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Shayo MJ, Shayo P, Haukila KF, Norman K, Burke C, Ngowi K, Goode AP, Allen KD, Wonanji VT, Mmbaga BT, Bettger JP. Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:982175. [PMID: 36684685 PMCID: PMC9853889 DOI: 10.3389/fresc.2022.982175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
Introduction Musculoskeletal (MSK) disorders such as low back pain and osteoarthritis are a leading cause of disability and the leading contributor to the need for rehabilitation services globally. This need has surpassed the availability of trained clinicians; even in urban areas where services and providers are thought to be more abundant, access can be challenged by transportation options and financial costs associated with travel, care and lost time from work. However, continuing standard of fully in-person rehabilitation care for MSK-associated pain and disability may no longer be necessary. With increased ownership or access to even a basic mobile phone device, and evidence for remote management by trained clinicians, some individuals with MSK disorders may be able to continue their rehabilitation regimen predominantly from home after initial evaluation in primary care or an outpatient clinic. Methods This manuscript describes application of a framework we used to culturally and contextually adapt an evidence-based approach for leveraging digital health technology using a mobile phone (mHealth) to expand access to rehabilitation services for MSK-associated pain and disability. We then conducted a multi-level analysis of policies related to the adapted approach for rehabilitation service delivery to identify opportunities to support sustainability. Results Our study was conducted in Tanzania, a lower-middle income country with their first National Rehabilitation Strategic Plan released in 2021. Lessons learned can be applied even to countries with greater infrastructure or fewer barriers. The seven-step adaptation framework used can be applied in other regions to improve the likelihood of local mHealth adoption and implementation. Our practice and policy assessment for Tanzania can be applied in other regions and used collaboratively with government officials in support of building or implementing a national rehabilitation strategic plan. Conclusion The work described, lessons learned and components of the plan are generalizable globally and can improve access to rehabilitation services using mHealth to address the significant and increasing burden of disability.
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Affiliation(s)
- Mathew J. Shayo
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Pendo Shayo
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kelvin F. Haukila
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, United States
| | - Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, United States
- Department of Veterans Affairs Health Services Research & Development Service, Durham, NC, United States
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States
| | - Kelli D. Allen
- Department of Veterans Affairs Health Services Research & Development Service, Durham, NC, United States
- Thurston Arthritis Research Center, University of North Carolina Chapel Hill, NC, United States
| | - Vivian Timothy Wonanji
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States
- Department of Health and Rehabilitation Sciences, TempleUniversity College of Public Health, Philadelphia, United States
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Cento AS, Leigheb M, Caretti G, Penna F. Exercise and Exercise Mimetics for the Treatment of Musculoskeletal Disorders. Curr Osteoporos Rep 2022; 20:249-259. [PMID: 35881303 PMCID: PMC9522759 DOI: 10.1007/s11914-022-00739-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The incidence of musculoskeletal disorders affecting bones, joints, and muscles is dramatically increasing in parallel with the increased longevity of the worldwide population, severely impacting on the individual's quality of life and on the healthcare costs. Inactivity and sedentary lifestyle are nowadays considered the main drivers of age-associated musculoskeletal disorders and exercise may counteract such alterations also in other bone- and muscle-centered disorders. This review aims at clarifying the potential use of exercise training to improve musculoskeletal health. RECENT FINDINGS Both the skeletal muscle and the bone are involved in a complex crosstalk determining, in part through tissue-specific and inflammatory/immune released factors, the occurrence of musculoskeletal disorders. Exercise is able to modulate the levels of those molecules and several associated molecular pathways. Evidence from preclinical and clinical trials supports the adoption of exercise and the future use of exercise mimicking drugs will optimize the care of individuals with musculoskeletal disorders.
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Affiliation(s)
- Alessia S Cento
- Department of Clinical and Biological Sciences, University of Torino, Corso Raffaello, 30, 10125, Torino, Italy
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, "Maggiore della Carità" Hospital, Department of Health Sciences, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Giuseppina Caretti
- Department of Biosciences, University of Milan, Via Celoria 26, 20133, Milan, Italy
| | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Torino, Corso Raffaello, 30, 10125, Torino, Italy.
