Relationships between leisure-time physical activity, obesity and disability in elderly men

The Physical Activity Paradox in Low Muscle Mass in Middle-Aged and Older Adults

INTRODUCTION

Physical activity is widely accepted as a therapeutic approach to age-related muscle mass loss. However, it is unclear whether all physical activity domains benefit muscle mass maintenance. This study investigated the association between low muscle mass and domain-specific physical activity, including leisure-time and occupational moderate-to-vigorous physical activity (MVPA).

METHODS

This study included 27,357 middle-aged and older individuals (≥40 years) whose data were collected from 2014 to 2022 and analyzed in 2024. Low muscle mass was defined as a muscle mass index 2 SDs below the sex-specific average of 9,426 young individuals (aged 20-39 years). Leisure-time and occupational MVPA were assessed using the Global Physical Activity Questionnaire and categorized as 0 min/wk, 1-149 min/wk, and ≥150 min/wk. Logistic regression analysis focused on all participants, and additional analyses stratified by sex, age, sedentary time, and transfer time were performed.

RESULTS

For leisure-time MVPA, participants with 1-149 min/wk and ≥150 min/wk had significantly lower odds of low muscle mass compared to those with no MVPA, with ORs of 0.795 (95% CI=0.691, 0.914) and 0.740 (95% CI=0.649, 0.843), respectively (p<0.01 for both). No significant association was found between occupational MVPA and low muscle mass. These findings were consistent across different strata of sex, age, sedentary time, and transfer time.

CONCLUSIONS

Leisure-time MVPA is inversely associated with low muscle mass, whereas occupational MVPA shows no association, highlighting the importance of dynamic movements of sufficient intensity and recuperation time in maintaining muscle mass.

Rapid weight change as a predictor of disability among community-dwelling Japanese older adults

AIM

To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system.

METHODS

We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death.

RESULTS

During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups.

CONCLUSIONS

Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.

Lymphaticovenous Anastomosis for Treating Secondary Lower Limb Lymphedema in Older Patients-A Retrospective Cohort Study

Despite an increased incidence of secondary lower limb lymphedema (LLL) and severity of comorbidities with age, the impact of age on the effectiveness of lymphaticovenous anastomosis (LVA) in the older patients remains unclear. Methods: This retrospective cohort study enrolled older patients (age > 65 years) with secondary unilateral LLL. All patients underwent supermicrosurgical LVA. Demographic data and intraoperative findings including lymphatic vessel (LV) diameter, LV functionality (indocyanine green-enhanced and Flow positivity), and lymphosclerosis classification were recorded. Magnetic resonance volumetry was used for measuring preoperative and postoperative volume changes at 6 months and one year after LVA as primary and secondary endpoints. Results: Thirty-two patients (29 females/3 males) with a median age of 71.0 years [range, 68.0 to 76.3] were enrolled. The median duration of lymphedema was 6.4 [1.0 to 11.7] years. The median LV diameter was 0.7 [0.5 to 0.8] mm. The percentage of ICG-enhanced and Flow-positive LVs were 89.5% and 85.8%, respectively. The total percentage of suitable LVs (s0 and s1) for LVA based on lymphosclerosis classification was 75.9%. There were significant six-month and one-year post-LVA percentage volume reductions compared to pre-LVA volume (both p < 0.001). A significant reduction in cellulitis incidence was also noted after LVA (p < 0.001). No surgical or postoperative complications were found. Conclusion: Relief of secondary LLL was achievable through LVA in older patients who still possessed favorable LV characteristics, including larger LV diameters as well as a high proportion of functional LVs with a low grade of lymphosclerosis.

Optimal dose and type of exercise to improve cognitive function in older adults: A systematic review and bayesian model-based network meta-analysis of RCTs

OBJECTIVE

To examine the dose-response relationship between overall and specific types of exercise with cognitive function in older adults.

DESIGN

Systematic Review and Bayesian Model-Based Network Meta-Analysis.

DATA SOURCES

Systematic search of MEDLINE, Web of Science, Scopus, PsycINFO and SPORTDiscus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomized controlled trials of exercise interventions in participants aged 50 years or over, and that reported on at least one global cognition outcome.

