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Boord MS, Brown P, Soriano J, Meola T, Dumuid D, Milte R, Roughead EE, Lovell NH, Stone H, Whitehouse J, Janetzki JL, Gebreyohannes EA, Lim R. A Digitally Enabled, Pharmacist service to detecT medicine harms in residential aged care (nursing home) (ADEPT): protocol for a feasibility study. BMJ Open 2024; 14:e080148. [PMID: 38341209 PMCID: PMC10862280 DOI: 10.1136/bmjopen-2023-080148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This feasibility study aims to develop and test a new model of practice in Australia using digital technologies to enable pharmacists to monitor early signs and symptoms of medicine-induced harms in residential aged care. METHODS AND ANALYSIS Thirty residents will be recruited from an aged care facility in South Australia. The study will be conducted in two phases. In phase I, the study team will work with aged care software providers and developers of digital technologies (a wearable activity tracker and a sleep tracking sensor) to gather physical activity and sleep data, as well as medication and clinical data from the electronic medication management system and aged care clinical software. Data will be centralised into a cloud-based monitoring platform (TeleClinical Care (TCC)). The TCC will be used to create dashboards that will include longitudinal visualisations of changes in residents' health, function and medicine use over time. In phase II, the on-site pharmacist will use the centralised TCC platform to monitor each resident's medicine, clinical, physical activity and sleep data to identify signs of medicine-induced harms over a 12-week period.A mixed methods process evaluation applying the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework will be used to assess the feasibility of the service. Outcome measures include service reach, changes in resident symptom scores (measured using the Edmonton Symptom Assessment System), number of medication adverse events detected, changes in physical activity and sleep, number of pharmacist recommendations provided, cost analysis and proportion of all pharmacists' recommendations implemented at 4-week, 8-week and 12-week postbaseline period. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of South Australia's Human Research Ethics Committee (205098). Findings will be disseminated through published manuscripts, conference presentations and reporting to the study funder. TRIAL REGISTRATION NUMBER ACTRN12623000506695.
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Affiliation(s)
- Monique S Boord
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Brown
- Tyree Foundation Institute of Health Engineering (IHealthE) and Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian Soriano
- Tanunda Lutheran Home Inc, Tanunda, South Australia, Australia
- SA Pharmacy, Adelaide, South Australia, Australia
| | - Tahlia Meola
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Milte
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nigel H Lovell
- Tyree Foundation Institute of Health Engineering (IHealthE) and Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Stone
- Pharmaceutical Society of Australia, Deakin, Australian Capital Territory, Australia
| | | | - Jack L Janetzki
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Eyob Alemayehu Gebreyohannes
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Lim R, Dumuid D, Parfitt G, Stanford T, Post D, Bilton R, Kalisch Ellett LM, Pratt N, Roughead EE. Using wrist-worn accelerometers to identify the impact of medicines with anticholinergic or sedative properties on sedentary time: A 12-month prospective analysis. Maturitas 2023; 172:9-14. [PMID: 37054659 DOI: 10.1016/j.maturitas.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/06/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Studies have shown that use of medicines with sedative or anticholinergic properties is associated with a decline in physical function; however, the effects have not been quantified, and it is not known how and which specific physical movements are affected. This prospective study quantified the impact of a change in sedative or anticholinergic load over time on 24-hour activity composition. METHODS This study used data collected from a randomised trial assessing an ongoing pharmacist service in residential aged care. The 24-hour activity composition of sleep, sedentary behaviour, light-intensity physical activity, and moderate to vigorous physical activity was derived from 24-hour accelerometry bands. Mixed effect linear models were used to regress the multivariate outcome of 24-hour activity composition on medication load at baseline and at 12 months. A fixed effect interaction between trial stage and medication load was included to test for differing sedative or anticholinergic load effects at the two trial stages. RESULTS Data for 183 and 85 participants were available at baseline and 12 months respectively. There was a statistically significant interaction between medication load and time point on the multivariate outcome of 24-hour activity composition (sedative F = 7.2, p < 0.001 and anticholinergic F = 3.2, p = 0.02). A sedative load increase from 2 to 4 over the 12-month period was associated with an average increase in daily sedentary behaviour by an estimated 24 min. CONCLUSION As sedative or anticholinergic load increased, there was an increase in sedentary time. Our findings suggest wearable accelerometry bands are a possible tool for monitoring the effects on physical function of sedative and anticholinergic medicines. TRIAL REGISTRATION The ReMInDAR trial was registered on the Australian and New Zealand Trials Registry ACTRN12618000766213.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia
| | - Tyson Stanford
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide 5000, Australia
| | - Rebecca Bilton
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
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Brustio PR, Mulasso A, D’Emanuele S, Zia G, Feletti L, Del Signore S, Rainoldi A. Indoor Mobility, Frailty, and Disability in Community-Dwelling Older Adults: A Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11386. [PMID: 36141659 PMCID: PMC9517026 DOI: 10.3390/ijerph191811386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The general population, but especially older adults, were forced or encouraged to stay home during the recent COVID-19 pandemic. In this context, indoor mobility (IM, the number of steps performed daily at home) may be informative about the general health status of older adults. The present study aimed at evaluating the relationship between IM, frailty (loss of functional reserve including both physical and psychosocial domains), and disability (loss of autonomy measured as activities of daily life, ADLs) in a sample of community-dwelling Italian older adults. Specifically, the primary objective was to investigate IM and disability differences between robust and frail older adults. The secondary objective was to test if frailty is in the causal sequence between IM and disability, i.e., as a mediator in their relationship. Thirty-two participants (mean age = 70 ± 6 years; 56.2% women) were recruited. Frailty and disability were evaluated using the Tilburg Frailty Indicator and the Groningen Activity Restriction Scale, respectively. IM at home was measured via an Adamo wristwatch (a connected accelerometer). One-way analyses of covariance, controlling for age and gender, showed that robust participants, classified according to a score higher than five points in the Tilburg Frailty Indicator, performed significantly more IM (F1,28 = 4.639; p = 0.04) and presented lower disability grade than frail ones (F1,28 = 4.342; p =0.046). Only physical frailty was a mediator in the relationship between IM and disability (F2,29 = 8.538, p < 0.001), with a fully mediated model (z = -2.073, p < 0.04). Conversely, the total frailty score was not a mediator in the same relationship, but with IM accounted for the variance in disability (F2,29 = 8.538, p < 0.001; R2 = 33.7%). Our results suggested that frail older adults restricted their IM more and presented a higher level of disability compared to robust older adults. Moreover, data suggest that IM reduction may have a negative impact on physical frailty and indirectly increase disability.
