Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

Predictors of cigarette smoking and physical inactivity among teachers during the SARS-CoV-2 pandemic in Germany: a cross-sectional analysis of a nationwide online survey

Background

The SARS-CoV-2 pandemic significantly impacted professional and private lives, which influenced social and health-related behavior. Schools in particular were greatly affected as restrictions made teaching more challenging, leading to new stresses and additional workloads. Prior to the pandemic, teachers were already facing many physical and psychological stressors that were exacerbated by the pandemic. This may have resulted in a deterioration in the teachers' health behaviors. Therefore, the aim of this study was to examine the prevalence of cigarette smoking and physical activity among German teachers during the SARS-CoV-2 pandemic, to assess possible changes considering cigarette smoking and physical activity habits during the pandemic compared to the pre-pandemic period, and to identify predictors of teachers' cigarette smoking and physical inactivity during the pandemic.

Methods

In March 2021, a nationwide online survey was conducted among teachers in Germany. A total of 31,089 participants entered the analysis. Data on cigarette smoking and physical activity as well as sociodemographic, workplace-related, psychological, SARS-CoV-2-related, and health-related items were collected using established instruments and, if necessary, self-developed items. Two binary logistic regressions with stepwise inclusion of six different variable groups were performed to predict cigarette smoking and physical inactivity.

Results

Among all surveyed teachers, 13.9% reported smoking cigarettes, and 76.6% did not meet the physical activity recommendations. The regression analyses revealed 16 significant predictors of cigarette smoking and six significant predictors of physical inactivity.

Conclusions

The predictors revealed in the present study can help target interventions for teachers who are at higher risk for unhealthy behaviors during the SARS-CoV-2 pandemic and potential future pandemics. In particular, the alarming finding that more than three-quarters of teachers were physically inactive during the pandemic should place special emphasis on improving physical activity.

Physical inactivity, depressive symptoms, and progression to sarcopenia in older adults: a 4-year longitudinal study

OBJECTIVES

To examine the combined association of physical inactivity and depressive symptoms with the progression to sarcopenia in community-dwelling older adults.

DESIGN

A 4-year follow-up longitudinal study.

SETTING

Community-dwelling older adults living in Japan, who were not sarcopenic at baseline.

PARTICIPANTS

The participants were 2,538 community-dwelling older adults and with a mean age of 70.9 ± 4.6 years, of whom 1,327 (52.3%) were women.

MEASUREMENTS

Sarcopenia, defined according to the European Working Group on Sarcopenia in Older People 2, was assessed at baseline and at the 4-year follow-up. Participants were divided into four groups according to their inactivity and depressive symptoms. Physical inactivity was assessed using two face-to-face questions regarding the frequency of regular exercise, sports, and light exercise per week. Depressive symptoms were defined as a score of six or higher on the Geriatric Depression Scale 15-item version. Logistic regression analysis was used to determine whether inactivity and depressive symptoms were associated with progression to sarcopenia 4 years later. For participants who could not be followed and participants with missing data in the follow-up assessment, the data at the follow-up assessment were imputed using the multiple imputations.

RESULTS

After 4 years, 518 participants (20.4%) with complete data progressed to sarcopenia. The rate of progression to sarcopenia after multiple imputations was 23.4%. Logistic regression analysis after multiple imputations showed that the group with both factors was significantly associated with the progression to sarcopenia [Odds ratio, 1.64 (95% Confidence interval 1.11-2.44), p = 0.014]. By contrast, no significant association was found for either inactivity or depressive symptoms alone.

CONCLUSION

This study indicates that the coexistence of physical inactivity and depressive symptoms may contribute to the progression of sarcopenia. Addressing both physical and mental factors, rather than limiting the problem to a single factor, may be essential for preventing sarcopenia.

