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Choudhury R, Park JH, Banarjee C, Coca MG, Fukuda DH, Xie R, Stout JR, Thiamwong L. Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults. FRONTIERS IN AGING 2024; 5:1284694. [PMID: 38660534 PMCID: PMC11040232 DOI: 10.3389/fragi.2024.1284694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.
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Affiliation(s)
- Renoa Choudhury
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - Joon-Hyuk Park
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
| | - Chitra Banarjee
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Grisales Coca
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - David H. Fukuda
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Jeffrey R. Stout
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Ladda Thiamwong
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
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Schene MR, Wyers CE, Driessen JHM, Vranken L, Meijer K, van den Bergh JP, Willems HC. The "Can Do, Do Do" Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service. J Pers Med 2024; 14:337. [PMID: 38672964 PMCID: PMC11050804 DOI: 10.3390/jpm14040337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
The "can do, do do" framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can't do) and physical activity (PA, measured by accelerometer, do do/don't do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the "can do, do do" group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the "can do, do do" framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. "Can't do, don't do" group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45-1.23), first fracture HR: 0.58 (95% CI: 0.24-1.41), and mortality HR: 1.19 (95% CI: 0.54-6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable.
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Affiliation(s)
- Merle R. Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Johanna H. M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM School for Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C. Willems
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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3
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Kwok WS, Khalatbari-Soltani S, Dolja-Gore X, Byles J, Tiedemann A, Pinheiro MB, Oliveira JS, Sherrington C. Leisure-Time Physical Activity and Falls With and Without Injuries Among Older Adult Women. JAMA Netw Open 2024; 7:e2354036. [PMID: 38294812 PMCID: PMC10831579 DOI: 10.1001/jamanetworkopen.2023.54036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Falls and fall-related injuries are common among older adults. Older adults are recommended to undertake 150 to 300 minutes of physical activity per week for health benefits; however, the association between meeting the recommended level of physical activity and falls is unclear. Objectives To examine whether associations exist between leisure-time physical activity and noninjurious and injurious falls in older women. Design, Setting, and Participants This population-based cohort study used a retrospective analysis of the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH participants born from 1946 to 1951 who completed follow-up questionnaires in 2016 (aged 65-70 years) and 2019 (aged 68-73 years) were included. Statistical analysis was performed from September 2022 to February 2023. Exposure Self-reported weekly amounts (0, 1 to <150, 150 to <300, ≥300 minutes) and types of leisure-time physical activity, including brisk walking and moderate- and vigorous-intensity physical activity, in the 2016 survey. Main outcome and measures Noninjurious and injurious falls in the previous 12 months reported in the 2019 survey. Associations between leisure-time physical activity and falls were quantified using directed acyclic graph-informed multinomial logistic regression and presented in odds ratios (ORs) and 95% CIs. Results This study included 7139 women (mean [SD] age, 67.7 [1.5] years). Participation in leisure-time physical activity at or above the level recommended by the World Health Organization (150 to <300 min/wk) was associated with reduced odds of noninjurious falls (150 to <300 min/wk: OR, 0.74 [95% CI, 0.59-0.92]; ≥300 min/wk: OR, 0.66 [95% CI, 0.54-0.80]) and injurious falls (150 to <300 min/wk: OR, 0.70 [95% CI, 0.56-0.88]; ≥300 min/wk: OR, 0.77 [95% CI, 0.63-0.93]). Compared with women who reported no leisure-time physical activity, those who reported brisk walking (OR, 0.83 [95% CI, 0.70-0.97]), moderate leisure-time physical activity (OR, 0.81 [95% CI, 0.70-0.93]), or moderate-vigorous leisure-time physical activity (OR, 0.84 [95% CI, 0.70-0.99]) had reduced odds of noninjurious falls. No statistically significant associations were found between the types of leisure-time physical activity and injurious falls. Conclusions and Relevance Participation in leisure-time physical activity at the recommended level or above was associated with lower odds of both noninjurious and injurious falls. Brisk walking and both moderate and moderate-vigorous leisure-time physical activity were associated with lower odds of noninjurious falls.
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Affiliation(s)
- Wing S. Kwok
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), The University of Sydney, Sydney, New South Wales, Australia
| | - Xenia Dolja-Gore
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anne Tiedemann
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Marina B. Pinheiro
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Juliana S. Oliveira
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Liang C, Shi L, Li B, He Z. The Mediating Role of Sarcopenia in the Association between Physical Activity and Falls among Chinese Older Adults: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:3146. [PMID: 38132036 PMCID: PMC10743279 DOI: 10.3390/healthcare11243146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023] Open
Abstract
Physical inactivity and sarcopenia are potentially modifiable risk factors for falls in older adults, but the strength of the association between physical activity (PA), sarcopenia, and falls in Chinese older adults is unclear. This study sought to investigate the potential mediation mechanism relationship in the connection between PA, sarcopenia, including its elements (muscle strength, physical performance, and skeletal muscle mass), and falls among Chinese older people. The subjects were 3592 community-dwelling Chinese aged 60 or over, selected from the China Health and Retirement Longitudinal Study (CHARLS). PA was evaluated through the International Physical Activity Questionnaire (IPAQ), and sarcopenia was determined through the Asian Working Group on Sarcopenia (AWGS) 2019 guidelines. We employed logistic regression to explore the link between physical activity, sarcopenia, and falls. Additionally, we applied Karlson, Holm and Breen's (KHB) method to estimate two different mediation models. The results demonstrated that PA lowers the risk of falls [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.48-0.61], whereas sarcopenia increases the risk of falls (OR 1.34, 95% CI 1.16-1.55). Sarcopenia mediated the association between PA and falls, explaining a total of 2.69% of the association (indirect effect = -0.02). PA also had a significant mediating effect on the association between sarcopenia and falls, explaining a total of 20.12% of the association (indirect effect = 0.06). The proportion mediated by sarcopenia was 2.69% for PA and falls (indirect effect = -0.02). Our findings suggest that PA and sarcopenia have a direct effect on falls as well as an indirect effect through each other. Enhancing PA levels and preventing sarcopenia may help prevent falls in older adults.
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Affiliation(s)
| | - Lei Shi
- Sports Centre, Xi’an Jiaotong University, Xi’an 710049, China; (C.L.); (B.L.); (Z.H.)
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Zhao C, Wang T, Yu D, Li W. Physical exercise habits are related with reduced prevalence of falling among elderly women in China. BMC Womens Health 2023; 23:653. [PMID: 38066469 PMCID: PMC10704620 DOI: 10.1186/s12905-023-02808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Although some studies have examined the association between exercise and falls, most have focused on specific exercises, and the results have been inconsistent. In addition, there is a lack of evidence on elderly Chinese women who have different living and exercise habits compared to those in other countries. Therefore, this study aimed to investigate whether physical exercise is associated with falls in elderly Chinese women. METHODS This cross-sectional study included 1429 elderly Chinese women with a mean age of 69.2 years. Information on physical exercise habits and fall experiences was collected using a self-report questionnaire. Logistic regression models were used to analyze the association between physical exercise habits and falls. RESULTS The results showed that 15% participants had a fall in the past year. After adjusting for confounding factors, the odd ratios (ORs) and 95% Confidence Intervals (CIs) for fall experiences across categories of exercise frequency were as follow: 1 (reference) for no exercise behavior, 0.50 (0.29, 0.85) for exercise 1 to 5 times a week, and 0.37 (0.25, 0.55) for exercise more than 6 times a week. Furthermore, the ORs (95% CIs) across categories of exercise insistence were 1 (reference) for less than 1 year, 0.78 (0.37, 1.65) for 1 to 3 years, and 0.38 (0.20, 0.74) for more than 3 years. In terms of exercise duration, the ORs (95% CIs) for < 1 h/day, 1-2 h/day, and > 2 h/day were 1 (reference), 0.85 (0.53, 1.36), and 2.80 (1.30, 6.05). Unlike other variables, longer exercise duration was associated unfavorably with falls. CONCLUSION Physical exercise habits were associated with falls in elderly Chinese women. Keeping a proper exercise habit may contribute to lower risk of falling in elderly women.
