Sex differences in relationships between habitual physical activity and health in the elderly: Practical implications for epidemiologists based on pedometer/accelerometer data from the Nakanojo Study

The impact of goal-directed prehabilitation therapy on functional capacity in patients undergoing hepatobiliary and pancreatic surgery: A randomized clinical trial

BACKGROUND

Emerging evidence has supported the idea that goal-directed prehabilitation is a promising approach to boost functional capacity in preoperative patients. However, its usefulness has not been tested in the hepatobiliary and pancreatic fields. The objective of this trial was to investigate the efficacy of goal-directed prehabilitation for improving functional capacity in patients who were planned to undergo major hepatobiliary and pancreatic operations.

METHODS

This assessor-blinded, parallel-arm, randomized clinical trial recruited patients who were scheduled for major hepatobiliary and pancreatic surgeries for malignancy. Patients were randomly allocated into the step goal-directed prehabilitation group as the test group and into the conventional prehabilitation group as the control group. Patients in the goal-directed prehabilitation group participated in a walking prehabilitation program with an intergrading goal of the step count. Patients in the conventional prehabilitation group received standard physical and nutritional prehabilitation. The primary outcome was change in the 6-minute walking distance, which ranged from the time before starting prehabilitation (baseline) to the time after completing prehabilitation (immediately before surgery).

RESULTS

Among 180 randomized patients, 144 patients were included in the primary analysis (73 patients in the conventional prehabilitation group and 71 patients in the goal-directed prehabilitation group). The mean change in the 6-minute walking distance was 27 meters in the conventional prehabilitation group and 31 meters in the goal-directed prehabilitation group (P = .633).

CONCLUSION

In patients undergoing major hepatobiliary and pancreatic surgeries for malignancies, a goal-directed prehabilitation program did not result in a significantly greater increase in functional capacity than did conventional prehabilitation.

REGISTRATION NUMBER

UMIN000038791 (https://www.umin.ac.jp/).

Nutrition, Exercise, and Cognitive Rehabilitation for Dementia Prevention

Dementia is one of the most significant global challenges in medical and social care in the 21st century. It affects not only the patients themselves, but also their families, caregivers, and society in general, causing physical, psychological, and socioeconomic effects. As of 2020, there are approximately 6 million people in Japan aged 65 or older with dementia, and this number is expected to increase to around 7 million by 2025, meaning that one out of every five elderly people will have dementia. To prevent the onset and progression of dementia, it is crucial to have a proper understanding of its risks and adopt a healthy lifestyle. Leading an active life from an early stage can also aid in delaying or preventing the onset of dementia. Livingston has identified 12 risks that can lead to dementia, including physical inactivity, smoking, excessive alcohol consumption, air pollution, head injury, social isolation, poor educational history, obesity, hypertension, diabetes, depression, and hearing loss. Modifying one's lifestyle and leading an active life can be crucial in reducing these risks. The Mediterranean diet is gaining attention as a good practice for dementia prevention due to its diversity, richness in omega-3 fatty acids and vitamins. Exercise has been shown to prevent dementia on biological, behavioral, and socio-psychological levels. Repetitive transcranial magnetic stimulation is a non-invasive brain stimulation method that can alter brain plasticity and is being studied for clinical applications as a non-drug therapy for preventing dementia progression.

Depression is associated with discoordination between heart rate variability and physical acceleration in older women

Background and Aims

It is well known that depression is closely associated with the autonomic nervous system and physical acceleration (PA), which may cause functional time-deviance between these two parameters. Exploring this relationship is important in sustaining the mental and physical health of older adults in daily life. However, few studies have assessed the relationship between depression and the coordination of parasympathetic nervous activity (PSNA) and PA. The present study was designed to investigate whether the coordination between PSNA and PA is associated with the mental state of healthy volunteers in normal daily lives and the underlying mechanism.

Methods

In total, 95 adult women were divided into non-older and older groups comprising 50 (aged 20-59 years) and 45 (aged 60-85 years) women, respectively. PSNA and PA data were simultaneously obtained every minute for 24 h during the free-moving day using the ActiveTracer accelerometer. Lag time was determined as the time difference between PSNA and PA, and it was introduced as a parameter of %lag0, which is the percent ratio of the lag = 0 min between PSNA and PA in 1 h. The General Health Questionnaire 28 (GHQ28) was used to evaluate the effects of psychological distress, including depression.

Results

In the hour before sleep, %lag0 was significantly lower in older women (38.7 ± 6.4) who had higher GHQ28 values (subscale D = 0, n = 12) compared with that in older women (19.4 ± 10.5) with lower values (subscale D ≧ 1, n = 33) (p < 0.05).

Conclusion

Impairments in coordination between PSNA and PA are significantly associated with depression in older women, particularly in the hour before sleep on free-moving days.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

The relationship of daily physical activity and sleep in adults: variations by age, sex, and race

Prior work suggests physical activity (PA) is related to quantity and quality of sleep. Questions remain regarding directionality, and whether relationships vary by age, sex, and race. We examined daily bidirectional associations between PA and sleep over one week. Participants were 427 adults from the MIDUS Biomarker study, with a mean age of 54.21 ± 11.67 (61% female, 30% non-white). PA (total activity) and sleep (total sleep time; TST and waking after sleep onset; WASO) were measured with an ActiWatch 64. Multilevel mixed-effects models showed differences in the relationships between PA and sleep by age, race, and sex. Following a day with increased PA, younger and nonwhite participants had significantly shorter TST. Days with higher PA were also associated with less WASO for younger participants. Bidirectional effects also emerged; following a night with shorter TST, men, not women, engaged in less next-day PA. Like other studies of daily PA and sleep, effect sizes were small. Future studies should assess potential mechanisms that could explain these demographic differences.

Dose-response relationship between daily step count and prevalence of sarcopenia: A cross-sectional study

OBJECTIVES

Daily step counts are an easy-to-understand indicator of physical activity; however, there is limited evidence regarding the optimal daily step count to prevent sarcopenia. This study examined the dose-response relationship between daily step count and the prevalence of sarcopenia and explored the optimal dose.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The study included 7949 community-dwelling middle-aged and older adults (aged 45-74 years) from Japan.

