31), el ser mujer (OR = 2,80; IC del 95%, 1,59-4,95) y el antecedente de haber recibido fisioterapia son factores asociados a la necesidad de prescripción de ejercicio, en consonancia con otros estudios en los que se describen además otros factores, como la comorbilidad, el bajo nivel de actividad física o la obesidad 24,25 . ...
Aim:
Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2criteria to select the beneficiary population of the program.
Design:
Population-based cross-sectional study.
Settings:
Primary Care.
Participants:
Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332).
Main measurements:
The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10).
Results:
The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27).
Conclusion:
Almost 2thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community.
... Our data are consistent with previous studies showing that people who are more physically active have a reduced risk to develop mobility disability compared with those who are less active [18][19][20][21]. These findings corroborate the knowledge in this field and also show that the age-related decline in physical performance is potentially amendable. ...
The maintenance of muscle function into late life protects against various negative health outcomes. The present study was undertaken to evaluate the impact of habitual physical activity and exercise types on physical performance across ages in community-living adults. The Longevity check-up 7+ (Lookup 7+) project is an ongoing cross-sectional survey conducted in unconventional settings (e.g., exhibitions, malls, and health promotion campaigns across Italy) that began on June 1st 2015. The project was designed to raise awareness in the general population on major lifestyle behaviors and risk factors for chronic diseases. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Physical performance is evaluated through the 5-repetition chair stand test. Analyses were conducted in 6,242 community-living adults enrolled between June 1st 2015 and June 30th 2017, after excluding 81 participants for missing values of the variables of interest. The mean age of the 6,242 participants was 54.4 years (standard deviation 15.2, range 18–98 years), and 3552 (57%) were women. The time to complete the chair stand test was similar from 18 to 40–44 years, and declined progressively across subsequent age groups. Overall, the performance on the chair stand test was better in physically active participants, who completed the test with a mean of 0.5 s less than sedentary enrollees (p < .001). After adjusting for potential confounders, a different distribution of physical performance across exercise intensities was observed, with better performance being recorded in participants engaged in more vigorous activities. Our findings suggest that regular physical activity modifies the age-related pattern of decline in physical performance, with greater benefits observed for more intensive activities. Efforts are needed from health authorities and healthcare providers to promote the large-scale adoption of an active lifestyle throughout the life course.
... Se ha observado que la actividad física presenta beneficios para las personas mayores tanto a nivel físico, psicológico y social (Varo et al., 2003;Márquez, Rodríguez y De Abajo, 2006). Además, el ejercicio físico regular adaptado tiene un papel fundamental en la calidad de vida relacionada con la salud y esperanza de vida del mayor (Blain, Vuillemin, Blain y Jeandel, 2007;Poon y Fung, 2008;Vogel et al., 2009) y otros estudios muestran que se relaciona con el bienestar y satisfacción vital, la calidad de vida en general, la salud física y los hábitos de vida saludables (Landi et al., 2007;Rebollo, 2008). ...
La participación es uno de los tres pilares del envejecimiento con éxito, junto con la salud y el alto funcionamiento cognitivo y físico. La importancia de la participación radica en su influencia sobre otras variables como el bienestar, la salud física y mental. El objetivo de este estudio fue analizar el impacto de la participación sobre el bienestar, depresión y salud y determinar si existen diferencias según el tipo de actividad realizada. Para ello se utilizó una muestra de 139 personas de entre 55 y 94 años de la provincia de Granada (49 hombres y 90 mujeres). A los participantes se les preguntó sobre su participación en una lista de 16 actividades clasificadas como formativas, físicas o de manualidades, se les pidió que valoraran su salud subjetiva y se les aplicaron las Escalas de Bienestar Psicológico y la versión abreviada de la Escala de Depresión Geriátrica (GDS). Los resultados indican diferencias de género en la participación pero no en las otras variables analizadas. La participación total en actividades se relacionaba y fue predictor del bienestar psicológico, la salud subjetiva y la depresión pero se observaron diferencias según el tipo de actividad realizada. Las actividades formativas se relacionan con el crecimiento personal, las actividades manuales con el dominio del entorno y la salud y las actividades físicas con las relaciones personales, salud y depresión. Estos resultados resaltan la importancia de lograr una participación integral en diferentes actividades si queremos potenciar el envejecimiento exitoso de las personas mayores.
... In fact, most studies investigating mobile health tracking have focused on young or middle-aged individuals or examined the effects only in individuals who are already physically active (Dallinga et al., 2015). However, older adults in particular might profit from innovative approaches, such as mobile physical activity tracking for individual health promotion and prophylaxis, since an appropriate level of physical activity can contribute to healthier aging processes (e.g., Gruenfelder-Steiger et al., 2017;Landi et al., 2007;Peel, McClure, & Bartlett, 2005). Moreover, an increasing number of older individuals have already started to use new mobile devices, and the potential uses of technology for coping with everyday life have been well documented (e.g., Seifert & Schelling, 2016;Schulz et al., 2015). ...
This study explored the use of wearable devices to track self-recorded health data and the willingness to share this data with re- searchers. Participants aged ≥ 50 years (n = 1,013) were interviewed in a representative telephone survey. Results indicated that 43.3% of all participants used one or more mobile devices (activity tracker, smartwatch, smartphone, or tablet), and that 27.6% used those devices for the purposes of recording health data. Additionally, 57.2% of the participants who tracked their health data were willing to share it with research- ers. Income significantly contributed to predicting this willingness, whereas other independent variables were not significant predictors. This study indicates a relatively positive overall willingness to share self-recorded mobile health data with the science community.
... 22 Older adults in particular might profit from innovative approaches such as mobile physical activity tracking for individual health promotion and prophylaxis, since an appropriate level of physical activity can contribute to healthier aging processes. 23,24 An increasing number of older individuals have already started to use new digital media devices. 25 Nevertheless, there is still a gap between younger and older individuals in relation to usage rates, usage intensity, and the range of commonly used functions of new media. ...
