Predictors of physical activity in community-dwelling elderly white women

Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey

Background

Abundant literature supports the beneficial effects of physical activity for improving health of people with chronic diseases. The relationship between multimorbidity and physical activity levels, however, has been little evaluated. The purpose of the current exploratory study was to examine the relationship between a) multimorbidity and physical activity levels, and b) long-term limitations on activity, self-rated general health, psychological distress, and physical activity levels for each sex in adults, after age, education, income, and employment factors were controlled for.

Methods

Data from the Quebec Health Survey 1998 were used. The sample included 16,782 adults 18–69 yr of age. Independent variables were multimorbidity, long-term limitations on activity, self-rated general health, and psychological distress. The dependent variable was physical activity levels. Links between the independent and dependent variables were assessed separately for men and women with multinomial regressions while accounting for the survey sampling design and household clustering.

Results

About 46% of the participants were men. Multimorbidity was not associated with physical activity levels for either men or women. Men and women with long-term limitations on activity and with poor-to-average self-rated general health were less likely to be physically active. No relationship between psychological distress and physical activity was found for men. Women with high levels of psychological distress were less likely to be physically active.

Conclusion

Multimorbidity was not associated with physical activity levels in either sex, when age, education, income, and employment factors were controlled for. Long-term limitations on activity and poor-to-average self-rated general health seem related to a reduction in physical activity levels for both sexes, whereas psychological distress was associated with a reduction in physical activity levels only among women. Longitudinal studies using a comorbidity or multimorbidity index to account for severity of the chronic diseases are needed to replicate the results of this exploratory study.

The impact of momentary pain and fatigue on physical activity in women with osteoarthritis

OBJECTIVE

To examine the daily life patterns of both pain and fatigue symptoms and objective physical activity (using ambulatory monitoring) in women with symptomatic lower extremity osteoarthritis (OA), and to evaluate how momentary symptoms impact physical activity levels.

METHODS

Sixty women age >or=55 years (40 with knee or hip OA and 20 matched controls) participated in an observational study involving 2 laboratory visits and a 5-day home data collection period. During the home period physical activity levels were assessed continuously, and symptoms were inputted 6 times a day into an enhanced accelerometer at prespecified time points.

RESULTS

In the OA group as compared with the control group over the 5-day period, average physical activity was significantly lower (P = 0.02) and peak physical activity tended to be lower (P = 0.06). Although pain and fatigue overall were of moderate severity in this cohort, fatigue escalated throughout each day. In a hierarchical linear model, fatigue was most strongly associated with physical activity (beta = -30.1, P < 0.0001). Pain was more weakly associated with physical activity and in the direction opposite to what was hypothesized (beta = 16.9, P = 0.04).

CONCLUSION

Momentary reports of fatigue negatively predicted physical activity levels and were much more strongly related to physical activity than momentary pain. In order to help women with knee or hip OA manage symptoms and become more physically active, it may be important to emphasize fatigue management.

Factors influencing health behaviors in the National Health and Nutritional Examination Survey, III (NHANES III)

This study investigated the influence of age, gender, race, place of residence, social networks, and socioeconomic status (SES) on health behaviors in the NHANES III, a large public domain database of approximately 16,000 subjects. Multiple regression analysis indicated that age, gender, social networks, and SES were statistically significant predictors of both positive and negative health behaviors, while race and place of residence were not. These results suggest an influence of age, gender, SES, and social support factors on health behaviors and reinforce the need for social work to take into account these factors at both the individual and public policy levels.

Beliefs about physical activity--focus group results of Chinese community elderly in Seattle and Taipei

The purpose of this study was to identify the beliefs about physical activity held by Chinese immigrant older adults in Seattle and to compare them with the beliefs held by Chinese elderly in Taipei. Researchers conducted 2 focus groups of Chinese older adults to explore their behavioral beliefs, normative beliefs, and perceived control beliefs. The first group included 10 elderly recruited from the Chinese Information and Service Center in Seattle, Washington. The second group included 14 elderly adults recruited from a health center in Taipei, Taiwan. This study used a qualitative study design, and deductive content analysis was used for analyzing information gathered. The results showed that Chinese immigrant older adults in Seattle had positive attitudes toward physical activity and that, compared with the group in Taipei, the group in Seattle perceived more positive social and environmental supports. The factors influencing Chinese older adults' physical activity and behaviors both in Seattle and in Taipei are discussed.

