Both Light Intensity and Moderate-to-Vigorous Physical Activity Measured by Accelerometry Are Favorably Associated With Cardiometabolic Risk Factors in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study

Temporal Associations of Physical Activity With Subsequent Knee Pain in Individuals With Knee Osteoarthritis: An Ecological Momentary Assessment Study

BACKGROUND

Physical activity (PA) is a first-line treatment for knee osteoarthritis and provides benefits for functional improvement and pain relief. However, movement-evoked pain often hinders PA participation and long-term adherence. The relationship between PA and pain is not fully understood and may vary across individuals. We examined the temporal associations between PA and subsequent knee pain in individuals with knee osteoarthritis.

METHODS

In a 10-day ecological momentary assessment (EMA) cohort study, PA was recorded using an Actigraph accelerometer; momentary knee pain intensity was rated on a numeric rating scale in responses to four daily text prompts. Linear mixed-effects models examined within-day and between-day associations between PA and knee pain, adjusting for age, sex and BMI.

RESULTS

The sample included up to 454 observations across 10 days from 17 participants (age = 64 ± 7 years, BMI = 27 ± 4 kg/m2, 61% women), each consisting of a temporal pair of PA minutes and subsequent momentary pain. Within-day, greater moderate-to-vigorous PA (MVPA) minutes were associated with a subsequent increase in knee pain (adjusted β = 0.112, 95% CI: 0.023, 0.201, p = 0.014); while light-intensity PA showed no association with subsequent pain (adjusted β = -0.003, 95% CI: -0.011, 0.005, p = 0.461). Current-day MVPA and light-intensity PA minutes were not associated with next-day knee pain.

CONCLUSIONS

While MVPA may temporarily increase knee pain, its impact was transient. Light-intensity PA showed no association with pain, suggesting it may be a suitable alternative for those with movement-evoked pain. Understanding these temporal patterns can help guide tailored pain management and PA adherence strategies. Further research is needed to confirm these preliminary findings.

SIGNIFICANCE STATEMENT

Understanding the dynamic relationship between PA and knee pain is crucial for optimising the management of knee OA. This exploratory study offers new insights by leveraging high-frequency data to examine the intra- and inter-day associations of MVPA and light-intensity PA with subsequent knee pain. The preliminary findings demonstrate that MVPA may lead to transient pain increases, while light-intensity PA is not associated with pain intensity. Identifying these PA-pain temporal patterns can inform personalised strategies for pain management and improving long-term activity adherence.

Associations of step accelerations and cardiometabolic risk markers in early adulthood

Physical activity (PA) has a positive effect on risk factors related to cardiometabolic health yet amount of PA and time of onset is unclear. Therefore, we investigated the relationship of PA estimates and cardiometabolic risk factors in a large healthy population of an understudied age group of young adults using a standard gravity-based method on body adiposity and risk markers. In 856 (532 women, 324 men, 32-35 years) subjects we evaluated the association of PA and cardiometabolic risk factors in early adulthood. PA was measured using accelerometers for a period of two weeks. Step counts were divided into light (LPA), moderate (MPA), and vigorous (VPA) intensity classes. Income of the household was 63 446 ± 46 899€ and 57.5% had higher education. Total daily step numbers were 11962.5 ± 5163.2, LPA 5459.6 ± 2986.6, MPA 5932 ± 3404.6, and VPA 572.3 ± 668. Higher total PA volume was associated with lower weight, BMI, % body fat, smaller visceral fat area (VFA) and waist circumference, lower total cholesterol, LDL, and reflection coefficient of the pulse wave. LPA correlated with weight, BMI, waist circumference, total cholesterol, LDL, and central pulse pressure (cPP). Percent body fat (%BF), VFA, total cholesterol, LDL, reflection coefficient, heart minute index, and heart minute volume were significantly associated with MPA and VPA intensity PA volume. Lower PA in early adulthood correlates with increased cardiometabolic risk markers which should be translated into specific recommendations to thrive for a healthier lifestyle to delay and decrease their onset.