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Affiliation(s)
- Cuiqing Zhao
- Division of Physical Education, Myongji University, Seoul, 03674, South Korea.
| | - Tongling Wang
- Institute of Physical Education, Huzhou University, Huzhou, Zhejiang Province, 313000, People's Republic of China.
| | - Dawei Yu
- Institute of Physical Education, Huzhou University, Huzhou, Zhejiang Province, 313000, People's Republic of China
| | - Wang Li
- Department of Physical Education, Huaiyin Institute of Technology, Huaian, Jiangsu Province, 223003, People's Republic of China
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Smith MC, O'Loughlin J, Karageorgiou V, Casanova F, Williams GKR, Hilton M, Tyrrell J. The genetics of falling susceptibility and identification of causal risk factors. Sci Rep 2023; 13:19493. [PMID: 37945700 PMCID: PMC10636011 DOI: 10.1038/s41598-023-44566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Falls represent a huge health and economic burden. Whilst many factors are associated with fall risk (e.g. obesity and physical inactivity) there is limited evidence for the causal role of these risk factors. Here, we used hospital and general practitioner records in UK Biobank, deriving a balance specific fall phenotype in 20,789 cases and 180,658 controls, performed a Genome Wide Association Study (GWAS) and used Mendelian Randomisation (MR) to test causal pathways. GWAS indicated a small but significant SNP-based heritability (4.4%), identifying one variant (rs429358) in APOE at genome-wide significance (P < 5e-8). MR provided evidence for a causal role of higher BMI on higher fall risk even in the absence of adverse metabolic consequences. Depression and neuroticism predicted higher risk of falling, whilst higher hand grip strength and physical activity were protective. Our findings suggest promoting lower BMI, higher physical activity as well as psychological health is likely to reduce falls.
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Affiliation(s)
- Matt C Smith
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jessica O'Loughlin
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Vasileios Karageorgiou
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Francesco Casanova
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Genevieve K R Williams
- Public Health and Sports Sciences Department, University of Exeter Medical School, Exeter, UK
| | - Malcolm Hilton
- Clinical and Biomedical Science, University of Exeter Medical School, Exeter, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, College of Biomedical and Clinical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Schene MR, Meijer K, Cheung D, Willems HC, Driessen JHM, Vranken L, van den Bergh JP, Wyers CE. Physical Functioning in Patients with a Recent Fracture: The "Can Do, Do Do" Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors. Calcif Tissue Int 2023:10.1007/s00223-023-01090-3. [PMID: 37367955 PMCID: PMC10371931 DOI: 10.1007/s00223-023-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the "can do, do do" framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can't do/can do) and PA by accelerometer (don't do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) "can't do, don't do"; (2) "can do, don't do"; (3) "can't do, do do"; (4) "can do, do do". Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% "can't do, don't do"; 3.0% "can do, don't do"; 19.3% "can't do, do do"; 69.5% "can do, do do". For the "can't do" group the OR for low PA was 9.76 (95% CI: 4.82-19.80). Both the "can't do, don't do" and "can't do, do do" group differed significantly compared to the "can do, do do" group on several fall and fracture risk factors and had lower physical performance. The "can do, do do" framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% "can't do, but "do do" while having a high prevalence of fall risk factors compared to persons that "can do, do do", which may indicate this group is prone to fall.
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Affiliation(s)
- M R Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - K Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - D Cheung
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - H C Willems
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, The Netherlands
| | - J H M Driessen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School of Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - L Vranken
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - J P van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C E Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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8
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Liu X, Abudukeremu A, Jiang Y, Cao Z, Wu M, Zheng K, Ma J, Sun R, Chen Z, Chen Y, Zhang Y, Wang J. Association of motor index scores with fall incidence among community-dwelling older people. BMC Geriatr 2022; 22:1008. [PMID: 36585625 PMCID: PMC9805168 DOI: 10.1186/s12877-022-03680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several kinds of motor dysfunction have been studied for predicting future fall risk in community-dwelling older individuals. However, no study has tested the ability of the fine motor index (FINEA) and gross motor index (GROSSA) to predict the risk of falling, as well as the specific fall type. OBJECTIVE We investigated the associations of FINEA/GROSSA scores with fall risk, explained falls, and unexplained falls. METHODS A total of 6267 community-dwelling adults aged ≥ 50 years from the Irish Longitudinal Study on Aging (TILDA) cohort were included. First, the associations of FINEA and GROSSA scores with the history of total falls, explained falls and unexplained falls were assessed in a cross-sectional study and further verified in a prospective cohort after 2 years of follow-up by Poisson regression analysis. RESULTS We found that high FINEA and GROSSA scores were positively associated with almost all fall histories (FINEA scores: total falls: adjusted prevalence ratio [aPR] = 1.28, P = 0.009; explained falls: aPR = 1.15, P = 0.231; unexplained falls: aPR = 1.88, P < 0.001; GROSSA scores: total falls: aPR = 1.39, P < 0.001; explained falls: aPR = 1.28, P = 0.012; unexplained falls: aPR = 2.18, P < 0.001) in a cross-sectional study. After 2 years of follow-up, high FINEA scores were associated with an increased incidence of total falls (adjusted rate ratio [aRR] = 1.42, P = 0.016) and explained falls (aRR = 1.51, P = 0.020) but not with unexplained falls (aRR = 1.41, P = 0.209). High GROSSA scores were associated with an increased incidence of unexplained falls (aRR = 1.57, P = 0.041) and were not associated with either total falls (aRR = 1.21, P = 0.129) or explained falls (aRR = 1.07, P = 0.656). Compared with individuals without limitations in either the FINEA or GROSSA, individuals with limitations in both indices had a higher risk of falls, including total falls (aRR = 1.35, P = 0.002), explained falls (aRR = 1.31, P = 0.033) and unexplained falls (aRR = 1.62, P = 0.004). CONCLUSION FINEA scores were positively associated with accidental falls, while GROSSA scores were positively associated with unexplained falls. The group for whom both measures were impaired showed a significantly higher risk of both explained and unexplained falls. FINEA or GROSSA scores should be investigated further as possible tools to screen for and identify community-dwelling adults at high risk of falling.
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Affiliation(s)
- Xiao Liu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ayiguli Abudukeremu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuan Jiang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhengyu Cao
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Maoxiong Wu
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Zheng
- Medical Care Strategic Customer Department, China Merchants Bank Shenzhen Branch, Shenzhen, China
| | - Jianyong Ma
- grid.24827.3b0000 0001 2179 9593Department of Pharmacology and Systems Physiology University of Cincinnati College of Medicine, Cincinnati, USA
| | - Runlu Sun
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiteng Chen
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yangxin Chen
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuling Zhang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jingfeng Wang
- grid.412536.70000 0004 1791 7851Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China ,grid.412536.70000 0004 1791 7851Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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9
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van Gameren M, Hoogendijk EO, van Schoor NM, Bossen D, Visser B, Bosmans JE, Pijnappels M. Physical activity as a risk or protective factor for falls and fall-related fractures in non-frail and frail older adults: a longitudinal study. BMC Geriatr 2022; 22:695. [PMID: 35996101 PMCID: PMC9396867 DOI: 10.1186/s12877-022-03383-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity may be both a risk and protective factor for falls and fall-related fractures. Despite its positive effects on muscle and bone health, physical activity also increases exposure to situations where falls and fractures occur. This paradox could possibly be explained by frailty status. Therefore, the aim of this study was to investigate the associations between physical activity and both falls and fractures, and to determine whether frailty modifies the association of physical activity with falls, and fractures. Methods Data of 311 community-dwelling participants aged 75 years or older from the Longitudinal Aging Study Amsterdam, who participated in a three-year longitudinal study with five nine-monthly measurements between 2015/2016 and 2018/2019. Their mean age was 81.1 (SD 4.8) years and frailty was present in 30.9% of the participants. Physical activity in minutes per day was objectively assessed with an inertial sensor (Actigraph) for seven consecutive days. Falls and fractures were assessed every nine months using self-report during an interview over a follow-up period of three years. Frailty was determined at baseline using the frailty index. Associations were estimated using longitudinal logistic regression analyses based on generalized estimating equations. Results No association between physical activity and falls was found (OR = 1.00, 95% CI: 0.99–1.00). Fall risk was higher in frail compared to non-frail adults (OR = 2.21, 95% CI: 1.33–3.68), but no effect modification was seen of frailty on the association between physical activity and falls. Also no relation between physical activity and fractures was found (OR = 1.00, 95% CI: 0.99–1.01). Fracture risk was higher in frail compared to non-frail adults (OR = 2.81, 95% CI: 1.02–7.75), but also no effect modification of frailty was present in the association between physical activity and fractures. Conclusions No association between physical activity and neither falls nor fractures was found, and frailty appeared not to be an effect modifier. However, frailty was a risk factor for falls and fractures in this population of older adults. Our findings suggest that physical activity can be safely recommended in non-frail and frail populations for general health benefits, without increasing the risk of falls. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03383-y.