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Lynæs C, Lynæs M, Simon LS, Tugwell P, D'Agostino MA, Strand V, Juhl CB, Nielsen SM, De Witt M, Beaton D, Maxwell LJ, Meara AS, Christensen R. Physicians’ vs patients’ global assessments of disease activity in rheumatology and musculoskeletal trials: A meta-research project with focus on reasons for discrepancies. Semin Arthritis Rheum 2022; 56:152074. [DOI: 10.1016/j.semarthrit.2022.152074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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Joyce C, Rajak R. A clinical audit into the adherence of foot health management standards of rheumatoid arthritis compared with the foot health management standards of diabetes mellitus in North-East London. Rheumatol Adv Pract 2021; 5:rkab006. [PMID: 33818577 PMCID: PMC8008102 DOI: 10.1093/rap/rkab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives RA has an affinity for smaller joints, thus its effect on the foot/ankle is widely known. Despite this, there is lack of adherence to foot management standards by podiatrists. This research aimed to audit the adherence to these standards and compare them with well-established adherence to management standards in the diabetic foot. Methods In this clinical audit, data were obtained via six National Health Service (NHS) podiatry departments in North-East London on service provision, management, treatment and professional development on both RA and diabetic foot health via foot management clinical audit tools. Descriptive analyses were conducted and analysed to identify patterns and trends, with set standard compliance conditions calculated on the Net Promotor Score (NPS) metric to allow for multi-comparison. Results All areas of RA foot health management were found to have poor compliance when compared with diabetes foot health management. When using NPS, no trust audited met the majority of foot health standards in RA, with only two having a positive score (meeting the minimum standards), compared with all trusts posting a positive NPS on diabetes foot health standards. Conclusion Our results indicate that poor compliance to RA foot health standards is prevalent across the audited region and might be resulting in worsening foot outcomes despite a paradigm shift in other areas of RA management. Enhanced training and knowledge are required for better adherence to the standards set out and to improve foot health management in RA.
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Affiliation(s)
- Christopher Joyce
- Department of Podiatric Medicine and Surgery, Homerton University Hospital NHS Foundation Trust
| | - Rizwan Rajak
- Department of Rheumatology, Croydon Health Service NHS Trust, London, UK
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Singaram S, Naidoo M. The psychological impact of long bone fractures in KwaZulu-Natal, South Africa: A cross-sectional study. J Public Health Afr 2020; 11:1128. [PMID: 33623650 PMCID: PMC7893312 DOI: 10.4081/jphia.2020.1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/16/2020] [Indexed: 11/27/2022] Open
Abstract
Background Long bone fractures are known to cause a decline in quality of life due to loss of physical functioning. Loss of independence due to loss or decline of physical functioning can also cause poorer psychological health. There is limited data on depression among orthopaedic patients in South Africa. Methods The validated Patient Health Questionnaire-9 depression scale was used to establish patient reported outcomes. The Chisquare or Fishers exact test was used where appropriate to compare the various psychological variables and the impact from upper and lower extremity sites. The Kruskal Wallis test was used to test differences in the overall depression score between subgroups. Univariate and multivariate linear regression was used to assess the relationship between variables of interest and the overall depression score, while adjusting for age and gender. Results A total of 821 research participants completed the questionnaire. The overall depression score in patients with a fracture ranged from 0 to 23 with a mean of 8.26 and a standard deviation of 4.76. The majority of participants (37.64%) had depression scores ranging from 5 to 9 which is associated with mild depression.