A Content Analysis of African Americans' Experience of Engaging in Qigong Exercise Intervention in a Community Setting

Introduction: Although an increasing number of African Americans 50 years of age and older practice qigong, a mind-body exercise, to manage their health conditions, little is known about their perceptions and experiences of engaging in and learning qigong exercise. This study aimed to explore the subjective perceptions of the health benefits, engagement, adherence, and learning of qigong exercise in African Americans 45-85 years of age as a foundation for promoting this approach for African Americans' physical and psychological health. Methods: Fifteen African Americans were enrolled in a 1-h qigong exercise program twice a week for 8 weeks (a total of 16 sessions) in the activity center of a local church. Participants were interviewed after the intervention to explore their perceptions of learning and practicing qigong exercise. Interviews were conducted in person, audio recorded, transcribed verbatim, and analyzed using content analysis. Results: Five themes emerged: (1) Perceived benefits of practicing qigong, (2) helpful strategies for qigong learning, (3) facilitators for home qigong practice, (4) motivators for qigong exercise adherence, and (5) recommending qigong to others. qigong exercise was perceived to be effective for balance, flexibility, muscle strength, sleep quality, emotion regulation, and stress management. Nearly 75% of participants reported home qigong practice at least twice a week. Conclusions: Middle-age and older African Americans' responses provide insights on health benefits associated with practicing qigong exercise, adherence, home practice, and learning, which may serve as the first step to promoting the use of qigong exercise in this population and may be adopted to similar exercise interventions with minority older adults in the future.

Examining physical activity participation barriers among adults 50 years and older: a scoping review

Background

Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools.

Objectives

Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older.

Methods

We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties.

Results

The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible.

Conclusion

The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.

Detecting Depression-related Movement Changes in Older Adults using Smart Home Motion Sensors - A Feasibility Study

Smart home sensor data is being increasingly used to identify health risks through passive tracking of specific behaviours and activity patterns. This study explored the feasibility of using motion sensor data to track changes in daytime movement patterns within the home, and their potential association with depression in older adults. This study analysed the motion sensor data collected during a one-year smart home trial, and explored their association with Geriatric Depression Scale (GDS) scores collected at three different time points during the trial (i.e., baseline, mid-trial, and end-trial). Our results showed that movement patterns are generally reduced when older adults are in a depressed state compared to when being in a not-depressed state. In particular, the reduced movement activity in depressed states was significant (p<.05) when the participant's GDS state changed between depressed and not-depressed for the first time during the three time points of the trial when GDS was collected.Clinical relevance- Our results establish the feasibility and potential use of motion sensor data from ambient sensors in a smart home for passive and remote assessment of older adults' depression status, that is comparable to their GDS scores, through changes in their in-home day-time movement patterns. Also since reduced movement activity may be a general indicator of potential health risks, this study provides preliminary evidence for using in-home movement activity monitoring as an general indicator of health risks.

Motor alterations in depression and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Psychomotor retardation has long been recognized as a major feature of depression, and anxiety disorders have been linked with freeze and flight motor responses. This systematic review and meta-analysis aimed a) to synthesize available evidence of motor alterations comparing individuals with depression and anxiety disorders to healthy individuals and b) to evaluate the effect of experimental manipulations of motor displays within these clinical groups.

METHOD

The databases PubMed and PsycINFO were searched for studies either assessing motor differences between clinical and healthy control groups or manipulating the motor system within a clinical group.

RESULTS

The literature search yielded 87 relevant papers, comprising 82 studies comparing a clinical group to a healthy group and 5 studies investigating motor manipulations within a clinical sample. The results of the meta-analysis (K = 71) indicated a statistically significant combined estimate of differences between healthy and clinical groups (g = 0.38 [0.31, 0.45], adjusted for publication bias g = 0.26 [0.19, 0.33]) of a small size. This effect did not vary according to type of disorder (anxiety vs. depression, p = .468). From a narrative review of experimental studies within clinical groups, four out of five studies reported statistically significant effects of manipulating the motor system on affective outcomes.

DISCUSSION

This synthesis adds to the accumulating empirical evidence of motor alterations in depression and anxiety disorders. Future research will need to investigate how individuals suffering from depression or anxiety disorders could benefit from psychological, behavioral, and physical interventions directly aimed at the motor system.

Effects of Mood Regulation on Sociodemographic Status, Exercise Pattern, and Physical Conditions of Chinese Adults and the Elderly

Objective

This study focused on mood regulations and their association with sociodemographic status, exercise pattern, and physical conditions of adults and older adults in China who did not undergo interventions.

Method

Data were based on the 2016 to 2018 Guangdong National Physique Monitoring data, in which 5242 participants aged 20-69 years were recruited. Multiple statistical analysis methods, such as descriptive and logistic regression analyses, were used to study each exercise motivation and its association with influencing factors, including sociodemographic characteristics, exercise measurements, and physical conditions. An exercise index for mental health was also used to investigate the number and types of people who were more likely to meet the index.