MEASUREMENTS

Skeletal muscle mass (SMM) was assessed using bioelectrical impedance spectroscopy, and muscle strength was quantified through handgrip strength (HGS) measurement. Participants who exhibited both low HGS (men: <28 kg, women: <18 kg) and low SMM (lowest quartile in each sex-specific category) were defined as having sarcopenia. Daily step counts were measured for 10 days using a waist-mounted accelerometer. To examine the association between daily step count and sarcopenia, a multivariate logistic regression analysis was performed, adjusting for potential confounding factors such as age, sex, body mass index, smoking status, alcohol consumption, protein intake, and medical history. The odds ratios (ORs) and confidence intervals (CIs) were calculated based on the daily step counts categorized into quartiles (Q1-Q4). Finally, a restricted cubic spline curve was fitted to further investigate the dose-response relationship between daily step count and sarcopenia.

RESULTS

The prevalence of sarcopenia in the overall participants was 3.3 % (259/7949 participants), with a mean daily step count of 7292 ± 2966 steps. Expressed in quartiles, the mean daily step counts were 3873 ± 935 steps in Q1, 6025 ± 503 steps in Q2, 7942 ± 624 steps in Q3, and 11,328 ± 1912 steps in Q4. The prevalence of sarcopenia in each quartile of daily step count was 4.7 % (93/1987 participants) in Q1, 3.4 % (68/1987 participants) in Q2, 2.7 % (53/1988 participants) in Q3, and 2.3 % (45/1987 participants) in Q4. The ORs and 95 % CIs adjusted for covariates demonstrated a statistically significant inverse association between daily step count and sarcopenia prevalence (P for trend <0.01), as follows: Q1, reference; Q2, 0.79 (95 % CI: 0.55-1.11); Q3, 0.71 (95 % CI: 0.49-1.03); Q4, 0.61 (95 % CI: 0.41-0.90). The restricted cubic spline curve indicated that the ORs leveled off at approximately 8000 steps per day, and no statistically significant decrease in ORs was observed for daily step counts above this threshold.

CONCLUSIONS

The study found a significant inverse association between daily step count and the prevalence of sarcopenia, with the association plateauing when the daily step count exceeded approximately 8000 steps. These findings suggest that 8000 steps per day may be the optimal dose to prevent sarcopenia. Further intervention and longitudinal studies are needed to validate the results.

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.

Relationship between asthma and sarcopenia in the elderly: a nationwide study from the KNHANES

OBJECTIVE

Few studies have investigated the relationship between asthma and sarcopenia. We aimed to examine the relationship between asthma and sarcopenia in a community-dwelling geriatric population, especially regarding lung function and asthma control.

METHODS

A cross-sectional dataset from the Korean National Health and Nutrition Examination Survey 2008-2011 was utilized. Data regarding asthma history, age at asthma onset, recent asthma exacerbations, and hospitalization for asthma exacerbations were obtained using structured questionnaires. Appendicular skeletal muscle was calculated as the sum of the skeletal muscle mass, and physical activity was assessed using the International Physical Activity Questionnaire.

RESULTS

Asthma presented an estimated incidence of 6.17 ± 0.37% in the elderly. Groups were divided and analyzed according to asthma, muscle mass, and physical activity. Sarcopenia was associated with aging, male sex, smoking history, low body mass index (BMI), and reduced lung function with or without asthma. Sarcopenic asthma had a younger onset and reduced physical activity than non-sarcopenic asthma. Obstructive patterns were more frequent in asthmatics exhibiting low or moderate physical activity levels than in those with high activity, but asthma control was not associated with sarcopenia and physical activity. Multivariate logistic regression analyses showed that compared with control, sarcopenic asthma was associated with FEV1 < 60%, and airway obstruction, and with aging, male, and lower BMI, compared with non-sarcopenic asthma.

CONCLUSIONS

Our findings suggest that decreased muscle mass and physical activity levels contribute to reduced lung function in elderly asthmatics. Furthermore, sarcopenic asthma was associated with aging, low BMI, and reduced lung function in the elderly.

Relationships between dietary diversity and gut microbial diversity in the elderly

Diet is considered as a major driver of gut microbiota composition. However, little is known about the relationship between overall dietary balance and gut microbiota, especially in the elderly. Here, using the Quantitative Index for Dietary Diversity (QUANTIDD), we analysed the relationships between dietary diversity and gut microbiota diversity in 445 Japanese subjects aged 65-90 years. We also examined the effect of age by comparing the young-old group aged 65 to 74 years (<75 years group; n=246) and the old-old group aged 75 years and older (≥75 years group; n=199). QUANTIDD showed significant positive relationships with Pielou's evenness and Shannon indices, two α-diversity indices related to the uniformity of species distribution. This suggests that a more diverse diet is associated with a more uniform abundance of various bacterial groups, rather than a greater variety of gut bacteria. QUANTIDD also showed significant positive associations with the abundance of Anaerostipes, Eubacterium eligens group, and Eubacterium ventriosum group, which produce short-chain fatty acids (SCFAs) and are beneficial to health. Negative association was found with the abundance of Ruminococcus gnavus group, which produces inflammatory polysaccharides. Positive associations between QUANTIDD and α-diversity indices or the abundance of specific bacterial groups were identified among all subjects and in the <75 years group, but not in the ≥75 years group. Our results suggest that dietary diversity contributes to the diversity of the gut microbiota and increases the abundance of SCFAs-producing bacteria, but only up to a certain age. These findings help to understand the complex relationship between diet and gut microbiota, and provide hints for specific dietary interventions to promote beneficial gut microbiota in the elderly.

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).

Fast walking and physical activity are independent contributors to improved physical function

BACKGROUND AND OBJECTIVES

To clarify whether the presence or absence of fast walking and habitual physical activity are independently associated with the incidence of functional disability.

METHODS

This historical cohort study was comprised of 9,652 (4,412 men, mean age 65 years) individuals aged 39-98 years without functional disability at baseline. Functional disability was determined based on the Japanese long-term care insurance system, which specified requirements for assistance in the activities of daily living. The impact of fast walking and habitual physical activity on the incidence of functional disability was analysed by Cox proportional hazards models.