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Affiliation(s)
| | - Mergan Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa
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Dave M, Rankin J, Pearce M, Foster HE. Global prevalence estimates of three chronic musculoskeletal conditions: club foot, juvenile idiopathic arthritis and juvenile systemic lupus erythematosus. Pediatr Rheumatol Online J 2020; 18:49. [PMID: 32532304 PMCID: PMC7291758 DOI: 10.1186/s12969-020-00443-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are a major source of morbidity and disability. There is a lack of global comparable data on the burden of MSK conditions in children and young people. Our aim was to estimate the global prevalence of three MSK conditions - Talipes Equinovarus (Clubfoot), Juvenile Idiopathic Arthritis (JIA) and Juvenile Systemic Lupus Erythematosus (JSLE). METHODS Using reported prevalence rates, age-stratified population data within the World Bank Data Bank in 2017 and United Nations country classification, we estimated the prevalence of these MSK conditions in < 5 year olds (clubfoot) and < 16 year olds (JIA and JSLE) across the world. RESULTS We estimated that in 2017, there were ~ 675,061 < 5 year olds with clubfoot among 675,100,000 < 5 year olds, ~ 2,069,246 < 16 year olds with JIA and ~ 206,931 < 16 year olds with JSLE per 2,069,000,000 < 16 year olds, totalling ~ 2,951,238 with one of these conditions. Disease prevalence was greatest in Asia (South Asia), followed by Africa, Americas, Europe and Oceania. CONCLUSIONS An estimated 3 million children and young people globally are currently living with either clubfoot, JIA or JSLE; many in Asia and Africa. Further work is needed urgently to engage with global stakeholders to work together to improve access to effective care for the many who are affected and reduce the otherwise adverse lifelong impact on their health, quality of life and the impact on society.
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Affiliation(s)
- Mona Dave
- Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear, NE24HH, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear, NE24HH, UK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear, NE24HH, UK
| | - Helen E Foster
- Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear, NE24HH, UK.
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Jackson MJ, Roche DM, Amirabdollahian F, Koehn S, Khaiyat OA. The Musculoskeletal Health Benefits of Tennis. Sports Health 2019; 12:80-87. [PMID: 31710819 DOI: 10.1177/1941738119880862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines. HYPOTHESIS Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness. RESULTS Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, -0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, -0.16 ± 1.70; P < 0.05). CONCLUSION The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis. CLINICAL RELEVANCE The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.
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Affiliation(s)
| | - Denise M Roche
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
| | | | - Stefan Koehn
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
| | - Omid A Khaiyat
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
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Changes in the Sagittal Cranio-Cervical Posture Following a 12-Week Intervention Using a Simple Spinal Traction Device. Spine (Phila Pa 1976) 2019; 44:447-453. [PMID: 30234817 DOI: 10.1097/brs.0000000000002874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Non-controlled clinical trial. OBJECTIVE To assess the efficacy of a simple home spinal traction device on sagittal cranio-cervical posture and related symptoms. SUMMARY OF BACKGROUND DATA Forward head protraction (FHP) and cranio-cervical malalignment were shown to be consequential in the development adverse musculoskeletal radiographic findings and symptoms in that region. METHODS Participants (n = 13, 18-36-year-old) were drawn from a mildly symptomatic population, all presented with cranio-cervical malalignment and considerable FHP. Participants used a simple home spinal traction device for 12 weeks, 10 min/d. Sagittal cervical radiographs and the SF36 health survey were obtained pre/post intervention and guideline compliance was recorded. Radiographic evaluation included typical measurements of sagittal cranio-cervical alignment and FHP (e.g., atlas plane line, vertical axis line, sagittal cranial angle, absolute rotation angle). Standard paired samples t tests, chi-squared, and effect size analyses were used to assess pre- and post-intervention changes. RESULTS Each of the key radiographic variables recorded significant moderate to very large positive changes as a result of the intervention. Similarly, Chi-squared analyses indicated that saggital cervical spine configuration tended to become more lordotic (P = 0.007), with four participants shifting from a kyphotic to a lordotic presentation. SF36 health survey data demonstrated mostly significant positive changes throughout all tested domains, and moderate positive changes were recorded across all radiographic cranio-cervical mesured paramenters (e.g., decreased FHP, increased cervical lordosis, and cranial extention). Participants indicated high level of protocol compliance. CONCLUSION This study has demonstrated that the unsupervised daily use of a simple home spinal traction device (Thoracic Pillow) proved effective in bringing positive plastic changes to the sagittal cranio-cervical alignment and reduction in symptoms in the tested population during a short intervention period. LEVEL OF EVIDENCE 3.