Results

We observed that 44.9% (2355/5242) of participants did not engage in physical exercise in this study. Only older participants (40 to 69 years old) and those with an average level of education (high school/technical secondary school) showed a significant association with exercising for mood regulation. Few people met the index that is good for mental health (16.64% [872/5242] met index 1, and 2.84% (149/5242) met index 2), and higher education showed a significant association with a reduction in the mental health burden and the prevention of depression.

Conclusion

This study found that motivating people to be more active and educating them on the potential mental health benefits of exercise could help them to exercise more.

Effects of Qigong Exercise on Physical and Psychological Health among African Americans

Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.

Assessing physical performance and physical activity in large population-based aging studies: home-based assessments or visits to the research center?

Background

The current study aims to compare correlations between a range of measures of physical performance and physical activity assessing the same underlying construct in different settings, that is, in a home versus a highly standardized setting of the research center or accelerometer recording. We also evaluated the selective attrition of participants related to these different settings and how selective attrition affects the associations between variables and indicators of health, functioning and overall activity.

Methods

Cross-sectional analyses comprising population-based samples of people aged 75, 80, and 85 years living independently in Jyväskylä, Finland. The AGNES study protocol involved the following phases: 1) phone interview (n = 1886), 2) face-to-face at-home interview (n = 1018), 3) assessments in the research center (n = 910), and 4) accelerometry (n = 496). Phase 2 and 3 included walking and handgrip strength tests, and phase 4 a chest-worn and thigh-worn accelerometer estimating physical activity and assessing posture, respectively, for 3–10 days in free-living conditions.

Results

Older people with poorer health and functioning more likely refrained from subsequent study phases, each requiring more effort or commitment from participants. Paired measures of walking speed (R = 0.69), handgrip strength (R = 0.85), time in physical activity of at least moderate intensity (R = 0.42), and time in upright posture (R = 0.30) assessed in different settings correlated with each other, and they correlated with indicators of health, functioning and overall activity. Associations were robust regardless of limitations in health and functioning, and low overall activity.

Conclusions

Correlational analyses did not clearly reveal one superior setting for assessing physical performance or physical activity. Inclusion of older people with early declines in health, functioning and overall activity in studies on physical performance and physical activity is feasible in terms of study outcomes, but challenging for recruitment.

Analysis of risk factors for mild cognitive impairment based on word list memory test results and questionnaire responses in healthy Japanese individuals registered in an online database

Although the development of effective therapeutic drugs and radical treatment options for dementia and Alzheimer’s disease (AD) remains urgent, progress in recent clinical trials of AD drugs has been less than adequate. In order to advance the progress of clinical trials, it is necessary to establish more efficient methods of recruitment. In Japan, there are registration systems stratified by mild cognitive impairment and preclinical and clinical stages of early and advanced stage dementia, but there is no registration system for healthy individuals yet. Therefore, in the present study, we developed a large-scale, internet-based health registry to investigate factors associated with cognitive function among registered participants. A total of 1038 participants completed the initial questionnaire and word list memory test. Among these participants, 353 individuals completed a second questionnaire and memory test. Stepwise multiple regression analysis was performed using IBM SPSS version 23.0 for Windows at a statistical significance level of p<0.05. We found that mood, motivation, and a decreased ability to perform activities of daily living were significantly associated with cognitive function. The results of the present study suggest that maintaining social involvement is important to prevent decreases in physical activity, daily function, mood, and motivation.

State of the Art Review: Physical Activity and Older Adults

Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.

Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults

OBJECTIVES

To examine the association between life-space mobility and different dimensions of depressive symptoms among older community-dwelling people.

METHODS

Cross-sectional analyses of baseline data of the 'Life-Space Mobility in Old Age' cohort study were carried out. The participants were community-dwelling women and men aged 75-90 years (N = 848). Data were gathered via structured interviews in participants' home. Life-space mobility (the University of Alabama at Birmingham (UAB) Life-Space Assessment - questionnaire) and depressive symptoms (Centre for Epidemiological Studies Depression Scale, CES-D) were assessed. Other factors examined included sociodemographic factors, difficulties walking 500 m, number of chronic diseases and the sense of autonomy in participation outdoors (subscale of Impact on Participation and Autonomy questionnaire).