RESULTS

The follow-up period was a median of 3.7 years during which 165 patients were newly certified as having functional disability. In the multivariate analysis, baseline age in 5-year increments (hazard ratio 2.42 [95% confidence interval 2.18-2.69]), no habitual physical activity (1.56 [1.07-2.27]), and not fast walking (1.89 [1.32-2.69]) significantly increased the risk of functional disability after adjustment for covariates. The stratified analysis showed that compared with physical activity (+), the impact of physical activity (-) on the incidence of functional disability was observed in those aged ≥75 years regardless of fast walking (+). Fast walking (-) significantly increased the risk of disability compared with fast walking (+) in those aged <75 years regardless of a physical activity habit.

CONCLUSION

In Japanese, slow walking speed and lack of a physical activity habit were shown to be independent risk factors for incident functional disability, with their impact differing according to age.

Association between Daily Physical Activity and Locomotive Syndrome in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study

This study aimed to evaluate the association between locomotive syndrome (LS) and daily physical activity (PA) in community-dwelling older adults. This cross-sectional study included 80 healthy Japanese older adults (40 men and 40 women; age: 60-79 years). Habitual daily PA was evaluated using a triaxial wrist accelerometer. Participants were divided into two groups based on the results of the two-step test, stand-up test, and 25-question geriatric locomotive function scale. Binomial logistic regression analysis was conducted to examine the statistical relationships between daily PA and category of LS, adjusting for age from adjusted odds ratio (adjusted OR) with the 95 percent confidence intervals (95%CI) and bootstrap 95%CI. The mean step count and time spent on moderate to vigorous physical activity (MVPA) were significantly higher among non-LS participants than among LS participants in women, but not in men. Logistic regression analyses indicated that spending longer than 28 min/day on MVPA was significantly associated with a lower likelihood of LS relative to short time category under 28 min/day in women (adjusted OR = 0.12, 95%CI = 0.02-0.59, bootstrap 95%CI = 0.01-0.43), but not in men. This study suggests that in community-dwelling older women, those with higher MVPA had lower odds of LS, and daily MVPA was associated with LS, but not in men. Therefore, the associations between LS and daily physical activity were partly dependent on sex differences.

The association between objectively measured physical activity and health-related quality of life, life-space mobility and successful ageing in older Indian adults

Background

Longevity is increasing, accompanied by a rise in disability and chronic diseases with physical activity (PA) delaying disability, ensuring successful ageing (SA) and independent living in older adults.

Aim

This study aimed to determine objectively measure PA levels, health-related quality of life (HRQoL), life-space mobility and SA of older adults as well as their mutual associations.

Setting

KwaZulu-Natal province, South Africa.

Methods

A total of 210 older adults aged 65–92 years were purposively sampled and completed the Medical Outcomes Study 36-Item Short-Form Health Survey, the Life-Space Mobility, and Successful Ageing questionnaires. Physical activity levels were measured using an Omron Pedometer, which the participants wore for seven consecutive days.

Results

The average number of steps taken per day for the 7 days was 2025, with 98.6% of the entire study population classified as sedentary. The Vitality domain (one of 8 categorised) reflected the best health status (M = 59.9, s.d. ± 18.8) with a significant 93% of the participants indicating that they had not visited places outside their immediate neighbourhood (p < 0.0005). A significant, negative association between the average number of steps taken in 7 days and all three SA variables, namely, the physical (r = –0.152, p = 0.027), sociological (r = –0.148, p = 0.032) and psychological (r = –0.176, p = 0.010), and a significant, positive association with life-space mobility (r = 0.224, p = 0.001) was noted.

Conclusion

The majority of the older adults were sedentary, affecting their HRQoL, life-space mobility, and SA negatively.

Contribution

It is imperative to develop effective physical activity programmes to ensure successful ageing by improving older adults’ quality of life and physical activity levels.

Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study

Background

Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design.

Objective

The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women.

Methods

We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions.

Results

We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences.

Conclusions

MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication.

Coordination between heart rate variability and physical activity may be diminished by fatigability in non-older women in the hour before sleep

Fatigability is related to several diseases as well as the autonomic nervous system. We investigated whether fatigability is associated with coordination between physical acceleration (PA) and parasympathetic nervous activity (PSNA) in women. Overall, 95 women were divided into non-old (n = 50; age: 22-59 years) and old (n = 45; age: ≥60 years) groups. PSNA and PA data were simultaneously obtained every minute for 24 h. We defined %lag0 as the percent ratio of lag = 0 min between PSNA and PA in 1 h. Cornell Medical Index was used to determine the degrees of physical and psychological symptoms. In the non-older group in the hour before sleep, the participants with high fatigability scores had significantly lower %lag0 than those with low fatigability (p < 0.05). Additionally, those with higher fatigability combined with exhaustion in the morning had significantly lower %lag0 than those without exhaustion in the hour before sleep (p < 0.05) but not in the hour after waking up. These results suggest that fatigability in non-older women was associated with loss of coordination between PSNA and PA in the hour before sleep. Additionally, exhaustion in the morning may be related to loss coordination of PSNA and PA during the previous night.

Protein Requirements for Master Athletes: Just Older Versions of Their Younger Selves

It is established that protein requirements are elevated in athletes to support their training and post-exercise recovery and adaptation, especially within skeletal muscle. However, research on the requirements for this macronutrient has been performed almost exclusively in younger athletes, which may complicate their translation to the growing population of Master athletes (i.e. > 35 years old). In contrast to older (> 65 years) untrained adults who typically demonstrate anabolic resistance to dietary protein as a primary mediator of the ‘normal’ age-related loss of muscle mass and strength, Master athletes are generally considered successful models of aging as evidenced by possessing similar body composition, muscle mass, and aerobic fitness as untrained adults more than half their age. The primary physiology changes considered to underpin the anabolic resistance of aging are precipitated or exacerbated by physical inactivity, which has led to higher protein recommendations to stimulate muscle protein synthesis in older untrained compared to younger untrained adults. This review puts forth the argument that Master athletes have similar muscle characteristics, physiological responses to exercise, and protein metabolism as young athletes and, therefore, are unlikely to have protein requirements that are different from their young contemporaries. Recommendations for protein amount, type, and pattern will be discussed for Master athletes to enhance their recovery from and adaptation to resistance and endurance training.