Measuring physical activity in asthma patients: two-minute walk test, repeated chair rise test, and self-reported energy expenditure

Although prudent exercise is recommended for most patients with well-controlled asthma, many patients avoid exercise and physical activity because they are concerned about triggering asthma. In a sample of 258 asthma patients (mean age 42 years, 75% women), the objectives of this study were to assess the two-minute walk test and the repeated chair rise test and to compare results to self-reported physical activity recorded with the Paffenbarger Physical Activity and Exercise Index (PAEI). Patients walked a mean of 510 feet, required a mean of 14 seconds for the chair rise test, and reported a mean of 1,810 kilocalories per week from activities, mostly walking. In multivariable analysis, male sex, younger age, more education, lower body mass index, and better short-term asthma control, but not long-term asthma severity, were associated with better performance-based test results and more self-reported physical activity. Better short-term control also was associated with less breathing and leg exertion during both tests. Correlations between the PAEI and performance-based tests were approximately 0.38. Performance-based and self-reported measures provide information about various aspects of exercise capacity and can be used during routine clinical practice to assess physical activity in asthma patients.

How active are older Americans?

INTRODUCTION

Regular physical activity can reduce age-related functional decline, as well people's risk for chronic diseases such as coronary heart disease, hypertension, colon cancer, and diabetes. The objective of this study was to estimate the level of participation in aerobic, muscle-strengthening, and flexibility activities among Americans aged 50 years or older.

METHODS

Using population-based data from the 2001 National Health Interview Survey, we classified qualified respondents (N = 11,969) according to whether they met the activity criteria used in Healthy People 2010 goals for leisure-time participation in regular aerobic physical activity, vigorous-intensity aerobic activity, strength-training activity, and flexibility activity. We also classified respondents according to their level of aerobic activity (i.e., inactive, insufficiently active, and regularly active).

RESULTS

We estimated that 46.4% of older Americans engaged in no leisure-time aerobic activity; that 26.1% were regularly active (participated in light- to moderate-intensity aerobic activities at least 5 days per week for at least 30 minutes or vigorous-intensity activities at least 3 days per week for at least 20 minutes); that 16.2% participated in vigorous-intensity aerobic activities at least 3 days per week for at least 20 minutes; that 13.7% participated in strength-training activities at least 2 days per week; and that 24.5% participated in flexibility activities at least 1 day per week. Among the 26.1% of older Americans who were regularly active, 30.5% engaged in strengthen-training activities at least 2 days per week. Overall, only 8.2% of older Americans met the criteria for both aerobic and strength-training activity.

CONCLUSION

As of 2001, the percentage of older Americans who met recommended activity levels of physical activity were well below the goals for U.S. adults in Healthy People 2010. Further efforts are needed to encourage older Americans to engage in aerobic activities and in strengthening and flexibility activities.

Long-term maintenance of increased exercise involvement following a self-management intervention for housebound older adults with arthritis

Background

Sustained maintenance of health behaviors is a determinant of successful symptom reduction strategies for older adults with arthritis. This study examined whether or not short-term improvements in exercise involvement were maintained 8 months following a home-based arthritis self-management intervention as well as the moderating role of individual characteristics in the maintenance of behavior change.

Methods

Of the 113 housebound older adult participants at pre-intervention, 97 completed the post-intervention interview, and 80 completed the 8-month post-intervention interview.

Results

Some post-intervention improvements in exercise involvement were maintained 8 months later. More specifically, weekly exercise frequency, particularly regarding walking frequency, and variety of exercise activities were still significantly greater in the experimental group than in the control group 8 months following the completion of the intervention. No moderating influences were observed for any of the individual characteristics.

Conclusion

We conclude that gains in exercise involvement achieved through a self-management intervention can be maintained 8 months following the intervention.

Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls

OBJECTIVE

Low energy expenditure is a risk for cardiovascular morbidity. The goals of this study were to compare energy expenditure between patients with rheumatoid arthritis (RA) and healthy controls.

METHODS

A total of 121 RA patients and 120 healthy controls in New York City completed the Paffenbarger Physical Activity and Exercise Index at time of enrollment (1999-2000) and 1 year later to measure energy expenditure from walking, climbing stairs, and exercise/sports. Analyses were adjusted for age, sex, education, pain, social support, and depressive symptoms and were compared with recommended thresholds of energy expenditure.

