Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis

Assessing adherence to physical activity guidelines and correlates among older Korean adults with a focus on 10-minute bout duration using subjective and objective measures

BACKGROUND

Understanding physical activity (PA) patterns in older adults is crucial for effectively promoting adherence to PA guidelines. However, measuring PA can be challenging because it involves a balance between ease of administration and accuracy of data collection. The primary objective of this study was to analyze PA levels in older Korean adults using both self-reported and objective accelerometer measures, and the secondary objective was to investigate the factors associated with adherence to PA guidelines.

METHODS

Using data from the Korea National Health and Nutrition Examination Survey (KNHANES VII-2) 2017, we assessed 425 older adults who provided both self-reported and accelerometer data. Adherence to PA guidelines was evaluated using two different thresholds for the accelerometer data, each applied both strictly and with a tolerance of one to two minutes when defining a 10-minute bout.

RESULTS

Self-reported data indicated a 34% adherence rate, whereas accelerometer-based rates ranged from 16% to 62.8%, depending on the cutoff values and tolerance settings. Bland-Altman analyses demonstrated notable differences between subjective and objective measurements. In terms of correlates, the questionnaire data highlighted factors such as education and household income, whereas the accelerometer-based findings emphasized sex, age, hypertriglyceridemia, and low high-density lipoprotein cholesterol.

CONCLUSIONS

This study revealed substantial discrepancies in both moderate-to-vigorous PA adherence estimates and significant predictors when comparing self-reported surveys to accelerometer data among older adults. For estimating population-level adherence, in the absence of accelerometer cutoff values established by a specialized lab, both self-reported data and accelerometer measurements offer unique insights. Meanwhile, when analyzing the factors influencing PA adherence, accelerometer data may be preferable, as subjective biases in self-report can affect the observed correlates in statistical results.

Estimating the risk reduction in disability incidence by adhering to recommendation-based physical activity in older adults: a cohort study

BACKGROUND

The WHO recommends ≥150 min/week of moderate-to-vigorous physical activity (MVPA) for older adults, while the Japanese Ministry of Health, Labour and Welfare suggests ≥6000 steps/day. However, the potential of meeting these recommendations to reduce the incidence of disability remains unclear.

METHODS

This study included 4079 community-dwelling older people from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Physical activity was measured using triaxial accelerometers over 1 month, with 12-month data used in sensitivity analyses. Disability incidence was defined as new certification by the Japanese Long-Term Care Insurance system for 58 months. To compare the cumulative incidence of disability between adherent and non-adherent groups, we applied the parametric g-formula accounting for sociodemographic, physical and medical covariates.

RESULTS

For MVPA adherence, disability incidence was reduced by -2.17% (95% CI -4.50% to 0.16%). Continuous MVPA adherence over 12 months significantly reduced disability incidence by -3.15% (95% CI -6.08% to -0.22%). A significant reduction in severe disability incidence was observed with MVPA adherence (-1.18%, 95% CI -3.59% to -0.17%). Subgroup analyses indicated greater reductions in disability incidence among individuals aged <75 years (-2.56%, 95% CI -4.81% to -0.31%). For daily step adherence, the largest risk reduction was observed in the subgroup of older adults aged ≥75 years (-4.40%, 95% CI -10.12% to 1.33%), although the CI was wide.

CONCLUSIONS

Adherence to recommendation-based physical activity may effectively prevent disability in community-dwelling Japanese older adults.

Association Between Prevention Focus and Sedentary Behavior in Older Adults: Cross-Sectional Study

Background

Older adults engage in increased amounts of sedentary behavior (SB), which can result in a significant decline in muscle function and overall health. An understanding of the motivational driving factors that lead older adults to engage in SB can help to create effective intervention programs.

Objective

This study aimed to determine the association between prevention and promotion focus with SB in older adults, as well as compare these associations with two factors (ie, age and BMI) that are commonly known to have an association with SB among older adults.

Methods

A cross-sectional analysis was conducted among 93 community-dwelling older adults with a mean age of 74.98 (SD 6.68) years. Prevention and promotion focus were both assessed using the Regulatory Focus Questionnaire. Correlation analysis was performed to determine the associations between prevention focus, promotion focus, age, and BMI with SB. Anderson-Darling tests confirmed nonnormal data distributions for all factors (except age); therefore, Spearman rank correlation was used to determine correlations between factors. Comparative analysis of significant correlations was performed using Fisher Z transformation.

Results

Prevention focus had the greatest statistically significant correlation with SB (ρ=0.296; P=.004), followed by BMI (ρ=0.204; P=.049). Both age (ρ=0.116; P=.27) and promotion focus (ρ=0.002; P=.99) had statistically insignificant correlations with SB, indicating no associations. The correlation between prevention focus and SB did not significantly differ from the correlation between BMI and SB (P=.51).

Conclusions

Prevention focus was found to have a weak, but significant positive association with SB in older adults. Although age and BMI have been found to have an association with SB in previous literature, age was not associated with SB in this study, while BMI had a significant but relatively weaker association with SB than that with prevention focus. However, the association found between BMI and SB did not statistically differ from the association found between prevention focus and SB. These findings suggest that older adults could be driven to engage in increased amounts of SB due to having a dominant prevention focus, which revolves around thoughts of safety and avoiding negative consequences. The recognition of this association has the potential to aid in developing intervention programs that could promote shifting from prevention to promotion focus, thereby reducing SB in older adults.

The future of healthy ageing: Wearables in public health, disease prevention and healthcare

Wearables have evolved into accessible tools for sports, research, and interventions. Their use has expanded to real-time monitoring of behavioural parameters related to ageing and health. This paper provides an overview of the literature on wearables in disease prevention and healthcare over the life course (not only in the older population), based on insights from the Future of Diagnostics Workshop (Leiden, January 2024). Wearable-generated parameters include blood glucose, heart rate, step count, energy expenditure, and oxygen saturation. Integrating wearables in healthcare is protracted and far from mainstream implementation, but promises better diagnosis, biomonitoring, and assessment of medical interventions. The main lifestyle factors monitored directly with wearables or through smartphone applications for disease prevention include physical activity, energy expenditure, gait, sleep, and sedentary behaviour. Insights on dietary consumption and nutrition have resulted from continuous glucose monitors. These factors are important for healthy ageing due to their effect on underlying disease pathways. Inclusivity and engagement, data quality and ease of interpretation, privacy and ethics, user autonomy in decision making, and efficacy present challenges to but also opportunities for their use, especially by older people. These need to be addressed before wearables can be integrated into mainstream medical and public health strategies. Furthermore, six key considerations need to be tackled: 1) engagement, health literacy, and compliance with personalised feedback, 2) technical and standardisation requirements for scalability, 3) accountability, data safety/security, and ethical concerns, 4) technological considerations, access, and capacity building, 5) clinical relevance and risk of overdiagnosis/overmedicalisation, and 6) the clinician's perspective in implementation.

Community-based going-out program and dementia onset in Japanese older adults: A longitudinal observational study

OBJECTIVES

With dementia prevalence rising globally among older adults, effective and scalable community-based interventions are urgently needed to reduce dementia onset. This study aimed to estimate the association of the going-out program with dementia onset in older adults.

METHODS

A 5-year longitudinal observational study was employed. Following a baseline assessment in 2015 and 2017, we observed 2,977 individuals engaging in a community-based going-out program for 12 months in Japan. Participants with continuous data over 12 months were defined as the engaged group, while those without such data were classified as the non-engaged group. After propensity score matching, 1,690 participants were selected. Dementia onset was obtained from the Japanese National Health Insurance and Later-Stage Medical Care System for 48-month follow-up. Incidence of dementia, absolute risk reduction (ARR), and number needed to treat (NNT) were calculated. The Cox proportional hazards model was used to estimate the effect of engagement in the program on dementia onset and to calculate a hazard ratio and 95 % confidential interval (CI).

RESULTS

The incidence of dementia onset was 59 out of 845 (7.0 %) in the non-engagement group and 34 out of 845 (4.0 %) in the engagement group. The ARR rate was 3.0 % (95 % CI 0.8, 5.2), and the NNT was 33 (95 % CI 19, 125). The hazard ratio was 0.57 (95 % CI 0.37, 0.86).

DISCUSSION

Engagement in the going-out program resulted in a 3.0 % reduction in the risk of dementia onset. The going-out program, which can be implemented in communities, holds potential efficacy in preventing dementia onset.

Trajectories of Burden or Benefits of Caregiving Among Informal Caregivers of Older Adults: A Systematic Review

Background and Objectives

Informal caregiving for older adults can be both burdensome and beneficial. Given that the informal caregiving situation may evolve over time, and care needs of older adults can result from diverse health conditions, it is valuable to understand the trajectories of burden or benefits of caregiving and how these trajectories vary across health conditions common among older care-recipients. This review is the first to summarize the literature on trajectories of burden or benefits of caregiving, including caregiver and care-recipient characteristics associated with the trajectories.

Research Design and Methods

We reviewed longitudinal observational quantitative studies, from 5 bibliographic databases, that assessed burden or benefits of caregiving at 3 or more time points among informal caregivers of older adults (60 years or above).