Impact of relative muscle power on hospitalization and all-cause mortality in older adults

BACKGROUND

The purpose of this study was to evaluate the relationship of lower-limb muscle power with mortality and hospitalization.

METHODS

A total of 1928 subjects from the Toledo Study for Healthy Aging were included. Muscle power was assessed with the 5-repetition STS test and subjects were classified into different groups of relative power (i.e. normalized to body mass) according to sex-specific tertiles and their inability to perform the test. Mean follow-up periods for hospitalization and all-cause mortality were 3.3 and 6.3 years, respectively.

RESULTS

Compared to the high relative muscle power group, men with low (HR [95%CI]= 2.1 [1.2-3.6]) and women with very low and low (HR [95%CI]= 4.7 [3.0-7.4] and 1.8 [1.2-2.7]) relative power had an increased age-adjusted risk of hospitalization. After adjusting for several covariates (age, physical activity, BMI education, depression, comorbidities, disability and handgrip strength) these effects were attenuated (men and women with very low relative power: HR [95%CI]= 1.6 [0.9-2.9] and 2.8 [1.6-4.9]). The very low relative muscle power group had also an increased all-cause mortality risk (age-adjusted) in both men and women (HR [95%CI]= 2.3 [1.4-3.9] and 2.9 [1.6-5.3]). After adjusting for all the covariates, a significantly increased mortality risk was observed only in men (HR [95% CI]= 2.1 [1.1-3.8], (women HR [95% CI]= 1.6 [0.8-3.2]), with very low levels of relative power.

CONCLUSION

Relative muscle power was independently and negatively associated with mortality and hospitalization in older adults. An augmented all-cause mortality risk was noted in the lowest group of relative muscle power.

Yearly changes in the composition of gut microbiota in the elderly, and the effect of lactobacilli intake on these changes

The onset and worsening of some diseases are related to the variation and instability of gut microbiota. However, studies examining the personal variation of gut microbiota in detail are limited. Here, we evaluated the yearly variation of individual gut microbiota in 218 Japanese subjects aged 66–91 years, using Jensen-Shannon distance (JSD) metrics. Approximately 9% of the subjects showed a substantial change, as their formerly predominant bacterial families were replaced over the year. These subjects consumed fermented milk products less frequently than their peers. The relationship between the intake frequencies of fermented milk products containing Lacticaseibacillus paracasei strain Shirota (LcS) and JSD values was also investigated. The intra-individual JSD of subjects ingesting LcS products ≥ 3 days/week over the past 10 years was statistically lower than the < 3 days/week group (P = 0.045). Focusing on subjects with substantial gut microbiota changes, only 1.7% of the subjects were included in the LcS intake ≥ 3 days/week group whereas 11.3% were found in the < 3 days/week group (P = 0.029). These results suggest that about one-tenth of the elderly Japanese could experience a substantial change in their gut microbiota during a 1-year period, and that the habitual intake of probiotics may stabilize their gut microbiota.

Associations between Plasma Branched Chain Amino Acids and Health Biomarkers in Response to Resistance Exercise Training Across Age

Leucine, isoleucine and valine (i.e., the branched chain amino acids, BCAA) play a key role in the support and regulation of tissue protein regulation and also as energy substrates. However, positive relationships exist between elevated levels of BCAA and insulin resistance (IR). Thus, we sought to investigate the links between fasting plasma BCAA following a progressive resistance exercise training (RET) programme, an intervention known to improve metabolic health. Fasting plasma BCAA were quantified in adults (young: 18-28 y, n = 8; middle-aged: 45-55 y, n = 9; older: 65-75 y, n = 15; BMI: 23-28 kg/m², both males and females (~50:50), in a cross-sectional, intervention study. Participants underwent 20-weeks whole-body RET. Measurements of body composition, muscle strength (1-RM) and metabolic health biomarkers (e.g., HOMA-IR) were made pre- and post-RET. BCAA concentrations were determined by gas-chromatography mass spectrometry (GC-MS). No associations were observed across age with BCAA; however, RET elicited (p < 0.05) increases in plasma BCAA (all age-groups), while HOMA-IR scores reduced (p < 0.05) following RET. After RET, positive correlations in lean body mass (p = 0.007) and strength gains (p = 0.001) with fasting BCAA levels were observed. Elevated BCAA are not a robust marker of ageing nor IR in those with a healthy BMI; rather, despite decreasing IR, RET was associated with increased BCAA.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Instrumental activities of daily living and number of daily steps in frail older females

[Purpose] Reportedly, males take fewer steps than females among frail older adults. The step count of frail older adults may be influenced by domestic roles in the instrumental activities of daily living. In this study, we aimed to investigate the association between instrumental activities of daily living and the number of steps in frail older females. [Participants and Methods] In this cross-sectional study, we included 27 frail older females aged 84.4 ± 6.5 years who attended a day-care center. We used the Fillenbaum’s instrumental activities of daily living screener and measured the number of steps using an accelerometer, functional independence measure, grip strength, and short physical performance battery. We investigated the association between instrumental activities of daily living and daily steps. Furthermore, we compared the outcomes of the differences in the independence using a subscale of instrumental activities of daily living. [Results] Instrumental activities of daily living and step counts showed a significant correlation. Participants dependent on meal preparation and housework took significantly fewer steps per day. The dependence of their activities also caused low functional independence measure and weak grip strength. [Conclusion] In frail older females, decreased ability for instrumental activities of daily living were associated with fewer steps. Domestic roles may increase the daily steps in frail older adults.

Association Between Objectively Measured Physical Activity and the Number of Chronic Musculoskeletal Pain Sites in Community-Dwelling Older Adults

OBJECTIVE

Physical inactivity is recognized as a pandemic health problem. The association of pain with physical activity, particularly when measured objectively, in older adults is unclear. This study investigates the association of number of chronic musculoskeletal pain sites and pain severity with objectively measured physical activity in community-dwelling older adults.