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The contribution of musculoskeletal disorders in multimorbidity: Implications for practice and policy. Best Pract Res Clin Rheumatol 2017; 31:129-144. [PMID: 29224692 DOI: 10.1016/j.berh.2017.09.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
People frequently live for many years with multiple chronic conditions (multimorbidity) that impair health outcomes and are expensive to manage. Multimorbidity has been shown to reduce quality of life and increase mortality. People with multimorbidity also rely more heavily on health and care services and have poorer work outcomes. Musculoskeletal disorders (MSDs) are ubiquitous in multimorbidity because of their high prevalence, shared risk factors, and shared pathogenic processes amongst other long-term conditions. Additionally, these conditions significantly contribute to the total impact of multimorbidity, having been shown to reduce quality of life, increase work disability, and increase treatment burden and healthcare costs. For people living with multimorbidity, MSDs could impair the ability to cope and maintain health and independence, leading to precipitous physical and social decline. Recognition, by health professionals, policymakers, non-profit organisations, and research funders, of the impact of musculoskeletal health in multimorbidity is essential when planning support for people living with multimorbidity.
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Reducing arthritis pain through physical activity: a new public health, tiered approach. Br J Gen Pract 2017; 67:438-439. [PMID: 28963400 DOI: 10.3399/bjgp17x692633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Ellis BM, Newton JN. A new public health, tiered approach to improving musculoskeletal health through physical activity provision. J Public Health (Oxf) 2017; 39:429-432. [PMID: 28911218 DOI: 10.1093/pubmed/fdx105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Benjamin M Ellis
- Imperial College Healthcare NHS Trust, London, and Arthritis Research UK, Chesterfield, UK
| | - John N Newton
- University of Manchester and Public Health England, London, UK
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Bell JA, Sabia S, Singh-Manoux A, Hamer M, Kivimäki M. Healthy obesity and risk of accelerated functional decline and disability. Int J Obes (Lond) 2017; 41:866-872. [PMID: 28220042 PMCID: PMC5467240 DOI: 10.1038/ijo.2017.51] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/13/2017] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Some obese adults have a normal metabolic profile and are considered 'healthy', but whether they experience faster ageing than healthy normal-weight adults is unknown. We compared decline in physical function, worsening of bodily pain and likelihood of future mobility limitation and disability between these groups. SUBJECTS/METHODS This was a population-based observational study using repeated measures over 2 decades (Whitehall II cohort data). Normal-weight (body mass index (BMI) 18.5-24.9 kg m-2), overweight (25.0-29.9 kg m-2) and obese (⩾30.0 kg m-2) adults were considered metabolically healthy if they had 0 or 1 of 5 risk factors (hypertension, low high-density lipoprotein cholesterol, high triacylglycerol, high blood glucose and insulin resistance) in 1991/1994. Decline in physical function and worsening of bodily pain based on change in Short Form Health Survey items using eight repeated measures over 18.8 years (1991/1994-2012/2013) were compared between metabolic-BMI groups using linear mixed models. Odds of mobility limitation based on objective walking speed (slowest tertile) and of disability based on limitations in ⩾1 of 6 basic activities of daily living, each using three repeated measures over 8.3 years (2002/2004-2012/2013), were compared using logistic mixed models. RESULTS In multivariable-adjusted mixed models on up to 6635 adults (initial mean age 50 years; 70% male), healthy normal-weight adults experienced a decline in physical function of -3.68 (95% CI=-4.19, -3.16) score units per decade; healthy obese adults showed an additional -3.48 (-4.88, -2.08) units decline. Healthy normal-weight adults experienced a -0.49 (-1.11, 0.12) score unit worsening of bodily pain per decade; healthy obese adults had an additional -2.23 (-3.78, -0.69) units worsening. Healthy obesity versus healthy normal-weight conferred 3.39 (2.29, 5.02) times higher odds of mobility limitation and 3.75 (1.94, 7.24) times higher odds of disability. CONCLUSIONS Our results suggest that obesity, even if metabolically healthy, accelerates age-related declines in functional ability and poses a threat to independence in older age.
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Affiliation(s)
- J A Bell
- Department of Epidemiology and Public Health, University College London, London, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - S Sabia
- Department of Epidemiology and Public Health, University College London, London, UK
- INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - A Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK
- INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - M Hamer
- National Centre for Sport & Exercise Medicine, Loughborough University, Leicestershire, UK
| | - M Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
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