RESULTS

The search returned 1998 records, of which 44 studies (4793 participants; 102 different effect sizes) were included in this review with meta-analysis. There was a non-linear, dose-response association between overall exercise and cognition. We found no minimal threshold for the beneficial effect of exercise on cognition. The estimated minimal exercise dose associated with clinically relevant changes in cognition was 724 METs-min per week, and doses beyond 1200 METs-min per week provided less clear benefits. We also found that the dose-response association was exercise type dependent, and our results show that clinically important effects may occur at lower doses for many types of exercise. Our findings also highlighted the superior effects of resistance exercises over other modalities.

CONCLUSIONS

If provided with the most potent modalities, older adults can get clinical meaningful benefits with lower doses than the WHO guidelines. Findings support the WHO recommendations to emphasise resistance training as a critical component of interventions for older adults.

Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function

The relationship between the age-associated decline in mitochondrial function and its effect on skeletal muscle physiology and function remain unclear. In the current study, we examined to what extent physical activity contributes to the decline in mitochondrial function and muscle health during aging and compared mitochondrial function in young and older adults, with similar habitual physical activity levels. We also studied exercise-trained older adults and physically impaired older adults. Aging was associated with a decline in mitochondrial capacity, exercise capacity and efficiency, gait stability, muscle function, and insulin sensitivity, even when maintaining an adequate daily physical activity level. Our data also suggest that a further increase in physical activity level, achieved through regular exercise training, can largely negate the effects of aging. Finally, mitochondrial capacity correlated with exercise efficiency and insulin sensitivity. Together, our data support a link between mitochondrial function and age-associated deterioration of skeletal muscle.

Aging is associated with a progressive loss of muscle function. Here the authors characterize mitochondrial capacity and muscle function in young and older adults with similar habitual physical activity and also compared to older adults with exercise training or with physical impairment.

Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia

Background

To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA.

Methods

Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes.

Results

Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ²(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02).

Conclusions

Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia.

Trial registration

ClinicalTrial.gov Identifier NCT01401582.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02201-1.

Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies

Background

Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally.

Methods

We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities.

Results

Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare.

Conclusions

Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.

Effect of a Multicomponent Intervention Program on Community-Dwelling People With Intellectual Disabilities

Objective

To investigate the effectiveness of a novel and complex intervention in community-dwelling people with intellectual disabilities.

Methods

Forty-three participants completed the experiment. The subjects were randomly assigned the experimental (n=33) or control (n=10) groups. The multicomponent intervention program comprised exercise and nutrition management and behavior modification. The intervention was performed for 60 minutes once weekly for 10 weeks. The assessment included anthropometric data, body composition and blood pressure analysis, and blood tests. In addition, pulmonary function, physical function, and health-related quality of life were measured before and after the intervention.

Results

No adverse events occurred during the intervention. After the intervention, the experimental group showed a significantly higher increase in high-density lipoprotein cholesterol level than did the control group (effect size=0.152, p=0.019).

Conclusion

This innovative intervention was effective in improving cardiovascular health. Even greater effects could be achieved through improvements in implementation strategies to increase compliance.

Is adiposity associated with objectively measured physical activity and sedentary behaviors in older adults?

BACKGROUND

Many older adults in the U.S. do not achieve the recommended amount of physical activity (PA) to fully realize a myriad of health benefits. Adiposity is one of those important correlates of PA and sedentary behaviors. However, the full extent to which adiposity is associated with PA and stationary time (STA) is uncertain. Therefore, we examined the association of adiposity with objectively measured PA and STA in black and white older adults.

METHODS

We conducted a cross-sectional study of older adults enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007 who participated in an ancillary accelerometer study 2009-2013. Assessment of body mass index (BMI) and waist circumference (WC) was completed during an in-home visit in the parent study. PA was measured by Actical™ accelerometers, which provided estimates of moderate-to-vigorous-intensity PA (MVPA), light-intensity PA (LPA), and STA for 4-7 consecutive days. Data from accelerometers were standardized to square root percentages of total wear time per day (SqrtMVPA%, SqrtLPA%, and SqrtSTA%). Interactions were tested for BMI and WC by race and sex, separately.