Objective:
The tracking of one's own physical activity with mobile devices is a way of monitoring and motivating oneself to remain healthy. Older adults' general use of mobile devices for physical activity tracking has not yet been examined systematically. The study aimed to describe the use of physical activity trackers, smartwatches and smartphones, or tablets for tracking physical activity and to examine the reasons for the use of these technologies.
Methods:
Participants aged ≥50 years (N = 1013) living in Switzerland were interviewed in a telephone survey. To address the research questions, we calculated descriptive frequency distributions, tested for differences between groups, and performed logistic regression analyses.
Results:
Descriptive and multivariate analyses showed that (a) 20.5% of participants used mobile devices for physical activity tracking; (b) men, younger individuals, those with a strong interest in new technology, and those who frequently exercised had a higher likelihood of using mobile devices for physical activity tracking; and (c) participants more often agreed with reasons for use relating to tracking physical activity and motivating oneself to remain healthy than they did with reasons relating to social factors.
Conclusions:
The study presented representative data about the actual use of mobile tracking technology in persons over 50 years of age. Today, mainly active and younger elderly (mostly men) with a high interest in technology are using tracking technologies. Results indicate a need for further studies on motivational and usability aspects regarding the use of mobile health tracking devices by older adults.
The decline in physical function and the deterioration of the neuromusculoskeletal system in older people can easily lead to reduced muscle strength and slower mobility in the joints of the lower limbs, increasing the incidence of chronic diseases such as muscle wasting disorders, osteoporosis, debilitation and fall and fracture. It may also affect the quality of life and functional independence of older people, and in serious cases, even directly threaten their health. This study was conducted to determine the differences in lower limb muscle activation characteristics between static semi-squat (SSS) and dynamic semi-squat (DSS) training in middle-aged and old women at different frequencies and amplitudes and to explore a personalized whole-body vibration (WBV) training instruction program suitable for them. Fifteen healthy middle-aged and old women (60.8 ± 4.18 years old) were recruited for SSS and DSS WBV training. Their muscle activity of the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and gastrocnemius (GS) were calculated using the BTS FreeEMG300 wireless surface electromyography (EMG), which participants were completed that the two different contraction patterns of squats on WBV training. The knee flexion was maintained at 45° while the subjects were performing the SSS training, while during the DSS training, the knee flexion fluctuates between 10° and 45°. The SSS exercise requires the subject to remain stationary in the squatting position and the DSS to be performed at a rhythm of 4 s/repetition, with 2 s of squatting, 1 s of standing up, and 1 s intervals. The vibration frequencies and amplitudes were changed to the WBV training intensity, and the vibration frequencies were set to 0 Hz, 30 Hz and 40 Hz, and the amplitudes were set to 0 mm, 2 mm and 4 mm. Each subject is randomised to participate in WBV training with 5 combinations of frequency and amplitude in both static and dynamic semi-squat patterns. These were 0 Hz 0 mm, 30 Hz 2 mm, 30 Hz 4 mm, 40 Hz 2 mm, 40 Hz 4 mm for the static and dynamic demi-squat patterns of WBV training. A two-way repeated measures ANOVA was applied to compare the changes in surface EMG of the lower limb muscles in different modes of SSS and DSS with WBV training. (1) Our results showed significantly interaction effects in the frequency × amplitude of root mean square (EMGrms) in GS (P < 0.05), while no significant differences were observed in the interaction effects of SSS/DSS patterns, frequencies and amplitude of RF, VM, VL and BF (P > 0.05). (2) Comparisons between groups showed that the EMGrms of the RF were significantly higher for the DSS than the SSS (P < 0.05). Additionally, the EMGrms of VL and BF at 30 Hz and 40 Hz were greater than 0 Hz (P < 0.05). Also, The EMGrms at 4 mm for the VM, VL and BF were significantly higher than 0 mm, the EMGrms at 4 mm for the VM and VL were significantly higher than 2 mm (P < 0.05), and the EMGrms at 2 mm of VL and BF were significantly higher than 0 mm (P < 0.05). (3) The results showed that WBV stimulation significantly increased the EMGrms of the GS in the SSS compared with the vibration free semi-squat alone (P < 0.05). However, there were no significant differences between WBV training protocols for SSS patterns with different frequencies and amplitudes (frequencies and amplitudes not were 0 Hz and 0 mm) (P > 0.05). Comparison of EMGrms for WBV training of the GS in DSS patterns showed that 40 Hz/4 mm was significantly higher than 0 Hz/0 mm (P < 0.05), but there was no significant difference between the remaining vibration conditions (P > 0.05). WBV training for DSS can significantly improve the activation of the RF compared to SSS pattern. Compared with no vibration, WBV could significantly improv the activity of the lower limb muscles. Additionally, an increase in amplitude from 2 to 4 mm could significantly improve VM and VL activation, while no significant improvement on lower limb muscle activation was observed for increasing vibration frequency from 30 to 40 Hz.
The most common way to analyze the effect of aging on breathing is to divide subjects into age groups. However, in addition to the fact that there is no consensus in the literature regarding age group division, such design critically influences the interpretation of the effects attributed to aging. Thus, this study aimed to investigate the feasibility to distinguish different age groups from the 3D kinematic variables of breathing motion (i.e., markers’ coordinate as a function of time allowing the calculation of compartmental volume variations) and to analyze whether the aging could influence these variables. Seventy-three physically active women aged 19–80 years performed quiet breathing and vital capacity maneuvers. To record the thoracoabdominal breathing motion, the 3D coordinates of 32 retroreflective markers positioned on the trunk were used to estimate the volume variation of the superior thorax, inferior thorax, and abdomen. The percentage of contribution and the correlation coefficient were calculated to analyze the breathing motion pattern from the estimated volumes. The k-means cluster analysis was performed to analyze the age group classification. Linear regression was performed to investigate whether age can predict changes in the breathing motion pattern. The results showed that physically active women could not be classified into age groups from breathing motion. Despite significant p values of the linear regression, the high variability of the data suggested that age itself is not enough to predict the changes in breathing motion pattern when non-sedentary women are considered.
https://authors.elsevier.com/c/1dL3S4-6-WTTU
free access untill August 21
Wearable activity sensors have the potential to reduce sedentary behavior and improve overall health status. Although there is a technology usage gap between young and elderly people, the impact of activity sensors still has not been clearly identified between them yet. Therefore, we explored the differences in physical activity performance, motivation, and attitudes between young (age: 22.4±1.3 years; N = 36) and elderly people (age: 71.7±2.0 years; N = 30) through a six-week usage of activity sensors. It was identified that there was no significant difference in walked steps between the two age groups. However, elderly participants showed more adherence to complete their daily activity goal compared to young participants. In addition, the elderly group had higher attitude scores in the activity commitment, the satisfaction of activity monitoring, and the significance of physical activity than the youth group. These findings support that elderly people are more likely to have positive attitudes and a higher activity obligation when using activity monitoring technology than youth.