RESULTS

Poorer life-space mobility was associated with higher prevalence of different dimensions of depressive symptoms. The associations were partially mediated through walking difficulties, health and the sense of autonomy in participation outdoor activities.

CONCLUSION

Poorer life-space mobility interrelates with higher probability for depressive symptoms, thus compromising older adults' mental wellbeing. A focus on older adults' life-space mobility may assist early identification of persons, who have elevated risk for depressive symptoms. The association between life-space mobility and depressive symptoms should be studied further utilizing longitudinal study designs to examine temporality and potential causality.

Can the Theory of Planned Behavior predict dietary intention and future dieting in an ethnically diverse sample of overweight and obese veterans attending medical clinics?

Obesity has become a world-wide epidemic; in the United States (U.S.) approximately two-thirds of adults are classified as overweight or obese. Military veterans' numbers are even higher, with 77% of retired or discharged U.S. veterans falling in these weight categories. One of the most common methods of changing one's weight is through dieting, yet little is known regarding the factors that facilitate successful dieting behavior. The current investigation tested the Theory of Planned Behavior's (TPB) ability to predict dietary intention and future dieting in a sample of 84 overweight and obese patients attending medical clinics at a Veterans Affairs Hospital in the southwestern part of the U.S. Participants primarily were male (92%) and ethnic/racial minorities (58%). Perceived need and anticipated regret were added to the standard TPB model. While the TPB predicted dietary intention, it did not significantly account for improved dietary behaviors. Anticipated regret significantly enhanced the basic TPB's ability to predict intention to diet, while perceived need did not. These findings highlight the difficulty in predicting sustained change in a complex behavior such as dieting to lose weight. The need for more work with older, overweight/obese medical patients attending veterans' facilities is stressed, as is the need for such work with male patients and ethnic minorities in particular.

Could autonomous motivation hold the key to successfully implementing lifestyle changes in affective disorders? A multicentre cross sectional study

There is a need for theoretically-based research on the motivational processes linked to the adoption and maintenance of an active lifestyle in people with affective disorders. Within the Self-Determination Theory (SDT) framework, we investigated the SDT tenets in people with major depressive disorder or bipolar disorder by examining the factor structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) and by investigating associations between motivation, the Positive and Negative Affect Scale (PANAS) and International Physical Activity Questionnaire (IPAQ) scores. A total of 165 patients (105 ♀) (45.6 ± 14.2 years) agreed to participate. An exploratory factor analysis demonstrated sufficient convergence with the original factor for amotivation, and external and introjected regulation. The items of identified and intrinsic regulation loaded on the same factor, which was labelled autonomous regulation. Significant correlations were found between the total IPAQ score and the subscales amotivation, external regulation, introjected regulation and autonomous regulation. The relative autonomy index (RAI) was associated with the PANAS scores. Differences in RAI were found between physically inactive and active participants. Our results suggest that in people with affective disorders the level of autonomous motivation may play an important role in the adoption and maintenance of health promoting behaviours.

The effect of out-of-home activity intervention delivered by volunteers on depressive symptoms among older people with severe mobility limitations: a randomized controlled trial

OBJECTIVES

To examine the effects of an individualized outdoor activity intervention carried out by volunteers on depressive symptoms among community-living older people with severe mobility limitations who have difficulties accessing the outdoors independently.

METHODS

Secondary analyses of the 'Volunteering, Access to Outdoor Activities and Wellbeing in Older People' (VOW) data (ISRCTN56847832). VOW was a randomized single blinded two-arm controlled trial conducted in Jyväskylä, Finland, in 2009-2011. At baseline, 121 people aged 67-92 years with severe mobility limitations were interviewed at home and randomized into either an intervention or waiting list control group. Volunteers (n = 47) had retired from regular work and were trained for the study. A volunteer assisted the participant in attending recreational out-of-home activities once a week for three months. Depressive symptoms were assessed using the Center for the Epidemiological Studies Depression Scale (CES-D).

RESULTS

In the intervention group the CES-D score did not change during the intervention (from 15.1 ± standard error 0.9 to 15.1 ± 0.9), while in the control group it increased from 17.0 ± 1.3 to 19.1 ± 1.4 (intervention effect p = .096). Among the subgroups with minor depressive symptoms at baseline (CES-D score 16-20), the CES-D score decreased in the intervention group and increased in the control group (p = .025).