RESULTS

Data were available for 7873 participants (69.8 ± 8.7 yr, 54.2% women, 31.5% African American). In mixed linear regression models, significant interactions existed in BMI by race and sex for the SqrtMVPA%, WC by race and sex for the SqrtMVPA% and the SqrtLPA% model(p < 0.05). No interaction was significant for the logistic model of meeting the PA guideline or not. In subgroup analyses, BMI was inversely associated with SqrtMVPA%, SqrtLPA%, and positively related to SqrtSTA% in black women, white men and white women after adjustments. Similar patterns were observed between WC and SqrtMVPA%, SqrtLPA%, and SqrtSTA% in all groups, respectively. However, BMI was not associated with SqrtMVPA% in black men. Those with higher BMI or WC were less likely to meet the PA guideline in all groups.

CONCLUSIONS

Adiposity was inversely associated with higher levels of MVPA/LPA and positively associated with higher levels of STA among black and white older adults. Prevention efforts aimed at promoting weight control may be beneficial to prevent physical inactivity and sedentary lifestyle among older adults.

The relationship between employment status and insulin resistance in the Korean elderly population

BACKGROUND/AIMS

This study aimed to investigate the relationship between employment status and insulin resistance in the Korean elderly population.

METHODS

The study included 2325 healthy participants (862 men and 1463 women) who did not have diabetes, were 60-74 years old, and participated in the 2007-2010 Korea National Health and Nutrition Examination Survey. Their employment status was categorized as employed or unemployed. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess insulin sensitivity. Insulin resistance was defined as values greater than the 75th percentile of the HOMA-IR (> 2.67 in men and > 2.87 in women).

RESULTS

Mean HOMA-IR values were significantly higher for both sexes in the unemployed group than in the employed group. Compared with the unemployed group, the odds ratios (95% confidence intervals) for insulin resistance in the employed group were 0.55 (0.34-0.87) in men and 0.68 (0.47-0.98) in women after adjusting for confounders.

CONCLUSIONS

Being employed was significantly associated with a lower risk of insulin resistance in the Korean elderly population. These findings suggest that insulin sensitivity could be increased by increasing physical activity through occupational activities in the elderly population.

Development of strategies for changing in physical activity behaviors on older adults with disabilities

The purpose of this study was to develop strategies for promoting physical activity for the disabled older adults who were in the transtheoretical model of precontemplation, contemplation, and preparation stages about participating physical activities for promoting healthy life-styles. In order to achieve this goal, we developed a preliminary strategy for promoting physical activity for the elderly with disabilities based on the data gathered through the ground-work studies and the results of the research on the changes of the exercise behavior directly investigated from the elderly with disabilities. Then the strategies were verified to completion of the final promoting strategies. The elderly with disabilities in the three stages of precontemplation, contemplation, and preparation should develop strategies to think positively about themselves and their surroundings as well as strengthen their appropriate healthy behaviors. Additionally, families, physicians, and healthy seniors who spent time with disabled older adults could help to promote physical activities. However, overall administrative support, in-stitutional system construction, and public policy support were needed and it suggested that multifaceted supports and a variety of cooperation were necessary to improve a quality of life among older adults with disabilities.

Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial

OBJECTIVES

To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.

DESIGN

Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).

SETTING

Eight U.S. centers.

PARTICIPANTS

Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.

INTERVENTION

Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).

MEASUREMENTS

MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).

RESULTS

Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04).

CONCLUSION

Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.

Physical mobility, physical activity, and obesity among elderly: findings from a large population-based Swedish survey

OBJECTIVE

To examine how physical activity and physical mobility are related to obesity in the elderly.

STUDY DESIGN

A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%.

METHODS

Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses.

RESULTS

The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14-3.75) than for physical inactivity (OR 1.63, 95% CI 1.28-2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility.

CONCLUSION

It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity.

To be or not to be physically active: Insights for a real chance to have an appropriate body mass in a sample of teachers

BACKGROUND

Studies on the relationship between physical activity (PA) and being overweight/obese are inconclusive.