This book is published by the University of Guadalajara and contents several different chapters of authors who are professors, researchers and postgraduate students of the sciences of Physical Education and Sports who belong to educational and research institutions of Mexico and other countries. Each year is delivery a new book and this version is the 2019 one.
It may at times seem like we are searching for a cure for obesity with a magic diet, evidenced by past fad diets and the current attraction to low-carbohydrate diets and ketogenic diets. This chapter discusses the biologic basis of our eating behaviors and the biologic basis of health improvement with weight loss. With this understanding, we discuss the behavioral change approaches that can be used to navigate the modern food environment and lose enough weight to improve health. First, we review the evidence base for lifestyle intervention with a purpose of understanding the push by all professional societies to implement intensive behavioral therapy for obesity. The chapter discusses calorie targets and calorie deficits, episodic fasting, mindfulness, and the emergence of electronic self-monitoring tools. All of these approaches are based on our understanding of the biology of food intake. But weight loss is only the beginning; the hard part of losing weight for most patients with obesity is weight loss maintenance, and we discuss the important shift in focus to maintain lost weight, along with promising methods to achieve this goal.
Background:
Outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a short length of hospital stay have been reported; however, most studies have not accounted for an inherent patient selection bias and discharge disposition. The purpose of this study was to utilize a propensity score to match and compare the outcomes of patients undergoing THA or TKA with short and longer lengths of stay with a discharge directly home.
Methods:
An administrative database from Ontario, Canada, which has a single-payer health-care system, was retrospectively reviewed to identify patients who underwent THA or TKA from 2008 to 2016. Patients were subsequently stratified into 2 groups based on their length of stay: short length of stay (≤2 days; thereafter referred to as short stay) and longer length of stay (>2 days; thereafter referred to as longer stay). Using a propensity score, patients who underwent short-stay THA or TKA were matched to patients who underwent longer-stay THA or TKA. Matching was based on 15 demographic, medical, and surgical factors. Our primary outcomes included postoperative complications, health-care utilization (readmission and emergency department presentation), and health-care costs.
Results:
Overall, 89,656 TKAs (14,645 short stays and 75,011 longer stays) and 52,610 THAs (9,426 short stays and 43,184 longer stays) were included in this study. Patients who underwent short-stay THA or TKA were significantly more likely (p < 0.05) to be younger, male, healthier, and from a higher socioeconomic status and to have undergone the procedure with a higher-volume surgeon. Over 95% of short-stay cases were successfully matched to longer-stay cases, and we found no significant difference in complications, health-care utilization, and costs between patients on the basis of the length of stay.
Conclusions:
Patients undergoing short-stay THA or TKA with a discharge home were more likely to be younger, healthy, male patients from a higher socioeconomic status. Higher-volume surgeons are also more likely to perform short-stay THA or TKA. These characteristics confirm the previously held belief that a selection bias exists when comparing cohorts based on time to discharge. When comparing matched cohorts of patients who underwent short-stay and longer-stay THA or TKA, we observed no difference in outcomes, suggesting that a short stay with a discharge home in the appropriately selected patient is safe following THA or TKA.
Level of evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background:
Previous studies have reported on the higher risk of functional decline among older patients with cancer. However, few have focused on factors of functional decline in older persons with cancer and are mainly hospital-based and focus on consequences of cancer treatment. The aim of the study was to identify determinants of functional decline in older subjects with cancer in a population-based study.
Methods:
Using cancer registries, we identified older subjects (age ≥ 65 years) with cancer in three prospective cohort studies from Gironde, a French department. Functional status was measured using the Instrumental Activities of Daily Living (IADL) and the basic Activities of Daily Living (ADL) scales, and functional decline was measured between cancer pre- and post-diagnosis visits. Studied variables were demographic and socioeconomic (age at diagnosis, sex, living alone, education), cancer-related (stage at diagnosis, treatment received), smoking status, health-related (polypharmacy, depressive symptomatology), and geriatric-specific (cognitive impairment or dementia). Analyses were performed using logistic regression models.
Results:
Age (≥85 years), cognitive impairment or dementia, and advanced stage at diagnosis were associated with a higher risk of ADL limitations, whether considering death or not. Age (≥85 years), education and polypharmacy were associated with a higher risk of ADL and/or IADL limitations.
Conclusions:
We identified factors that could impact on ADL and/or IADL limitations in older patients with cancer. The information on these determinants is useful in clinical settings to identify patients with cancer at high risk of functional decline.
Artículo del Boletín Informativo de la Federación Española de Psicología del Deporte.