Decrease in accelerometer assessed physical activity during the first-year post-myocardial infarction: a prospective cohort study

OBJECTIVES

To elucidate physical activity in the first year after myocardial infarction (MI), and to explore differences in various subgroups, delineated by age, participation in exercise-based cardiac rehabilitation (exCR), or restrictions due to the covid-19 pandemic. Secondly, to explore associations between changes in physical activity variables with blood pressure and lipid levels.

METHODS

A longitudinal study in 2017-2023. Physical activity variables were assessed via accelerometers at two- and twelve months post-MI. The intensity was divided into, sedentary, light, moderate, and vigorous-intensity physical activity, according to established cut-offs. Blood pressure and lipids were measured by standardized procedures at the same time points.

RESULTS

There were 178 patients included at baseline, 81% male, mean age of 64 (9 SD) years. Patients spent 72% of their time sedentary, followed by light (19%), moderate (8%), and vigorous physical activity (1%). Patients included during covid-19 restrictions and younger patients had a higher level of moderate-intensity physical activity compared to patients included during non-pandemic restrictions and older patients. At 12-month follow-up, patients overall increased time (1%) in sedentary behavior (p = 0.03) and decreased time (0.6%) in moderate-intensity physical activity (p = 0.04), regardless of participation in exCR or age. There was a positive association between the change in mean physical activity intensity and HDL-cholesterol (p = 0.047).

CONCLUSIONS

Participants had a low fraction of time in moderate-to-vigorous-intensity physical activity two months post-MI, which deteriorated during the first year. This emphasizes the need for improved implementation of evidence-based interventions to support and motivate patients to perform regular physical activity.

Relationship between physical activity and abdominal obesity and metabolic markers in postmenopausal women

This study aimed to investigate the impact of physical activity indicators monitored by the POLAR accelerometer on body obesity indicators, metabolic syndrome parameters, and energy metabolism hormones in postmenopausal women. Was included 71 participants from this study program (68.8 ± 4.3 years). We divided participants into LPA and MVPA groups based on their level of moderate to vigorous physical activity per week; Physical activity levels over 7 days were assessed using a POLAR accelerometer, with daily step counts and sedentary time recorded. Measurements included waist circumference, visceral fat volume, body fat percentage, blood pressure, fasting blood glucose, triglyceride levels, HDL cholesterol, and energy metabolism hormone levels (leptin, resistin, adiponectin). The MVPA group displayed lower waist circumference, body fat percentage, abdominal fat, and BMI compared to the LPA group (p < 0.05). A significant negative correlation was observed between daily step count and obesity indicators, including waist circumference (r = -0.301), body fat percentage (r = -0.295), abdominal fat (r = -0.318), and BMI (r = -0.238). Conversely, sedentary time showed a positive correlation with obesity indicators such as waist circumference (r = 0.258), body fat percentage (r = 0.239), and abdominal fat (r = 0.244). Moreover, daily step count exhibited a significant negative correlation with leptin levels (r = -0.245), while sedentary time was positively correlated with the energy metabolic factor leptin (r = 0.279). Waist circumference demonstrated significant positive correlations with triglycerides, blood glucose, adiponectin, resistin, and leptin levels. Postmenopausal women who engage in at least 150 min of MVPA weekly show lower obesity indices. There is a significant correlation between physical activity levels and obesity indicators, which relate to metabolic syndrome and energy metabolism factors. Thus, increased physical activity may help prevent metabolic syndrome and cardiovascular diseases in this population.

Influence of physical activity measurement on the association between Life's Essential 8 and incident cardiovascular disease in older women

Objective

The American Heart Association's Life's Essential 8 (LE8) metric includes self-reported physical activity as one of the metrics for assessing cardiovascular health. Self-reported physical activity is prone to misclassification, whereas accelerometer measures are less biased. We examined associations of LE8 and incident cardiovascular disease (CVD) using self-reported and accelerometer-measured physical activity.