Results

The narrative synthesis included 41 studies, with only 7 (17%) considering trajectories of benefits. A stable average trajectory of burden or benefits of caregiving was the most common pattern over time across various care-recipient health conditions. However, an increasing burden over time was primarily observed among caregivers of persons with dementia, while a decreasing burden was noted among caregivers of persons discharged from the hospital after an acute health event. Only 6 (10%) studies, which reported heterogeneity in the progression of burden or benefits separately or jointly, identified distinctive trajectories within the same set of caregivers. Risk factors consistently identified to be associated with trajectories indicating persistently higher burden or persistently lower benefits included more care-recipient functional limitations and behavioral problems, being a non-spousal caregiver, being a solo caregiver, and perceiving less self-efficacy or competence.

Discussion and Implications

Future studies should focus on the trajectories of benefits of caregiving, untangle heterogeneity in trajectories of burden or benefits of caregiving, and consider both burden and benefits concurrently to identify factors that both enhance benefits and alleviate burden over time.

Chronic low back pain and decreased physical activity are associated with social frailty incidence among community-dwelling older adults

AIM

Nearly half of older adults with frailty experience chronic pain. Chronic pain contributes to activity restrictions. Decreased physical activity with chronic pain is associated not only with physical dysfunction but also with reduced engagement in social activities. We aimed to verify the hypothesis that chronic pain and decreased physical activity are associated with social frailty incidence.

METHODS

The study included 1198 community-dwelling older adults (aged 70.2 ± 6.3 years) without social frailty at baseline. Chronic pain, physical activity and basic information were assessed at baseline. The participants were divided into two groups based on the presence (yes, n = 167) or absence (no, n = 1031) of chronic low back pain. The incidence of social frailty was investigated during the follow-up examination after 2.5 years.

RESULTS

Binomial logistic regression analysis showed that older adults with chronic low back pain and low step counts had a higher odds ratio for the development of incident social frailty than older adults without chronic low back pain and high step counts (odds ratio 1.89, 95% confidence interval 1.03-3.46).

CONCLUSION

Our results suggest that a combination of chronic low back pain and low step counts is associated with the incidence of social frailty. Further research is required to establish intervention methods for pain and decreased physical activity to prevent social frailty. Geriatr Gerontol Int 2025; 25: 25-30.

Dose-Response Relationships of Daily Steps with Disability Incidence and All-Cause Mortality Stratified by Age and Physical Frailty

OBJECTIVES

To examine the optimal range of steps for an individual based on the dose-response relationship of the number of steps taken with disability incidence and all-cause mortality stratified by age and physical frailty.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

8664 community-dwelling older adults.

METHODS

The daily number of steps was measured using an accelerometer. Disability incidence and mortality were prospectively determined over 60 months. Participants were stratified using a nonlinear restricted cubic spline based on age ≥75 or <75 years and physical frailty, per the revised Japanese version of the Cardiovascular Health Study criteria.

RESULTS

The study cohort's median age was 74 years [interquartile range (IQR) range 71-78), and 54.0% were female. Incidental disability and death were observed in 1373 (15.8%) and 529 (6.1%) participants, respectively. The median steps per day were 5514 (IQR 3878-7616). Daily steps were nonlinearly associated with disability incidence and mortality. The optimal cutoff points for frail and nonfrail participants were, respectvely, 2168 [hazard ratio (HR) 0.74, 95% CI 0.56-0.98] and 7459 (HR 0.86, 95% CI 0.74-0.99) steps for disability incidence and 2593 (HR 0.63, 95% CI 0.40-0.98) and 3282 (HR 0.77, 95% CI 0.61-0.98) steps for all-cause mortality. The optimal cutoff points for participants >75 and <75 years were, respectively, 6066 (HR 0.83, 95% CI 0.72-0.99) and 8573 (HR 0.77, 95% CI 0.59-0.99) steps for disability incidence and 1824 (HR 0.67, 95% CI 0.46-0.98) and 4128 (HR 0.72, 95% CI 0.52-0.99) steps for all-cause mortality.

CONCLUSIONS AND IMPLICATIONS

Participants ≥75 years and frail participants required lower daily steps for preventing disability incidence and all-cause mortality than those <75 years and nonfrail participants, indicating that lower targets may still provide health-promoting benefits. Thus, the optimal step number should be considered based on individual characteristics, including age and frailty.

Physical activity and cognition: longitudinal findings from the Thinking and Living with Cancer Study

BACKGROUND

Physical activity can improve cognition; however, little is known regarding the relationships between longitudinal objectively measured physical activity, cognition, and inflammation in older breast cancer survivors.

METHODS

Older (aged 60 years and older) breast cancer survivors (n = 216) and frequency-matched noncancer control participants (n = 216) were assessed at baseline (presystemic therapy for survivors) and annually for up to 5 years. Assessments included hip-worn actigraphs worn for 7 days, neuropsychological tests, the Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment subscale, and circulating levels of C-reactive protein and interleukin-6. Data were analyzed using linear mixed-effect, random-effect contemporaneous fluctuation, and multilevel mediation models, considering covariates; a P value less than .05 (2-sided) was considered statistically significant.

RESULTS

Survivors had fewer minutes of moderate-to-vigorous physical activity than controls at 36-, 48-, and 60-month time points (P < .03). Fewer survivors met aerobic physical activity guidelines at 36 months than control participants (17.7% vs 33.0%, P = .030). When guidelines were met (vs not), Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment scores were 2.1 (1.0) (P = .034) points higher. Higher moderate-to-vigorous physical activity and meeting aerobic guidelines were not related to objective neuropsychological performance. Moderate-to-vigorous physical activity was inversely associated with C-reactive protein and interleukin-6 (P < .001), but inflammation did not mediate physical activity effects on perceived cognition.

CONCLUSIONS

Older breast cancer survivors were less physically active than older noncancer controls, especially farther from baseline. Meeting aerobic guidelines was associated with better perceived cognition in survivors. Survivorship care should consider physical activity monitoring and referral to rehabilitation and supervised exercise programs to promote physical activity and improve recovery in older survivors.

Combined Self-Reported and Device-Measured Physical Activity Assessment and Disability Incidence in Older Adults

OBJECTIVES

To clarify the relationship between self-reported and device-measured physical activity (PA) and disability incidences in community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

In total, 4504 (median age 75 [range, 72-79] years; women, 52.1%) community-dwelling older adults were included in this study.

METHODS

Device-measured moderate-to-vigorous PA (MVPA) was measured using a triaxial accelerometer. Self-reported MVPA was assessed using the Japanese version of the International Physical Activity Questionnaire, Short Form. The cutoff MVPA was 150 min/wk. PA was divided into 4 groups based on self-reported and device-measured assessments: (1) self-reported/device-measured inactive, (2) self-reported active/device-measured inactive, (3) self-reported inactive/device-measured active, and (4) self-reported/device-measured active. The disability incidence, defined as a long-term care insurance certification of any level indicating a requirement for support or continuous care, was prospectively determined using data extracted from the Japanese long-term care insurance system.

RESULTS

Of the participants, 892 (19.8%) developed disabilities within 62 (range, 60-64) months. The prevalence of self-reported inactive/device-measured inactive, self-reported active/device-measured inactive, self-reported inactive/device-measured active, and self-reported active/device-measured active were 884 (34.9%), 441 (17.4%), 693 (27.3%), and 515 (20.3%) participants, respectively. Multivariate Cox regression analysis showed that self-reported/device-measured active, self-reported inactive/device-measured active, and self-reported active/device-measured inactive independently decreased the disability incidence risk (self-reported/device-measured active: hazard ratio [HR], 0.555, 95% confidence interval [CI], 0.412-0.749; self-report inactive/device-measured active: HR, 0.656; 95% CI, 0.518-0.831; self-reported active/device-measured inactive: HR, 0.718; 95% CI, 0.556-0.928). In the post hoc analysis, those who were self-reported active/device-measured inactive were divided into 2 groups according to involvement in sports. Those who played sports had a lower disability risk; however, the difference was not significant.

CONCLUSIONS AND IMPLICATIONS

Combined self-reported and device-measured PA assessments may allow for disability risk stratification in older adults. The findings will also help in creating methods for evaluating PA levels to prevent disability incidences among older adults.

A multi-method feasibility trial of a multi-component behaviour change intervention to reduce sedentary behaviour and increase physical activity among ethnically diverse older adults

INTRODUCTION

Evidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and highly sedentary of all the age groups. The present study intends to examine the feasibility of a wearable gadget to remind users to break sitting time (by standing up and moving more), coupled with a brief health coaching session, pamphlet and reminder messages to decrease SB and improve PA.

METHODS AND ANALYSIS

This study will employ a multi-methods approach that generates quantitative data from questionnaires and qualitative data from semi-structured interviews following OAs' involvement in the study. This intervention will be informed by the socio-ecological model (SEM) and the habit formation model. The quantitative and qualitative data will be analysed separately and then integrated for interpretation and reporting, which will assist our knowledge of the feasibility of the programme.