CONCLUSION

A three-month outdoor activity intervention may improve mood among older people with severe mobility limitations. More randomized controlled trials of the topic are needed.

Barriers to outdoor physical activity and unmet physical activity need in older adults

OBJECTIVE

To profile participants based on reported outdoor physical activity barriers using a data-driven approach, describe the profiles and study their association with unmet physical activity need.

METHOD

Cross-sectional analyses of 848 community-dwelling men and women aged 75-90 living in Central Finland in 2012. Barriers to outdoor physical activity and unmet physical activity need were enquired with a questionnaire. The latent profiles were identified by profiling participants into latent groups using a mixture modeling technique on the multivariate set of indicators of outdoor physical activity barriers. A path model was used to study the associations of the profiles with unmet physical activity need.

RESULTS

Five barrier profiles were identified. Profile A was characterized with minor barriers, profile B with weather barriers, profile C with health and weather barriers, profile D with barriers concerning insecurity, health and weather; and profile E with mobility and health barriers. The participants in the profiles differed in the proportion of individual and environmental barriers. The risk for unmet physical activity need was highest among people whose severe mobility difficulties restricted their outdoor physical activity.

CONCLUSION

Outdoor physical activity barriers reflect the imbalance in person-environment fit among older people, manifested as unmet physical activity need.

Maintenance of physical function in frail older adults

Inactivity leads to frailty and loss of function for older adults. Most older adults are sedentary. Participating in a regular routine of physical activity is recommended for maintaining physical function required to sustain quality of life and independence for older adults. Annual screening for level of physical activity is required to determine changes from year to year. Research shows older adults are more likely to initiate a regular routine of physical activity when a health care provider writes a prescription for physical activity including the type, frequency, and specific duration of physical activity sessions.

"I don't have the heart": a qualitative study of barriers to and facilitators of physical activity for people with coronary heart disease and depressive symptoms

BACKGROUND

Physical activity has been shown to reduce depression in people with coronary heart disease (CHD), however many people with CHD do not engage in sufficient levels of physical activity to reap its positive effects. People with depression and CHD are at particular risk of non-adherence to physical activity. Little is known about the barriers to and facilitators of physical activity for people with CHD and depressive symptoms. Using qualitative interviews, the aim of this study was to explore the barriers to and facilitators of physical activity for cardiac patients with depressive symptoms.

METHODS

Fifteen participants with CHD and depressive symptoms (assessed using the Cardiac Depression Scale) participated in in-depth semi-structured interviews. The interviews were focussed on investigating participants' experiences of physical activity since their cardiac event. Interviews were content analysed to determine major themes.

RESULTS

Participants identified a number of barriers to and facilitators of physical activity. Barriers included having negative perceptions towards health and life changes as a result of the cardiac event, having low mood and low motivation to exercise, feeling physically restricted towards or fearful of exercise, lacking knowledge regarding exercise and perceiving external barriers. Facilitators included having a reason for exercising, being able to identify the psychological benefits of exercise, having positive social support and using psychological strategies. 'Inactive' participants reported more barriers and fewer facilitators than did 'active' participants.

CONCLUSIONS

The barriers reported in this study were highly salient for a number of participants. Health professionals and researchers can use this information to assist people with CHD and depressive symptoms to identify and possibly overcome barriers to physical activity. Relevant barriers and facilitators could be taken into account to increase their effectiveness when designing interventions to encourage physical activity maintenance in this population.

Depressive symptoms interfere with post-rehabilitation exercise: outcome expectancies and experience as mediators

The aim of the study was to examine the relationship between depressive symptoms and physical exercise by unveiling how outcome expectancies regarding exercise and positive exercise experience could mediate between depressive symptoms and exercise. A longitudinal study included 178 cardiac and orthopedic rehabilitation patients in Germany. Patients responded to psychometric scales at two points in time with a six-week interval, assessing depressive symptoms (Time 1), outcome expectancies regarding exercise (Time 1), exercise experiences (Time 2), and exercise behavior (Times 1 and 2). Depressive symptoms were negatively related to physical exercise (r =- 0.18), to positive outcome expectancies (r =- 0.23), and to positive exercise experiences (r =- 0.26). In a multiple-step mediation model, expectancies and experiences mediated between depressive symptoms and exercise. In total, 15% of the exercise variance was accounted for. Outcome expectancies and a lack of positive experience seem to partly explain why depressed individuals are less likely to exercise.

