Associations of physical activity and body mass index with activities of daily living in older adults

Functional fitness and physical independence in later years: cut-off values and validation

BACKGROUND

To establish and validate the criterion-referenced standards of functional fitness in predicting physical independence in 80 + years.

METHODS

A group of 2,749 older community dwellers (60-84 years) were recruited, and 2,050 were identified with moderate-to-high independent living ability according to the proposed minimum composite physical function score. The Senior Fitness Test battery was applied to measure functional fitness at five-year intervals. The declining rate for each fitness dimension was calculated based on the differences between any two adjacent age groups and was adjusted according to the reported degradation rate differences between the cross-sectional and longitudinal studies.

RESULTS

The age-and-sex-specific criterion-referenced standards were identified for muscle strength, cardiovascular endurance, and dynamic balance that older adults should possess at 60-79 to maintain independent living abilities. Moderate to high consistency (k = 0.622-0.650) and associations (φ = 0.641-0.694) were found between the predicted physical independence by criterion-referenced standards of functional fitness and the results from the composite physical function scale. Moreover, the predicted independent living abilities in later years from the criterion-referenced standards of functional fitness showed high test-retest reliability (Pa = 0.90-0.96).

CONCLUSION

The criterion-referenced standards for functional fitness are valid and reliable to predict independent living abilities in later years, and provide the threshold to identify the limitations in physical fitness and detect the risks of functional disabilities among older adults in an early stage.

Association of Regular Leisure-Time Physical Activity with Self-Reported Body Mass Index and Obesity Risk among Middle-Aged and Older Adults in Taiwan

Through this study, we aimed to determine the association of regular leisure-time physical activity (LTPA) with self-reported body mass index (BMI) and obesity risk among middle-aged and older adults in Taiwan. We conducted a cross-sectional study and reviewed the data derived from the Taiwan National Physical Activity Survey (TNPAS). Responses from 12,687 participants aged 45–108 years from the database were collected in this study. All the participants completed a standardized structured questionnaire that solicitated information regarding their demographic characteristics (age, gender, education, occupation, and self-reported health status), physical activity behaviors (regular/nonregular LTPA), and self-reported anthropometrics (height, weight, and BMI). Multiple linear and logistic regressions were used to examine the association between regular LTPA and BMI, and between regular LTPA and obesity status, respectively. Regular LTPA was associated with male gender, normal weight, excellent or good self-reported health status, and a lower rate of being underweight compared with nonregular LTPA. Regular LTPA was significant negatively associated with being underweight (OR = 0.71, p < 0.05), whereas it had no significant relationship with BMI and obesity (p > 0.05). Regular LTPA was associated with a reduced risk of being underweight among middle-aged and elderly adults in Taiwan. Further research on the relevant mechanism underlying this phenomenon is warranted.

The prevalence of obesity in older adults in Iran: a systematic review and meta-analysis

Background

one of the most important age-dependent physiologic alterations in the body composition of older adult people is obesity and overweight, increasing the risk of cardiovascular disease and mortality rate.

Objective

The aim of the present study is to determine the prevalence of obesity in older adults in Iran.

Methods

The present study was conducted via meta-analysis and systematic review method, from March 2000 to October 2018. Subject-related literature was obtained via searches in ScienceDirect, Medline (PubMed), SID, Magiran, Scopus, and Google Scholar databases. Heterogeneity of studies was assessed using the I² index, and data were analyzed by Comprehensive-Meta analysis software.

Results

In the assessment of 18 studies and 29,943 persons aged over 50 years, the prevalence of obesity in older adults of Iran was 21.4% (95%CI: 26.6–16.9%) based on the meta-analysis. The highest obesity prevalence was obtained in older adults of Babol (Amir Shahr) which was 44.2% (95%CI: 41.1–47.2%) in 2007, while the minimum obesity prevalence was found in older adults of Razavi Khorasan which was 11.3% (95%CI, 10–12.8%) in 2007. Further, as the sample size and the study year increased, the obesity prevalence diminished in older Iranian adults (p < 0.05).

Conclusion

This study suggests that the prevalence of obesity in the older adults of Iran is high. Accordingly, healthcare planners and politicians should consider effective and practical policies to reduce obesity in older adults.