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Affiliation(s)
- Maaike van Gameren
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. .,Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Public Health, Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Public Health, Amsterdam, the Netherlands
| | - Daniël Bossen
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Bart Visser
- Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Amsterdam, the Netherlands
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10
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Relationship between the recognition error of dynamic postural control ability and the extent of exercise in middle-aged older women. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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The onset of falls and its effects on perceived social exclusion and loneliness. Evidence from a nationally representative longitudinal study. Arch Gerontol Geriatr 2022; 100:104622. [DOI: 10.1016/j.archger.2022.104622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/15/2022] [Indexed: 12/11/2022]
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12
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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study. J Aging Phys Act 2021; 30:635-645. [PMID: 34627127 DOI: 10.1123/japa.2021-0159] [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: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63-97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.
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13
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E JY, Mihailovic A, Schrack JA, Li T, Friedman DS, West SK, Gitlin LN, Ramulu PY. Characterizing Longitudinal Changes in Physical Activity and Fear of Falling after Falls in Glaucoma. J Am Geriatr Soc 2021; 69:1249-1256. [PMID: 33418602 DOI: 10.1111/jgs.17014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to adverse health consequences associated with falls than those with normal vision. This study characterizes longitudinal changes in objectively measured physical activity and fear of falling (FoF) occurring after various types of falls in visually impaired older adults. DESIGN Prospective cohort study. SETTING Hospital-based enrollment. PARTICIPANTS People with glaucoma or suspected glaucoma. MEASUREMENTS Falls were defined as unintentionally coming to rest on the ground or a lower level, and injurious falls were determined though follow-up calls. Study participants were categorized into three groups-fallers with injurious consequences, fallers without injurious consequences, and non-fallers based on fall status in the first year. Physical activity was assessed by waist-bound accelerometer. FoF was evaluated by questionnaire, with Rasch modeling generating FoF scores where higher scores reflected worse FoF. The 3-year longitudinal changes of physical activity and FoF were modeled using mixed-effects models. RESULTS In linear models fully adjusted for visual field damage and other covariates, physical activity among injurious fallers showed greater annual (per year) declines in daily steps (-425 steps/d, 95% confidence interval (CI) = -793, -57), daily active minutes (-13 min/d, 95% CI = -21, -6), and daily moderate and vigorous physical activity (MVPA) minutes (-3 MVPA minutes/d, 95% CI = -5, 0) over the 3-year period as compared to non-fallers; however, physical activity did not significantly decline among non-injurious fallers. No longitudinal increases in FoF scores were observed in injurious or non-injurious fallers when compared to non-fallers. CONCLUSION Among visually impaired older adults, injurious falls identified prospectively over 12 months contributed to a significant decline in physical activity over a 3-year period, while minimal changes were observed in FoF.
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Affiliation(s)
- Jian-Yu E
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aleksandra Mihailovic
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Kang DW, Wang SM, Um YH, Na HR, Kim NY, Han K, Lee CU, Lim HK. Differential Risk of Incident Fractures Depending on Intensity and Frequency of Physical Activity According to Cognitive Status: A Nationwide Longitudinal Study. Front Med (Lausanne) 2020; 7:572466. [PMID: 33364244 PMCID: PMC7753209 DOI: 10.3389/fmed.2020.572466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Previous studies have demonstrated an increased risk of fractures in subjects with various degrees of cognitive impairments. Recently, there has been growing recognition of the vital effect of physical activity (PA) on delay and prevention of fractures in older adults. Objectives: This study aimed to evaluate the optimal intensity and frequency of PA needed to prevent fractures in cognitively preserved older adults (CP), participants with subjective cognitive decline (SCD), and dementia patients using a large-scale nationwide cohort study. Methods: Data from a nationwide health screening program for individuals at the transitional age of 66 years were used in this study. A total of 968,240 subjects was enrolled, followed from 2007 to 2014, and classified as CP (n = 759,874), SCD (n = 195,365), or dementia group (n = 13,001). Adjusted hazard ratios (aHRs) by demographic and known risk factors for fractures were evaluated to identify the impact of various frequency and intensity PA on the occurrence of hip, vertebral, and limb fractures. Results: In CP participants, the most noticeable reduction of hip and vertebral fracture risk was shown in those performing vigorous-intensity PA at least three times per week. In the SCD group, the risk decrement in hip and vertebral fractures was most prominent in subjects who performed multiple-intensity PAs at least three times a week regardless of intensity. In the dementia group, only high-frequency walking and high-frequency & multiple-intensity PA decreased the risk of hip fractures compared with absence of PA. Conclusion: These findings suggest a role for various PA intensity and frequency levels to prevent hip and vertebral fractures according to cognitive status. Further study is needed to validate the effects of PA intensity and frequency proposed in this study on fractures according to cognitive status.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sheng-Min Wang
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Hae-Ran Na
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Nak-Young Kim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Chang Uk Lee
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Kook Lim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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15
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Association between accelerometer-measured physical activity and falls among community-dwelling older people living in cold, snowy areas. Eur Geriatr Med 2020; 12:91-98. [PMID: 32975746 DOI: 10.1007/s41999-020-00398-9] [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: 06/19/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present study was to investigate the association between falls, including falls on frozen roads, and physical activity among older people living in cold, snowy regions in Japan. METHODS Participants were subjects of the Japan Gerontological Evaluation Study 2016 who had agreed to the Hokkaido additional visit survey in winter 2017/18 and lived in cold, snowy regions in Japan. The analysis included 461 participants (mean age 74.7 years; standard deviation 2.8 years; 46.5% male). Sociodemographic characteristics, physical activity (min/day of moderate-to-vigorous intensity physical activity [MVPA] and light intensity physical activity, and walking steps/day) measured by accelerometer, cognitive function, depression, visual impairment, and history of stroke were surveyed. Poisson regression analyses were performed to clarify the association between prevalence of falls and physical activity. RESULTS Of those who reported a fall with location, 86 (69.9%) fell on frozen roads, 24 (19.5%) fell on unfrozen roads and 13 (10.6%) fell indoors. There were significant positive associations between MVPA (adjusted prevalence ratio [aPR] Tertile [T] 3 vs T1, 1.73; 95% confidence interval [CI], 1.04-2.87) and all falls. When limited to falls on frozen roads, higher MVPA levels and walking steps were associated with falls on frozen roads (MVPA, aPR T3 vs T1, 2.16; 95% CI, 1.19-3.94; walking steps, aPR T3 vs T1, 2.49; 95%CI 1.33-4.68). CONCLUSION The risk of falls, especially on frozen roads, increased among active older people living in cold, snowy regions, and environmental factors should be considered when determining prevention strategies.