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Affiliation(s)
- Paolo Riccardo Brustio
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37124 Verona, Italy
- Department of Clinical and Biological Sciences, University of Torino, 10126 Torino, Italy
| | - Anna Mulasso
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Samuel D’Emanuele
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37124 Verona, Italy
| | | | | | | | - Alberto Rainoldi
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy
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Cokorilo N, Ruiz-Montero PJ, González-Fernández FT, Martín-Moya R. An Intervention of 12 Weeks of Nordic Walking and Recreational Walking to Improve Cardiorespiratory Capacity and Fitness in Older Adult Women. J Clin Med 2022; 11:jcm11102900. [PMID: 35629025 PMCID: PMC9142967 DOI: 10.3390/jcm11102900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: The main aim of this study was to examine the effect of an intervention of 12 weeks in three groups on anthropometric measurement and heart rate (HR) variables, fitness index, and maximal oxygen consumption (VO2max) in older women. (2) Methods: In total, 166 Serbian adult women, aged 50 to 69 years old, participated in this study, comprising a control group (60 participants, μage = 57.8 + 6.6), Nordic-walking (NW) group (53 participants, μage = 57.5 + 6.8), and recreational-walking (RW) group (53 participants, μage = 57.8 + 6.6) in a physical fitness programme for 12 weeks. (3) Results: Anthropometric measurement variables were measured using a stadiometer and an electronic scale. The data showed differences in walking heart rate (bt/min) (p < 0.001; η2 = 0.088) between control, NW, and RW groups in the pretest analysis. Moreover, there were significant differences in walking heart rate (bt/min) (η2 = 0.155), heart rate at the end of the test (bt/min) (η2 = 0.093), total time of fitness index test (min) (η2 = 0.097), fitness index (η2 = 0.130), and VO2max (η2 = 0.111) (all, p < 0.001) between control, NW, and RW groups in the posttest analysis. (4) Conclusions: NW group training resulted in slightly greater benefits than RW group training. The present study demonstrated that both groups could act as modalities to improve the functionality and quality of life of people during the ageing process, reflected mainly in HR variables; UKK test measurements, and VO2max. It also contributes to the extant research on older women during exercise and opens interesting avenues for future research.
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Affiliation(s)
- Nebojsa Cokorilo
- Faculty of Sport, University UNION Nikola Tesla, 11158 Belgrade, Serbia;
| | - Pedro Jesús Ruiz-Montero
- Physical Education and Sport Department, Faculty of Education and Sport Sciences, Campus of Melilla, University of Granada, 52005 Melilla, Spain; (F.T.G.-F.); (R.M.-M.)
- Correspondence:
| | - Francisco Tomás González-Fernández
- Physical Education and Sport Department, Faculty of Education and Sport Sciences, Campus of Melilla, University of Granada, 52005 Melilla, Spain; (F.T.G.-F.); (R.M.-M.)
| | - Ricardo Martín-Moya
- Physical Education and Sport Department, Faculty of Education and Sport Sciences, Campus of Melilla, University of Granada, 52005 Melilla, Spain; (F.T.G.-F.); (R.M.-M.)