ETHICS AND DISSEMINATION

Ethical approval for this study has been obtained from Swansea University (NM_ 2023 6667 6123). Informed consent will be obtained from participants. The findings of the study will be disseminated to the scientific community through conference presentations and scientific publications. The findings of the current study will determine the suitability of a future effectiveness trial.

TRIAL REGISTRATION NUMBER

NCT06407557.

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

The lifestyle of new middle-aged and older adults in Taiwan described by wearable device: age and gender differences

Studies of lifestyle through comprehensive objective and subjective measurements of health outcomes are lacking. An examination of lifestyle factors in middle-aged and older adults in terms of age, gender, and the interaction effect of age and gender from physiological and psychological perspectives are imperative. Recent advances in technology such as actigraphy have facilitated objective measurements. This exploratory study contributes to research on age and gender interactions on circadian rhythm, physical activity, sleep, and psychological variables by employing wrist accelerometers to measure behavioral circadian rhythm objectively and by using questionnaires to assess psychological status subjectively. The data were drawn from 218 participants aged 50 and older from the "Middle-aged and older adults Chinese Health and Actigraphy in Taiwan (MOCHA-T)". The results: (1) older adult group is associated with declined physical activity (MVPA time 79.9 min VS. 107.9 min, p = .002), worse sleep efficiency (78.1% VS. 81.9%, p = .008), and earlier lifestyle (Acrophase 14.19 h VS. 14.69 h, p = .01) comparing to middle-aged group. (2) Women have a more regular lifestyle (Interdaily stability 0.6 VS. 051, p < 0.001), higher physical activity (MVPA time 105.7 min VS. 79.3 min, p = .004), and better sleep efficiency (81.6% VS. 77.8%, p = .011) than men. (3) Significant age-by-gender interactions existed in life satisfaction (p = .025), relative amplitude (p = .016), and total wake time (p = .038). Furthermore, aging was associated with significant increases in life satisfaction among men as well as significant decreases in relative amplitude and reductions in the total wake time among women. In conclusion, aging exerted differential effects on life satisfaction in men as well as relative amplitude and the total wake time in women. This result highlights disparities in lifestyle arising from interconnected social and biological challenges.

Perseverative cognition and health behaviours: exploring the role of intentions and perceived behavioural control

OBJECTIVE

Worry and rumination (Perseverative Cognition, PC) have been associated with health behaviours, but the underlying mechanisms are unknown. Given the role of physiological experiences on perceived behavioural control (PBC) and emotion regulation on intention-health behaviour relationships, we tested whether: PC prospectively predicts poorer health behaviours; PC moderates the relationship(s) between intentions/PBC and health behaviour, as well as whether the relationship between PC and health behaviour is mediated by intentions and PBC.

METHODS AND MEASURES

In a prospective design, 650 participants (mean age = 38.21 years; 49% female) completed baseline measures of intentions, PBC and PC (worry and rumination) and 590 (mean age = 38.68 years; 50% female) completed follow-up (Time 2) measures of health behaviours (physical activity, sleep, sedentary activity, unhealthy snacking) 1-week later.

RESULTS

Worry and rumination (at T1) predicted poorer sleep quality. Worry, but not rumination, moderated PBC-physical activity frequency relations. Consistent with mediation, the indirect paths from both worry and rumination, through PBC, to sleep quality and total sleep time were significant.

CONCLUSION

PC is associated with poorer sleep quality and PBC can play a mediating role in such relationships. Future research should further consider the role that PBC plays in PC-health behaviour relations.

Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis

BACKGROUND

As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered.

OBJECTIVE

In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment.

METHODS

Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence.

RESULTS

Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps≥.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps≤.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps≤.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps≥.08).

CONCLUSIONS

In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154.

Associations between accelerometer-measured physical activity and sedentary behaviour with physical function among older women: a cross-sectional study

BACKGROUND

This study aimed to investigate the relationships between accelerometer-measured physical activity (PA) and sedentary behaviour (SB) with physical function (PF) among older Chinese women in the community.

METHODS

The present study comprised 1,113 community-dwelling older females, with an average age of 65 ± 2 years. We employed a linear regression analysis to investigate the relationship between patterns of PA and SB with PF. PA variables consisted of total PA time, bouted PA time (a continuous PA that lasts equal to or more than 10 min), and sporadic PA time (a continuous PA that lasts less than 10 min). SB variables included total SB time, 30-min bout of SB (a continuous SB that lasts equal to or more than 30 min), and 60-min bout of SB (a continuous SB that lasts equal to or more than 60 min). PF variables comprised handgrip strength (HGS), one-legged stance test with eyes closed (OLSTEC), usual walking speed (UWS), maximum walking speed (MWS) and chair-stand time (CT). To explore the joint effects of moderate-to-vigorous-intensity PA (MVPA) and SB on PF, we divided the duration of SB and MVPA participation in older women into different combinations: low MVPA & high SB, low MVPA & low SB, high MVPA & high SB, high MVPA & low SB.

RESULTS

The study revealed a significant association between 30-min bout of SB and CT, which remained after adjusting for total MVPA time (P = 0.021). Both total MVPA and bouted MVPA were found to be positively associated with better UWS, MWS, CT, and PF Z-score. When the combination of low MVPA & high SB was used as a reference, the regression coefficients for PF ascended by 1.32 (P < 0.001) in the high MVPA & high SB group and by 1.13 (P < 0.001) in the high MVPA & low SB group.

CONCLUSIONS

A significant association was observed between poorer lower limb function and prolonged, uninterrupted SB in older women, rather than with the total SB time. Concurrently, the insufficient engagement in MVPA may also be a crucial factor contributing to poorer PF in older women. Engaging in longer durations and higher intensity of PA, such as bouts of MVPA lasting a minimum of 10 min or longer, may contribute to better PF.

Estimating the Effect of Engagement in Community-Based Going-Out Program on Incidence Disability in Older Adults

OBJECTIVES

Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults.

DESIGN

Longitudinal, observational study.

SETTING AND PARTICIPANTS

Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score-matching scheme.

METHODS

After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio.

RESULTS

Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67).

CONCLUSIONS AND IMPLICATIONS

This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities.

Cognitive Reserve, Physical Reserve, and Cognitive Efficiency of Older People Living in the Sardinian Blue Zone. An Exploratory Study

This study mainly intended to disentangle the role played by physical reserve as a mediator of the relationship between cognitive reserve and global cognitive functioning in older people aging well. A sample of 120 67-101-year-old community-dwellers was recruited in the Sardinian Blue Zone, an area characterized by the extreme longevity of its inhabitants. Each respondent completed a battery of tests examining cognitive functioning, perceived physical health, cognitive reserve, and physical reserve (objectively assessed through accelerometric-derived measures). Significant associations were found among measures of cognitive reserve, physical reserve, perceived physical health, and cognition. Besides, two mediational analyses pointed out that physical reserve and distinct indexes of cognitive reserve explained 18% and 32% of the variance associated with global cognitive functioning. In conclusion, the combination of high cognitive reserve and more preserved motor functioning seems to contribute to the maintenance of healthy cognition in older people aging well.

Association of objectively measured physical activity with incidence disability in older adults with/without social isolation

PURPOSE

This study aimed to investigate association between objectively measured physical activities with incidence disability in older adults with and without social isolation.

METHODS

This 5-year longitudinal observational study used a population-based study from a sub-cohort of the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome. In Japan, Incident disability is defined as a new case of public insurance certification for long-term care. As participants, we enrolled 5,257 community-dwelling older adults aged ≥ 70 years. The Participants on whom incomplete baseline physical activity assessments were performed; who required long-term care; had a history of dementia, Parkinson's disease, stroke, or depression; who lacked independence in basic ADL; who had Mini-Mental State Examination scores; or who had missing measurements; were excluded. Thus, 2,071 participants were included.

RESULTS

Of the participants, 1,183 non-socially isolated participants had 151 (4.3%) cases of disability, while socially isolated participants had 150 (13%) cases. Cox proportional-hazards regression analysis presented the adjusted hazard ratio (HR) and 95% confidence interval (95%CI) of daily steps and low-intensity and moderate-to-vigorous physical activities-0.62(0.43-0.89), 0.84(0.60-1.18), 0.62(0.43-0.89) in participants with social isolation, and 0.58(0.40-0.85), 0.86(0.60-1.24), 0.70(0.49-1.01) in those with social isolation.

CONCLUSIONS

Daily steps were significantly associated with a decreased risk of incidence disability, regardless of social isolation. These results suggest the greater importance of daily physical activity than its specific intensity in socially isolated older adults.

Actual physical activity after major abdominal cancer surgery: Far from optimal

BACKGROUND

Enhanced recovery after surgery protocols emphasize the importance of early postoperative mobilization. However, literature quantifying actual physical activity after major abdominal cancer surgery is scarce and inconclusive.

MATERIAL AND METHODS

A single-center prospective cohort study was conducted at the University Medical Center Groningen from 2019 to 2021. Patients' postoperative physical activity was measured using an accelerometer, with the primary aim of assessing daily physical activity. Secondary aims were identifying patient-related factors associated with low physical activity and studying the consequences of low physical activity in terms of complication rate and length of hospital stay.