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16
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Lu Z, Lam FMH, Leung JCS, Kwok TCY. The U-Shaped Relationship Between Levels of Bouted Activity and Fall Incidence in Community-Dwelling Older Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 75:e145-e151. [PMID: 32115656 PMCID: PMC7518560 DOI: 10.1093/gerona/glaa058] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It remains uncertain whether the association between physical activity (PA) and falls is U-shaped, and few studies have explored the potential mediation of PA accumulation pattern. METHODS We measured PA in 671 community-dwelling older adults (82.7 ± 3.8 years) using wrist-worn accelerometer for 7 days. PA was further classified to bouted PA (≥10 minutes bout length) and sporadic PA (<10 minutes bout length) for subanalysis. Fall incidence in the following 12-month was recorded through tri-monthly telephone interviews. Classification and Regression Tree analysis was used to identify two optimal cutoff values of each PA measurement to predict falls. Participants were then divided into "inactive," "moderately active," and "highly active" groups accordingly. Negative binomial regression models were used to estimate the association between the PA measures and fall incidence. RESULTS Six hundred and thirty-nine participants completed 12-month follow-up. Ninety-three (14.6%) experienced a total of 118 falls. Inactive and highly active older adults had higher falls per person month relative to the moderately active group (inactive: incidence rate ratios [IRR] = 2.372, 95% confidence interval [CI] = 1.317-4.271; highly active: IRR = 2.731, 95% CI = 1.196-6.232). Subanalyses found similar significant finding with bouted PA (p < .001) but not sporadic PA (p ≥ .221). The association between bouted PA and falls remained significant even after adjusting fall incidence for bouted activity time (inactive: IRR = 3.636, 95% CI = 2.238-5.907; highly active: IRR = 1.823, 95% CI = 1.072-3.1). Further adjustments for fall-related risk factors did not meaningfully change the results. CONCLUSION A U-shaped relationship was identified between bouted but not sporadic PA and fall incidence. There is an approximately twofold increase in fall rate in highly active older adults even after adjusting for activity time.
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Affiliation(s)
- Zhihui Lu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Freddy M H Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China
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17
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Porto JM, Cangussu-Oliveira LM, Freire Júnior RC, Vieira FT, Capato LL, de Oliveira BGM, de Abreu DCC. Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study. J Appl Gerontol 2020; 40:339-346. [DOI: 10.1177/0733464820932778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls ( p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.
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18
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DiPietro L, Campbell WW, Buchner DM, Erickson KI, Powell KE, Bloodgood B, Hughes T, Day KR, Piercy KL, Vaux-Bjerke A, Olson RD. Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review. Med Sci Sports Exerc 2019; 51:1303-1313. [PMID: 31095087 PMCID: PMC6527126 DOI: 10.1249/mss.0000000000001942] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To review and update the evidence of the relationship between physical activity, risk of fall-related injury, and physical function in community-dwelling older people that was presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (PAGAC Report). METHODS Duplicate independent screenings of 1415 systematic reviews and meta-analyses published between 2006 and 2016 identified from PubMed®, Cochrane Library, and CINAHL databases yielded 111 articles used for the PAGAC Report. The PAGAC Aging Subcommittee members graded scientific evidence strength based upon a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. An updated search of 368 articles published between January 2017 and March 2018 yielded 35 additional pertinent articles. RESULTS Strong evidence demonstrated that physical activity reduced the risk of fall-related injuries by 32% to 40%, including severe falls requiring medical care or hospitalization. Strong evidence also supported that physical activity improved physical function and reduced the risk of age-related loss of physical function in an inverse graded manner among the general aging population, and improved physical function in older people with frailty and with Parkinson's disease. Aerobic, muscle-strengthening, and/or multicomponent physical activity programs elicited the largest improvements in physical function in these same populations. Moderate evidence indicated that for older adults who sustained a hip fracture or stroke, extended exercise programs and mobility-oriented physical activity improved physical function. CONCLUSIONS Regular physical activity effectively helps older adults improve or delay the loss of physical function and mobility while reducing the risk of fall-related injuries. These important public health benefits underscore the importance of physical activity among older adults, especially those living with declining physical function and chronic health conditions.
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Affiliation(s)
- Loretta DiPietro
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Wayne W. Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | | | | | | | | | - Timothy Hughes
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Kelsey R. Day
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Katrina L. Piercy
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
| | - Alison Vaux-Bjerke
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
| | - Richard D. Olson
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
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19
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Pettee Gabriel K, Griswold ME, Wang W, Conway SH, Windham BG, Palta P, Kucharska-Newton A, Pompeii LA. Physical activity trajectories and subsequent fall risk: ARIC Study. Prev Med 2019; 121:40-46. [PMID: 30742870 PMCID: PMC6448408 DOI: 10.1016/j.ypmed.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/25/2018] [Accepted: 02/08/2019] [Indexed: 01/17/2023]
Abstract
To examine the impact of moderate to vigorous intensity physical activity (MVPA) trajectories during midlife and older adulthood with subsequent fall risk in later life. Cross-temporal analyses were conducted in 15,792 participants (27% black, 55% women) aged 45 to 64 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. MVPA was collected at Exams 1 (1987-89), 3 (1993-95) and 5 (2011-13) using the ARIC/Baecke questionnaire. Latent class growth analysis was used to identify the MVPA trajectory groups. Reported falls outcomes were collected in 2013-14, 2015-16, and 2016-17. Generalized Linear Models were used to estimate associations of baseline predictors with trajectory class membership, as well as associations of trajectory classes with any falling (adjusted incident relative risks, aIRR) and with number of falls (adjusted relative rates, aRR). Four primary trajectory classes emerged, reflecting longitudinal patterns of maintained high (48%), maintained low (22%), increasing (14%) and decreasing (15%) MVPA. After adjustment for covariates, the decreasing MVPA trajectory group had a 14% higher risk of reporting any falling compared to the maintained high MVPA group [aIRR = 1.14 (1.01, 1.28)]. When compared to the maintained high MVPA group, the maintained low and decreasing group had a 28% [aRR = 1.28 (1.14, 1.44)] and 27% [aRR = 1.27 (1.17, 1.38)] higher rate in the reported number of falls, respectively. Findings support public health campaigns targeting habitual MVPA or exercise for fall prevention and suggest that interventions should be initiated in midlife; a time when individuals may be more able and willing to change behavior.
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Affiliation(s)
- Kelley Pettee Gabriel
- UTHealth School of Public Health - Austin Campus, Department of Epidemiology, Human Genetics, and Environmental Sciences, Austin, TX, USA; The University of Texas at Austin, Dell Medical School, Department of Women's Health, Austin, TX, USA; The University of Texas at Austin, Department of Kinesiology and Health Education, Austin, TX, USA.
| | - Michael E Griswold
- The University of Mississippi Medical Center, Department of Data Science, Jackson, MS, USA
| | - Wanmei Wang
- The University of Mississippi Medical Center, Department of Data Science, Jackson, MS, USA
| | - Sadie H Conway
- UTHealth School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Houston, TX, USA
| | - B Gwen Windham
- The University of Mississippi Medical Center, Department of Medicine, Division of Geriatrics, Jackson, MS, USA
| | - Priya Palta
- Columbia University, Department of Medicine, Division of General Medicine, New York, NY, USA
| | - Anna Kucharska-Newton
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Lisa A Pompeii
- Baylor College of Medicine, Department of Pediatrics, Center for Epidemiology & Population Health, Houston, TX USA
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Oliveira AEPD, Ostolin TLVDP, Vieira WDO, Arantes RL, Gagliardi ARDT, Sperandio EF, Dourado VZ. The association between physical activity, sedentary behavior and the occurrence of falls in asymptomatic adults over 40 years old. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Sedentary behavior (SB) has been described as an independent risk factor for health, regardless of the recommended amount of moderate-to-vigorous physical activity (MVPA). However, SB and MVPA as predictors of falls have been poorly investigated. Objective: To compare the associations between SB and MVPA and the occurrence of falls in middle-aged and older adults. Method: The participants wore a triaxial accelerometer over the dominant hip for seven days to measure SB and MVPA. The occurrence of falls and cardiovascular risk factors were assessed by self-report. Isokinetic peak torque (PT) of knee extension, peak oxygen uptake (V’O2) in a ramp treadmill protocol, and lean (LBM) body mass and body fat (BFM) (bioelectrical impedance) were also assessed. The critical roles of SB and MVPA on the occurrence of falls were compared by multiple logistic regression adjusted for age, sex, cardiovascular risk factors, LBM, peak V’O2, and PT of knee extension. Results: 379 participants were evaluated, aged 40-80 years. Forty-eight participants reported at least one fall in the previous 12 months (14.5%). Fallers presented lower SB and higher MVPA. They were predominantly women and older adults with lower physical fitness. After multivariate analysis, MVPA, but not SB, was selected as an independent predictor of falls, increasing the odds ratio of having a fall (1.184, 95% confidence interval, 1.016 - 1.378). Conclusion: Episodes of falls in predominantly middle-aged and women subjects were associated with a higher amount of MVPA, not the opposite, indicating an adverse effect of MVPA in these subjects.