DESIGN

Observational study.

SETTING

Community.

SUBJECTS

We analyzed 267 community-dwelling older adults (mean age = 75.3 years, 67.0% women).

METHODS

Number of chronic musculoskeletal pain sites and pain severity were measured using a self-reported questionnaire. Mean steps per day and mean minutes of light physical activity per day and moderate to vigorous physical activity per day were measured using an accelerometer. Linear regression models were applied to analyze the association of number of chronic musculoskeletal pain sites and pain severity with physical activity.

RESULTS

The results suggest that a higher number of chronic musculoskeletal pain sites is associated with lower step count (beta = -333.5, 95% confidence interval = -655.9 to -11.0, P < 0.05) and moderate to vigorous physical activity (beta = -2.5, 95% confidence interval = -4.7 to -0.4, P < 0.05) even after adjustment for age, gender, years of schooling, obesity, alcohol habits, smoking status, number of comorbidities, recent surgery, and depressive symptoms.

CONCLUSIONS

Our results suggest that the number of chronic musculoskeletal pain sites is associated with low physical activity in older adults. Therefore, low physical activity due to chronic musculoskeletal pain should not be overlooked.

Independent and Interactive Effects of Habitually Ingesting Fermented Milk Products Containing Lactobacillus casei Strain Shirota and of Engaging in Moderate Habitual Daily Physical Activity on the Intestinal Health of Older People

Infrequent bowel movements decrease the number of beneficial bacteria in the human intestines, thereby potentially increasing the individual's risk of colorectal cancer. The correction of such bowel problems could therefore make an important contribution to improving population health and quality-adjusted lifespan. We examined independent and interactive effects upon the fecal microbiota of two potentially favorable determinants of intestinal motility: the intake frequency of a fermented milk product containing Lactobacillus casei strain Shirota (LcS) and the quantity/quality of habitual physical activity in 338 community-living Japanese aged 65-92 years. Subjects were arbitrarily grouped on the basis of questionnaire estimates of LcS intake (0-2, 3-5, and 6-7 days/week) and pedometer/accelerometer-determined patterns of physical activity [<7000 and ≥7000 steps/day, or <15 and ≥15 min/day of activity at an intensity >3 metabolic equivalents (METs)]. After adjustment for potential confounders, the respective numbers of various beneficial fecal bacteria tended to be larger in more frequent consumers of LcS-containing products, this trend being statistically significant (mostly P < 0.001) for total Lactobacillus, the Lactobacillus casei subgroup, and the Atopobium cluster; in contrast, there were no statistically significant differences in fecal bacterial counts between the physical activity groups. A multivariate-adjusted logistic regression analysis estimated that the risk of infrequent bowel movements (arbitrarily defined as defecating ≤3 days/week) was significantly lower (P < 0.05) in subjects who ingested LcS-containing products 6-7 rather than 0-2 days/week [odds ratio (95% confidence interval) 0.382 (0.149-0.974)] and was also lower in those who took ≥7000 rather than <7000 steps/day [0.441 (0.201-0.971)] or spent ≥15 rather than <15 min/day of physical activity at an intensity >3 METs [0.412 (0.183-0.929)]. The risk of infrequent bowel movements in subjects who combined 6-7 days/week of LcS with ≥7000 steps/day or ≥15 min/day of activity at >3 METs was only a tenth of that for individuals who combined 0-2 days/week of LcS with <7000 steps/day or <15 min/day at >3 METs. These results suggest that elderly individuals can usefully ingest LcS-containing supplements regularly (≥6 days/week) and also engage in moderate habitual physical activity (≥7000 steps/day and/or ≥15 min/day at >3 METs) in order to enhance their gastrointestinal health.

Individual variations in steps per day for meeting physical activity guidelines in young adult women

Cross-sectional studies have found a correlation between the duration or volume of moderate-to-vigorous physical activity (MVPA) and steps per day (STEP), but there is little information on why this relationship varies among individuals. No previous research has established whether STEP can be used to estimate the duration of physical activity (PA) at or above lactate threshold (≥LT), such as for maintaining cardiorespiratory fitness. This study explored the association among STEP, MVPA indices, and ≥LT under free-living conditions. Seventy young adult women measured their PA for 7 days using a validated accelerometer. The mean LT measured by an exercise test was 5.8 ± 1.0 METs. STEP, MVPA, METs×h, and ≥LT were 9324 ± 2677 steps/day, 231.9 ± 101.5 min/week, 16.6 ± 7.4 METs×h/week and 24.0 ± 22.2 min/week, respectively. Significant correlations were found between STEP and MVPA duration and between STEP and METs×h/week (r = 0.81 and r = 0.81); however, approximately 1600 steps/day of the standard error of estimates in the regression equations were found. Multiple stepwise regression analysis revealed that the percentage of total time spent at light-intensity PA (LPA) and MVPA were significant determinants of the percent deviation of STEP from the linear relationships between STEP and MVPA indices. No significant relationship was observed between ≥LT and STEP. The association between STEP and MVPA fluctuated depending on individual daily LPA and MVPA. Thus, consideration of both STEP and the PA at specific intensities are necessary to ensure the PA guidelines are met and the health benefits gained. STEP alone would be not a sufficient indicator for assessing the ≥LT.

The Hardest Part

Aging has a significant impact not only on every single individual but on society as a whole. Today, people throughout the world exhibit an extended lifespan. Therefore, it becomes increasingly important to develop novel concepts that encourage a modern understanding of the aging process. The concept of healthy aging shifts the perception of aging as a burden towards aging as an opportunity for an extended healthy phase in later life. Morbidity and mortality in the elderly population are greatly defined by a raise in the incidence and prevalence of cardiovascular diseases. Consequently, it is critical to identify risk factors and underlying mechanisms that render the aging (cardio)vascular system prone to disease. In this review, we focus on structural mechanisms of arterial stiffening as a major manifestation of vascular aging and its functional implications for the concept of healthy aging.