Le vieillissement de la population associé à un nombre croissant de cancers constituent une réalité épidémiologique qui soulève des interrogations sur l’accès aux soins et le pronosticdes sujets âgés avec un cancer, pour lesquels des disparités ont été mises en évidence. Toutefois, les études présentent plusieurs limites dont l’absence de facteurs spécifiques aux personnes âgées (PA). L’objectif de ce travail était d’étudier les déterminants sociodémographiques, socioéconomiques et cliniques de l’accès aux soins (stade de cancer, traitement) et du pronostic (déclin fonctionnel, survie) chez des PA atteintes d’un cancer. Les travaux ont été réalisés à partir de données issues de registres de cancers et de troiscohortes de PA en Gironde (486 patients de 65 ans et plus, période 2005-14). Les cohortes ont permis de disposer de données telles que le niveau d’éducation, le revenu, la prise demédicaments, la dépendance ou la démence. Selon l’objectif (accès/pronostic), nous avons utilisé différentes méthodes pour prendre en compte le type de données et de critères (régression logistique, modèles multiniveaux, modèles multi-état et de Cox). Notre population était composée pour plus de la moitié de PA de 80 ans et plus, de sexe masculin et ayant un niveau d’éducation supérieur au niveau primaire. Nous nous sommes d’abord intéressés aux déterminants de l’accès aux soins. Aucun déterminant d’un stade avancé de cancer au diagnostic n’a pu être mis en évidence, un niveau d’éducation faible était proche de la significativité pour les cancers avec un stade avancé (p=0,0671). Pour l’accès à un traitement du cancer, nous avons mis en évidence qu’un stade avancé (p=0,003) et la présence d’une démence (p=0,0109) étaient associés à un risque plus faible de recevoir un traitement. Nous avons ensuite étudié les déterminants du pronostic. Les sujets les plus âgés présentaient toujours un risque plus élevé de déclin fonctionnel (p<0,005), quel que soit le critère analysé. Les sujets ayant un faible niveau d’éducation (p=0,027), prenant plus de six médicaments par jour (p=0,047), présentant une démence (p<0,001) ou diagnostiqués à un stade avancé (p<0,001) avaient une probabilité de déclin fonctionnel plus importante, les résultats variant selon le critère. Enfin, à 12, 24 et 36 mois, la probabilité de survie globale était respectivement de 66, 57 et 48%. Le risque de décès était plus élevé chez les hommes (p=0,019), diagnostiqués à un stade avancé de cancer (p<0,001) et sans traitement du cancer (p<0,001), mais aussi chez les fumeurs (actuels et anciens) (p=0,019) et les PA dépendantes (p<0,001). En sus de déterminants classiques de l’accès aux soins ou du pronostic des cancers, nous avons mis en évidence pour les PA, le rôle des déficits cognitifs pour l’accès à un traitement ou sur le pronostic fonctionnel et celui de la dépendance sur la survie. Chez les PA avec un cancer, les facteurs spécifiques aux PA semblent donc essentiels à analyser. L’analyse des liens de causalité entre les déterminants de santé reste un sujet particulièrement intéressant dans cette population de PA comme pour les patients avec un cancer.
Limited transportation leads to restriction of activity. However, few studies have paid attention to the effect of the type of transportation. This study focused on car driving and bicycle riding and aimed to examine the association of these transportation methods with physical activity and social participation in Japanese older adults. This cross-sectional study included 374 Japanese older adults living in a rural area. Physical activity was evaluated using the Physical Activity Scale for the Elderly. The data on transportation mode and 4 types of social participation were obtained from a self-reported questionnaire. An analysis of covariance and a multivariate Poisson regression analysis were conducted to evaluate associations. The sample comprised 304 participants who usually drive a car and 106 who regularly ride a bicycle. Although there was no significant association between car driving and physical activity, bicycle riding showed positive association with leisure time activity (p = .009), household activity (p = .001), and total physical activity (p community association (PR = 1.75, 95% CI: 1.11–2.77) and volunteer activities (PR = 1.62, 95% CI: 1.08–2.43). These results suggested that car driving and bicycle riding have different effects on physical activity and social participation.
Wollen wir nicht alle gesund altern? Dieser Wunsch kann als einfache Frage verstanden – oder aber als sozialer Druck wahrgenommen werden. Denn er entspricht dem, was unsere Leistungsgesellschaft von uns fordert. Human Enhancement ist deshalb auch für die Gerontologie ein wichtiges Thema. Dieser Beitrag richtet den Blick auf die Potenziale einer technisch unterstützten Gesundheitsvorsorge durch Wearables und zeigt auf, wie selbsterhobene Daten für die Forschung zunehmend relevant werden.
Quelle: Seifert, A. (2018). Technisch unterstütztes Enhancement im Alter. Suchtmagazin, 2018(1), 16-19.
Freiexemplar: https://www.suchtmagazin.ch/tl_files/templates/suchtmagazin/user_upload/texte/suchtmagazin_2018-1_leseprobe.pdf
Non-contributory pensions have become extremely popular in the last decade, with 78 developing countries currently distributing money in this way, and their acclaimed impacts are increasingly celebrated. Studies have found them to contribute not only to ‘obvious’ needs such as increased consumption and income security but also to investments in productivity, social relationships, health, increased access to credit and savings, while it has become common to claim that they contribute to intangible goals such as dignity and citizenship. The danger of some of these claims is that they assume that wellbeing is heavily responsive to monetary wealth, rather than other areas. To study this, an ethnographic methodology, based on participant observation and semi-structured interviews, was employed in two rural communities located in the La Paz department in the highland Altiplano region of Bolivia close to Lake Titicaca. Our analysis shows that while the Renta Dignidad increases older persons’ livelihood security, its contributions to other areas where non-contributory pensions are claimed to have major impacts, such as productive investment, health care and relational wellbeing, are actually relatively limited. The policy implication of this is that a more integral approach needs to be adopted to older persons' wellbeing, going beyond cash transfers to greater efforts to bring health-care services to older people in remote rural areas.
Physical activity and fitness are believed to reduce premature mortality, but whether genetic factors modify this effect is not known.
To investigate leisure physical activity and mortality with respect to familial aggregation of health habits during childhood and factors that may enable some individuals to achieve higher levels of fitness.
Prospective twin cohort study.
Finland.
In 1975, at baseline, 7925 healthy men and 7977 healthy women of the Finnish Twin Cohort aged 25 to 64 years who responded to a questionnaire on physical activity habits and known predictors of mortality. Those who reported exercising at least 6 times per month with an intensity corresponding to at least vigorous walking for a mean duration of 30 minutes were classified as conditioning exercisers, those who reported no leisure physical activity were classified as sedentary, and other subjects were classified as occasional exercisers.
All-cause mortality and discordant deaths among same-sex twin pairs from 1977 through 1994.