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Soares WJS, Lopes AD, Nogueira E, Candido V, de Moraes SA, Perracini MR. Physical Activity Level and Risk of Falling in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. J Aging Phys Act 2018; 27:1-10. [PMID: 29543113 DOI: 10.1123/japa.2017-0413] [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] [Indexed: 11/18/2022]
Abstract
This systematic review examines the association between physical activity (PA) level and risk of falling in community-dwelling older adults. A search of PubMed, Embase, CINAHL, SPORTDiscus, and Web of Science was performed in January 2017. Four prospective cohort studies investigating the incidence of falls in a period of at least 12 months and its association with the level of PA in people aged 60 years and older were reviewed and pooled for meta-analysis. The pooled risk ratio (RR) for being a recurrent faller (2,420 participants) was 39% higher among those who were in the lowest PA level (RR = 1.39; 95% confidence interval [1.17, 1.65]; I2 = 0%, p = .43; p < .0001). The association between being a faller (7,927 participants) and PA level was inconclusive. This review identified that the benefit of general PA for preventing falls is associated with the adopted PA level.
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Associations of distinct levels of physical activity with mobility in independent healthy older women. Exp Gerontol 2018; 110:209-215. [DOI: 10.1016/j.exger.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022]
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Abdulrazaq S, Oldham J, Skelton DA, O'Neill T, Munford L, Gannon B, Pilling M, Todd C, Stanmore EK. A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in community dwelling adults with rheumatoid arthritis. BMC Health Serv Res 2018; 18:574. [PMID: 30029649 PMCID: PMC6053737 DOI: 10.1186/s12913-018-3383-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Falls are one of the major health problems in adults with Rheumatoid Arthritis (RA). Interventions, such as the Otago Exercise Programme (OEP), can reduce falls in community dwelling adults by up to 35%. The cost-benefits of such a programme in adults with RA have not been studied. The aims of this study were to determine the healthcare cost of falls in adults with RA, and estimate whether it may be cost efficient to roll out the OEP to improve function and prevent falls in adults living with RA. Methods Patients with Rheumatoid Arthritis aged ≥18 years were recruited from four rheumatology clinics across the Northwest of England. Participants were followed up for 1 year with monthly fall calendars, telephone calls and self-report questionnaires. Estimated medical cost of a fall-related injury incurred per-person were calculated and compared with OEP implementation costs to establish potential economic benefits. Results Five hundred thirty-five patients were recruited and 598 falls were reported by 195 patients. Cumulative medical costs resulting from all injury leading to hospital services is £374,354 (US$540,485). Average estimated cost per fall is £1120 (US$1617). Estimated cost of implementing the OEP for 535 people is £116,479 (US$168,504) or £217.72 (US$314.34) per-person. Based on effectiveness of the OEP it can be estimated that out of the 598 falls, 209 falls would be prevented. This suggests that £234,583 (US$338,116) savings could be made, a net benefit of £118,104 (US$170,623). Conclusions Implementation of the OEP programme for patients with RA has potentially significant economic benefits and should be considered for patients with the condition.
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Affiliation(s)
- Siyar Abdulrazaq
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Jackie Oldham
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Terence O'Neill
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Luke Munford
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - Brenda Gannon
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - Mark Pilling
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Chris Todd
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Emma K Stanmore
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK.
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Balogun S, Winzenberg T, Wills K, Scott D, Jones G, Callisaya M, Aitken D. Longitudinal associations between serum 25-hydroxyvitamin D, physical activity, knee pain and dysfunction and physiological falls risk in community-dwelling older adults. Exp Gerontol 2018; 104:72-77. [PMID: 29421606 DOI: 10.1016/j.exger.2018.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 11/29/2022]
Abstract
AIMS To describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. METHODS Data for 1053 participants (51% women; mean age 63 ± 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. RESULTS Between-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (β = -0.005 per nmol/l, 95% CI: -0.008, -0.002), log-MVPA (β = -0.16 per minute, 95% CI: -0.22, -0.10) and lower mean WOMAC score (β = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (β = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (β = -0.15 per minute, 95% CI: -0.24, -0.06), but not 25OHD, at the same time-point. CONCLUSION Having higher WOMAC global score above an individual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors.
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Affiliation(s)
- Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia; Melbourne Medical School (Western Campus) and Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St Albans, Victoria 3021, Australia.
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Australia.
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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Low ST, Balaraman T. Physical activity level and fall risk among community-dwelling older adults. J Phys Ther Sci 2017; 29:1121-1124. [PMID: 28744029 PMCID: PMC5509573 DOI: 10.1589/jpts.29.1121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] To find the physical activity level and fall risk among the community-dwelling
Malaysian older adults and determine the correlation between them. [Subjects and Methods]
A cross-sectional study was conducted in which, the physical activity level was evaluated
using the Rapid Assessment of Physical Activity questionnaire and fall risk with Fall Risk
Assessment Tool. Subjects recruited were 132 community-dwelling Malaysian older adults
using the convenience sampling method. [Results] The majority of the participants were
under the category of under-active regular light-activities and most of them reported low
fall risk. The statistical analysis using Fisher’s exact test did not show a significant
correlation between physical activity level and fall risk. [Conclusion] The majority of
community-dwelling Malaysian older adults are performing some form of physical activity
and in low fall risk category. But this study did not find any significant correlation
between physical activity level and fall risk among community-dwelling older adults in
Malaysia.
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Affiliation(s)
- Sok Teng Low
- Physiotherapy program, Faculty of Health and Life Sciences, INTI International University, Malaysia
| | - Thirumalaya Balaraman
- Physiotherapy program, Faculty of Health and Life Sciences, INTI International University, Malaysia
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Donath L, van Dieën J, Faude O. Exercise-Based Fall Prevention in the Elderly: What About Agility? Sports Med 2016; 46:143-9. [PMID: 26395115 DOI: 10.1007/s40279-015-0389-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Annually, one in three seniors aged over 65 years fall. Balance and strength training can reduce neuromuscular fall risk factors and fall rates. Besides conventional balance and strength training, explosive or high-velocity strength training, eccentric exercises, perturbation-based balance training, trunk strength, and trunk control have also been emphasized. In contrast, aerobic exercise has to date not been included in fall-prevention studies. However, well-developed endurance capacity might attenuate fatigue-induced declines in postural control in sports-related or general activities of daily living. Physical performance indices, such as balance, strength, and endurance, are generally addressed independently in exercise guidelines. This approach seems time consuming and may impede integrative training of sensorimotor, neuromuscular, and cardiocirculatory functions required to deal with balance-threatening situations in the elderly. An agility-based conceptual training framework comprising perception and decision making (e.g., visual scanning, pattern recognition, anticipation) and changes of direction (e.g., sudden starts, stops and turns; reactive control; concentric and eccentric contractions) might enable an integrative neuromuscular, cardiocirculatory, and cognitive training. The present paper aims to provide a scientific sketch of how to build such an integrated modular training approach, allowing adaptation of intensity, complexity, and cognitive challenge of the agility tasks to the participant's capacity. Subsequent research should address the (1) link between agility and fall risk factors as well as fall rates, (2) benefit-risk ratios of the proposed approach, (3) psychosocial aspects of agility training (e.g., motivation), and (4) logistical requirements (e.g., equipment needed).