OBJECTIVE

The purpose of this study was to examine the prevalence of excess body weight (EBW) and its association with daily PA level in a sample of 1506 Brazilian teachers.

METHODS

The PA level was analyzed with the International Physical Activity Questionnaire and EBW was categorized as a body mass index (BMI) ≥25 kg/m2 and called 'overweight'. Chi-squared test and odds ratios (OR) were applied in the analysis.

RESULTS

The prevalence of persons who were overweight was lower as a function of higher PA levels and higher PA levels resulted in a lower prevalence of overweight for men and women, respectively. The authors found that for men, moderate (OR: 1.69; P = 0.03) and high (OR: 2.57; P = 0.002) PA levels were predictive for being in the normal body mass index (BMI) range. In women, a greater association of being in the normal BMI range was reported only for a moderate PA level (OR: 1.43; P = 0.004).

CONCLUSIONS

Higher daily PA levels are associated with being in the normal BMI range. To date, these findings will have important public health implications for an effective plan for the prevention of weight gain in Brazilian teachers.

Consideration of Age-Related Changes in Behavior Trends in Older Adults in Assessing Risks of Environmental Exposures

Objectives: To explore age-related behavior differences between older and younger adults, and to review how older adult activity patterns are considered in evaluating the potential risk of exposure to environmental pollutants. Methods: Activity pattern data and their use in risk assessments were analyzed using the U.S. EPA Exposure Factors Handbook (EFH), U.S. EPA Consolidated Human Activity Pattern Database (CHAD), and peer-reviewed literature describing human health risk assessments. Results: The characterization by age of some factors likely to impact older adults’ exposures remains limited. We demonstrate that age-related behavior trends vary between younger and older adults, and these differences are rarely explicitly considered in environmental health risk assessment for older adults. Discussion: Incorporating older adult exposure factors into risk assessments may be challenging because of data gaps and difficulty in defining and appropriately binning older adults. Additional data related to older adult exposure factors are warranted for evaluating risk among this susceptible population.

Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain

INTRODUCTION

Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people.

OBJECTIVES

To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association.

STUDY DESIGN

A cross-sectional study in a sample of 3136 people ≥65 years of age.

MAIN OUTCOMES MEASURES

Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire.

RESULTS

For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p<0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p<0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p<0.01). Age or time spent walking did not significantly change these results.

CONCLUSION

Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time.

The aging musculoskeletal system and obesity-related considerations with exercise

Advancing age and adiposity contribute to musculoskeletal degenerative diseases and the development of sarcopenic obesity. The etiology of muscle loss is multifactorial, and includes inflammation, oxidative stress and hormonal changes, and is worsened by activity avoidance due to fear of pain. The risk for mobility disability and functional impairment rises with severity of obesity in the older adult. Performance measures of walking distance, walking speed, chair rise, stair climb, body transfers and ability to navigate obstacles on a course are adversely affected in this population, and this reflects decline in daily physical functioning. Exercise training is an ideal intervention to counteract the effects of aging and obesity. The 18 randomized controlled trials of exercise studies with or without diet components reviewed here indicate that 3-18 month programs that included aerobic and strengthening exercise (2-3 days per week) with caloric restriction (typically 750 kcal deficit/day), induced the greatest change in functional performance measures compared with exercise or diet alone. Importantly, resistance exercise attenuates muscle mass loss with the interventions. These interventions can also combat factors that invoke sarcopenia, including inflammation, oxidative stress and insulin resistance. Therefore, regular multimodal exercise coupled with diet appears to be very effective for counteracting sarocpenic obesity and improving mobility and function in the older, obese adult.

Does the amount of fat mass predict age-related loss of lean mass, muscle strength, and muscle quality in older adults?

BACKGROUND

An excessive amount of adipose tissue may contribute to sarcopenia and may be one mechanism underlying accelerated loss of muscle mass and strength with aging. We therefore examined the association of baseline total body fat with changes in leg lean mass, muscle strength, and muscle quality over 7 years of follow-up and whether this link was explained by adipocytokines and insulin resistance.