Methods

Participants in the Women's Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health Study (n = 4,243; mean age = 79 ± 7 years) with no CVD history completed the WHI physical activity questionnaire and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire prior to wearing a hip-worn accelerometer for up to seven days in 2012-2014. LE8 components (physical activity, diet, sleep, body mass index, smoking, blood pressure, non-HDL cholesterol, and glucose) were scored according to guidelines. Scores were created using five physical activity measures: WHI questionnaire (LE8WHI), CHAMPS (LE8CHAMPS), accelerometer-measured physical activity (LE8A), and sample quantiles of accelerometer-measured physical activity (LE8AQ) and daily steps (LE8STEPS). Hazard ratios (HR) for physician-adjudicated CVD were estimated using Cox regression.

Results

707 incident CVD events occurred over an average 7.5 years. Multivariable HRs (95 % CI) comparing women in the highest vs. lowest quartiles of LE8 scores were: LE8WHI = 0.53 (0.43-0.67), LE8CHAMPS = 0.47 (0.38-0.60), LE8A = 0.44 (0.36-0.56), LE8AQ = 0.44 (0.35-0.55), and LE8STEPS = 0.45 (0.35-0.57).

Conclusions

The LE8-incident CVD association varies by physical activity measurement, however all methods showed reduced risk. Device-measures of physical activity may be more accurate in the LE8, but when impractical to implement, also support use of self-reported measures.

A geographic perspective of the association between physical activity and cardiovascular health: A need for community-level intervention

Cardiovascular diseases (CVDs) are a major cause of death globally, and minority communities are at higher risk of chronic health outcomes. A combination of lifestyle, including physical activity (PA), good nutrition, and reduced stress, can improve life expectancy. This study aimed to analyze the association between CVDs and PA among the adult population (N = 3,956) based on the World Health Organization (WHO) STEPwise Approach to Surveillance (STEPS) survey in Afghanistan. Descriptive statistics, logistic regression, and spatial analytical techniques were used to analyze the data. Based on the WHO STEPS data, the computed prevalence of CVDs, obesity, hypertension, diabetes, and high cholesterol were 7.41%, 45.57%, 34.06%, 9.51%, and 12.16%, respectively. Multivariate logistic analysis indicated that moderate work-related PA was associated with higher odds of CVDs and high cholesterol while inversely associated with obesity. Moderate leisure-related PA was positively associated with obesity. Vigorous leisure-related PA was associated with lower risks of CVDs, obesity, and high cholesterol but had a positive association with hypertension. Spatial analysis revealed a CVD hotspot in the southern region and the risk factors clustered in the northern region. These findings offer valuable insights for community and public health practitioners to design targeted interventions for reducing the burden of CVDs and risk factors in communities in developing countries.

Adult Sports Participation and Physical Activity: How About Curling?