Web-based intervention to promote weight-loss maintenance using an activity monitor: A randomized controlled trial

The present study examined whether a web-based intervention could promote weight-loss maintenance, after weight loss. The study was a two-phase, 27-month, randomized controlled trial conducted in Ibaraki, Japan, from 2014 to 2017; 133 participants were recruited through local newspaper advertisements. The eligibility criteria were as follows: age of 40–64 years, body mass index of 25–40 kg/m², and having at least one metabolic syndrome component. In phase 1, a 3-month, group-based weight-loss program was provided to all eligible participants (n = 119). We then randomly assigned (1:1) participants who had lost 5% or more of their weight during phase 1 (n = 95) to either the self-help (mean 3-month weight loss 7.30 kg) or the web-support group (7.00 kg). Participants in the web-support group regularly reported their body weight and physical activity through a web-based system. They received monthly personalized feedback from a study staff for 24 months. The primary outcome, 27-month body-weight change (mean ± standard deviation), in the self-help and web-support groups were − 5.3 ± 5.0 kg and −4.5 ± 4.9 kg, respectively. There was no significant difference. An exploratory secondary analysis demonstrated that those with greater 27-month increases in their step count, assessed with an accelerometer, lost more weight with no difference in changes in energy intake. The mean 27-month body-weight change in the 4th quartile of changes in step count was −7.78 kg. Although web-based intervention using an activity monitor failed to promote weight-loss maintenance, increased physical activity was associated with successful weight-loss maintenance.

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Web-based intervention using an activity monitor delivered no benefit on weight.

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Participants with larger increases in step count lost more weight.

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Increased physical activity was associated with successful weight loss maintenance.

Changes in and Interactions between Physical and Mental Health in Older Japanese: The Nakanojo Study

BACKGROUND

An age-related decrease in functional capacity is consistently reported, but it is not consistently related to a worsening of health-related quality of life (HRQOL) or psychological adjustment. A poor functional capacity and HRQOL have been associated with anxiety or depression, but the possible causal nature and direction of the relationship remain to be explored using long-term longitudinal data.

OBJECTIVE

The purpose of this study was to examine age-related changes in functional capacity, HRQOL, and scores on the Hospital Anxiety and Depression Scale (HADS), and possible causal interrelationships between these variables.

METHODS

Study participants were 5,124 Japanese aged ≥65 years. After the baseline study (2003), annual follow-up observations continued for 10 years. Generalized linear mixed models examined age-related changes in Barthel index (BI), Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), HRQOL, and HADS. Cross-lagged effects models tested possible causal interrelationships.

RESULTS

With age, functional capacity and HRQOL scores showed similar declines in both sexes. Changes in mental health, anxiety, and depression developed more slowly than decreases in physical health (BI, TMIG-IC, and physical functioning scores). Cross-lagged effects models demonstrated that functional capacity had positive effects on psychological adjustment, and that psychological adjustment had positive effects on functional capacity 5 years later. Interactions between functional capacity and psychological adjustment showed no sex differences. A decline in functional capacity negatively affected psychological adjustment, but reduced psychological adjustment had no significant impact on functional capacity 5 and 10 years later. Moreover, functional capacity and poor psychological adjustment showed no interactions in either sex.

CONCLUSION

Functional capacity and mood state are interrelated. Greater function could sustain vitality and mental health, possibly reducing anxiety and depression.

Objectively measured habitual physical activity and sleep-related phenomena in 1645 people aged 1-91 years: The Nakanojo Community Study

Relationships between habitual physical activity and sleep-related phenomena were examined in 623 male and 1022 female Japanese participating in the Nakanojo Community Study, using data collected in 2012–2013. Ages ranged from infancy to very old. Daily step count and daily duration of exercise at an intensity >3 metabolic equivalents (METs) were determined by pedometer/accelerometer, 24 h/day for 1 week. Duplicate axillary temperatures were also taken on rising and when retiring. Total bed time was noted, and the efficiency of sleep determined as hours of actual sleep (from a validated pedometer/accelerometer algorithm) divided by bed time. Step counts and especially duration of activity >3 METs peaked in teenagers and decreased as age advanced (p < 0.001). Both axillary temperatures subsequently showed a gradual age-related decline (p < 0.001). The duration and efficiency of sleep also showed a small age-dependent decrease (p < 0.001). Multivariate-adjusted correlation coefficients indicated a better quality of sleep in individuals who took greater habitual physical activity. In individuals aged ≥40 years, these findings were modified by chronic disease conditions including hypertension, diabetes mellitus and hyperlipemia; after controlling statistically for potential confounders, both physical activity and axillary temperature were lower (p < 0.05 or 0.01), and the time spent lying was longer but the efficiency of sleep was poorer (p < 0.01) in those with chronic conditions. These results suggest that habitual physical activity bears an important relationship to sleep-related phenomena at all ages, with a modification of relationships by chronic disease in people aged ≥40 years.

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Habitual physical activity is related to body temperature and sleep patterns.

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Body temperature is higher and sleep quality is better in physically active people.

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In people aged ≥40 years, these relationships are modified by chronic disease.

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Physical activity and body temperature are lower in older people with chronic disease.

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The time spent lying is longer but the quality of sleep is poorer in such people.

Lifestyle and overall health in high school children: Results from the Toyama birth cohort study, Japan

BACKGROUND

The aim of this study was to investigate the relationship between lifestyle and overall health in high school children.

METHODS

Subjects were from the Toyama Birth Cohort Study, a prospective, longitudinal study of children born between 1989 and 1990, and who lived in Toyama Prefecture, Japan, at the time of the survey. This investigation used data from phase 5 of the Birth Cohort Study, which was conducted in 2005, when the children were in high school. Participants included 4,966 children (2,449 boys and 2,517 girls) aged 15-16 years old. A questionnaire was designed to measure lifestyle factors such as eating habits, physical activity, sedentary behavior, and sleeping pattern. A question from a validated Japanese version of the Dartmouth Primary Care Cooperative Information Project was used to evaluate overall health in children. Logistic regression analysis was used to determine if lifestyle factors are associated with overall health in high school children.