RESULTS

143 patients included (48 % male; mean age 65 years), 38.5 %, 24.5 %, 19.6 %, and 14 % underwent pancreatic, hepatic, colorectal, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, respectively. Median daily step count was low; from median 71 steps on the first to 918 steps on the seventh postoperative day. An association between physical activity and age (OR 3.597, p = 0.013), preoperative weight loss ≥10 % (OR 4.984, p = 0.004), Eastern Cooperative Oncology Group performance status ≥2 (OR 4.016, p = 0.001), midline laparotomy (OR 2.851, p = 0.025), and operation duration (OR 1.003, p = 0.044) was found. An association was observed between physical activity and the occurrence of complications (OR 3.197, p = 0.039) and prolonged hospital stay (β 4.068, p = 0.013).

CONCLUSION

Postoperative physical activity is low in patients undergoing major abdominal cancer surgery and is linked to postoperative outcomes. Although physical activity should be encouraged in all patients, patient-specific risk factors were identified that can aid early recognition of patients at risk of low physical activity.

Concurrent Validity of Four Activity Monitors in Older Adults

Sedentary behaviour (SB) and physical activity (PA) have been shown to be independent modulators of healthy ageing. We thus investigated the impact of activity monitor placement on the accuracy of detecting SB and PA in older adults, as well as a novel random forest algorithm trained on data from older persons. Four monitor types (ActiGraph wGT3X-BT, ActivPAL3c VT, GENEActiv Original, and DynaPort MM+) were simultaneously worn on five anatomical sites during ten different activities by a sample of twenty older adults (70.0 (12.0) years; 10 women). The results indicated that collecting metabolic equivalent (MET) data for 60 s provided the most representative results, minimising variability. In addition, thigh-worn monitors, including ActivPAL, Random Forest, and Sedentary Sphere-Thigh, exhibited superior performance in classifying SB, with balanced accuracies ≥ 94.2%. Other monitors, such as ActiGraph, DynaPort MM+, and GENEActiv Sedentary Sphere-Wrist, demonstrated lower performance. ActivPAL and GENEActiv Random Forest outperformed other monitors in participant-specific balanced accuracies for SB classification. Only thigh-worn monitors achieved acceptable overall balanced accuracies (≥80.0%) for SB, standing, and medium-to-vigorous PA classifications. In conclusion, it is advisable to position accelerometers on the thigh, collect MET data for ≥60 s, and ideally utilise population-specific trained algorithms.

Prospective associations between changes in physical activity and sedentary time and subsequent lean muscle mass in older English adults: the EPIC-Norfolk cohort study

BACKGROUND

The longitudinal associations between physical behaviours and lean muscle mass indices need to be better understood to aid healthy ageing intervention development.

METHODS

We assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers. We also assessed domain-specific physical behaviours (walking, cycling, gardening and housework time) with self-report questionnaires at baseline (2006-2011) and follow-up (2012-2016) in the European Prospective Investigation into Cancer (EPIC)-Norfolk study. We assessed body composition using dual-energy X-ray absorptiometry (DEXA) at follow-up in 1535 participants (≥ 60 years at baseline). From this, we derived appendicular lean muscle mass (ALM) indices (% relative ALM = (ALM/total body weight)*100), body mass index (BMI)-scaled ALM (ALM/BMI, kg/kg/m2) and height-scaled ALM (ALM/height2, kg/m2)). We evaluated the prospective associations of both baseline and change in physical behaviours with follow-up muscle mass indices using multivariable linear regression.

RESULTS

Over 5.5 years (SD 14.8) follow-up, higher baseline accelerometer-measured physical activity and lower sedentary time were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.02% higher subsequent relative ALM per minute/day of baseline MVPA for men). Greater increases in physical activity and greater declines in sedentary time variables were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.001 kg/kg/m2 subsequent BMI-scaled ALM and 0.04% subsequent relative ALM per min/day/year increases in LPA over follow-up; 0.001 kg/kg/m2 subsequent BMI-scaled ALM and -0.03% subsequent relative ALM per min/day/year less of total sedentary time over follow-up). Greater increases in women's cycling and gardening over follow-up were associated with greater subsequent relative ALM (cycling 0.9% per hour/week/year; gardening 0.2% per hour/week/year) and BMI-scaled ALM (cycling 0.03 kg/kg/m2 per hour/week/year; gardening 0.004 kg/kg/m2 per hour/week/year).

CONCLUSION

Physical behaviours across all intensities, and in women more specifically cycling and gardening, may help prevent age-related declines in muscle mass.

The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T): protocol for a multidimensional dataset of health and lifestyle

BACKGROUND AND OBJECTIVES

Older adults keep transforming with Baby Boomers and Gen Xers being the leading older population. Their lifestyle, however, is not well understood. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T) collected both objective and subjective data to depict the health and lifestyle of this population. The objectives, design, and measures of the MOCHA-T study are introduced, and the caveats and future directions related to the use of the data are presented.

METHODS

People aged 50 and over were recruited from the community, with a subset of women aged 45-49 invited to supplement data on menopause and aging. Four instruments (i.e., self-reported questionnaires, diary, wrist actigraphy recorder, and GPS) were used to collect measures of sociodemographic, health, psychosocial, behavioral, temporal, and spatial data.

RESULTS

A total of 242 participants who returned the informed consent and questionnaires were recruited in the MOCHA-T study. Among them, 94.6%, 95.0%, and 25.2% also completed the diary, actigraphy, and GPS data, respectively. There was almost no difference in sociodemographic characteristics between those with and without a completed diary, actigraphy, and GPS data, except for age group and educational level for those who returned completed actigraphy data.

CONCLUSION

The MOCHA-T study is a multidimensional dataset that allows researchers to describe the health, behaviors, and lifestyle patterns, and their interactions with the environment of the newer generation of middle-aged and older adults in Taiwan. It can be compared with other countries with actigraphy and GPS-based lifestyle data of middle-aged and older adults in the future.

Accelerometry-assessed physical activity and sedentary behavior patterns using single- and multi-component latent class analysis among postmenopausal women

BACKGROUND

Patterns of physical activity and sedentary behavior among postmenopausal women are not well characterized.

OBJECTIVES

To describe the patterns of accelerometer-assessed physical activity and sedentary behavior among postmenopausal women.

DESIGN

Cross-sectional study.

METHODS

Women 63-97 years (n = 6126) wore an ActiGraph GT3X + accelerometer on their hip for 1 week. Latent class analysis was used to classify women by patterns of percent of wake time in physical activity and sedentary behavior over the week.

RESULTS

On average, participants spent two-thirds of their day in sedentary behavior (62.3%), 21.1% in light low, 11.0% in light high, and 5.6% in moderate-to-vigorous physical activity. Five classes emerged for each single-component model for sedentary behavior and light low, light high, and moderate-to-vigorous physical activity. Six classes emerged for the multi-component model that simultaneously considered the four behaviors together.

CONCLUSION

Unique profiles were identified in both single- and multi-component models that can provide new insights into habitual patterns of physical activity and sedentary behavior among postmenopausal women.

IMPLICATIONS

The multi-component approach can contribute to refining public health guidelines that integrate recommendations for both enhancing age-appropriate physical activity levels and reducing time spent in sedentary behavior.

Is Cognitive Reserve a Determinant of Functional and Mental Health in Older People of the Sardinian Blue Zone? A Mediational Approach

The main purpose of this study was to examine the mediating role of cognitive reserve in the relationship between functional health (expressed through the amount and intensity of performed physical activity objectively assessed using wearable accelerometers) and psychological well-being (i.e., assessed in terms of self-reported depressive signs) of older people living in an area of exceptional longevity, the so-called Sardinian Blue Zone. A further goal was to investigate the impact of gender on the cognitive reserve and physical health of our participants, using global cognitive functioning as a covariate. A battery of tests assessing motor efficiency, cognitive reserve, global cognitive functioning, and self-reported depressive symptoms was individually presented to 120 community dwellers (Mage = 82 years, SD = 8.4 years) of the Sardinian Blue Zone. Significant associations were found between cognitive reserve, motor efficiency, and self-reported depressive signs. Moreover, three mediation analyses documented that distinct indexes of cognitive reserve and motor efficiency explain 27.2-31% of the variance in the self-reported depression condition. Following this, it was also found that people with scarce cognitive reserve tended to exhibit significant signs of depression and showed worse motor abilities. In addition, after controlling for the effect of global cognitive functioning, motor efficiency, and cognitive reserve were generally more preserved in males than in females. Overall, these findings suggest that cognitive reserve is a compensatory resource that contributes significantly to the enhancement of health-related quality of life in the last decades of life.