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Huisingh-Scheetz M, Wroblewski K, Waite L, Huang ES, Schumm LP, Hedeker D. Variability in Hourly Activity Levels: Statistical Noise or Insight Into Older Adult Frailty? J Gerontol A Biol Sci Med Sci 2021; 76:1608-1618. [PMID: 33049032 DOI: 10.1093/gerona/glaa262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty is associated with lower mean activity; however, hourly activity is highly variable among older individuals. We aimed to relate frailty to hourly activity variance beyond frailty's association with mean activity. METHOD Using the 2010-2011 National Social Life, Health and Aging Project wrist accelerometry data (n = 647), we employed a mixed-effects location scale model to simultaneously determine whether an adapted phenotypic frailty scale (0-4) was associated with the log10-mean hourly counts per minute (cpm) and between-and within-subject hourly activity variability, adjusting for demographics, health characteristics, season, day-of-week, and time-of-day. We tested the significance of a Frailty × Time-of-day interaction and whether adjusting for sleep time altered relationships. RESULTS Each additional frailty point was associated with a 7.6% (10-0.0343, β = -0.0343; 95% CI: -0.05, -0.02) lower mean hourly cpm in the morning, mid-day, and late afternoon but not evening. Each frailty point was also associated with a 24.5% (e0.219, β = 0.219; 95% CI: 0.09, 0.34) greater between-subject hourly activity variance across the day; a 7% (e0.07, β = 0.07; 95% CI: 0.01¸ 0.13), 6% (e0.06, β = 0.06; 95% CI: 0, 0.12), and 10% (e0.091, β = 0.091; 95% CI: 0.03, 0.15) greater within-subject hourly activity variance in the morning, mid-day, and late afternoon, respectively; and a 6% (e-0.06, β = -0.06; 95% CI: -0.12, -0.003) lower within-subject hourly activity variance in the evening. Adjusting for sleep time did not alter results. CONCLUSIONS Frail adults have more variable hourly activity levels than robust adults, a potential novel marker of vulnerability. These findings suggest a need for more precise activity assessment in older adults.
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Affiliation(s)
| | | | - Linda Waite
- Department of Sociology and NORC, University of Chicago, Illinois
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Illinois
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Illinois
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Illinois
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Slysz JT, Rejeski WJ, Treat-Jacobson D, Bazzano LA, Forman DE, Manini TM, Criqui MH, Tian L, Zhao L, Zhang D, Guralnik JM, Ferrucci L, Kibbe MR, Polonsky TS, Spring B, Sufit R, Leeuwenburgh C, McDermott MM. Sustained physical activity in peripheral artery disease: Associations with disease severity, functional performance, health-related quality of life, and subsequent serious adverse events in the LITE randomized clinical trial. Vasc Med 2021; 26:497-506. [PMID: 33829920 DOI: 10.1177/1358863x21989430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle-brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustained PA with 6-minute walk (6MW) distance and the Short Form-36 physical functioning domain (SF-36 PF) score in cross-sectional analyses and with serious adverse events (SAEs) in longitudinal analyses of people with PAD. PA was measured continuously for 10 days using a tri-axial accelerometer at baseline in 277 participants with PAD randomized to the LITE clinical trial. In regression analyses, each 0.15 lower ABI value was associated with a 5.67% decrease in the number of daily bouts of sustained PA (95% CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46; p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI: 0.34-1.28; p < 0.001). Participants with values of daily bouts of sustained PA below the median had higher rates of SAEs during follow-up, compared to participants above the median (41% vs 24%; p = 0.002). In conclusion, among participants with PAD, lower ABI values were associated with fewer bouts of daily sustained PA. A greater number of bouts of daily sustained PA were associated with better 6MW performance and SF-36 PF score, and, in longitudinal analyses, lower rates of SAEs. Clinicaltrials.gov ID: NCT02538900.
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Affiliation(s)
- Joshua T Slysz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science and Geriatric Medicine, Wake Forest University, Winston Salem, NC, USA
| | | | - Lydia A Bazzano
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Daniel E Forman
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | - Luigi Ferrucci
- National Institute of Aging, The Intramural Research Program, Baltimore, MD, USA
| | - Melina R Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Effect of Inpatient and Outpatient Pneumonia on Mobility Disability, Gait Speed, and Physical Activity in Older Adults. J Clin Med 2021; 10:jcm10061236. [PMID: 33809731 PMCID: PMC8002307 DOI: 10.3390/jcm10061236] [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: 01/11/2021] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Pathophysiological changes caused by pneumonia may influence physical functioning in older adults. This study was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study. The LIFE Study included 1635 individuals over an average follow-up of 2.6 years at eight clinical sites during 2010–2013. Adults ≥70 years-old with mobility limitations (Short Physical Performance Battery score ≤9) were randomized to a physical activity (exercise) intervention or health education control arm. This analysis evaluated the association between pneumonia events and major mobility disability (MMD), gait speed, and physical activity levels. Pneumonia events, classified as inpatient or outpatient, were assessed by self-report during longitudinal follow-up. MMD was measured by the inability to complete a 400-m walk test, or other proxies, as a binary outcome and separately analyzed as “short-term” and “long-term” MMD. Short-term MMD was defined as MMD occurring in the assessment period immediately following (between 1-day to 6-months after) a pneumonia event and long-term was in the following assessment period (6 to 12 months after the event). Short- and long-term gait speed was similarly recorded during the walk test in meters per second (m/s) and measured on a linear scale. Physical activity levels were captured via accelerometry and shown visually. Mixed-effects repeated measures regression adjusted for intervention assignment, baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, n = 174 (10.7%) had a pneumonia event of which 80 (46% of events) were hospitalized. Those with pneumonia during follow-up had higher baseline medication use, prior hospitalizations, and higher prevalence of lung disorders but similar baseline functioning. Pneumonia hospitalization was associated with a 4-fold increase [OR = 4.1 (3.2–5.0)] and outpatient events were associated with a 2-fold increase [OR = 2.6 (2.1–3.1)] in the odds of short-term MMD. Pneumonia hospitalizations, but not outpatient events, were associated with a nearly 10% decrement in short-term gait speed. Pneumonia events were not associated with either long-term MMD or gait speed outcomes. Physical activity levels decreased from baseline immediately following the pneumonia episode (10–30% reductions) and returned to baseline after 6 months. These results emphasize the importance of managing pneumonia risk factors to prevent disease in order to maintain physical independence and activity in older adults.