METHODS

Data were from 2,307 men and women, aged 70-79 years, participating in the Health, Aging, and Body Composition study. Total fat mass was acquired from dual energy X-ray absorptiometry. Leg lean mass was assessed by dual energy X-ray absorptiometry in Years 1, 2, 3, 4, 5, 6, and 8. Knee extension strength was measured by isokinetic dynamometer in Years 1, 2, 4, 6, and 8. Muscle quality was calculated as muscle strength divided by leg lean mass.

RESULTS

Every SD greater fat mass was related to 1.3 kg more leg lean mass at baseline in men and 1.5 kg in women (p < .01). Greater fat mass was also associated with a greater decline in leg lean mass in both men and women (0.02 kg/year, p < .01), which was not explained by higher levels of adipocytokines and insulin resistance. Larger fat mass was related to significantly greater muscle strength but significantly lower muscle quality at baseline (p < .01). No significant differences in decline of muscle strength and quality were found.

CONCLUSIONS

High fatness was associated with lower muscle quality, and it predicts accelerated loss of lean mass. Prevention of greater fatness in old age may decrease the loss of lean mass and maintain muscle quality and thereby reducing disability and mobility impairments.

Association of age and physical exercise with bodyweight and body composition in Asian Chinese men

BACKGROUND

The present study sought to examine the association between physical exercise as a lifestyle habit with anthropometric parameters and body composition and aging in men.

METHODS

Intensity of exercise was scored as metabolic equivalent-min/week (MET-min/week) from data of the questionnaire, while anthropometric parameters and body composition were carried out by standard measuring instruments and dual-energy X-ray absorptiometry scanner, respectively.

RESULTS

Age was associated with decreases in bodyweight, height, total lean mass and bone mass, but an increase in fat mass. The negative association of lean mass with age was predominantly due to the negative association of lean masses in the legs and arm, while the positive association of fat mass with age was primarily due to the positive association of fat masses in the trunk and abdomen. Exercise of intensity greater than 1000 MET-min/week was significantly associated with higher lean and bone masses and lower fat mass. The increase in lean mass was predominantly in the legs, while the decreases in fat mass were in the trunk and abdomen.

CONCLUSION

The study showed that the high intensity of physical exercise, equivalent to greater than 1000 MET-min/week, is required to effect beneficial changes in the body composition. Hence, results from the study support the importance of promoting a lifestyle habit of exercise of sufficient intensity in order to mitigate the increase risks of sarcopenia and obesity and their attendant ill effects on health in men as they age.

Personal factors, perceived environment, and objectively measured walking in old age

This study examined the associations between walking behavior and the perceived environment and personal factors among older adults. Sixty participants age 65 yr or older (mean 77 +/- 7.27, range 65-92) wore pedometers for 3 consecutive days. Perceived environment was assessed using the Neighborhood Environment Walkability Scale (abbreviated version). Physical function was measured using the timed chair-stands test. The mean number of steps per day was 5,289 steps (SD = 4,029). Regression analyses showed a significant association between personal factors, including physical function (relative rate = 1.05, p < .01) and income (RR = 1.43, p < .05) and the average daily number of steps taken. In terms of perceived environment, only access to services was significantly related to walking at the univariate level, an association that remained marginally significant when controlling for personal characteristics. These results suggest that among this sample of older adults, walking behavior was more related to personal and intrinsic physical capabilities than to the perceived environment.

Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines

BACKGROUND

The purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence.

METHODS

Prospective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed.

RESULTS

Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices.

CONCLUSIONS

There is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.

Comparison of body composition, handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants

Immigration to a foreign country has a significant impact on a person's health status and health management behavior. The purpose of this pilot study was to examine body composition (body mass index and muscle area of the mid-upper arm and mid-calf), handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants. In this cross-sectional study, a convenience sample of 87 elderly Korean immigrants and 294 elderly Koreans were recruited from senior centers and senior apartments in the United States and Korea. Compared with elderly Koreans, elderly Korean immigrants had higher mid-calf muscle area (p = 0.06), handgrip strength (p = 0.01), and functional capacity (p = 0.01) and less physical activity (p < 0.01). Older men were more physically active and had more muscle areas, greater handgrip strength, and better functional capacity than older women, whereas older women had higher BMI scores than older men. This study provides motives for the development of health promotion intervention studies (e.g., culturally relevant exercise programs incorporating strength training). Future studies could identify culturally relevant strategies to promote physical activity in elderly Korean immigrants and especially elderly Korean women in both groups.

Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults?

This study examined if reported physical activity has beneficial outcomes on disability through cognitive performance-mediated effects and if these mediation effects are comparable for White and African American elders. Longitudinal data from the Assets and Health Dynamics among the Oldest Old study (N = 4,472) are used to test mediation in multilevel models. During the 7-year follow-up, cognitive performance mediated the effects of reported physical activity on disability in the entire sample and in Whites but not in African Americans. Our results indicate that reported physical activity may delay the disability development through improvement in cognitive performance. Unmeasured education and comorbidity influences may have obscured the mediation effects in African Americans. Reported physical activity plays a key role in the independence of older adults and should be particularly promoted in African Americans and during the entire life course.

Dietary supplement use among elderly, long-term cancer survivors

INTRODUCTION

The purpose of the present study was to assess dietary supplement use and its association with micronutrient intakes and diet quality among older (>or=65 years), long-term survivors (>or=5 years post-diagnosis) of female breast, prostate, and colorectal cancer.

METHODS

The sample included 753 survivors who participated in telephone screening interviews to determine eligibility for a randomized diet and physical activity intervention trial entitled RENEW: Reach-out to ENhancE Wellness in Older Cancer Survivors. Telephone surveys included two 24-hour dietary recalls and items regarding supplement use (type, dose, and duration). Nutrient intakes were compared to Dietary Reference Intakes (DRIs). Diet quality was assessed using the revised Healthy Eating Index (HEI). Descriptive statistics and multivariate logistic regression were used in this cross-sectional study.

RESULTS

A majority of survivors (74%) reported taking supplements, with multivitamins (60%), calcium/vitamin D (37%), and antioxidants (30%) as the most prevalent. Overall proportions of the total sample with dietary intakes below Estimated Average Requirements (EARs) were substantial, although supplement users had more favorable mean HEI scores (P < 0.01) and nutrient intakes for 12 of the 13 vitamins and minerals investigated (P values < 0.05). Supplement use was positively associated with older age (>or=70 years) (odds ratio (OR)=1.70; 95% confidence interval (95% CI)=1.17, 2.46) and female gender (OR=1.49; 95% CI=1.04, 2.13), and negatively associated with current smoking (OR=0.40, 95% CI=0.21, 0.76). Individuals scoring higher on the Total Fruit (OR=1.12, 95% CI=1.01, 1.23), Whole Grain (OR=1.14, 95% CI=1.04, 1.25), and Oil (OR=1.10, 95% CI=1.01, 1.11) components of the HEI were significantly more likely to take supplements, while those scoring higher on the Meat and Beans category (OR=0.81, 95% CI=0.71, 0.93) were significantly less likely to take supplements. Compared to those with less than a high school education, survivors with a professional or graduate degree were significantly more likely to use supplements (OR=2.18, 95% CI=1.13, 4.23).

DISCUSSIONS/CONCLUSIONS

Demographic, disease, and health-related correlates of supplement use follow similar trends observed in the general population as well as previous reports from other cancer survivor populations. Supplement use may reduce the prevalence of nutrient inadequacies in this population, though survivors who use supplements are the least likely to need them.

IMPLICATIONS FOR CANCER SURVIVORS

Supplement use may be an effective means for many survivors to achieve adequate nutrient intakes; however, open communication between healthcare providers and survivors is needed to ensure potential concerns are addressed as supplement use may not always be beneficial.

Regular vigorous physical activity and disability development in healthy overweight and normal-weight seniors: a 13-year study

OBJECTIVES

We examined the relationship of regular exercise and body weight to disability among healthy seniors.