Among the entire cohort, 1253 subjects died. The hazard ratio for death adjusted for age and sex was 0.71 (95% confidence interval [CI], 0.62-0.81) in occasional exercisers and 0.57 (95% CI, 0.45-0.74) in conditioning exercisers, compared with those who were sedentary (Pfor trend <.001). Among the twin pairs who were healthy at baseline and discordant for death (n=434), the odds ratio for death was 0.66 (95% CI, 0.46-0.94) in occasional exercisers and 0.44 (95% CI, 0.23-0.83) in conditioning exercisers compared with those who were sedentary (P for trend, .005). The beneficial effect of physical activity remained after controlling for other predictors of mortality.
Leisure-time physical activity is associated with reduced mortality, even after genetic and other familial factors are taken into account.
Objective.
—To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
OBJECTIVE--To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS--A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE--The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS--Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise \"public health message was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION--Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the weekType: CONSENSUS DEVELOPMENT CONFERENCEType: JOURNAL ARTICLEType: REVIEWLanguage: Eng
Physical activity is recommended by physicians to patients with non-insulin-dependent diabetes mellitus (NIDDM), because it increases sensitivity to insulin. Whether physical activity is effective in preventing this disease is not known.
We used questionnaires to examine patterns of physical activity and other personal characteristics in relation to the subsequent development of NIDDM in 5990 male alumni of the University of Pennsylvania. The disease developed in a total of 202 men during 98,524 man-years of follow-up from 1962 to 1976.
Leisure-time physical activity, expressed in kilocalories expended per week in walking, stair climbing, and sports, was inversely related to the development of NIDDM: The incidence rates declined as energy expenditure increased from less than 500 kcal to 3500 kcal. For each 500-kcal increment in energy expenditure, the age-adjusted risk of NIDDM was reduced by 6 percent (relative risk, 0.94; 95 percent confidence interval, 0.90 to 0.98). This association remained the same when the data were adjusted for obesity, hypertension, and a parental history of diabetes. The association was weaker when we considered weight gain between the time of college attendance and 1962 (relative risk, 0.95; 95 percent confidence interval, 0.90 to 1.00). The protective effect of physical activity was strongest in persons at highest risk for NIDDM, defined as those with a high body-mass index, a history of hypertension, or a parental history of diabetes. These factors, in addition to weight gain since college, were also independent predictors of the disease.
Increased physical activity is effective in preventing NIDDM, and the protective benefit is especially pronounced in persons at the highest risk for the disease.
Evidence for an independent role of increased physical activity in the primary prevention of coronary heart disease has grown in recent years. The authors apply the techniques of meta-analysis to data extracted from the published literature by Powell et al. (Ann Rev Public Health 1987;8:253-87), as well as more recent studies addressing this relation, in order to make formal quantitative statements and to explore features of study design that influence the observed relation between physical activity and coronary heart disease risk. They find, for example, a summary relative risk of death from coronary heart disease of 1.9 (95% confidence interval 1.6-2.2) for sedentary compared with active occupations. The authors also find that methodologically stronger studies tend to show a larger benefit of physical activity than less well-designed studies.
Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very old and its reversibility through strength training. Ten frail, institutionalized volunteers aged 90 ± 1 years undertook 8 weeks of high-intensity resistance training. Initially, quadriceps strength was correlated negatively with walking time (r= -.745). Fat-free mass (r=.732) and regional muscle mass (r=.752) were correlated positively with muscle strength. Strength gains averaged 174% ±31% (mean ± SEM) in the 9 subjects who completed training. Midthigh muscle area increased 9.0%± 4.5%. Mean tandem gait speed improved 48% after training. We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age.
(JAMA. 1990;263:3029-3034)
The association between leisure-time physical activity and 28-year (1965-1993) risk of death from all causes and cardiovascular disease was studied in 6,131 adults who participated in the Alameda County Study in Northern California. Because study participants were interviewed on a number of occasions, it was possible to include in the analyses information on changes over time in levels of leisure-time physical activity as well as changes in a wide variety of other risk factors. There were 47,616 person-years of observation for males (639 deaths from all causes and 321 from cardiovascular disease) and 57,666 person-years of observation for females (587 deaths from all causes and 388 from cardiovascular disease). In analyses in which only the baseline values of all covariates were included, a four-point increase on the leisure-time physical activity scale, the interquartile range, was associated with reduced risk of death from all causes (relative risk (RR) = 0.90, 95% confidence interval (CI) 0.83-0.99) and cardiovascular disease (RR = 0.85, 95% CI 0.75-0.97). When time-varying information on leisure-time physical activity and all other covariates was included, there was still a protective effect for all-cause and cardiovascular disease mortality (RR = 0.84, 95% CI 0.77-0.92 and RR = 0.81, 95% CI 0.71-0.93, respectively). The association between leisure-time physical activity and risk of death was not altered when information on variations over time in leisure-time physical activity and many determinants and consequences of physical activity were explicitly included in survival models.
The purpose of this study was to estimate the prevalence of having no disability in the year prior to death in very old age
and to examine factors associated with this outcome. Participants were men and women aged 65 years and older who were followed
prospectively between 1981 and 1991 from three communities: New Haven, Connecticut; lowa and Washington counties, lowa; and
East Boston, Massachusetts. Persons who died in late old age with known disability status within 15 months of death (n = 1,097)
were studied for predictors of dying without disability at the last follow-up interview prior to death. The probability of
a nondisabled 65-year-old man's surviving to age 80 and then being nondisabled prior to death was 26% and, for a 65-year-old
woman, the probability of surviving to age 85 and being nondisabled before death was 18%. Physical activity was a key factor
predicting nondisability before death. There was nearly a twofold increased likelihood of dying without disability among the
most physically active group compared with sedentary adults (adjusted odds ratio = 1.86, 95% confidence interval 1.24–2.79).
These findings provide encouraging evidence that disability prior to death is not an inevitable part of a long life but may
be prevented by moderate physical activity. Am J Epidemiol 1999; 149:654–64.
Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population. Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures, the functional benefits have not been shown in independently living older adults. The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function, not detected by commonly used measures of physical function.