Exploring Perceived Barriers to Physical Activity among Older Adults Living in Low-Population Density Regions: Gender Differences and Associations with Activity Dimensions

Older people in low-population density regions tend to have fewer resources to engage in regular physical activity (PA) compared to their counterparts in urban areas. Moreover, PA assumes different dimensions, and the amount of PA related to each dimension may differ between women and men, predisposing them to different PA practices. Therefore, this cross-sectional study aims to describe the prevalence of barriers to PA, gender differences, and their associations with different PA dimensions. A total of 259 older adults (153 women and 106 men; age, 75.17 ± 8.05 years old) living in the community in the region of Guarda (Portugal) were interviewed face to face to record their sociodemographic characteristics, general health status (comorbidity index and self-reported health), PA behaviour, and barriers to PA. Women were more likely to report "low" income and living alone (p ≤ 0.05), while men reported a higher negative health status than women (p < 0.05). Two intrinsic ("Fear of injury" (40.1%) and "Need for rest" (26.3%)) and two extrinsic barriers ("Lack of nearby facilities" (30.5%) and "I don't have transport" (25.6%)) were the most prevalent. For women, age, self-reported health, comorbidity index, and intrinsic and extrinsic barriers were similarly associated with the different PA dimensions. However, only self-reported health and extrinsic barriers were the variables associated with the different PA dimensions in men. Therefore, strategies to promote active ageing in low-population density regions should be focused on reducing intrinsic and extrinsic barriers based on gender and the PA dimension to be achieved.

Participation in youth sports influences sarcopenia parameters in older adults

Background

The degree of deterioration in sarcopenia parameters may be affected by a person's level of physical activity (PA) and sedentary behavior (SB). Our study focused on examining the PA and SB of active older adults including those with and without history of sports in youth.

Methods

Forty-four participants (20 men and 24 women, mean age of total sample 76.1 ± 5.2 years) were included in analysis of PA, SB habits and sarcopenia parameters, determined by skeletal muscle index, hand-grip strength, gait speed, Timed Up and Go tests (TUG). PA and SB were recorded with accelerometers. Our primary aim was to compare participants with (AH) or without a sport history in youth (NAH), in their sarcopenia parameters and PA and SB habits.

Results

When divided participants in two groups (AH and NAH) and adjusting for age, we have detected the differences for skeletal muscle index (p = 0.007) and hand-grip strength (p = 0.004) in favor of participants who were engaged in sports in youth. We did not find any differences in PA and SB habits between the AH and NAH groups. After adjusting for age, participants with a higher number of daily steps, longer moderate to vigorous physical activity (MVPA) bouts, a higher number of MVPA bouts in a day and higher overall MVPA engagement achieved better results in hand-grip strength and TUG. Participants with lower SB had better TUG and gait speed results.

Conclusions

Our findings suggest that engaging in sports activities in youth can make a difference with sarcopenia parameters. Although we found no differences in PA and SB habits between participants with AH and NAH, participants with an athlete history performed better results in sarcopenia parameters.

Accelerometer Use to Measure Physical Activity in Older Adults With Coronary Artery Disease: An Integrative Review

BACKGROUND

Physical activity is necessary for improved health outcomes among older adults with coronary artery disease (CAD), and device-based assessment of physical activity is preferred for accurate measurement. Many previous studies have applied accelerometry to examine physical activity in this population, but no reviews have systematically examined the application of various accelerometers to measure physical activity in older adults with CAD.

OBJECTIVE

This integrative review aimed to examine accelerometry application to measure physical activity in older adults with CAD and provide guidance for accelerometer selection and settings.

METHODS

Six databases-CINAHL, PubMed, PsycINFO, Scopus, EMBASE, and Google Scholar-were searched for information sources. Authors of selected studies applied accelerometers to measure physical activity and included adults 60 years or older with CAD.

RESULTS

Among 12 studies reviewed, 5 were randomized controlled trials, and most used an age cutoff of 65 years for older adults. The most frequently used accelerometer was the RT3, and the most common device placement was the waist/hip. Data collection duration was typically 3 consecutive days. However, many study authors did not report epoch length, sampling frequency, number of valid hours of data required per day, total number of valid days of data needed, or criteria for nonwear time.

CONCLUSIONS

On the basis of data synthesis and previous study results, triaxial research-grade accelerometers, waist/hip placement, and a 5- to 7-day monitoring period are recommended for measuring physical activity in older adults with CAD. However, the study purpose, device and participant characteristics, and physical activity outcomes of interest should be considered during device selection.

Does the built environment influence location- and trip-based sedentary behaviors? Evidence from a GPS-based activity space approach of neighborhood effects on older adults

OBJECTIVE

Evidence on the influence of built environments on sedentary behaviors remains unclear and is often contradictory. The main limitations encompass the use of self-reported proxies of sedentary time (ST), the scarce consideration of the plurality of sedentary behaviors, and environmental exposures limited to the residential neighborhood. We investigated the relationships between GPS-based activity space measures of environmental exposures and accelerometer-based ST measured in total, at the place of residence, at all locations, and during trips.

METHODS

This study is part of the CURHA project, based on 471 older adults residing in Luxembourg, who wore a GPS receiver and a tri-axial accelerometer during 7 days. Daily ST was computed in total, at the residence, at all locations and during trips. Environmental exposures included exposure to green spaces, walking, biking, and motorized transportation infrastructures. Associations between environments and ST were examined using linear and negative binomial mixed models, adjusted for demographics, self-rated health, residential self-selection, weather conditions and wear time.

RESULTS

Participants accumulated, on average, 8 h and 14 min of ST per day excluding sleep time. ST spent at locations accounted for 83 % of the total ST. ST spent at the residence accounted for 87 % of the location-based ST and 71 % of the total ST. Trip-based ST represents 13 % of total ST, and 4 % remained unclassified. Higher street connectivity was negatively associated with total ST, while the density of parking areas correlated positively with total and location-based ST. Stronger associations were observed for sedentary bouts (uninterrupted ST over 20 and 30 min).

CONCLUSION

Improving street connectivity and controlling the construction of new parking, while avoiding the spatial segregation of populations with limited access to public transport, may contribute to limit ST. Such urban planning interventions may be especially efficient in limiting the harmful uninterrupted bouts of ST among older adults.

Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery

INTRODUCTION

The ageing population has led to an increasing proportion of surgical patients with greater frailty and comorbidity. Complications and mortality within 30 days of a surgical procedure are often used to evaluate success in the perioperative period however these measures can potentially underestimate a substantial level of morbidity associated with surgery. Personal wearable technologies are now readily available and can offer detailed information on activity intensity, sedentary behaviour and sleeping patterns. These devices may provide important information perioperatively by acting as a non-invasive, and cost-efficient means to risk stratify patients.

METHODS AND ANALYSIS

The Peri-Operative Wearables in Elder Recover After Surgery (POWERS) study is a multicentre observational study of 200 older adults (≥65 years) having major elective non-cardiac surgery. The objectives are to characterise the association between preoperative and postoperative activity monitor measurements with postoperative disability and recovery, as well as characterise trajectories of activity and sleep in the perioperative period. Activity will be monitored with the ActiGraph GT3X device and measured for 7-day increments, preoperatively, and at 1 week, 1 month and 3 months postoperatively. Disability will be assessed using the WHO Disability Assessment Schedule 2.0 assessed at 1 week, 1 month and 3 months postoperatively.

ETHICS AND DISSEMINATION

The POWERS study received research ethics board approval at all participating sites on 1 August 2019 (REB # 19-121 (CTO 1849)). Renewal was granted on 19 May 2022.

The Decline of Physical Activity with Age in School-Aged Children with Cerebral Palsy: A Single-Center Cross-Sectional Observational Study

Maintaining physical activity is important for children with cerebral palsy (CP). This study examined whether age predicted habitual physical activity (HPA) or cardiorespiratory fitness (CRF) in school-aged children with CP and clarified the relationship between HPA and CRF. We utilized cross-sectional data from 39 children with CP (18 girls and 21 boys; mean age 7.44 years; mean body weight 24.76 kg; mean body mass index 15.97 kg/m²; hemiplegic or diplegic CP). The participants wore an accelerometer (ActiGraph) for five days to measure HPA, physical activity energy expenditure (kcal/kg/d), sedentary physical activity (%SPA), light physical activity, moderate-to-vigorous physical activity (%MVPA), and activity counts (counts/min). Participants underwent cardiopulmonary exercise tests on a treadmill using a modified Naughton protocol. Linear regression and correlation analyses were performed. p-value (two-tailed) < 0.05 was considered statistically significant. Age was positively associated with SPA. MVPA negatively correlated with resting heart rate (HR), and activity counts were negatively correlated with resting HR. In conclusion, our study found strong evidence of a negative association between HPA and age in school-aged children with CP. It highlights the importance of creating and improving recreational opportunities that promote physical activity in all children with CP, regardless of whether they are considered therapeutic.

Associations between change in physical activity and sedentary time and health-related quality of life in older english adults: the EPIC-Norfolk cohort study

BACKGROUND

No previous studies have examined the associations between changes in objectively-measured physical behaviours with follow-up QoL in older adults. Based on cross-sectional evidence, it is biologically plausible that such associations exist. If so, this bolsters the case for the commissioning of activity interventions and for including QoL as an outcome in trials of such interventions.