Despite its well-documented physical and psychosocial benefits, sport remains the least engaged form of physical activity (PA) among adults. Many adults may lack the skills needed to play or continue to play sports and aging adults are more likely to avoid participation for fear of poor performance or injury. A sport that shows great promise for adults seeking new sports participation outlets is curling. Curling is a team sport comprised of four interchangeable positions working collectively to deliver granite stones across a sheet of ice in an effort to outscore the opponent team. While it seems reasonable that walking on ice, "throwing" a 44 lb granite stone across a sheet of ice, and periodically sweeping while walking on ice over a two-hour period would generate at least a moderate amount of physical activity, research to date is quite limited. Therefore, the purpose of this study was to objectively measure the amount and intensity of PA achieved by average recreational curling participants during a typical curling match. Members of a curling club in NC were asked to wear ActiGraph Accelerometers (model GT3X) while they participated in their regularly scheduled curling match. All participants had at least one year of curling experience. Curling matches lasted between 90 and 120 minutes. Participants were asked to indicate their age, gender, and curling position during the match (lead, second, vice, skip) which were matched with accelerometer data. Overall, 110 participants (37 female, 73 male, avg. age 50 yrs) spent most of their curling time in light or moderate-intensity activity (18.1% Sedentary; 49.5% light; 32.4% moderate; .03% vigorous). In terms of minutes, the average participant spent 35.9 minutes engaged in Moderate-to-Vigorous PA (MVPA) per curling experience. This represents 23.9% of the weekly 150min of MVPA suggested by the CDC. Estimates of METs indicated that curling would be classified on the border of light and moderate physical activity. While total step data indicated that participation in beginning curling could make a significant contribution toward meeting the 10,000 - 13,000 daily step recommendation with an average of 2936 steps (~30%) within the curling sessions. The second position had the highest percentage of moderate activity level and a small percentage of vigorous activity. No other position reached a vigorous level. The skip position had the highest amount of sedentary activity as well as light activity. Females had a higher level of moderate activity in comparison to males. However, males reached a small amount of vigorous activity. The age group of 18 - 36 had the highest amount of moderate activity and the lowest amount of sedentary activity. This age group reached an average of 41.0 minutes of MVPA per curling experience. The age group of > 58 had the highest amount of sedentary activity and the lowest amount of moderate activity. Findings clearly show that regardless of position, curling participants achieved a moderate amount of physical activity during typical gameplay and that a majority of playing time was spent engaged in light or moderate levels. Participants should consider playing in one of the first three positions to maximize the amount and intensity of PA achieved while playing. Furthermore, since curling also requires balance, coordination, muscular strength, multitasking, strategic reasoning, and can cater to most physical challenges without compromising the integrity of the game, it may be an ideal sport to promote for adults of all ages and sport abilities. Findings should be used to inform strategies for promoting curling as an opportunity for team sport involvement that has the added value of contributing to daily physical activity. However, access and opportunities to play, especially for underserved populations, are limited. Given that most curling clubs in America are private and require a membership to play (Kanters, et. al, 2023), partnership arrangements between existing clubs and public parks and recreation departments could increase both access and opportunities to play.

Arriba por la Vida Estudio: a randomized controlled trial promoting standing behavior to reduce sitting time among postmenopausal Latinas

Postmenopausal Hispanic/Latina (N = 254) women with a body mass index (BMI) ≥ 25 kg/m2 were randomized to an intervention to reduce sitting time or a comparison condition for 12 weeks. The standing intervention group received three in-person health-counseling sessions, one home visit, and up to eight motivational interviewing calls. The heart healthy lifestyle comparison group (C) received an equal number of contact hours to discuss healthy aging. The primary outcome was 12-week change in sitting time measured via thigh-worn activPAL. Group differences in outcomes were analyzed using linear mixed-effects models. Participants had a mean age of 65 (6.5) years, preferred Spanish language (89%), BMI of 32.4 (4.8) kg/m2, and sat for an average of 540 (86) minutes/day. Significant between-group differences were observed in reductions of sitting time across the 12-week period [Mdifference (SE): C - 7.5 (9.1), SI - 71.0 (9.8), p < 0.01]. Results demonstrate that coaching models to reduce sitting are feasible and effective.

Stressors and Subjective Cognition in Daily Life: Tests of Physical Activity and Age as Moderators

OBJECTIVE

Growing research indicates that daily stress is associated with poorer same-day cognitive performance, for example, memory and attention. However, it is unclear whether this relationship holds across diverse ages and engagement in physical activity (PA), or whether these factors might buffer the relationship between daily stress and subjective cognitive function.

METHODS

Ecological momentary assessment data were collected from adults aged 25 to 88 years across British Columbia, Canada. For 14 days, participants ( N = 204) wore a triaxial physical activity monitor, reported stressor occurrence in mobile surveys four times per day, and rated their subjective attention and memory at the end of each day.

RESULTS

Multilevel models evaluated daily stressor occurrence as a predictor of subjective attention and memory, with same-day PA engagement and age as moderators. Subjective attention and memory were lower on days when a stressor had occurred, compared to stressor-free days. Neither PA nor age moderated the within-person associations of daily stressors with subjective cognition.