In a randomized controlled study, 49 independently living men and women were assigned to either a nonexercise control group (Control; n = 26) or an exercise training group (Exercise; n = 23). Participants (age = 76+/-4) in good general health were recruited from retirement communities or apartments. The combined endurance and strength training was performed at 75% to 80% intensity; the groups met 3 times/week for 6 months of supervised sessions. Outcome measures included physical capacity, health status, and physical function using a newly developed performance test--the Continuous Scale-Physical Functional Performance test (CS-PFP).
Compared to the Control group, the Exercise group showed significant increases in maximal oxygen consumption (11%) and muscle strength (33%). No significant differences were found between groups for changes in the Sickness Impact Profile, SF-36 scales, or the 6-minute walk. However, the CS-PFP score improved significantly in the Exercise group (14%, effect size 0.80).
Independent older adults gain meaningful functional benefits from several months of exercise training. The public health importance of physical activity may relate not just to its role in preventing decline, but also to its role in enhancing physical function.
There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.
Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.
The risk-factor-free group showed average disability scores near zero 10-12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.
These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.
Unlabelled:
This focused review highlights the benefits of exercise and physical activity for community-dwelling older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the benefits of physical activity and exercise for older adults with regard to morbidity, mortality, and disability. It discusses the appropriate preexercise screening and evaluation procedures for older adults contemplating exercise. Last, it reviews the current literature on the benefits of varying modes of exercise to modify the most prevalent chronic medical conditions of late life, including arthritis, heart disease, diabetes, stroke, pulmonary disease, and osteoporosis.
Overall article objective:
To summarize the current knowledge regarding the therapeutic benefits of exercise for community-dwelling older adults.
The authors describe the prevalence of moderate-intensity physical activity in a population of older persons living in the community. In addition, they explore the relationship between physical activity and mortality.
In this longitudinal observational study, the authors analyzed data from patients admitted to home care programs collected as part of the Italian Silver Network Home Care project. Twelve home health agencies participated in the project, which evaluated the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the current study. The primary outcome measures were the prevalence of 2 or more hours per week of physical activity and survival.
Fewer than 20% of patients had regular physical activity. During a median follow-up period of 10 months from the initial MDS-HC assessment, 442 (16%) patients died. After adjusting for sex, physical and cognitive disability, and all potential risk factors for death, active patients were less likely to die compared with those with no or very low-intensity physical activity (relative risk ratio [RR], 0.51; 95% confidence interval [CI], 0.35-0.73). This inverse relationship was also significant in patients aged 80 years and older (RR 0.55; 95% CI, 0.32-0.95).
Physical activity is associated with a significantly lower risk of all-cause mortality. The current findings support the possibility that moderate-intensity physical activity has an independent effect on survival even among frail and old persons.
To examine associations of leisure time physical activity and physical strenuousness of work with physical functioning 28 years later.
A cohort (n = 902) of metal industry employees was studied for exercise and housework activity in 1973 and 1978, and for BMI, current smoking, strenuousness of work, grip strength, and chronic diseases in 1973. Of the 670 survivors in 2000, 529 (79%) responded to all studied items in a follow up questionnaire including the SF-36 Physical Functioning (PF) scale. Belonging to the lower quartile of the PF scale denoted poor functioning.
Vigorous exercise and housework activity were inversely associated with poor PF 28 years later in both white-collar and blue-collar workers. Engaging in activities of any intensity was similarly associated among the blue-collar workers. In a multiple logistic regression model including as independent variables age, sex, occupational class, the number of chronic diseases, vigorous leisure time physical activity, BMI, physical work strenuousness, and smoking (all measured at baseline), the risk of poor PF at follow up was decreased by vigorous leisure time physical activity and increased by high physical strenuousness of work, high BMI, and smoking. The effect of work strenuousness was mainly due to that among the blue-collar group. Allowing for baseline grip strength did not materially alter the results.
Vigorous leisure time physical activity decreased the risk of poor physical functioning as perceived considerably later in life, while high work strenuousness, smoking, and overweight increased it. Among blue-collar workers a beneficial association was observed with all leisure time activity, including that of lower intensity.
Community care for older people is increasing dramatically in most European countries as the preferred option to hospital and long-term care. While there has been a rapid expansion in Evidence-Based Medicine, apart from studies of specific interventions such as home visiting and hospital at home (specialist visits or hospital services provided to people in their own homes in the community), there is little evidence of characteristics of the recipients of community care services or the organisation of services that produce the best outcomes for them and their informal carers. The AdHOC Study was designed to compare outcomes of different models of community care using a structured comparison of services and a comprehensive standardised assessment instrument across 11 European countries. This paper describes the study and baseline data.
4,500 people 65 years and older already receiving home care services within the urban areas selected in each country were randomly sampled. They were assessed with the MDS-HC (Minimum Data Set-Home Care) instrument, containing over 300 items, including socio-demographic, physical and cognitive characteristics of patients as well as medical diagnoses and medications received. These data were linked to information on the setting, services structures and services utilization, including use of hospital and long-term care. After baseline assessment, patients were re-evaluated at 6 months with an abbreviated version of the instrument, and then at the end of one year. Data collection was performed by specially-trained personnel. In this paper, socio-demographics, physical and cognitive function and provision of hours of formal care are compared between countries at baseline.
The final study sample comprised 3,785 patients; mean age was 82+/-7.2 years, 74.2% were females. Marital and living status reflected close family relationships in southern Europe relative to Nordic countries, where 5 times as many patients live alone. Recipients of community care in France and Italy are characterised by very high physical and cognitive impairment compared with those in northern Europe, who have comparatively little impairment in Activities of Daily Living and cognitive function. The provision of formal care to people with similar dependency varies extremely widely with very little formal care in Italy and more than double the average across all levels of dependency in the UK.
The AdHOC study, by virtue of the use of a common comprehensive standardised assessment instrument, is a unique tool in examining older recipients of community care services in European countries and their widely varied organisation. The extreme differences seen in dependency and hours of care illustrate the probable contribution the study will make to developing an evidence based on the structure, quantity and targeting of community care, which will have major policy implications.
Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify populations at risk and specifically target risk-management strategies. In contrast, in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability.
To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries.