RESULTS

Boys who skipped breakfast and had short night-time sleep duration (≤6 h per night) were more likely to have poor health status. Girls who skipped breakfast, and had night-time eating patterns, personal computer use >4 h per day, and short night-time sleep duration (≤6 h/night) were more likely to have poor health status.

CONCLUSIONS

Undesirable lifestyle was associated with poor health status in high school boys and girls. Further understanding of these relationships is needed to facilitate the development of interventions that will help children with poor health status.

Healthy Weight in Lesbian and Bisexual Women Aged 40 and Older: An Effective Intervention in 10 Cities Using Tailored Approaches

BACKGROUND

Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks.

METHODS

Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report.

ANALYTICAL PLAN

Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models.

RESULTS

Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67).

CONCLUSION

This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

Effect of Residence in Temporary Housing After the Great East Japan Earthquake on the Physical Activity and Quality of Life of Older Survivors

OBJECTIVE

This study aimed to compare the physical activity level and health-related quality of life (HRQOL) between older survivors residing in temporary housing after the Great East Japan Earthquake (GEJE; temporary housing group) and older individuals residing in their own homes (control group) and to clarify whether mobility function and muscle strength were correlated with physical activity among older temporary housing residents.

METHODS

Subjects were recruited to the temporary housing group (n=64, 19 men and 45 women) or control group (n=64, 33 men and 31 women) according to their residence. Physical activity was assessed by the number of walking steps determined by using a triaxial accelerometer, mobility function by the Timed Up and Go test, muscle strength by the grasping power test, and HRQOL by the Medical Outcome Study 36-Item Short Form Survey v2.

RESULTS

In the temporary housing group, reduced physical activity and correlation between physical activity and mobility function in men, and muscle strength in both men and women, were observed. There was no significant difference in HRQOL between groups except for bodily pain in women.

CONCLUSION

Support for older evacuees should focus on maintaining their physical activity level as well as on HRQOL to avoid deterioration of health in these survivors. (Disaster Med Public Health Preparedness. 2017;11:701-710).

Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis

Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia. The positive influence of PA interventions on sarcopenia has been described previously on many occasions. Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published. The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies. We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia. Twenty-five articles were ultimately included in the qualitative and quantitative syntheses. A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development. Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =0.45; 95% confidence interval [CI] 0.37–0.55). The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia.

Habitual intake of fermented milk products containing Lactobacillus casei strain Shirota and a reduced risk of hypertension in older people

This study investigated relationships between the frequent intake of fermented milk products containing Lactobacillus casei strain Shirota (LcS) and the onset of hypertension (resting systemic pressure ≥140 mmHg [systolic]/≥90 mmHg [diastolic], a doctor’s diagnosis and/or antihypertensive medicine use) during a 5-year period in 352 communityliving Japanese aged 65 to 93 years (125 men and 227 women). Initially normotensive subjects were divided into two groups (n=254 and n=98) on the basis of their intake of fermented milk products (<3 or ≥3 times/week, respectively), as estimated during an interview by a certified nutritionist. The incidence of hypertension over the 5-year interval was significantly lower in those who took fermented milk products ≥3 rather than <3 times/week (6.1 vs 14.2%, P=0.037). A multivariate-adjusted proportional hazards model predicted that blood pressures were significantly more likely to remain normal over 5 years in subjects who took ≥3 fermented milk products rather than <3 times/ week (relative risk 0.398 [95% confidence interval 0.167-0.948], P=0.037). These results suggest that after adjustment for potential confounders, the risk of developing hypertension is substantially lower in elderly people who take fermented milk products containing LcS at least 3 times a week.

Association of Maximum Temperature With Sedentary Time in Older British Men

Background

Sedentary behavior is very common in older adults and a risk factor for mortality. Understanding determinants of sedentary behavior may help in defining strategies aimed to reduce the time spent sedentary. The degree of difference in sedentary time attributable to varying temperatures has not been yet estimated in older men.

Methods

Men aged 71 to 91 years participating in an established UK population-based cohort study were invited to wear an Actigraph GT3X accelerometer for 1 week in 2010–12. Outcome was sedentary time (<1.5 Metabolic Equivalent of Task) in minutes per day. Associations between daily outdoor maximum temperature and accelerometer-measured sedentary time were estimated using multilevel models.

Results

43% (1361/3137) of invited men participated in the study and provided adequate data. Men spent on average 615 minutes in sedentary time per day (72% of the total accelerometer-wear time). After adjusting for covariates, men spent 26 minutes more per day (P < .001) in sedentary time when temperatures were in the lowest (–3.5; 9.2°C) versus highest quintile (19.1; 29.5°C).

Conclusions

Sedentary time in older adults is highest at lowest temperatures, typically recorded in winter. Findings are relevant for guidelines: interventions may consider targeting older men in winter providing recommendations for minimizing sedentariness on daily basis.

Validity of activity monitors worn at multiple nontraditional locations under controlled and free-living conditions in young adult women

The purpose of this study was to examine the validity of counting steps and computing indices of moderate-to-vigorous physical activity (MVPA) using miniature activity monitors with 3-D technology worn at various locations under controlled (CON) and free-living conditions (FL). Kenz e-style2, Tanita Calorism Smart, and Omron Calori Scan HJA-306 activity monitors were assessed. Nine and 31 young adult women were assigned to the CON and FL studies, respectively. While walking or jogging on a treadmill at 5 different speeds, the subjects simultaneously carried the 3 different monitors in a pants pocket (PP), a chest shirt pocket, and a shoulder bag (B). Under the FL condition, the 3 monitors were placed only at the PP and B locations for practical reasons. Significant effects of monitor location and walking/jogging speed on the step count measured by the 3 monitors were evaluated under the CON condition. Monitors placed at both PP and B tended to underestimate the number of steps; however, there were no significant differences between the values obtained with the Kenz monitor and those obtained with a criterion accelerometer under the FL condition. Moreover, strong correlations were observed between steps measured by monitors placed at PP and steps measured by the criterion accelerometer. The amount of MVPA for the PP location and the non-carrying duration of the bag for the B location were considered to be important determinants of the accuracy of step counting under the FL condition. In conclusion, monitors placed at the PP location, especially the Kenz monitor, showed acceptable accuracy for young adult women in real-life settings. In contrast, MVPA indices assessed using these monitors showed limited validity.