METHODS

We assessed body mass index (BMI) and vigorous exercise yearly (1989-2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4 groups: normal-weight active (BMI< 25 kg/m(2); exercise> 60 min/wk); normal-weight inactive (exercise<or= 60 min/wk); overweight active (BMI>or= 25 kg/m(2)); and overweight inactive. Disability was measured with the Health Assessment Questionnaire (0-3; 0= no difficulty, 3= unable to do). We used multivariable analysis of covariance to determine group differences in disability scores after adjustment for determinants of disability.

RESULTS

The cohort was 72% men and 96% White, with a mean age of 65.2 years. After 13 years, overweight active participants had significantly less disability than did overweight inactive (0.14 vs 0.19; P= .001) and normal-weight inactive (0.22; P= .03) participants. Similar differences were found between normal-weight active (0.11) and normal-weight inactive participants (P< .001).

CONCLUSIONS

Being physically active mitigated development of disability in these seniors, largely independent of BMI. Public health efforts that promote physically active lifestyles among seniors may be more successful than those that emphasize body weight in the prevention of functional decline.

Effect of co-morbidity on the association of high body mass index with walking limitation among men and women aged 55 years and older

BACKGROUND AND AIMS

Obesity among older persons is rapidly increasing, thus affecting their mobility negatively. The aim of this study was to examine the association of high body mass index (BMI) with walking limitation, and the effect of obesity-related diseases on this association.

METHODS

In a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, chronic diseases, and BMI were ascertained in a health examination. Walking limitation was defined as maximal walking speed of less than 1.2 m/s or difficulty in walking 500 meters. To analyze the effects of chronic conditions, smoking, marital status, and education on BMI class differences in walking limitation, covariates were sequentially adjusted in logistic regression analyses.

RESULTS

In women, an increasing gradient in the age-adjusted risk of walking limitation was observed with higher BMI: overweight (OR 1.47, 95% CI 1.10-1.96), obese (OR 2.77, 95% CI 2.01-3.82), and severely obese (OR 5.80, 95% CI 3.52-9.54). In men, the risk was significantly increased among the obese (OR 1.63, 95% CI 1.04-2.55) and severely obese (OR 4.33, 95% CI 2.20- 8.53). After adjustment of multiple covariates, the association remained significant among the obese (OR 1.99, 95% CI 1.38-2.86) and severely obese women (OR 3.64, 95% CI 2.12-6.26), as well as severely obese men (OR 2.78, 95% CI 1.30-5.95). Knee osteoarthritis in women and diabetes in men contributed most to the excess risk of walking limitation among obese persons, 18 and 32% respectively.

CONCLUSIONS

Obesity increases the risk of walking limitation, independent of obesity-related diseases, smoking, marital status, and education, especially in older women. The results of this study emphasize the importance of maintaining normal body weight, in order to prevent obesity-related health risks and loss of functioning in older age.

Health practices that predict recovery from functional limitations in older adults

BACKGROUND

Although previous studies show the benefits of certain health behaviors in reducing physical disability in older people, their effects on functional limitation, an antecedent of disability, are not well established. This study aims to identify health behavioral practices that affect recovery from functional limitations in older adults.

METHODS

A total of 312 community-dwelling adults aged 65 and older with functional limitations were examined in 2002 for functional recovery in 2003. Functional limitations were measured by self-reports of difficulty performing upper- and lower-body movements. Positive health practices included regular physical activity, normal body mass index (BMI), periodic medical checkups, and moderate alcohol consumption. Logistic regression models were fitted to identify individual as well as combined health practices that predict functional recovery, adjusting for sociodemographic and health-related covariates.

RESULTS

Although each of the positive health practices was significantly associated with functional recovery in the bivariate analyses, only physical activity continued to be a strong independent predictor in the multivariate analysis. The likelihood of functional recovery tended to increase with the number of health practices adopted by the elderly. Physical activity, in combination with normal BMI, proved to be one of the most influential health practice profiles, resulting in a high percentage of functional recovery.

CONCLUSIONS

Health behaviors, especially physical activity, contribute to an older person's functional independence. The benefit of an increased number of health practices on recovery from functional limitations suggests that targeting multiple behavioral risks may help delay the onset of disability in later life.