Retrospective cross-sectional study of 2707 elderly patients receiving home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy, the Netherlands, Norway, and the United Kingdom. Patients were prospectively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument.
Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons (Beers and McLeod). Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model.
Combining all 3 sets of criteria, we found that 19.8% of patients in the total sample used at least 1 inappropriate medication; using older 1997 criteria it was 9.8% to 10.9%. Substantial differences were documented between Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%, ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate medication use was associated with patient's poor economic situation (adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36), polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82; 95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92) and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate medication use significantly increased with the number of associated factors (P<.001).
Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background. Since financial resources and selected patient-related characteristics are associated with such prescribing, specific educational strategies and regulations should reflect these factors to improve prescribing quality in elderly individuals in Europe.
The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.
To determine whether physical inactivity and obesity increase risk for colon cancer and adenomas, which are precursors of cancer, and whether the abdominal distribution of obesity is an independent risk factor for these events.
Prospective cohort study.
United States.
47,723 male health professionals, 40 to 75 years of age, who responded to a questionnaire mailed in 1986.
Questionnaires in 1986 about physical activity level and body mass index, and questionnaires in 1987 (31,055 respondents) about waist and hip circumferences. Between 1986 and 1992, 203 new patients were diagnosed with colon cancer and 586 were diagnosed with adenomas.
Physical activity was inversely associated with risk for colon cancer (high compared with low quintiles of average energy expenditure from leisure-time activities: relative risk, 0.53 [95% CI, 0.32 to 0.88], P for trend = 0.03) after adjustment for age; history of colorectal polyp; previous endoscopy; parental history of colorectal cancer; smoking; body mass; use of aspirin; and intake of red meat, dietary fiber, folate, and alcohol. Body mass index was directly associated with risk for colon cancer independently of physical activity level. Waist circumference and waist-to-hip ratio were strong risk factors for colon cancer (waist-to-hip ratio > or = 0.99 compared with waist-to-hip ratio < 0.90: multivariate relative risk, 3.41 [CI, 1.52 to 7.66], P for trend = 0.01; waist circumference > or = 43 inches compared with waist circumference < 35 inches: relative risk, 2.56 [CI, 1.33 to 4.96], P for trend < 0.001). These associations persisted even after adjustment for body mass and physical activity. Similar associations were seen between obesity and physical inactivity and adenomas of 1 cm or more, but no association was observed for smaller adenomas. Height was also associated with a higher risk for colon cancer (height > or = 73 inches compared with height < or = 68 inches: multivariate relative risk, 1.76 [CI, 1.13 to 2.74], P for trend = 0.02).
The results support an inverse association between physical activity and risk for colon cancer, whereas height and obesity, particularly abdominal adiposity, are associated with an elevated risk.
The evidence suggesting that regular exercise can help to prevent coronary artery disease is overwhelming. While some studies have suggested that exercise will not provide health benefits, our inactive population needs to pay heed to the substantial data presented by the many international health organisations suggesting the opposite. The American Heart Association Medical/Scientific Statement on Exercise emphasised the large role regular aerobic physical activity plays in the prevention of cardiovascular disease. Several human studies have also demonstrated the positive effects of long term exercise on the human heart. For example, it has been shown that a consistent exercise programme can lessen the impact of atherosclerotic plaques through increasing coronary artery diameter. Echocardiography studies on a training group of competitive swimmers have shown that exercise training can induce rapid changes in left ventricular dimensions and mass, which can ultimately lead to an increased stroke volume and increased maximal oxygen consumption. Studies on sedentary individuals have also demonstrated an increase in maximal oxygen uptake with a regular endurance exercise programme. In addition to these health benefits, habitual dynamic exercise can also decrease the likelihood of a cardiac event. Others have demonstrated a 50% lower incidence of coronary events in those individuals maintaining rigorous activity 2 days a week. With the preponderance of evidence revealing the health benefits of habitual exercise, it is striking to learn that more than 50% of the US population exercises for less than 20 minutes, 3 days a week. The widespread nature of this sedentary lifestyle makes inactivity an attributable fraction of the total risk factors associated with cardiac disease. The amount of exercise needed to reduce the risk of coronary artery disease is a minimum aerobic workout of 30 minutes, 4 to 5 times a week, such as a vigorous walk. Comprehensive programmes promoting exercise training should be implemented at a level appropriate to an individual's capacity and need.
While positive health behaviors have been shown to extend life, their association with extending active life has not been well investigated. In this report, several health behaviors were investigated in relation to maintaining mobility during 4 years of follow-up among 6,981 men and women aged 65 years and older with intact mobility at baseline between 1981 and 1983 who lived in one of three communities: East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Intact mobility, defined as the ability to climb up and down stairs and walk a half mile, was determined annually by interview, and study subjects were classified into one of three categories at the end of 4 years of follow-up: 1) maintained mobility (55.1%); 2) lost mobility (36.2%); or 3) died without evidence of having lost mobility prior to death (8.7%). After adjustment for age and all of the health behaviors, risk of losing mobility was significantly associated with current smoking, not consuming alcohol compared with small-to-moderate amounts of alcohol consumption, high (> 80th percentile) compared with moderate (21-80th percentiles) body mass index, and low physical activity levels in both men and women. These findings suggest that positive health behaviors can not only extend longevity but also reduce the risk of losing mobility and independence in later life.
This study investigated the association between regular physical activity and risk of or increase in lower body disability in older, community dwelling Blacks and Whites.
The present study used the 1984 to 1990 Longitudinal Study on Aging, which included 413 Black and 3428 White self-respondents 70 years of age or older. Discrete-time hazard models provided estimates of the effects of self-reported walking frequency, and regular exercise on lower, body disability among Black and White self-respondents.
Whites who reported walking 4 to 7 days per week at baseline vs those who reported never walking 1 mile (1.6 km) or more experienced a one-third lower risk of increased disability. Blacks who reported walking 4 to 7 days per week experienced a two-thirds lower risk. Walking 4 to 7 days per week reduced the risk of disability onset by 50% to 80% on all five disability items within the Black sample and by 50% on two items within the White sample.