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Rosenberg DE, Rillamas-Sun E, Bellettiere J, LaMonte M, Buchner DM, Di C, Hunt J, Marshall S, Stefanick M, Zhang Y, LaCroix AZ. Accelerometer-Measured Sedentary Patterns are Associated with Incident Falls in Older Women. J Am Geriatr Soc 2021; 69:718-725. [PMID: 33252141 PMCID: PMC8020891 DOI: 10.1111/jgs.16923] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Falls cause significant problems for older adults. Sedentary time is associated with lower physical function and could increase the risk for falls. DESIGN Prospective study. SETTING Sites across the United States. PARTICIPANTS Older women (N = 5,545, mean age 79 years) from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS Accelerometers worn at the hip for up to 1 week collected measures of daily sedentary time and the mean sedentary bout duration, a commonly used metric for sedentary accumulation patterns. For up to 13 months after accelerometer wear, women reported daily whether they had fallen on monthly calendars. RESULTS In fully adjusted models, the incident rate ratios (95% confidence interval) for quartiles 1 (lowest), 2, 3, and 4 of sedentary time respectively were 1.0 (ref.), 1.07 (0.93-1.24), 1.07 (0.91-1.25), and 1.14 (0.96-1.35; P-trend = .65) and for mean sedentary bout duration was 1.0 (ref.), 1.05 (0.92-1.21), 1.02 (0.88-1.17), and 1.17 (1.01-1.37; P-trend = .01), respectively. Women with a history of two or more falls had stronger associations between sedentary time and falls incidence compared with women with a history of no or one fall (P for interaction = .046). CONCLUSIONS Older women in the highest quartile of mean sedentary bout duration had a significantly increased risk of falling. Women with a history of frequent falling may be at higher risk for falling if they have high sedentary time. Interventions testing whether shortening total sedentary time and/or sedentary bouts lowers fall risk are needed to confirm these observational findings.
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Affiliation(s)
- Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - John Bellettiere
- Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Michael LaMonte
- Department of Epidemiology and Environmental health, State University of New York, Buffalo, New York, USA
| | - David M Buchner
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julie Hunt
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Stephen Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marcia Stefanick
- Medicine - Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Yuzheng Zhang
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Family Medicine and Public Health, University of California, San Diego, California, USA
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Glass NL, Bellettiere J, Jain P, LaMonte MJ, LaCroix AZ. Evaluation of Light Physical Activity Measured by Accelerometry and Mobility Disability During a 6-Year Follow-up in Older Women. JAMA Netw Open 2021; 4:e210005. [PMID: 33620446 PMCID: PMC7903251 DOI: 10.1001/jamanetworkopen.2021.0005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Almost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous-intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown. OBJECTIVE To determine the association of light-intensity physical activity and incident mobility disability among older women. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health study, an ancillary study of the Women's Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women's Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability, and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019. EXPOSURES Light-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days. MAIN OUTCOMES AND MEASURES Incident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up. RESULTS A total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction). CONCLUSIONS AND RELEVANCE In this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.
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Affiliation(s)
- Nicole L Glass
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Purva Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
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10
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Fraysse F, Post D, Eston R, Kasai D, Rowlands AV, Parfitt G. Physical Activity Intensity Cut-Points for Wrist-Worn GENEActiv in Older Adults. Front Sports Act Living 2021; 2:579278. [PMID: 33521631 PMCID: PMC7843957 DOI: 10.3389/fspor.2020.579278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: This study aims to (1) establish GENEActiv intensity cutpoints in older adults and (2) compare the classification accuracy between dominant (D) or non-dominant (ND) wrist, using both laboratory and free-living data. Methods: Thirty-one older adults participated in the study. They wore a GENEActiv Original on each wrist and performed nine activities of daily living. A portable gas analyzer was used to measure energy expenditure for each task. Testing was performed on two occasions separated by at least 8 days. Some of the same participants (n = 13) also wore one device on each wrist during 3 days of free-living. Receiver operating characteristic analysis was performed to establish the optimal cutpoints. Results: For sedentary time, both dominant and non-dominant wrist had excellent classification accuracy (sensitivity 0.99 and 0.97, respectively; specificity 0.91 and 0.86, respectively). For Moderate to Vigorous Physical Activity (MVPA), the non-dominant wrist device had better accuracy (ND sensitivity: 0.90, specificity 0.79; D sensitivity: 0.90, specificity 0.64). The corresponding cutpoints for sedentary-to-light were 255 and 375 g · min (epoch independent: 42.5 and 62.5 mg), and those for the light-to-moderate were 588 and 555 g · min (epoch-independent: 98.0 and 92.5 mg) for the non-dominant and dominant wrist, respectively. For free-living data, the dominant wrist device resulted in significantly more sedentary time and significantly less light and MVPA time compared to the non-dominant wrist.