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Affiliation(s)
- Lars Donath
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
| | - Jaap van Dieën
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Brodie MA, Okubo Y, Annegarn J, Wieching R, Lord SR, Delbaere K. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis. Physiol Meas 2016; 38:45-62. [PMID: 27941237 DOI: 10.1088/1361-6579/38/1/45] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Falls and physical deconditioning are two major health problems for older people. Recent advances in remote physiological monitoring provide new opportunities to investigate why walking exercise, with its many health benefits, can both increase and decrease fall rates in older people. In this paper we combine remote wearable device monitoring of daily gait with non-linear multi-dimensional pattern recognition analysis; to disentangle the complex associations between walking, health and fall rates. One week of activities of daily living (ADL) were recorded with a wearable device in 96 independent living older people prior to completing 6 months of exergaming interventions. Using the wearable device data; the quantity, intensity, variability and distribution of daily walking patterns were assessed. At baseline, clinical assessments of health, falls, sensorimotor and physiological fall risks were completed. At 6 months, fall rates, sensorimotor and physiological fall risks were re-assessed. A non-linear multi-dimensional analysis was conducted to identify risk-groups according to their daily walking patterns. Four distinct risk-groups were identified: The Impaired (93% fallers), Restrained (8% fallers), Active (50% fallers) and Athletic (4% fallers). Walking was strongly associated with multiple health benefits and protective of falls for the top performing Athletic risk-group. However, in the middle of the spectrum, the Active risk-group, who were more active, younger and healthier were 6.25 times more likely to be fallers than their Restrained counterparts. Remote monitoring of daily walking patterns may provide a new way to distinguish Impaired people at risk of falling because of frailty from Active people at risk of falling from greater exposure to situations were falls could occur, but further validation is required. Wearable device risk-profiling could help in developing more personalised interventions for older people seeking the health benefits of walking without increasing their risk of falls.
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Affiliation(s)
- Matthew A Brodie
- Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia
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Increasing fall risk awareness using wearables: A fall risk awareness protocol. J Biomed Inform 2016; 63:184-194. [DOI: 10.1016/j.jbi.2016.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022]
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Jefferis BJ, Merom D, Sartini C, Wannamethee SG, Ash S, Lennon LT, Iliffe S, Kendrick D, Whincup PH. Physical Activity and Falls in Older Men: The Critical Role of Mobility Limitations. Med Sci Sports Exerc 2016; 47:2119-28. [PMID: 25668406 PMCID: PMC5131688 DOI: 10.1249/mss.0000000000000635] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental digital content is available in the text. Background Physical activity (PA) has many health benefits but may increase falls risk among older adults. We study how objectively measured habitual daily PA is related to falls by exploring the modifying effect of mobility limitations and the mediating roles of fitness and lower-limb strength. Methods One thousand six hundred fifty-five (53%) of 3137 surviving participants (men age 71–91 yr) in an ongoing UK-population-based cohort study wore an ActiGraph GT3x accelerometer over the hip for 1 wk in 2010–2012 to measure PA (exposure) and reported demographic and health status, including mobility limitations. One year later, 825 men reported falls history (outcome). Results Seven hundred of 825 men had ≥600 min·d−1 of accelerometer wear for ≥3 d. Nineteen percent (n = 128) reported falls 1 yr later. Associations between PA and falls differed by presence of mobility limitations. Among 66% (n = 471) of men without mobility limitations, number of falls increased incrementally (for every 30 min of moderate to vigorous PA [MVPA]: incidence rate ratio [IRR], 1.50; 95% confidence interval [CI], 1.10–2.03, adjusted for falls risk factors). Step count was not related to number of falls below 9000 steps per day but was related to number of falls ≥9000 steps per day (for every additional 1000 steps per day: IRR, 1.59; 95% CI, 1.16–2.18). Among 33% (n = 229) of men with mobility limitations, falls risk declined with increasing activity (for every 1000 steps per day: IRR, 0.80; 95% CI, 0.70–0.91; for every 30 min of MVPA: IRR, 0.61; 95% CI, 0.42–0.89; for every additional 30 min of sedentary behavior ≥600 min·d−1: IRR, 1.22; 95% CI, 1.07–1.40). Conclusions Interventions to promote MVPA in older men should incorporate falls prevention strategies. Among adults with mobility limitations, trials should investigate whether increasing MVPA levels can reduce falls risk.
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Affiliation(s)
- Barbara J Jefferis
- 1UCL Department of Primary Care and Population Health, University College London, London, England, UNITED KINGDOM; 2UCL Physical Activity Research Group, London, UNITED KINGDOM; 3School of Science and Health, University of Western Sydney, Penrith, NSW, AUSTRALIA; 4Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England, UNITED KINGDOM; and 5Population Health Research Institute, St. George's University of London, London, England, UNITED KINGDOM
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Johansson J, Nordström A, Nordström P. Greater Fall Risk in Elderly Women Than in Men Is Associated With Increased Gait Variability During Multitasking. J Am Med Dir Assoc 2016; 17:535-40. [PMID: 27006336 DOI: 10.1016/j.jamda.2016.02.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/06/2016] [Accepted: 02/12/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE As 90% of fractures are caused by falls, and as fractures are more common in elderly women than in elderly men, a better understanding of potential sex differences in fall rates and underlying mechanisms is needed. The purpose of this study was to determine whether women are more prone than men to falling, and to evaluate whether the risk of falling is associated with variations in gait patterns. DESIGN, SETTING, AND PARTICIPANTS The cohort for this prospective observational study consisted of 1390 community-dwelling men and women aged 70 years, examined in a health survey between July 2012 and November 2014. MEASUREMENTS Gait patterns were measured using a computerized walkway system during normal-speed, fast-speed, and dual-task trials. Triaxial accelerometers were used to collect objective data on physical activity, and self-reported fall data were collected by telephone 6 and 12 months after examination. Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground. RESULTS During the follow-up period, 148 study participants (88 women, 60 men; P = .01) reported falls. After adjusting for multiple confounders, including objective measures of physical activity, socioeconomic factors, cardiovascular disease, and cognitive function, the odds ratio for falling in women was 1.49 (95% confidence interval [CI] 1.02-2.19). Variations in gait pattern were significantly (20%-40%) increased in fallers compared with nonfallers during the dual-task trial for step width, step length, stride length, step time, stance time, stride velocity, and single support time (all P < .05). Furthermore, women showed 15% to 35% increased variability in all of these gait parameters during the dual-task trial compared with men (all P < .01). CONCLUSION In the present cohort, 70-year-old women were at greater risk of falls compared with their male counterparts. This increased risk was associated with increased variation in gait pattern during dual-task activities, and may contribute to women's greater fracture risk compared with men.
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Affiliation(s)
- Jonas Johansson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
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Brodie MA, Lord SR, Coppens MJ, Annegarn J, Delbaere K. Eight-Week Remote Monitoring Using a Freely Worn Device Reveals Unstable Gait Patterns in Older Fallers. IEEE Trans Biomed Eng 2015; 62:2588-94. [PMID: 25993701 DOI: 10.1109/tbme.2015.2433935] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Develop algorithms to detect gait impairments remotely using data from freely worn devices during long-term monitoring. Identify statistical models that describe how gait performances are distributed over several weeks. Determine the data window required to reliably assess an increased propensity for falling. METHODS 1085 days of walking data were collected from eighteen independent-living older people (mean age 83 years) using a freely worn pendant sensor (housing a triaxial accelerometer and pressure sensor). Statistical distributions from several accelerometer-derived gait features (encompassing quantity, exposure, intensity, and quality) were compared for those with and without a history of falling. RESULTS Participants completed more short walks relative to long walks, as approximated by a power law. Walks less than 13.1 s comprised 50% of exposure to walking-related falls. Daily-life cadence was bimodal and step-time variability followed a log-normal distribution. Fallers took significantly fewer steps per walk and had relatively more exposure from short walks and greater mode of step-time variability. CONCLUSIONS Using a freely worn device and wavelet-based analysis tools allowed long-term monitoring of walks greater than or equal to three steps. In older people, short walks constitute a large proportion of exposure to falls. To identify fallers, mode of variability may be a better measure of central tendency than mean of variability. A week's monitoring is sufficient to reliably assess the long-term propensity for falling. SIGNIFICANCE Statistical distributions of gait performances provide a reference for future wearable device development and research into the complex relationships between daily-life walking patterns, morbidity, and falls.