Among older Blacks, walking 4 to 7 days per week had a greater protective effect against lower body decline than any of the other factors, including age and chronic conditions.
To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women.
A randomized controlled trial.
Sherbrooke, Quebec, Canada.
A total of 124 community-living postmenopausal women, between 50 and 70 years of age, with low bone mass took part in the study.
Subjects allocated to the experimental group performed weight-bearing exercises (walking, stepping up and down from benches), aerobic dancing, and flexibility exercises for 60 minutes, three times a week, over a period of 12 months. All subjects were invited to attend bi-monthly educational seminars covering topics related to osteoporosis.
Spinal and femoral bone mineral density (BMD), functional fitness (flexibility, coordination, agility, strength/endurance, cardiorespiratory endurance), psychological well-being, back pain intensity, and self-perceived health.
Spinal BMD stabilized in the exercisers while decreasing significantly in the controls (P = .031). No change in femoral BMD was observed in either group (P = .597). Four of the five parameters chosen to evaluate functional fitness, namely flexibility, agility, strength, and endurance, were affected positively by the exercise program (all P < .01). Adjusting for prescores by means of an analysis of covariance revealed a significant difference between the groups in psychological well-being, which favored the exercisers (P = .012). After 12 months, back pain reported by exercisers was lower than that reported by controls (P = .008). Finally, self-perceived health increased in the exercise group, whereas no difference was observed in the control group (P = .790).
These results suggest that after 12 months, exercising can produce a significant increase above initial levels in the functional fitness, well-being, and self-perceived health of osteopenic women. Intensity of back pain can also be lowered by exercise. The exercise program succeeded in stabilizing spinal BMD but had no effect on femoral BMD.
The case manager, like many "new professions" does not yet have a defined curriculum. We consider that the principal requisite for case managers is a proficient knowledge of assessment for the care of elderly. Therefore, we focused a four-week teaching course for future case managers on the National Resident Assessment Instrument (RAI) of the United States and the Long-Term Care Program Application and Admission Form of British Columbia, Canada. We verified that this simple program provides students with adequate skills to become case managers.
Among community-living elderly persons, a single assessment of physical performance is a powerful predictor of dependence in activities of daily living (ADLs). The aim of this study was to determine whether an assessment of change in physical performance provides useful prognostic information beyond that available from a single assessment. Among a large representative cohort of elderly persons, we evaluated the 586 participants who were ADL independent at both the baseline and the one year interviews. For each of the three timed tests, participants who had a large decline in physical performance were significantly more likely to develop ADL dependence at three years than those who improved or showed no change. After adjusting for 1-year scores, however, change in physical performance was no longer associated with ADL dependence. However, among the 775 participants who were ADL independent at the baseline interview, change in physical performance was significantly associated with the onset of ADL dependence at one year, even after adjusting for baseline performance. When determining risk for ADL dependence, an assessment of change in physical performance over one year does not provide useful prognostic information beyond that available from a single assessment. Nevertheless, change in physical performance is independently associated with concurrent ADL dependence and may be useful in predicting future disability if measured over shorter intervals.
To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS-HC), including reliability estimates, a comparison of MDS-HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS-HC.
Independent, dual assessment of clients of home-care agencies by trained clinicians using a draft of the MDS-HC, with additional descriptive data regarding problem profiles for home care clients.
Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS-HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States.
The array of MDS-HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications.
Forty-seven percent of the functional, health status, social environment, and service items in the MDS-HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS-HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS-HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels.
Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community-based, second-generation problem and care plan-driven assessment instrument, disability assessment can be performed consistently across the world.
We studied the relations between physical activity and changes in physical activity, all-cause mortality, and incidence of major coronary-heart-disease events in older men.
In 1978-80 (Q1), 7735 men aged 40-59 were selected from general practices in 24 British towns, and enrolled in a prospective study of cardiovascular disease, which included physical activity data. In 1992 (Q92), 12-14 years later, 5934 of the men (91% of available survivors, mean age 63 years) gave further information on physical activity and were then followed up for a further 4 years. The main endpoints were all-cause mortality during 4 years of follow-up from Q92, and major fatal and non-fatal coronary-heart-disease events during 3 years of follow-up from Q92.
Among 4311 men with no history of coronary heart disease, stroke, or "other heart trouble" by Q92 and who did not report "poor health", there were 219 deaths. In the inactive/occasionally active, light, moderate, and moderately vigorous/vigorous activity groups there were 101 (18.5/1000 person-years) 48 (11.4), 23 (7.3), and 47 (9.1) deaths, respectively (adjusted risk ratios 1.00, 0.61 [95% CI 0.48-0.86], 0.50 [0.31-0.79], 0.65 [0.45-0.94]). Men who were sedentary at Q1 and who began at least light activity by Q92 had significantly lower all-cause mortality than those who remained sedentary, even after adjustment for potential confounders (risk ratio=0.55 [0.36-0.84]). Physical activity improved both cardiovascular mortality (0.66 [0.35-1.23]) and non-cardiovascular mortality (0.48 [0.27-0.85]). The relation between physical activity at Q92, changes in physical activity, and mortality were similar for men with pre-existing cardiovascular disease.
Maintaining or taking up light or moderate physical activity reduces mortality and heart attacks in older men with and without diagnosed cardiovascular disease. Our results support public-health recommendations for older sedentary people to increase physical activity, and for active middle-aged people to continue their activity into old age.
To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. Based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them.
Home care programs for the treatment of frail elderly have been developed in many countries around the world. In the Silver Network project all services are provided in an integrated fashion by one "single entry" center, differently from the traditional fee-for-service or not integrated systems. The delivery of health and social services for frail elderly individuals are integrated and coordinated by a case manager who uses a "second generation" assessment instrument, the Minimum Data Set for Home Care (MDS-HC). We describe the principal clinical and functional characteristics of nearly 1300 patients admitted between 1997 and 1998 to such an integrated home care program in eleven Italian Health Agencies. The database, derived from the serial MDS-HC assessments of each patient, provides a unique opportunity to delineate the different criteria for eligibility for home care, and compare the selected populations of the participating Health Agencies.