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Affiliation(s)
- François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Roger Eston
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Daiki Kasai
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Alex V Rowlands
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom.,Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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11
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Li P, Lim ASP, Gao L, Hu C, Yu L, Bennett DA, Buchman AS, Hu K. More random motor activity fluctuations predict incident frailty, disability, and mortality. Sci Transl Med 2020; 11:11/516/eaax1977. [PMID: 31666398 DOI: 10.1126/scitranslmed.aax1977] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
Mobile healthcare increasingly relies on analytical tools that can extract meaningful information from ambulatory physiological recordings. We tested whether a nonlinear tool of fractal physiology could predict long-term health consequences in a large, elderly cohort. Fractal physiology is an emerging field that aims to study how fractal temporal structures in physiological fluctuations generated by complex physiological networks can provide important information about system adaptability. We assessed fractal temporal correlations in the spontaneous fluctuations of ambulatory motor activity of 1275 older participants at baseline, with a follow-up period of up to 13 years. We found that people with reduced temporal correlations (more random activity fluctuations) at baseline had increased risk of frailty, disability, and all-cause death during follow-up. Specifically, for 1-SD decrease in the temporal activity correlations of this studied cohort, the risk of frailty increased by 31%, the risk of disability increased by 15 to 25%, and the risk of death increased by 26%. These incidences occurred on average 4.7 years (frailty), 3 to 4.2 years (disability), and 5.8 years (death) after baseline. These observations were independent of age, sex, education, chronic health conditions, depressive symptoms, cognition, motor function, and total daily activity. The temporal structures in daily motor activity fluctuations may contain unique prognostic information regarding wellness and health in the elderly population.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew S P Lim
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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12
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Arnal-GÓmez A, Navarro-Molina C, EspÍ-LÓpez GV. Bibliometric analysis of core journals which publish articles of physical therapy on aging. Phys Ther Res 2020; 23:216-223. [PMID: 33489662 PMCID: PMC7814227 DOI: 10.1298/ptr.e10024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Increase in population's longevity has led to considerable efforts worldwide on physical therapy aging research. The aim of this study is to identify which are the main scientific journals, as well as the most productive authors, institutions and keywords related to the journals, that have published about physical therapy and aging. METHODS Original articles published from 1990 to 2014 were retrieved from the bibliographic database Science Citation Index Expanded of Web of Science Core Collection. After standardization of the bibliographic information, a series of bibliometric indicators was obtained regarding authors, institutions, citation and keywords of the core journals using bibliometric software. The PAJEK network analysis program was used for graphic representation. RESULTS A total of 2,237 original articles are included in this analysis. The number of identified journals is 573, with an average growth of publishing journals throughout the studied period of 9.41%. Bradford's distribution shows 12 core journals, out of which 41.67% have published constantly all throughout the 25-year period, being the most productive one Physical Therapy. Fritz, Julie M is the most productive author, and University of Sydney the most productive institution. The keyword exercise is used in an outstanding way. CONCLUSIONS The productivity trends provided an indication of the greater scientific interest of physical therapy in aging as a line of research. Collectively, the data indicated that physical therapy-specific journals are being consolidated but non-specific are still a significant research source, and that a fundamental element of their research includes exercise and movement.
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Affiliation(s)
| | - Carolina Navarro-Molina
- Superior Council of Scientific Investigations. Institute of Agrochemistry and Food Technology, Catedrático Agustín Escardino. Paterna, Valencia
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13
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An Optimal Self-Report Physical Activity Measure for Older Adults: Does Physical Function Matter? J Aging Phys Act 2020; 29:193-199. [PMID: 32788419 DOI: 10.1123/japa.2019-0380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
The authors compared two self-report measures of physical activity, the Physical Activity Scale for the Elderly (PASE) and the Community Healthy Activities Model Program for Seniors (CHAMPS), against the device-derived SenseWear Armband (SWA), to identify a recommended self-report tool to measure physical activity in older adults across physical function levels. A total of 65 community-dwelling older adults completed the PASE, CHAMPS, and seven full days of SWA wear. The authors measured physical function using the modified short physical performance battery (SPPB) and a usual-paced 6-m walk. Age- and sex-adjusted Spearman correlations showed that CHAMPS and SWA were correlated in higher functioning participants (SPPB: ρ = .33, p = .03; gait speed: ρ = .40, p = .006) and also correlated in lower functioning participants for SPPB (ρ = .70, p = .003) only. PASE and SWA were not significantly correlated across physical function. When an objective measure of physical activity is not practical, the CHAMPS questionnaire appears to capture physical activity for older adults across physical function levels.