Physical activity, social network type, and depressive symptoms in late life: an analysis of data from the National Social Life, Health and Aging Project

OBJECTIVES

To clarify whether physical activity among older Americans is associated with depressive symptoms, beyond the effects of social network type, physical health, and sociodemographic characteristics.

METHOD

The analysis used data from a sub-sample, aged 65–85, from the National Social Life, Health and Aging Project (N=1349). Hierarchical regressions examined the respective effects of selected network types and extent of engagement in physical activity on depressive symptoms, controlling for physical health and sociodemographic background.

RESULTS

The findings showed that physical activity was correlated inversely with late life depressive symptoms. However, when interaction terms for the selected social network types and the extent of physical activity were also considered, the main effect of social network on depressive symptoms increased, while that of physical activity was eliminated.

CONCLUSIONS

The results show that older American adults embedded in family network types are at risk of limited physical activity. However, interventions aimed to increase their engagement in physical activity might help to reduce depressive symptoms within this group.

Depression, physical function, and risk of mortality: National Diet and Nutrition Survey in adults older than 65 years

OBJECTIVE

the authors used an objective assessment of physical function and a range of sociodemographic, dietary, and health behaviors to explore the possible factors that could explain the association between depression and mortality in community-dwelling elderly participants aged 65 years and older.

DESIGN

prospective follow-up of the National Diet and Nutrition Survey in older adults.

SETTING

community sample.

PARTICIPANTS

a total of 1,007 participants (522 men, 485 women; mean age: 76.4 ± 7.3 years).

MEASUREMENTS

: Depression was assessed from the 15 item Geriatric Depression Scale (GDS) and physical function using hand grip strength. Participants were followed up for death over an average of 9.2 years.

RESULTS

: At baseline, 20.9% of participants demonstrated depression (GDS-15 score ≥ 5). Depressed participants were at a higher relative risk of all cause mortality during follow-up (age- and sex-adjusted hazard ratio = 1.24, 95% confidence interval: 1.04-1.49). Other risk factors for depression also related to mortality included smoking, physical inactivity, and low grip strength. These factors collectively explained an estimated 54% of the association between depression and mortality. Low-grade inflammation and low plasma vitamin C were also independently associated with depression and mortality but did not explain any of the association between depression and mortality.

CONCLUSION

late-life depression is associated with a higher risk of mortality. Physical inactivity and physical dysfunction might partly mediate this association, although further longitudinal studies are required to fully elucidate these mechanisms.

Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture

We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities. We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D). There was a significant reduction in level of activity, frequency of participation in sport (both p < 0.001) and EQ-5D scores in patients of all age groups compared to a normal English population (p = 0.001). A total of 22 (42%) were able to return to their previous level of activities: 35 (67%) were able to take part in sport at some level. Of all the parameters analysed, the Matta radiological follow-up criteria were the single best predictor for resumption of sporting activity and frequency of participation.

Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study

STUDY DESIGN

This was a prospective cross-sectional study for people with chronic spinal cord injury (SCI).

OBJECTIVES

To (1) evaluate the intensity level and nature of physical activity in community-dwelling individuals living with SCI, and (2) explore the relation between descriptive individual variables (for example, lesion level), secondary complications and participation in physical activity.

SETTING

Urban community setting.

METHODS

A total of 49 subjects with SCI who used a manual wheelchair for primary mode of mobility (mean years since injury, 11.8; mean age, 43.7 years; 67% paraplegia) completed the physical activity recall assessment for people with SCI (PARA-SCI).

RESULTS

Approximately 50% of reported physical activity among individuals with SCI is due to activities of daily living. The amount of physical activity was not related to lesion level, age, body mass index or waistline size. Greater heavy-intensity activity was related to lower levels of pain and fatigue and higher levels of self-efficacy, whereas higher amounts of mild-intensity activity and total activity were related to less depressive symptoms.

CONCLUSIONS

Activities of daily living are a large component for physical activity among individuals with SCI. It appears that greater physical activity is associated with less secondary complications (pain, fatigue and depression) in individuals with SCI.