METHODS

We assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers at baseline (2006-2011) and follow-up (2012-2016) and health-related quality-of-life (QoL) using EQ-5D questionnaires at follow-up in 1433 participants (≥ 60 years) of the EPIC (European Prospective Investigation into Cancer)-Norfolk study. The EQ-5D summary score was used, with 0 as the worst to 1 as best perceived quality-of-life. We evaluated the prospective associations of baseline physical behaviours with follow-up QoL, and of changes in behaviours with follow-up QoL using multi-level regression.

RESULTS

On average, MVPA decreased by 4.0 min/day/year (SD 8.3) for men and 4.0 min/day/year for women (SD 12.0) between baseline and follow-up. Total sedentary time increased by an average 5.5 min/day/yr (SD 16.0) for men and 6.4 min/day/yr (SD 15.0) for women between baseline and follow-up. Mean (SD) follow-up time was 5.8 (1.8) years. We found that higher baseline MVPA and lower sedentary time was associated with higher subsequent QoL (e.g. 1 h/day greater baseline MVPA was associated with 0.02 higher EQ-5D score, 95% CI 0.06, 0.36). More pronounced declines in activity were associated with worse Hr-QoL (0.005 (95% CI 0.003, 0.008) lower EQ-5D per min/day/yr decrease in MVPA). Increases in sedentary behaviours were also associated with poorer QoL (0.002 lower EQ-5D, 95% CI -0.003, -0.0007 per hour/day/yr increase in total sedentary time).

CONCLUSIONS

Promotion of physical activity and limiting sedentary time among older adults may improve quality-of-life, and therefore this relationship ought to be included in future cost effectiveness analyses so that greater commissioning of activity interventions can be considered.

Association between COVID-19 emergency declarations and physical activity among community-dwelling older adults enrolled in a physical activity measurement program: Evidence from a retrospective observational study using the regression discontinuity design

BACKGROUND

The current study examines the negative impact of the coronavirus disease 2019 (COVID-19) emergency declarations on physical activity among the community-dwelling older adults, the participants of a physical activity measurement program, in Japan.

METHODS

This retrospective observational study included 1,773 community-dwelling older adults (aged 74.6 ± 6.3 years, 53.9% women) who had participated in the physical activity measurement project from February 2020 to July 2021. We measured physical activity using a tri-axial accelerometer during 547 consecutive days. Three emergency declarations, requesting people to avoid going outside, occurred during the observational period. We multiply-imputed missing values for daily physical activity, such as steps, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) for several patterns of datasets according to the maximum missing rates on a person level. We mainly report the results based on less than 50% of the maximum missing rate (n = 1,056). Other results are reported in the supplemental file. Changes in physical activity before and after the start of each emergency declaration were examined by the regression discontinuity design (RDD) within 14-, 28-, and 56-day bandwidths.

RESULTS

For all the participants in the multiply-imputed data with the 14-day bandwidth, steps (coefficients [[Formula: see text]][Formula: see text] 964.3 steps), LPA ([Formula: see text] 5.5 min), and MVPA ([Formula: see text] 4.9 min) increased after the first emergency declaration. However, the effects were attenuated as the RDD bandwidths were widened. No consistent negative impact was observed after the second and third declarations. After the second declaration, steps ([Formula: see text]-609.7 steps), LPA ([Formula: see text]-4.6 min), and MVPA ([Formula: see text]-2.8 min) decreased with the 14-day bandwidth. On the other hand, steps ([Formula: see text] 143.8 steps) and MVPA ([Formula: see text] 1.3 min) increased with the 56-day bandwidth. For the third declaration, LPA consistently decreased with all the bandwidths ([Formula: see text]-2.1, -3.0, -0.8 min for the 14, 28, 56-day bandwidth), whereas steps ([Formula: see text]-529 steps) and MVPA ([Formula: see text]-2.6 min) decreased only with the 28-day bandwidth.

CONCLUSIONS

For the community-dwelling older adults who regularly self-monitor their physical activity, the current study concludes that there is no evidence of consistently negative impacts of the emergency declarations by the COVID-19 pandemic.

To be well or not to be well: compositional associations of physical activity, sedentary behaviour and sleep with mental well-being in Flemish adults aged 55+ years

BACKGROUND

Well-being is a key aspect for healthy ageing and there is an established association between physical activity and well-being in ageing adults. Despite the recent interest in physical activity as part of a 24-h continuum also including sedentary behaviour and sleep, there is a lack of studies examining the link between these 24-h behaviours and well-being in older adults. Therefore, the aim of this study was twofold: (1) to describe 24-h behaviours and their associations with mental well-being in community dwelling adults aged 55+ years; and (2) to examine the theoretical changes in mental well-being if time were reallocated from one behaviour to another.

METHODS

This was a cross-sectional study (n = 410). Daily time spent in sedentary behaviour, light and moderate-vigorous physical activity, and sleep was assessed using wrist-worn accelerometers during 6 days. Mental well-being was assessed using the 14-item Warwick-Edinburgh Mental Well-being Scale (WEMWBS). The association of 24-h behaviours and well-being was examined using crude and adjusted linear regression models with compositional data analysis procedures (aim 1). Associations between reallocations of five-minute intervals from five to 60 min between these behaviours and well-being were modelled using compositional isotemporal substitutions (aim 2).

RESULTS

Mean age (SD) was 71.3 (6.3) years and 71% were female. In 24-h, participants spent 5.66 h asleep, 13.88 h sedentary, 2.58 h in light intensity and 1,89 h in moderate-vigorous intensity physical activity. There were no statistically significant associations between 24-h behaviours and mental well-being in fully adjusted models (aim 1). Reallocations up to 30 min were not significantly associated with changes in well-being (aim 2). There were some statistically significant theoretical changes of up to 2 points on the WEMWBS with substitutions larger than 30 min.

DISCUSSION

24-h behaviours and time reallocations between behaviours were not associated with better or worse well-being in community dwelling adults aged 55+ years. Considering well-being as a key aspect for healthy ageing, future public health research should continue to examine physical activity (both light and moderate-to-vigorous), sedentary behaviour, as well as sleep as a part of the 24-h continuum and its associations with mental health outcomes in older adults. Trial registration This trial was registered at ClinicalTrials.gov on 3th July, 2018 (Trial registration NCT03576209).

A non-pharmacological multidomain intervention of dual-task exercise and social activity affects the cognitive function in community-dwelling older adults with mild to moderate cognitive decline: A randomized controlled trial

The present study aimed to determine the impact of a 10-month multidomain program using dual-task exercise and social activity conducted at a community-based facility on improved cognitive function in older adults with mild to moderate cognitive decline. The participants included 280 community-dwelling older adults (age 71–91 years) with mild to moderate cognitive decline. The intervention group exercised for 90 min/day, once a week. Their routine included aerobic exercise and dual-task training which cognitive tasks were performed in combination with exercise. The control group attended health education classes thrice. Before and after the intervention, we measured their cognitive function, physical function, daily conversation, and physical activity. The mean adherence rate of the intervention class was 83.0%. According to a repeated-measures multivariate analysis of covariance in an intent-to-treat analysis, logical memory and 6-min walking distance demonstrated a significant time and group interaction effect. Regarding daily physical activities, we observed significant differences in the daily step count and moderate-to-vigorous physical activity in the intervention group. Our non-pharmacological multidomain intervention resulted in a modest improvement in the cognitive or physical function and building health behavior. It may be a helpful program with a potential role in preventing dementia.

Clinical Trial Registration: http://clinicaltrials.gov Identifier ID: UMIN000013097.

Validation of an Activity Type Recognition Model Classifying Daily Physical Behavior in Older Adults: The HAR70+ Model

Activity monitoring combined with machine learning (ML) methods can contribute to detailed knowledge about daily physical behavior in older adults. The current study (1) evaluated the performance of an existing activity type recognition ML model (HARTH), based on data from healthy young adults, for classifying daily physical behavior in fit-to-frail older adults, (2) compared the performance with a ML model (HAR70+) that included training data from older adults, and (3) evaluated the ML models on older adults with and without walking aids. Eighteen older adults aged 70-95 years who ranged widely in physical function, including usage of walking aids, were equipped with a chest-mounted camera and two accelerometers during a semi-structured free-living protocol. Labeled accelerometer data from video analysis was used as ground truth for the classification of walking, standing, sitting, and lying identified by the ML models. Overall accuracy was high for both the HARTH model (91%) and the HAR70+ model (94%). The performance was lower for those using walking aids in both models, however, the overall accuracy improved from 87% to 93% in the HAR70+ model. The validated HAR70+ model contributes to more accurate classification of daily physical behavior in older adults that is essential for future research.

Association between daily gait speed patterns and cognitive impairment in community-dwelling older adults

Gait speed over a short distance is associated with cognitive impairment in older adults. Recently, daily gait speed has been assessed using accelerometers. However, because daily gait speed is only weakly correlation with gait speed over a short distance, its association with cognitive impairment needs to be investigated. The present study compared the daily gait speed patterns of normal cognition (NC), mild cognitive impairment (MCI), and general cognitive impairment (GCI) subjects measured every 3 h for two weeks using accelerometers. A total of 1959 participants were classified into the NC (N = 1519), MCI (N = 353), and GCI groups (N = 87). The results showed that the average daily gait speed of the GCI group was significantly lower than that of the NC group (p = 0.03). Furthermore, the average daily gait speeds of the MCI and NC groups were the same. However, the average daily gait speed of the MCI group during a specific time (12-15 o'clock) was significantly lower than that of the NC group (p < 0.01). These results suggest that changes in daily patterns may be detected by measuring daily gait speed, which depends on the degree of cognitive function.