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Klenk J, Kerse N, Rapp K, Nikolaus T, Becker C, Rothenbacher D, Peter R, Denkinger MD. Physical Activity and Different Concepts of Fall Risk Estimation in Older People--Results of the ActiFE-Ulm Study. PLoS One 2015; 10:e0129098. [PMID: 26058056 PMCID: PMC4461251 DOI: 10.1371/journal.pone.0129098] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. DESIGN Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. SETTING The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. PARTICIPANTS 1,214 community-dwelling older people (≥65 years, 56.4% men). MEASUREMENTS Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, fall history, and walking speed. All analyses were adjusted either for gender, age, or both. RESULTS No statistically significant association was seen between falls per person-year and average daily physical activity. However, when looking at falls per 100 hours walked, those who were low active sustained more falls per hours walked. The highest incidence rates of falls were seen in low-active persons with slow walking speed (0.57 (95% confidence interval (95% CI): 0.33 to 0.98) falls per 100 hours walked) or history of falls (0.60 (95% CI: 0.36 to 0.99) falls per 100 hours walked). CONCLUSION Falls per hours walked is a relevant and sensitive outcome measure. It complements the concept of incidence per person years, and gives an additional perspective on falls in community-dwelling older people.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Risk factors of indoor fall injuries in community-dwelling older women: A prospective cohort study. Arch Gerontol Geriatr 2015; 60:259-64. [DOI: 10.1016/j.archger.2014.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
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Elman SA, Dong Y, Stenquist DS, Ghazinouri R, Alcantara L, Collins JE, Beagan C, Thornhill TS, Katz JN. Participation in physical activity in patients 1-4 years post total joint replacement in the Dominican Republic. BMC Musculoskelet Disord 2014; 15:207. [PMID: 24934210 PMCID: PMC4070407 DOI: 10.1186/1471-2474-15-207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/12/2014] [Indexed: 12/27/2022] Open
Abstract
Background To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level. Methods We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1–4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses. Results 64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009–2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic. Conclusion The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.
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Affiliation(s)
- Scott A Elman
- Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
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Keay L, Palagyi A, McCluskey P, Lamoureux E, Pesudovs K, Lo S, Ivers R, Boufous S, Morlet N, Ng JQ, Stapleton F, Fraser M, Meuleners L. Falls in Older people with Cataract, a longitudinal evalUation of impact and riSk: the FOCUS study protocol: Table 1. Inj Prev 2014; 20:e7. [DOI: 10.1136/injuryprev-2013-041124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tiedemann A, Sherrington C, Lord SR. The role of exercise for fall prevention in older age. MOTRIZ: REVISTA DE EDUCACAO FISICA 2013. [DOI: 10.1590/s1980-65742013000300002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Falls are a common, costly and preventable consequence of sensorimotor impairments that increase in prevalence with advancing age. A fall occurs when the physical ability of the individual is unable to match the immediate demands of the environment and/or of the activity being undertaken. Targeted exercise aimed at improving the physical ability of the individual, such as balance and strength training, is crucial for promoting functional independence and mobility and reducing the risk of falling in older age. Exercise programs that provide a high challenge to balance, have a high dose, include progression of intensity over time and are ongoing are most effective for preventing falls. This paper provides guidance to health professionals involved with the prescription of physical activity and exercise to older people regarding the safe and effective provision of programs aimed at improving strength and balance and preventing falls in older age.
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Beaudart C, Maquet D, Mannarino M, Buckinx F, Demonceau M, Crielaard JM, Reginster JY, Bruyère O. Effects of 3 months of short sessions of controlled whole body vibrations on the risk of falls among nursing home residents. BMC Geriatr 2013; 13:42. [PMID: 23647914 PMCID: PMC3649886 DOI: 10.1186/1471-2318-13-42] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/26/2013] [Indexed: 11/25/2022] Open
Abstract
Background Fatigue, lack of motivation and low compliance can be observed in nursing home residents during the practice of physical activity. Because exercises should not be too vigorous, whole body vibration could potentially be an effective alternative. The objective of this randomized controlled trial was to assess the impact of 3-month training by whole body vibration on the risk of falls among nursing home residents. Methods Patients were randomized into two groups: the whole body vibration group which received 3 training sessions every week composed of 5 series of only 15 seconds of vibrations at 30 Hz frequency and a control group with normal daily life for the whole study period. The impact of this training on the risk of falls was assessed blindly by three tests: the Tinetti Test, the Timed Up and Go test and a quantitative evaluation of a 10-second walk performed with a tri-axial accelerometer. Results 62 subjects (47 women and 15 men; mean age 83.2 ± 7.99 years) were recruited for the study. No significant change in the studied parameters was observed between the treated (n=31) and the control group (n=31) after 3 months of training by controlled whole-body-vibrations. Actually, the Tinetti test increased of + 0.93 ± 3.14 points in the treated group against + 0.88 ± 2.33 points in the control group (p = 0.89 when adjusted). The Timed Up and Go test showed a median evolution of - 1.14 (− 4.75-3.73) seconds in the treated group against + 0.41 (− 3.57- 2.41) seconds in the control group (p = 0.06). For the quantitative evaluation of the walk, no significant change was observed between the treated and the control group in single task as well as in dual task conditions. Conclusions The whole body vibration training performed with the exposition settings such as those used in this research was feasible but seems to have no impact on the risk of falls among nursing home residents. Further investigations, in which, for example, the exposure parameters would be changed, seem necessary. Trial registration Trial registration number: NCT01759680
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Affiliation(s)
- Charlotte Beaudart
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
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Couto FBD, Perracini MR. Análise multifatorial do perfil de idosos ativos com história de quedas. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2012. [DOI: 10.1590/s1809-98232012000400010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Explorar o relacionamento entre variáveis sociodemográficas, clínicas, funcionais e psico-cognitivas em idosos participantes de grupo de convivência, residentes na comunidade, e identificar a associação entre a interação dessas variáveis e quedas e quedas recorrentes. MÉTODO: Estudo transversal, exploratório com 150 idosos, de ambos os sexos, participantes de um grupo de terceira idade no município de Itu, São Paulo. Utilizou-se uma entrevista semiestruturada contendo características sociodemográficas, de saúde física, físico-funcionais (Brazilian OARS Multidimensional Functional Assessment Questionnaire - BOMFAQ e Timed up and go test - TUG), de saúde mental (Geriatric Depression Scale - GDS-15 e Mini Mental State Examination - MMSE). O nível de atividade física foi determinado por questões sobre frequência e duração das atividades físicas. A variável desfecho utilizada foi o número de quedas no último ano. Foi conduzida uma análise de cluster para se identificar perfis de grupos formados pela distribuição da variabilidade dos dados em cada bloco de variáveis: sociodemográficas, desempenho físico-funcional, saúde física e mental. Procedeu-se a análise de regressão uni e multivariada com quedas únicas e quedas recorrentes. RESULTADOS: A idade média dos participantes foi de 71,9 (±5,6) anos. A prevalência de quedas foi de 38,7%. A análise univariada revelou uma associação independente entre o cluster saúde mental (sem sintomas depressivos e com declínio cognitivo) e quedas recorrentes (OR=2,73 IC 95% 1,04-7,22 p=0,042), porém esta associação não foi significativa na análise multivariada (p=0,082). CONCLUSÃO: Não foi possível identificar um perfil de caidores e caidores recorrentes em idosos ativos. Mas nossos achados sugerem que, em idosos ativos com história de quedas, uma avaliação geriátrica abrangente com ênfase na função cognitiva seja considerada.