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14
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Parfitt G, Post D, Kalisch Ellett L, Lim R, Penington A, Corlis M, Roughead E. A cross-sectional assessment of the relationship between sedative medication and anticholinergic medication use and the movement behaviour of older adults living in residential aged care. PeerJ 2020; 8:e9605. [PMID: 32775054 PMCID: PMC7384436 DOI: 10.7717/peerj.9605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/04/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives Medications with anticholinergic or sedative effects are frequently used by older people but can increase risk of falls and adverse events; however, less is known about their effect on movement behaviour. Here we examine the cross-sectional association between medication use and movement behaviour in older adults living in residential aged care. Materials and Methods Twenty-eight older adults living in residential aged care in metropolitan Australia participated. Medication data were collected from participants’ medical charts and sedative load and anticholinergic burden were determined. Seven-day movement behaviour was objectively assessed by a wrist-worn triaxial accelerometer. Raw accelerations were converted to sleep, sedentary time, and time in light, moderate, and moderate-to-vigorous physical activity. To explore the relationship between medication and movement behaviour, Spearman’s Rho correlations were conducted, as the data were not normally distributed. Results Analyses indicated that while anticholinergic burden was not associated with movement behaviour, sedative load was negatively correlated with a number of variables, accounting for 14% variance in moderate-to-vigorous physical activity (MVPA), and 17% in the bout length of MVPA (p < .02). Conclusion The findings of this study showed a negative association between sedative load, due to medicines, and an individual’s movement behaviour. The impact of this could be a reduction in the ability of this population to maintain or improve their functional mobility, which may overshadow any benefits of the medicine in some circumstances.
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Affiliation(s)
- Gaynor Parfitt
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Dannielle Post
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | | | - Megan Corlis
- Helping Hand Organisation, Adelaide, South Australia, Australia
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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15
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Voss ML, Pope JP, Larouche R, Copeland JL. Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living. BMC Geriatr 2020; 20:277. [PMID: 32762644 PMCID: PMC7409493 DOI: 10.1186/s12877-020-01647-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This “low movement” environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted. Methods “Stand When You Can” (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility. Results There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although device-measured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen’s d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical. Conclusion This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary. Trial registration Name of Clinical Trial Registry: clinicaltrials.gov Trial Registration number: NCT04458896. Date of registration: July 8, 2020. (Retrospectively registered).
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Affiliation(s)
- M L Voss
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - J P Pope
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - R Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
| | - J L Copeland
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
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16
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Dos Santos VR, Alberto Gobbo L. Occupational and leisure-time physical activity decreases the odds of disability in older adults: Prospective study. Eur J Sport Sci 2020; 21:927-934. [PMID: 32615060 DOI: 10.1080/17461391.2020.1790669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractAging decreases physical function which can increase dependence in activities of daily living (ADL) and disability. However, physical activity (PA) may improve physical function and prevent disability in older adults. In addition, it is important to emphasize that research concerning the domains in which PA is practiced and the benefits for physical function of older adults is also important for the elaboration of preventative health measures for this population. Thus, the aim of this study was to analyse the association of total PA and PA in different domains and odds of disability in older adults in a 24-month follow-up. The study included 211 older adults, aged ≥60 years (72 ± 7 years, 72% women). Handgrip strength was measured using a digital dynamometer, gait speed and chair stand by functional tests. PA and dependence in ADL were self-reported. Older adults who remained sufficiently active in the occupational (OR:0.11;CI95%:0.01-0.93, OR:0.21;CI95%:0.07-0.69, and OR:0.13;CI95%:0.05-0.34) domain presented protection for high dependence in basic (BADL), instrumental (IADL) and advanced (AADL), respectively, as well as in total ADL (OR:0.25;CI95%:0.07-0.92). Older adults who remained sufficiently active in the leisure-time exercise (OR:0.28;CI95%:0.11-0.72, OR:0.44;CI95%:0.20-0.93 and OR:0.15;CI95%:0.04-0.49) domain presented protection for high dependence in IADL, AADL and total ADL, respectively. Moreover, older adults who remained sufficiently active in total PA (OR:0.11;CI95%:0.01-0.94, OR:0.30;CI95%:0.11-0.80 and OR:0.21CI95%:0.10-0.46) presented protection for high dependence in BADL, IADL and AADL, respectively, as well as in total ADL (OR:0.28;CI95%:0.09-0.86). The odds of disability are lower in older adults who are sufficiently active, especially in occupational and leisure-time exercise domains.