Physical activity monitoring during hospital stay: a validation study

PURPOSE

The primary aim of this study was to investigate the concurrent validity of the PAM AM400 accelerometer for measuring physical activity in usual care in hospitalized patients by comparing it with the ActiGraph wGT3X-BT accelerometer.

MATERIALS AND METHODS

This was a prospective single centre observational study performed at the University Medical Centre Utrecht in The Netherlands. Patients admitted to different clinical wards were included. Intraclass Correlation Coefficients (ICCs) were computed using a two-way mixed model with random subjects. Additionally, Bland-Altman plots were made to visualize the level of agreement of the PAM with the ActiGraph. To test for proportional bias, a regression analysis was performed.

RESULTS

In total 17 patients from different clinical wards were included in the analyses. The level of agreement between the PAM and ActiGraph was found strong with an ICC of 0.955. The Bland-Altman analyses showed a mean difference of 1.12 min between the two accelerometers and no proportional bias (p = 0.511).

CONCLUSIONS

The PAM is a suitable movement sensor to validly measure the active minutes of hospitalized patients. Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.IMPLICATIONS FOR REHABILITATIONPhysical inactivity is common during hospital admission and the main cause of loss of muscle mass and physical fitness.The PAM AM400 is a suitable movement sensor to validly measure the active minutes of hospitalized patients.Implementation of this device in daily care might be helpful to change the immobility culture in hospitals.

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?

Device assessed activity behaviours in patients with indwelling pleural catheter: A sub-study of the Australasian Malignant PLeural Effusion (AMPLE)-2 randomized trial

BACKGROUND AND OBJECTIVE

Device-assessed activity behaviours are a novel measure for comparing intervention outcomes in patients with malignant pleural effusion (MPE). Australasian Malignant PLeural Effusion (AMPLE)-2 was a multi-centre clinical trial where participants with MPE treated with an indwelling pleural catheter were randomized to daily (DD) or symptom-guided (SGD) drainage for 60-days. Our aim was to describe activity behaviour patterns in MPE patients, explore the impact of drainage regimen on activity behaviours and examine associations between activity behaviours and quality of life (QoL).

METHODS

Following randomization to DD or SGD, participants enrolled at the lead site (Perth) completed accelerometry assessment. This was repeated monthly for 5-months. Activity behaviour outcomes were calculated as percent of daily waking-wear time and compared between groups (Mann-Whitney U test; Median [IQR]). Correlations between activity behaviour outcomes and QoL were examined.

RESULTS

Forty-one (91%) participants provided ≥1 valid accelerometry assessment (DDn = 20, SGD n = 21). Participants spent a large proportion of waking hours sedentary (72%-74% across timepoints), and very little time in moderate-to-vigorous physical activity (<1% across timepoints). Compared to SGD group, DD group had a more favourable sedentary-to-light ratio in the week following randomization (2.4 [2.0-3.4] vs. 3.2 [2.4-6.1]; p = 0.047) and at 60-days (2.0 [1.9-2.9] vs. 2.9 [2.8-6.0]; p = 0.016). Sedentary-to-light ratio was correlated with multiple QoL domains at multiple timepoints.

CONCLUSION

Patients with MPE are largely sedentary. Preliminary results suggest that even modest differences in activity behaviours favouring the DD group could be meaningful for this clinical population. Accelerometry reflects QoL and is a useful outcome measure in MPE populations.

Associations between Active Mobility Index and objectively measured physical activity among older adults

BACKGROUND

Active mobility index (AMI) is a questionnaire to assess going-out behavior with physical and social activity. The association between AMI scores and objectively measured physical activity (PA) in older adults is unknown.

METHODS

Community-dwelling older adults aged ≥ 70 years participated in an examination and wore a triaxial accelerometer for seven or more days. The accelerometer measured the time of moderate-to-vigorous intensity PA (MVPA) and light intensity PA (LPA), and step counts. The AMI assessed life space (distance from the respondent's home: < 1, 1-10, or > 10 km) and related activities during the previous month. The AMI total, physical, and social scores were calculated.

RESULTS

The analyzed data were 2499 participants (mean age: 75.5 ± 4.0 years; 54.4% female). Comparing PA among quartile groups of each AMI score, higher AMI total and physical score groups were associated with higher MVPA, LPA, and step counts (all P < 0.01). The Q4 group of AMI social scores showed significantly higher LPA and step counts than the Q1 and Q2 groups (P < 0.01). The logistic regression model showed higher score groups of AMI total and physical scores associated with increased adjusted odds ratio (aOR) of meeting recommended PA, ≥ 150 min/week of MVPA.

CONCLUSIONS

Older adults with higher AMI total and physical scores, engaged in more PA. Future studies can use the present findings when estimating PA in older adults from AMI scores and examining the association between AMI scores and health outcomes.

Latent growth curve modeling of physical activity trajectories in a positive-psychology and motivational interviewing intervention for people with type 2 diabetes

Background: Physical activity is critical for preventing and treating Type 2 diabetes (T2D). It is important to identify different profiles of physical activity change among those participating in behavioral interventions to optimize intervention-person fit.

Methods: This study analyzes longitudinal trajectories of change in moderate-to-vigorous physical activity (MVPA) in a positive psychology (PP) and motivational interviewing (MI) intervention for T2D, using latent growth curve modeling (LGCM). Objective measures of MVPA were collected using accelerometers at three time points: pre-intervention, immediately post-intervention, and eight weeks post-intervention. LGCM analyses identified subpopulations of participants who responded similarly to the intervention and examined if sociodemographic, medical and psychosocial characteristics were associated with MVPA trajectories.

Results: Analyses included 47 participants with complete follow-ups: 49% male, 81% non-Hispanic white, average age 66.1 (SD = 10.1). Overall, 36% of the participants increased MVPA while 57% did not. LGCM identified three profiles with distinct MVPA trajectories. Profile 1 (‘Started Low, No Change’; 65.8% of participants) with a starting mean of 4.54 min of MVPA/day and decreased by −3.36 min. Profile 2 (‘Moderate-High Start, Minimal Change,’ 27.4% of participants) and had a starting mean of 22.86 min/day of MVPA with an average increase of 1.03 min. Profile 3 (‘Moderate Start, Ended High’; 6.8% of participants), had a starting mean of 7.33 min MVPA/day, and increased by 28.4 min. Being male, younger, having fewer medical and psychiatric comorbidities were associated with increases in MVPA.

Conclusions: This secondary analysis detected three distinct physical activity profiles during and after a PP-MI intervention. Future interventions can target individuals with characteristics that showed the greatest benefit and add additional supports to people in groups that did not increase physical activity as much. These findings show a need for targeted and sustained behavior change strategies during and after physical activity interventions.

Trial registration: ClinicalTrials.gov; identifier: NCT03001999.

Bidirectional associations of accelerometer-assessed physical activity and sedentary time with physical function among older English adults: the EPIC-Norfolk cohort study

To develop healthy ageing interventions, longitudinal associations between objectively assessed physical behaviours and physical function need to be better understood. We assessed associations between accelerometer-assessed total physical activity (PA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time and prolonged sedentary bout time, and clinically assessed physical function (grip strength, usual walking speed (UWS), chair stand speed) at two time-points in 3188 participants (≥ 60 years) of the EPIC-Norfolk study. Bidirectional associations were assessed using multivariable linear regression. Over an average of 6.1 years, baseline physical behaviours (greater total PA, MVPA and LPA, and less sedentary time) were associated with better subsequent walking and chair stand speed. Better baseline physical function was associated with better follow-up physical behaviours. There were no bidirectional associations between changes in physical behaviours and grip strength. Improvements in UWS were associated with improvements in all physical behaviours. Improvements in chair stand speed were associated with improvements in total PA, MVPA, and sedentary bout time. Improvements in physical behaviours were associated with improvements in UWS (3.1 cm/s/yr per 100 cpm/yr  total PA, 3.6 cm/s/yr per hr/day/yr MVPA, 2.5 cm/s/yr per hr/day/yr LPA, - 2.9 cm/s/yr per hour/day/yr sedentary time, and - 1.6 cm/s/yr per hr/day/yr prolonged sedentary bout time). Only improvements in total PA, MVPA and sedentary bout time were associated with improvements in chair stand speed. In conclusion, we found bidirectional associations between changes in some physical behaviours and physical function and between baseline physical behaviours and subsequent physical function, highlighting the importance of considering the full range of physical behaviours to promote healthy ageing.