The Impact of Leisure and Social Activities on Activities of Daily Living of Middle-Aged Adults: Evidence from a National Longitudinal Survey in Japan

This study investigated the effects of leisure and social activities on the ability of middle-aged adults to maintain activities of daily living (ADL), and whether performing these activities alone or with others contributed to the ability to perform ADL. The study used nationally representative longitudinal data of 22,770 adults in Japan, aged 50–59 years, who did not have limitations in performing ADL at the beginning of the 5-year survey period. The study considered six activity categories: two leisure activities (“hobbies or cultural activities” and “exercise or sports”) and four social activities (“community events,” “support for children,” “support for elderly individuals,” and “other social activities”). Multiple logistic regression analysis was used to examine the relation between participation in these categories at baseline and difficulties in ADL at the 5-year follow-up. The association between the extent of social interaction during these activities (“by oneself,” “with others,” or “both”) and difficulties in ADL was also investigated. The analysis yielded significant negative correlations between “exercise or sports” and difficulties in ADL for both men and women, and between “hobbies or cultural activities” and difficulties in ADL for women. However, these significant relationships occurred only when activities were conducted “with others.” The present findings might help prevent deterioration in middle-aged adults’ performance of ADL in Japan.

Factors associated with IADL independence: implications for OT practice

BACKGROUND

Globally, the population is aging. Instrumental activities of daily living (IADL) are an important component of independent function and impact the ability of older adults to age in place. Therefore, factors associated with IADL independence warrant further study.

OBJECTIVE

To explore the association of age, depressive symptoms and leisure participation with IADL independence, and the relative importance of these three factors in predicting IADL independence.

METHODS

A cross-sectional design using an existing data set was employed. Older adults age 60 and older (n = 98) who resided in senior housing or their own home/apartment were included in the study. A hierarchical multiple regression analysis was employed.

RESULTS

The second model predicting IADL independence using age, depressive symptoms and level of leisure participation was significant (F_(3,96) = 15.57, p < 0.001) and explained 31.00% of the variance in IADL independence compared to the first regression model, which included age alone (R² adjusted = 18.00%). Age was the strongest of the three predictors, accounting for 11.40% of the variance in IADL independence. Depressive symptoms and participation in leisure activities were also significant predictors, their unique contributions being 7.30 and 4.30%, respectively.

CONCLUSION AND SIGNIFICANCE

Age, depressive symptoms and leisure participation are all significant predictors of IADL independence among older adults. Therefore, according to our preliminary findings, leisure participation and non-pharmacological interventions for depressive symptoms warrant attention in practice in relation to IADL independence.

Balance training in elderly women using public parks

This study evaluates the effects of a balance training program developed in public parks on functionality and general state of health in elderly women. It was a randomized controlled trial. Women older than 65 years (n = 28; 68.5 ± 2.9) participated in a balance training program that lasted 6 weeks, with sessions taking place twice a week (12 exercises/session, 50 min). Balance was analyzed by the Berg Balance Scale and Timed Up & Go Test. The generic health status was measured by the SF-12 Health Survey. These tests showed statistically significant differences in the experimental group (p < .05). Public parks are adequate installations for developing balance.

The optimal value of BMI for the lowest risk of osteoporosis in postmenopausal women aged 40-88 years

The aim of this paper is to establish the optimal values of the body mass index (BMI) which would indicate the most favourable preservation of the bone mineral density in postmenopausal women. The material consists of the data of 369 healthy women aged between 40 and 88 years (mean age 67.84, SD=6.70) inhabitants of Wrocław, which were followed up between 2001 and 2006. The absolute measure of bone mineral density (BMD) of the femoral neck was assessed using dual energy X-ray absorptiometry (DEXA), expressed in g/(100mm(2)) and was transformed to T-score values. According to the value of BMI, the women were divided into eight groups, the reference group with value between 18.0 and 21.9kg/m(2) and seven other groups beginning with the value 22.0 with a 2-point interval. Postmenopausal status was defined according to the occurrence of menstruation within the last 360 days. The women with osteopenia and osteoporosis were pooled together and comprised the risk group, whereas the other women comprised the normal group (T-score values above -1.0). The adjusted odds ratio showed the highest value for intervals between 24.0 and 25.9 units of BMI, and the lowest value for interval 26.0-27.9 units of BMI. The Youden index showed the lowest value in the 26.0-27.9BMI kg/m(2) interval. For our sample the optimal value of BMI, with the lowest risk of osteopenia and/or osteoporosis was the value of 26.9kg/m(2). A further increase of BMI does not result in a favourable effect on the bones, it rather intensifies negative phenomena in the body resulting in the onset of many diseases.

Joint association of physical activity and body weight with subsequent physical and mental functioning: a follow-up study

Background

Physical inactivity and overweight are major threats to public health. However, it is not well understood to what extent physical activity might counteract the harmful effects of overweight on functioning. Thus, we examined the joint associations of leisure-time physical activity and body mass index (BMI) with subsequent physical and mental functioning over a follow-up of five to seven years.