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Affiliation(s)
- Vanessa Ribeiro Dos Santos
- Skeletal Muscle Assessment Laboratory, LABSIM, Department of Physical Education, School of Technology and Sciences, São Paulo State University, UNESP, Presidente Prudente, Sao Paulo, Brazil.,Post-Graduation Program in Movement Sciences, School of Technology and Sciences, São Paulo State University, UNESP, Presidente Prudente, Sao Paulo, Brazil
| | - Luís Alberto Gobbo
- Skeletal Muscle Assessment Laboratory, LABSIM, Department of Physical Education, School of Technology and Sciences, São Paulo State University, UNESP, Presidente Prudente, Sao Paulo, Brazil.,Post-Graduation Program in Movement Sciences, School of Technology and Sciences, São Paulo State University, UNESP, Presidente Prudente, Sao Paulo, Brazil
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17
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Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study. Rehabil Res Pract 2020; 2020:5907652. [PMID: 32411473 PMCID: PMC7204137 DOI: 10.1155/2020/5907652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023] Open
Abstract
Background Physical activity in elderly patients is crucial for recovery from proximal femoral fractures. Considering the limited possibilities for objective measurement, we aimed to evaluate the use of an accelerometer in this population to determine activity's association with functional independence, quality of life, and course of recovery. Methods 52 patients undergoing operative treatment for proximal femur fractures (81.3 ± 7.5 years) were included in a prospective cohort study. 12 patients with fall but without fracture of the lower extremities (80.8 ± 9.5 years) served as control. An Axivity AX3 tracker continuously recorded signal vector magnitudes during the hospital stay. Additionally, 2 ± 1 and 8 ± 3 days (time point 1 and 2) after operation EuroQol-5D and Barthel-20 indices were evaluated. Results Physical activity increased in all patients with time. Multiple regression analyses revealed that a high Barthel-20 before fracture, a low age, a high body mass index, high albumin, and low C-reactive protein levels were independent predictors for high physical activity at time point 1 (p < 0.05). Physical activity correlated significantly with EuroQol-5D and Barthel-20 at time point 1 and 2 (p < 0.02). Furthermore, physical activity at time point 1 predicted EuroQol-5D, physical activity, and Barthel-20 at time point 2 (p < 0.01). A multiple regression demonstrated equal physical activity in patients with or without a hip fracture. Conclusions Accelerometer signals correlate with postoperative physical activity, Barthel-20 and quality of life in elderly patients. Physical activity is thereby positively influenced by a high prefall functional independence and a good nutrition status. A timely and adequate operation provided, there is no difference between patients with or without a fracture. This trial is registered with DRKS 00011934 on 10th April 2017.
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18
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Savikangas T, Tirkkonen A, Alen M, Rantanen T, Fielding RA, Rantalainen T, Sipilä S. Associations of physical activity in detailed intensity ranges with body composition and physical function. a cross-sectional study among sedentary older adults. Eur Rev Aging Phys Act 2020; 17:4. [PMID: 31998411 PMCID: PMC6982388 DOI: 10.1186/s11556-020-0237-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is crucial to maintain older adults' health and functioning, but the health benefits of particular activity intensities remain unclear. The aim of this cross-sectional study was to peruse the distribution of physical activity, and to investigate the associations of particular physical activity intensities with body composition and physical function among older adults. METHODS The sample comprised of 293 community-dwelling sedentary or at most moderately active older adults (42% men, mean age 74 ± 4 years). Physical activity was measured with a hip-worn tri-axial accelerometer over seven consecutive days, and investigated in detailed intensity range and in categories of sedentary, light and moderate-to-vigorous activity. Fat percent and appendicular lean mass were measured with DXA. Physical function was assessed by six-minutes walking test (6-min walk), maximal walking speed over 10 m (10-m walk) and Short Physical Performance Battery (SPPB). Associations were estimated with partial correlation adjusted for sex and age. RESULTS Participants spent on average 602 min per day sedentary, 210 min in light activity and 32 min in moderate-to-vigorous activity. Light and moderate-to-vigorous activity were negatively associated with fat percent (r = - 0.360 and r = - 0.384, respectively, p < 0.001 for both), and positively with SPPB, 10-m walk and 6-min walk results (r = 0.145-0.279, p < 0.01, for light and r = 0.220-0.465, p < 0.001, for moderate-to-vigorous activity). In detailed investigation of the intensity range, associations of physical activity with fat percent, 6-min walk and 10-m walk were statistically significant from very light intensity activity onward, whereas significant associations between physical activity and SPPB were observed mostly at higher end of the intensity range. Sedentary time was positively associated with fat percent (r = 0.251, p < 0.001) and negatively with 6-min walk (r = - 0.170, p < 0.01). CONCLUSION Perusing the physical activity intensity range revealed that, among community-dwelling sedentary or at most moderately active older adults, physical activity of any intensity was positively associated with lower fat percent and higher walking speed over long and short distances. These findings provide additional evidence of the importance of encouraging older adults to engage in physical activity of any intensity. More intervention studies are required to confirm the health benefits of light-intensity activity.
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Affiliation(s)
- Tiina Savikangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35 (viv256), FIN-40014 Jyväskylä, Finland
| | - Anna Tirkkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35 (viv256), FIN-40014 Jyväskylä, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Taina Rantanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35 (viv256), FIN-40014 Jyväskylä, Finland
| | - Roger A. Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA USA
| | - Timo Rantalainen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35 (viv256), FIN-40014 Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35 (viv256), FIN-40014 Jyväskylä, Finland
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19
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Physical activity is associated with functional capacity of older women with osteosarcopenic obesity: 24-month prospective study. Eur J Clin Nutr 2019; 74:912-919. [PMID: 31551532 DOI: 10.1038/s41430-019-0505-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES Physical activity (PA) could be effective in the prevention of functional disability in older women, especially for those with body composition abnormalities. The aim this study was to analyze the association of total PA and in different domains with physical function and functional capacity in older women with or without osteosarcopenic obesity (OSO), as well as to assess the risk of functional disability in osteosarcopenic obesity older women insufficiently active. SUBJECTS/METHODS The study included 152 Brazilian older women, aged 60 years and older. Body composition was measured by dual energy X-ray absorptiometry (DXA) and physical function by physical tests. Functional capacity and PA were self-reported. RESULTS In older women without OSO, the practice of leisure-time exercise (β:-0.23; 95%CI -0.40 to -0.06) and total PA (β:-0.40; 95%CI -0.57 to -0.23) is inversely associated with dependence in ADL. In older women with OSO, the practice of leisure-time exercise was inversely associated with physical function (β:0.88; 95%CI 0.31-1.46) and functional capacity (β:-1.05; 95%CI 1.64 to -0.45), while total PA (β:-1.03; 95%CI -1.93 to -0.13) was inversely associated with functional capacity, independent of control variables. In addition, older women with OSO who remained insufficiently active in leisure-time exercise (HR:2.28; 95%CI 1.04-4.99) and locomotion (HR:2.62; 95%CI 1.28-5.36) domains presented risk for functional disability. CONCLUSIONS PA is inversely associated with physical function and functional capacity in older women with or without OSO, and older women with OSO who are insufficiently active in leisure-time exercise and locomotion domains presented a higher risk for functional disability.