Reliability of the accelerometer to control the effects of physical activity in older adults

Background

Reliable physical activity measurements in community-dwelling older adults are important to determine effects of targeted health promotion interventions. Many exercise interventions aim to improve time spent sedentary (SED), in light-intensity-physical-activity (LPA) and moderate-to-vigorous-intensity-physical-activity (MVPA), since these parameters have independently proposed associations with health and longevity. However, many previous studies rely on self-reports which have lower validity compared to accelerometer measured physical activity patterns. In addition, separating intervention-effects from reactivity measurements requires sufficient test-retest reliability for accelerometer assessments, which is lacking in older adults.

Objectives

The study objective was to investigate the reliability of sensor-based PA-patterns in community-dwelling older adults. Furthermore, to investigate change over time of physical activity patterns and examine any compensatory-effect from the eight-week supervised exercise-intervention.

Methods

An exercise-group (n = 78, age-range:65-91yrs) performed two 1h-exercise sessions/week during eight-weeks. PA-pattern was assessed (using hip-worn accelerometers), twice before and once during the last-week of the intervention. A control-group (n = 43, age-range:65-88yrs) performed one pre-test and the end-test with no exercise-intervention. A dependent-t-test, mean-difference (95%-CI), limits-of-agreement and intraclass-correlation-coefficient-ICC were used between the two pre-tests. Repeated-measures-ANOVA were used to analyze any intervention-effects.

Results

The exercise-groups´ two pre-tests showed generally no systematic change in any PA- or SED-parameter (ICC ranged 0.75–0.90). Compared to the control group, the exercise intervention significantly (time x group-interaction, p<0.05) increased total-PA-cpm (exercise-group/control-group +17%/+7%) and MVPA-min/week (+41/-2min) and decreased %-of-wear-time for SED-total (-4.7%/-2.7%) and SED-bouts (-5.7%/-1.8%), and SED-bouts min/d (-46/-16min). At baseline level, no significant differences were found between the two groups for any parameter.

Conclusions

The current study presents a good test-retest-reliability of sensor-based-one-week-assessed-PA-pattern in older-adults. Participating in an 8-week supervised exercise intervention improved some physical activity and sedentary parameters compared to the control group. No compensatory-effect was noted in the intervention-group i.e., no decrease in any PA-parameter or increase in SED at End-test (in %-of-wear-time, min/day or total-PA).

Physical Activity Intensity of Singles and Doubles Pickleball in Older Adults

The purpose of this study was to measure heart rate, activity intensity, and steps in recreational singles and doubles pickleball players. We collected data in 22 singles and 31 doubles players (62.1 ± 9.7 years of age) using Garmin Fenix 5 watches (Garmin International, Inc.) and ActiGraph GT3X+ (ActiGraph LLC) accelerometers. Mean heart rates during singles and doubles were 111.6 ± 13.5 and 111.5 ± 16.2 beats/min (70.3% and 71.2% of predicted maximum heart rate), respectively. Over 70% of singles and doubles playing time was categorized in moderate to vigorous heart rate zones whereas 80.5% of singles time and 50.4% of doubles time were moderate based on Freedson accelerometer cut-points. Steps per hour were higher in singles versus doubles (3,322 ± 493 vs. 2,791 ± 359), t(51) = 4.540, p < .001. Singles and doubles pickleball are moderate- to vigorous-intensity activities that can contribute substantially toward older adults meeting physical activity guidelines.

The effect of the inclusion of trunk-strengthening exercises to a multimodal exercise program on physical activity levels and psychological functioning in older adults: secondary data analysis of a randomized controlled trial

Background

Engaging in multimodal exercise program helps mitigate age-related decrements by improving muscle size, muscle strength, balance, and physical function. The addition of trunk-strengthening within the exercise program has been shown to significantly improve physical functioning outcomes. Whether these improvements result in improved psychological outcomes associated with increased physical activity levels requires further investigation. We sought to explore whether the inclusion of trunk-strengthening exercises to a multimodal exercise program improves objectively measured physical activity levels and self-reported psychological functioning in older adults.

Method

We conducted a secondary analysis within a single-blinded parallel-group randomized controlled trial. Sixty-four healthy older (≥ 60 years) adults were randomly allocated to a 12-week walking and balance exercise program with (n = 32) or without (n = 32) inclusion of trunk strengthening exercises. Each program involved 12 weeks of exercise training, followed by a 6-week walking-only program (identified as detraining). Primary outcome measures for this secondary analysis were physical activity (accelerometry), perceived fear-of-falling, and symptoms of anxiety and depression.

Results

Following the 12-week exercise program, no significant between-group differences were observed for physical activity, sedentary behaviour, fear-of-falling, or symptoms of anxiety or depression. Significant within-group improvements (adjusted mean difference [95%CI]; percentage) were observed in moderate-intensity physical activity (6.29 [1.58, 11.00] min/day; + 26.3%) and total number of steps per min/day (0.81 [0.29 to 1.33] numbers or + 16.3%) in trunk-strengthening exercise group by week 12. With respect to within-group changes, participants in the walking-balance exercise group increased their moderate-to-vigorous physical activity (MVPA) (4.81 [0.06 to 9.56] min/day; + 23.5%) and reported reduction in symptoms of depression (-0.26 [-0.49 to -0.04] points or -49%) after 12 weeks of the exercise program. The exercise-induced increases in physical activity levels in the trunk-strengthening exercise group were abolished 6-weeks post-program completion. While improvements in physical activity levels were sustained in the walking-balance exercise group after detraining phase (walking only).

Conclusions

The inclusion of trunk strengthening to a walking-balance exercise program did not lead to statistically significant between-group improvements in physical activity levels or psychological outcomes in this cohort following completion of the 12-week exercise program.

Trial registration

Australian and New Zealand Clinical Trials Registry (ACTRN12613001176752), registered on 28/10/2013.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03435-3.

The Physical Activity Assessment of Adults With Type 2 Diabetes Using Accelerometer-Based Cut Points: Scoping Review

BACKGROUND

Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking.

OBJECTIVE

This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist.

METHODS

We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized.

RESULTS

A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants' mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study.

CONCLUSIONS

An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning.

Facilitators and barriers to real-life mobility in community-dwelling older adults: a narrative review of accelerometry- and global positioning system-based studies

Real-life mobility, also called "enacted" mobility, characterizes an individual's activity and participation in the community. Real-life mobility may be facilitated or hindered by a variety of factors, such as physical abilities, cognitive function, psychosocial aspects, and external environment characteristics. Advances in technology have allowed for objective quantification of real-life mobility using wearable sensors, specifically, accelerometry and global positioning systems (GPSs). In this review article, first, we summarize the common mobility measures extracted from accelerometry and GPS. Second, we summarize studies assessing the associations of facilitators and barriers influencing mobility of community-dwelling older adults with mobility measures from sensor technology. We found the most used accelerometry measures focus on the duration and intensity of activity in daily life. Gait quality measures, e.g., cadence, variability, and symmetry, are not usually included. GPS has been used to investigate mobility behavior, such as spatial and temporal measures of path traveled, location nodes traversed, and mode of transportation. Factors of note that facilitate/hinder community mobility were cognition and psychosocial influences. Fewer studies have included the influence of external environments, such as sidewalk quality, and socio-economic status in defining enacted mobility. Increasing our understanding of the facilitators and barriers to enacted mobility can inform wearable technology-enabled interventions targeted at delaying mobility-related disability and improving participation of older adults in the community.

Light intensity physical activity is beneficially associated with brain volume in older adults with high cardiovascular risk

Background

Older people with high cardiovascular risk, including those without cardiovascular diseases, are an at-risk population for dementia. Regular physical activity is generally recommended to maintain brain health; however, the optimal intensity of physical activity for maintaining brain volume in older adults with cardiovascular risk remains unclear. We examined the associations between intensity-specific physical activity and brain volume stratified by absolute cardiovascular risk level in older adults without cardiovascular diseases.

Methods and results

This cross-sectional study involved 725 community-dwelling older Japanese adults without cardiovascular diseases. We estimated absolute cardiovascular risk using the World Health Organization risk estimation charts, which include variables such as age, sex, diabetes mellitus, smoking, systolic blood pressure, and total cholesterol, and stratified cardiovascular risk level into three risk categories: low (≤ 9%), moderate (10–14%), and high (≥15%). We measured daily physical activity using a triaxial accelerometer, and calculated the average time spent in moderate-to-vigorous intensity physical activity (MVPA) and light intensity physical activity (LPA). We performed brain T1-weighted magnetic resonance imaging and calculated the volume of the cortical gray matter, subcortical gray matter, and cerebral white matter, using the FreeSurfer software. In the overall sample, multivariable linear regression analysis showed that greater MVPA was significantly associated with greater volume of the cortical gray matter and cerebral white matter, and greater LPA was significantly associated with greater volume of the cerebral white matter. Additionally, in the analysis of the sample stratified by absolute cardiovascular risk level, cerebral white matter volume was significantly associated with both MVPA and LPA in the high cardiovascular risk group.

Conclusions

The association between physical activity and brain volume differed according to cardiovascular risk level in community-dwelling older adults. In a population at high cardiovascular risk, maintaining or increasing LPA might be a practical and achievable strategy for healthy brain aging.