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Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, Kemoun G. Estimation of the risk factors for falls in the elderly: Can meta-analysis provide a valid answer? Geriatr Gerontol Int 2012. [DOI: 10.1111/j.1447-0594.2012.00965.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Caroline Tournoux-Facon
- Department of Epidemiology and Biostatistics. Inserm CIC P802; University of Poitiers; Poitiers; France
| | - Cyril Brèque
- P'Institute UPR 3346; University of Poitiers; Poitiers; France
| | | | - Benoit Dugué
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
| | - Gilles Kemoun
- Laboratory «Mobilité, Vieillissement, Exercice» (MOVE), EA 6314; University of Poitiers; Poitiers; France
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Ferreira ML, Sherrington C, Smith K, Carswell P, Bell R, Bell M, Nascimento DP, Máximo Pereira LS, Vardon P. Physical activity improves strength, balance and endurance in adults aged 40-65 years: a systematic review. J Physiother 2012; 58:145-56. [PMID: 22884181 DOI: 10.1016/s1836-9553(12)70105-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
QUESTION Can physical activity in adults aged 40-65 years enhance strength and balance and prevent falls? DESIGN Systematic review with meta-analysis of randomised clinical trials. PARTICIPANTS Healthy adults aged 40-65 years. INTERVENTION Programs that involved the performance of any physical activity in community settings and workplaces. OUTCOME MEASURES Strength, balance, endurance, and falls rate. RESULTS Twenty-three eligible trials were identified and 17 of these were pooled in the meta-analyses. The meta-analysis of strength outcomes found a moderate effect of physical activity on strength (SMD=0.54, 95% CI 0.38 to 0.70). Larger effects were observed from programs that specifically targeted strength (SMD=0.68, 95% CI 0.49 to 0.87), when compared to those that did not (SMD=0.32, 95% CI 0.09 to 0.55). This difference was statistically significant (effect of strength in meta-regression p=0.045). Physical activity also had a moderate effect on both balance (SMD=0.52, 95% CI 0.24 to 0.79) and endurance (SMD=0.73, 95% CI 0.50 to 0.96). No trials reported effects of physical activity on falls soon after receiving the intervention. A statistically non-significant effect on falls 15 years after receiving a physical activity intervention was found in one trial (RR=0.82, 95% CI 0.53 to 1.26). CONCLUSIONS This review found that muscle strength, balance, and endurance can be improved by physical activity in people aged 40-65 years. There were bigger effects on muscle strength from programs that used resistance exercises, indicating the need to include a resistance training component if strength enhancement is the goal.
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Biddle SJ, Brehm W, Verheijden M, Hopman-Rock M. Population physical activity behaviour change: A review for the European College of Sport Science. Eur J Sport Sci 2012. [DOI: 10.1080/17461391.2011.635700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rosenblatt NJ, Grabiner MD. Relationship Between Obesity and Falls by Middle-Aged and Older Women. Arch Phys Med Rehabil 2012; 93:718-22. [DOI: 10.1016/j.apmr.2011.08.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 07/22/2011] [Accepted: 08/31/2011] [Indexed: 11/26/2022]
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Sherrington C. Prevention of fractures in older people: what does the evidence say? Physiother Can 2012; 63:146-51. [PMID: 22379253 DOI: 10.3138/physio.63.2.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Catherine Sherrington
- Catherine Sherrington, PhD, MPH, BAppSc (Physiotherapy): Associate Professor, The University of Sydney; Senior Research Fellow, The George Institute for Global Health, Sydney, Australia
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Tiedemann A, Sherrington C, Close JC, Lord SR. Exercise and Sports Science Australia Position Statement on exercise and falls prevention in older people. J Sci Med Sport 2011; 14:489-95. [DOI: 10.1016/j.jsams.2011.04.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
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Byles JE, Dobson A. The value of time in longitudinal studies of ageing. Lessons from the Australian Longitudinal Study on Women's Health. Australas J Ageing 2011; 30 Suppl 2:6-12. [DOI: 10.1111/j.1741-6612.2011.00531.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adverse Events Associated With the Res-Care Intervention. J Am Med Dir Assoc 2011; 12:584-589. [DOI: 10.1016/j.jamda.2010.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 05/28/2010] [Accepted: 05/28/2010] [Indexed: 11/24/2022]
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Sherrington C. La prévention des fractures chez les aînés : qu'en disent les faits cliniques? Physiother Can 2011. [DOI: 10.3138/physio.63.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Catherine Sherrington
- Catherine Sherrington, PhD, MPH, BAppSc (Physiotherapy): Associate Professor, The University of Sydney; Senior Research Fellow, The George Institute for Global Health, Sydney, Australia
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Hispanic ethnicity and fatal fall risk: do age, gender, and community modify the relationship? J Surg Res 2011; 175:113-7. [PMID: 21529828 DOI: 10.1016/j.jss.2011.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/04/2011] [Accepted: 02/18/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hispanic ethnicity is associated with a reduced risk of fatal falls in the elderly despite lower socioeconomic standing. The factors responsible for this "Hispanic paradox" are unknown. We hypothesized that age and gender would modify this relationship and that the association would be accentuated in a community with prominent Hispanic culture. MATERIALS AND METHODS The number of fatal falls in a 3-year period in the United States (US) and in Miami-Dade County, Florida (MDC) were obtained through the CDC's WISQARS database and the Florida Office of Vital Statistics. US Census Bureau data were used to define the total at-risk populations by age group and gender. Age group- and gender-specific ratios of the risk of fatal fall in Hispanic to white non-Hispanic individuals were calculated. RESULTS In the US and MDC, Hispanic ethnicity was associated with a reduced risk of fatal fall across all age and gender subgroups. In the US, the risk reduction associated with Hispanic ethnicity grew from 11% and 23% in 65- to 74-year-old men and women, respectively, to 43% for both men and women over 84-years-old. This relationship was stronger in MDC than nationally in five of the six age and gender subgroups examined. CONCLUSIONS Older individuals, women, and residents of communities with prominent Hispanic culture have the greatest reduction in fatal fall risk associated with Hispanic ethnicity.
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Heesch KC, Hill RL, van Uffelen JGZ, Brown WJ. Are Active Australia physical activity questions valid for older adults? J Sci Med Sport 2011; 14:233-7. [PMID: 21276752 DOI: 10.1016/j.jsams.2010.11.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 09/27/2010] [Accepted: 11/27/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Active Australia Survey (AAS) is used for physical activity (PA) surveillance in the general Australian adult population, but its validity in older adults has not been evaluated. Our aim was to examine the convergent validity of the AAS questions in older adults. DESIGN The AAS was validated against pedometer step counts as an objective measure of PA, self-reported physical function, and a step-test to assess cardiorespiratory fitness. METHOD Participants were community-dwelling adults, aged 65-89 y, with the ability to walk 100 m. They completed a self-administered AAS and the step-test in one interview. One week earlier, they completed the Short Form-36 physical function subscale. Between these two interviews, they each wore a YAMAX Digiwalker SW200 pedometer and recorded daily steps. Using the AAS data, daily walking minutes and total PA minutes (walking, moderate-intensity PA and vigorous-intensity PA) were compared with the validity measures using Spearman rank-order correlations. Fifty-three adults completed the study. RESULTS Median daily walking minutes were 34.2 (interquartile range [IQR] 17.1, 60.0), and median daily total PA minutes were 68.6 (IQR 31.4, 113.6). Walking and total PA minutes were both moderately correlated with pedometer steps (Spearman correlation r=0.42, p=0.003, for each) but not with step-test seconds to completion (r=-0.11, p=0.44; r=-0.25, p=0.08, respectively). Total PA minutes were significantly correlated with physical function scores (r=0.39, p=0.004), but walking minutes were not (r=0.15, p=0.29). CONCLUSIONS This initial examination of the psychometric properties of the AAS for older adults suggests that this surveillance tool has acceptable convergent validity for ambulatory, community-dwelling older adults.
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Affiliation(s)
- Kristiann C Heesch
- Queensland University of Technology, Institute of Health & Biomedical Innovation & School of Public Health, Victoria Park Road, Brisbane, Queensland 4059, Australia.
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