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Webber SC, Ripat JD, Pachu NS, Strachan SM. Exploring physical activity and sedentary behaviour: perspectives of individuals with osteoarthritis and knee arthroplasty. Disabil Rehabil 2019; 42:1971-1978. [DOI: 10.1080/09638288.2018.1543463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Sandra C. Webber
- Rady Faculty of Health Sciences, Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Jacquie D. Ripat
- Rady Faculty of Health Sciences, Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Navjot S. Pachu
- Applied Health Sciences Program, University of Manitoba, Winnipeg, Canada
| | - Shaelyn M. Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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Wanigatunga AA, Gill TM, Marsh AP, Hsu FC, Yaghjyan L, Woods AJ, Glynn NW, King AC, Newton RL, Fielding RA, Pahor M, Manini TM. Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults. J Am Geriatr Soc 2018; 67:261-268. [PMID: 30452084 DOI: 10.1111/jgs.15631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education. DESIGN Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013. PARTICIPANTS Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341). MEASUREMENTS Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment. RESULTS Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26). CONCLUSION Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization. J Am Geriatr Soc 67:261-268, 2019.
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Affiliation(s)
- Amal A Wanigatunga
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Thomas M Gill
- Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Adam J Woods
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California.,Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Robert L Newton
- Population and Public Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
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Ezeugwu VE, Manns PJ. The Feasibility and Longitudinal Effects of a Home-Based Sedentary Behavior Change Intervention After Stroke. Arch Phys Med Rehabil 2018; 99:2540-2547. [PMID: 29981314 DOI: 10.1016/j.apmr.2018.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/25/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary effects of a sedentary behavior change intervention on sedentary behavior, physical activity, function, and quality of life following inpatient stroke rehabilitation. DESIGN Single-group, longitudinal, intervention study with 1-week baseline, 8-week intervention, and 8-week follow-up. SETTING Community. PARTICIPANTS Individuals (N=34) with subacute stroke recruited within 1 month following discharge home from inpatient stroke rehabilitation. INTERVENTION STand Up Frequently From Stroke (STUFFS) intervention that involved interrupting and replacing sedentary time with upright activities (standing and walking) at home and in the community. A motivational wrist-worn activity monitor was used throughout the intervention. MAIN OUTCOME MEASURES Primary outcomes were reach (enrolled/eligible), retention (completed/enrolled), satisfaction, and compliance with the intervention. Secondary outcomes were sedentary behavior, physical activity, lower extremity impairment, self-efficacy, cognitive status, mobility, and quality of life outcomes. RESULTS Forty-four participants were eligible to participate. Of the eligible, 34 (77.3%; time since stroke onset: 3.5±1.1 months) were enrolled at baseline and 32 (94.1%) of the enrolled had complete data at follow-up. Satisfaction with the program was 89%. Sedentary time decreased by 54.2±13.7 minutes per day (P<.01) at postintervention and 26.8±14.0 minutes per day (P=.07) at follow-up, relative to baseline. There were significant improvements in walking speed, cognition, impairment, and self-reported quality of life over time (P<.05). Self-efficacy was high across all time points. The number of steps and time spent stepping were not statistically different across both time periods. CONCLUSIONS The program was feasible to deliver in the home environment with good retention and satisfaction. Further research is required to test the effectiveness of the STUFFS program compared with usual care.
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Affiliation(s)
- Victor E Ezeugwu
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Cochrane SK, Chen SH, Fitzgerald JD, Dodson JA, Fielding RA, King AC, McDermott MM, Manini TM, Marsh AP, Newman AB, Pahor M, Tudor-Locke C, Ambrosius WT, Buford TW. Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study. J Am Heart Assoc 2017; 6:JAHA.117.007215. [PMID: 29197830 PMCID: PMC5779035 DOI: 10.1161/jaha.117.007215] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Data are sparse regarding the value of physical activity (PA) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. Methods and Results Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. Conclusions Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.
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Affiliation(s)
| | | | | | - John A Dodson
- New York University School of Medicine, New York, NY
| | | | | | | | - Todd M Manini
- University of Florida College of Medicine, Gainesville, FL
| | | | | | - Marco Pahor
- University of Florida College of Medicine, Gainesville, FL
| | | | | | - Thomas W Buford
- Department of Medicine, University of Alabama at Birmingham, AL
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