Methods

The data were derived from the Helsinki Health Study, which is a cohort study among employees of the City of Helsinki, Finland. The baseline postal survey data were collected among 40-60-year-old employees in 2000–02 (n = 8960, response rate 67%), and the follow-up data in 2007 among all baseline survey respondents (n = 7332, response rate 83%). We divided the participants into six groups according to their amount of physical activity (inactive, moderately active and highly active) and their relative weight (normal weight and overweight). Highly active normal-weight participants were used as a reference group in all the analyses. Poor functioning was defined as the lowest quartile of the Short Form 36 (SF-36) health survey’s physical and mental component summaries, with the follow-up cut-off point also applied at baseline. We used logistic regression analysis adjusted for age, gender, baseline functioning, smoking, alcohol use, marital status, socioeconomic position and working conditions.

Results

At baseline 48% of the participants were overweight and 11% were inactive. After adjustments inactivity was associated with poor physical functioning at follow-up both among the normal-weight (OR 1.51, 95% CI 1.09-2.10) and overweight (OR 2.02, 95% CI 1.56-2.63) groups. Being overweight regardless of activity level was associated with poor physical functioning. Poor physical functioning was practically equally common among the highly active overweight group and the inactive normal-weight group. After adjustments, for mental functioning, only inactivity among the overweight was associated with poor mental functioning (OR 1.39, 95% CI 1.08-1.80).

Conclusions

Physical activity is likely to be beneficial for physical and mental functioning among both those with overweight and normal weight. However, maintaining normal weight is also important for good physical functioning. Therefore, efforts should be made to recommend people to engage in physical activity regardless of weight.

Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis

This study examined the relationship between normal weight, overweight and obesity class I and II+, and the risk of disability, which is defined as impairment in activities of daily living (ADL). Systematic searching of the literature identified eight cross-sectional studies and four longitudinal studies that were comparable for meta-analysis. An additional four cross-sectional studies and one longitudinal study were included for qualitative review. Results from the meta-analysis of cross-sectional studies revealed a graded increase in the risk of ADL limitations from overweight (1.04, 95% confidence interval [CI] 1.00-1.08), class I obesity (1.16, 95% CI 1.11-1.21) and class II+ obesity (1.76, 95% CI 1.28-2.41), relative to normal weight. Meta-analyses of longitudinal studies revealed a similar graded relationship; however, the magnitude of this relationship was slightly greater for all body mass index categories. Qualitative analysis of studies that met the inclusion criteria but were not compatible for meta-analysis supported the pooled results. No studies identified met all of the pre-defined quality criteria, and subgroup analysis was inhibited due to insufficient comparable studies. We conclude that increasing body weight increases the risk of disability in a graded manner, but also emphasize the need for additional studies using contemporary longitudinal cohorts with large numbers of obese class III individuals, a range of ages and with measured height and weight, and incident ADL questions.

Cardiorespiratory fitness, obesity, and functional limitation in older adults

One hundred forty-six abdominally obese adults age 60-80 yr were studied to investigate the interaction between cardiorespiratory fitness (CRF) and obesity on functional limitation. Obesity was determined by fat mass (FM), CRF was determined by a maximal treadmill test, and functional limitation was based on 4 different tasks that are predictive of subsequent disability. Both FM (r = -.34, p ≤ .01) and CRF (r = .54, p ≤ .01) were independently associated with functional limitation in bivariate analysis.After further control for sex, age, and the interaction term (CRF × FM), FM was no longer independently associated with functional limitation (p = .10). Analyses were also based on sex-specific tertiles of FM and CRF. The referent group demonstrated significantly lower functional limitation than the low-CRF/low-FM and the low-CRF/high-FM groups (both p ≤ .05). These results highlight the value of recommending exercise for abdominally obese adults.

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.

The relationship between obesity, physical activity, and physical function in older adults

OBJECTIVE

This study investigated the relationship between overweight and obesity, age, and gender with physical activity and physical function in community-dwelling older men and women.

METHOD

Multivariate analysis of covariance was used to analyze differences between normal weight, overweight, and obese adults (n = 821) above the age of 60 years.

RESULTS

Obesity but not overweight was associated with lower levels of physical activity and physical function. Within BMI groups, individuals who were physically active were less likely to have abnormal physical function scores compared to those who were sedentary. Compared to men, obese women had lower physical function scores, placing them at higher risk for future disability. Aging was associated with lower levels of physical activity and physical function.

DISCUSSION

The study illustrates the importance of avoiding obesity and participating in regular physical activity to prevent or slow down the loss of functioning in older age.