RESULTS

Participants' mean age was 49 years, and 87% were women. Patients with RA expended fewer kilocalories per week than controls (mean +/- SD 1,474 +/- 1,198 versus 1,958 +/- 1,940, P = 0.003), with most of this difference from less walking as opposed to high-intensity activities. Although similar percents of RA patients and controls met national recommendations for total weekly energy expenditure (56% versus 64% for the lower [> or =1,000 kilocalories per week] threshold; P = 0.14, and 41% versus 48% for the higher [> or =1,400 kilocalories per week] threshold; P = 0.17), fewer RA patients met the recommendations (> or =700 kilocalories per week) for walking (32% versus 48%; P = 0.01). The strongest predictor of more energy expenditure at 1 year for both groups was more energy expenditure at enrollment.

CONCLUSION

Most of the difference in energy expenditure between RA patients and healthy controls was due to less walking. Given that walking is an effective and relatively safe lifestyle activity, increasing walking should be a priority to improve cardiovascular risk in RA.

Physical activity patterns in adults with severe mental illness

Although physical inactivity is a leading cause of death and the Surgeon General recommends regular moderate physical activity, many Americans are inactive. Because of their increased burden of obesity and diabetes, people with severe mental illness (SMI) especially may benefit from physical activity, yet little is known about the prevalence and types of physical activity in people with SMI. We surveyed outpatients with schizophrenia and affective disorders at two psychiatric centers in Maryland and compared physical activity patterns to an age-gender-race-matched national sample (National Health and Nutrition Examination Survey III) of the general population. We found that people with SMI are overall less physically active than the general population, although the proportion with recommended physical activity levels was equal. The participants with SMI were more likely to walk as their sole form of physical activity. Within the SMI group, those without regular social contact and women had higher odds of being inactive.

Risk Adjusting Rehabilitation Outcomes

The complexity and mix of rehabilitation patients varies across clinicians and institutions. Comparisons of outcomes across providers must therefore adjust for differences in risk factors across patient populations. Research on risk adjustment has generally focused on acute care hospital outcomes, although techniques for risk adjusting financial outcomes are fairly well developed in rehabilitation, primarily to support Medicare and other prospective payment systems. This article reviews important methodologic issues in risk adjusting rehabilitation outcomes in observational studies of routine clinical practice or for management, such as assessing quality or costs of care. Risk adjusting rehabilitation outcomes is more difficult than risk adjusting other clinical results, such as outcomes of many acute care services. At the outset, characterizing rehabilitation interventions is frequently difficult. Furthermore, outcomes are diverse and depend on myriad factors, including patients' physical and cognitive abilities, underlying medical diseases, sensory and emotional factors, willingness to participate in care, and supportive environments. No risk-adjustment approach can control for every factor affecting outcomes of care. Knowing which risk factors are missing helps guide interpretation of the results and determines how well risk-adjusted outcomes fairly compare providers or treatments.

Social Predictors of Physical Activity in Later Life: The Contribution of Social-Network Type

The purpose of this study was to examine the association of social-network type and physical activity in an elderly population. The analysis was based on secondary analysis of a sample of Israeli retirees (N= 1,493). Five network types were considered: diverse, friends, neighbors, family, and restricted networks. Sociodemographic and health variables were addressed as control variables. A dichotomous physical activity measure was regressed in a hierarchical logistic procedure on the control and network-type variables. The multivariate results showed that respondents in diverse networks had the highest likelihood of all the network types for engaging in physical activity, and those in exclusively family or restricted networks had the lowest. The findings confirm that physically active older adults are also more socially connected.

The Association of Physical-Performance Level with Attitude Toward Exercise in Older Adults

The Hebrew Home Study of Impairment and Exercise is a cross-sectional community-based study of nondisabled adults age 75–85 years that assessed attitude toward exercise by asking level of agreement with four statements evaluating participants’ perceptions of the health benefits and personal rewards of exercise. A physical-performance battery evaluated lower extremity function on a scale of 0 to 12. Attitude toward exercise was compared across 4 groups: non-vigorous exercisers with scores of 4–6 (n= 21), 7–9 (n= 90), or 10–12 (n= 113) and vigorous exercisers (n= 71). Vigorous exercisers had a significantly better attitude toward exercise than the reference group did, with odds ratios of 1.8-5.5 in all attitude statements. The lowest and moderate-performance groups had less positive attitudes toward exercise than the reference group did, with odds ratios of 0.27–0.62 for all statements. There was a highly significant gradient with better attitude toward exercise and higher functional-status level. Future work in improving older adults’ compliance with exercise should take into account the less positive attitude of those with functional limitations toward the benefits of exercise.