Physical activity in non-frail and frail older adults

Introduction

Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA.

Aim

This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels.

Methods

Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA).

Results

Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home.

Conclusions

Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.

Maximal exercise testing variables and 10-year survival: fitness risk score derivation from the FIT Project

OBJECTIVE

To determine which routinely collected exercise test variables most strongly correlate with survival and to derive a fitness risk score that can be used to predict 10-year survival.

PATIENTS AND METHODS

This was a retrospective cohort study of 58,020 adults aged 18 to 96 years who were free of established heart disease and were referred for an exercise stress test from January 1, 1991, through May 31, 2009. Demographic, clinical, exercise, and mortality data were collected on all patients as part of the Henry Ford ExercIse Testing (FIT) Project. Cox proportional hazards models were used to identify exercise test variables most predictive of survival. A "FIT Treadmill Score" was then derived from the β coefficients of the model with the highest survival discrimination.

RESULTS

The median age of the 58,020 participants was 53 years (interquartile range, 45-62 years), and 28,201 (49%) were female. Over a median of 10 years (interquartile range, 8-14 years), 6456 patients (11%) died. After age and sex, peak metabolic equivalents of task and percentage of maximum predicted heart rate achieved were most highly predictive of survival (P<.001). Subsequent addition of baseline blood pressure and heart rate, change in vital signs, double product, and risk factor data did not further improve survival discrimination. The FIT Treadmill Score, calculated as [percentage of maximum predicted heart rate + 12(metabolic equivalents of task) - 4(age) + 43 if female], ranged from -200 to 200 across the cohort, was near normally distributed, and was found to be highly predictive of 10-year survival (Harrell C statistic, 0.811).

CONCLUSION

The FIT Treadmill Score is easily attainable from any standard exercise test and translates basic treadmill performance measures into a fitness-related mortality risk score. The FIT Treadmill Score should be validated in external populations.

Gardening as the dominant leisure time physical activity (LTPA) of older adults from a post-communist country. The results of the population-based PolSenior Project from Poland

OBJECTIVE

To describe the LTPA of older Polish citizens in the nationwide, representative population-based PolSenior Project.

METHODS

A study group comprising 4813 randomly recruited participants aged 65 and over was surveyed. Data concerning LTPA in relation to age, gender, place of residence, and social class have been reported.

RESULTS

Only 33.6% fulfilled the recommended LTPA criteria. Gardening (64.6%), walking (39.0%) and cycling (37.3%) were the most popular physical activities, followed by gymnastic exercises (18.2%) and dancing (12.8%). Village residents reported walking, gymnastics, swimming, tennis and dancing (32.5%, 9.1%, 1.8%, 0.1%, 8.1%) less frequently than those who live in cities, especially as compared to the residents of the largest cities (45.2%, 28.3%, 13.4%, 1.3%, 15.7%, respectively). However, the frequency of cycling generally decreased with the size of the place of residence. Village residents reported cycling and gardening more frequently (49.2% and 75.8%) than residents of the largest cities (20.6% and 45.8%, respectively).

CONCLUSION

There are several differences in the LTPA of older adults in Poland compared with those in North America or Western Europe. Community-based and environmental policies should concentrate on a combination of sustaining existing favorable physical activity (PA) habits (gardening and cycling), and developing access and motivation for participation in LTPA characteristic of developed countries.

Keeping older muscle “young” through dietary protein and physical activity

Sarcopenia is characterized by decreases in both muscle mass and muscle function. The loss of muscle mass, which can precede decrements in muscle function, is ultimately rooted in an imbalance between the rates of muscle protein synthesis and breakdown that favors a net negative balance (i.e., synthesis < breakdown). A preponderance of evidence highlights a blunted muscle protein synthetic response to dietary protein, commonly referred to as “anabolic resistance,” as a major underlying cause of the insipid loss of muscle with age. Dietary strategies to overcome this decreased dietary amino acid sensitivity include the ingestion of leucine-enriched, rapidly digested proteins and/or greater protein ingestion in each main meal to maximally stimulate muscle anabolism. Anabolic resistance is also a hallmark of a sedentary lifestyle at any age. Given that older adults may be more likely to experience periods of reduced activity (either voluntarily or through acute illness), it is proposed that inactivity is the precipitating factor in the development of anabolic resistance and the subsequent progression from healthy aging to frailty. However, even acute bouts of activity can restore the sensitivity of older muscle to dietary protein. Provided physical activity is incorporated into the daily routine, muscle in older adults should retain its capacity for a robust anabolic response to dietary protein comparable to that in their younger peers. Therefore, through its ability to “make nutrition better,” physical activity should be viewed as a vital component to maintaining muscle mass and function with age.

Metabolic syndrome in normoglycaemic elderly men

OBJECTIVE

Type-2 diabetes is mainly the metabolic defect involving multiple organs. To conclude their intricate relationships, the term 'ominous octet' had been proposed to denote this phenomenon. In this study, we enrolled older men without any medications for MetS components to further elucidate the relationships between normoglycaemic state and MetS.

METHODS

We enrolled male subjects with FPG less than 100 mg/dl and aged 65 and older undergoing routine health check-ups in Taiwan. After excluding subjects taking medications that might affect the components of MetS, a total of 6679 men were eligible for the analysis. Study subjects were further grouped into FPG tertiles (< 91 mg/dl, 92-95 mg/dl and > 95 mg/dl for tertil 1, tertil 2 and tertil 3, respectively).

RESULTS

There was a significant trend between the FPG and percentages of subjects having MetS (p = 0.009). The relationships between the MetS components were higher in FPG 2 and FPG 3 than FPG 1. In simple correlation, all of the MetS and LDL-C were positively correlated with FPG level and multiple regression further confirmed the same result except for HDL-C that became non-significant. Subjects in FPG3 had significantly higher ORs (ORs = 1.19) for having MetS than those in FPG1.

CONCLUSIONS

In conclusion, higher FPG still had higher risk of having MetS in normoglycaemic range in elderly male. More strict FPG level control may be valuable in CVD prevention and warrants further investigations.