CONCLUSION

The lack of stress-buffering effects for same-day PA and age raises questions about the contexts in which PA promotes cognitive functioning and about age-related processes underlying stress and cognition. Future work could examine the mechanisms that might explain the link between daily stress and cognition function, as well as the associations of different intensity and forms of physical activity on stress across age groups.

Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review

BACKGROUND

Monitoring free-living physical activity (PA) through wearable devices enables the real-time assessment of activity features associated with health outcomes and provision of treatment recommendations and adjustments. The conclusions of studies on PA and health depend crucially on reliable statistical analyses of digital data. Data analytics, however, are challenging due to the various metrics adopted for measuring PA, different aims of studies, and complex temporal variations within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized.

OBJECTIVE

This research aimed to review studies that used analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addressed three questions: (1) What metrics are used to describe an individual's free-living daily PA? (2) What are the current analytical tools for analyzing PA data, particularly under the aims of classification, association with health outcomes, and prediction of health events? and (3) What challenges exist in the analyses, and what recommendations for future research are suggested regarding the use of statistical methods in various research tasks?

METHODS

This scoping review was conducted following an existing framework to map research studies by exploring the information about PA. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were searched in February 2024 to identify related publications. Eligible articles were classification, association, or prediction studies involving human PA monitored through wearable accelerometers.

RESULTS

After screening 1312 articles, 428 (32.62%) eligible studies were identified and categorized into at least 1 of the following 3 thematic categories: classification (75/428, 17.5%), association (342/428, 79.9%), and prediction (32/428, 7.5%). Most articles (414/428, 96.7%) derived PA variables from 3D acceleration, rather than 1D acceleration. All eligible articles (428/428, 100%) considered PA metrics represented in the time domain, while a small fraction (16/428, 3.7%) also considered PA metrics in the frequency domain. The number of studies evaluating the influence of PA on health conditions has increased greatly. Among the studies in our review, regression-type models were the most prevalent (373/428, 87.1%). The machine learning approach for classification research is also gaining popularity (32/75, 43%). In addition to summary statistics of PA, several recent studies used tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements and functional data analysis with PA as a continuum for time-varying association (68/428, 15.9%).

CONCLUSIONS

Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals' overall PA. When the distribution and profile of PA need to be evaluated or detected, considering PA metrics as longitudinal or functional data can provide detailed information and improve the understanding of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings.

Accelerometer-Measured Physical Activity, Sedentary Time, and Heart Failure Risk in Women Aged 63 to 99 Years

Importance

Heart failure (HF) prevention is paramount to public health in the 21st century.

Objective

To examine incident HF and its subtypes with preserved ejection fraction (HFpEF) and reduced EF (HFrEF) according to accelerometer-measured physical activity (PA) and sedentary time.

Design, Setting, and Participants

This was a prospective cohort study, the Objective Physical Activity and Cardiovascular Health (OPACH) in Older Women study, conducted from March 2012 to April 2014. Included in the analysis were women aged 63 to 99 years without known HF, who completed hip-worn triaxial accelerometry for 7 consecutive days. Follow-up for incident HF occurred through February 2022. Data were analyzed from March to December 2023.

Exposure

Daily PA (total, light, moderate to vigorous PA [MVPA], steps) and sedentary (total, mean bout duration) behavior.

Main Outcomes and Measures

Adjudicated incident HF, HFpEF, and HFrEF.

Results

A total of 5951 women (mean [SD] age, 78.6 [6.8] years) without known HF were included in this analysis. Women self-identified with the following race and ethnicity categories: 2004 non-Hispanic Black (33.7%), 1022 Hispanic (17.2%), and 2925 non-Hispanic White (49.2%). There were 407 HF cases (257 HFpEF; 110 HFrEF) identified through a mean (SD) of 7.5 (2.6) years (range, 0.01-9.9 years) of follow-up. Fully adjusted hazard ratios (HRs) for overall HF, HFpEF, and HFrEF associated with a 1-SD increment were 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.67-0.91), and 1.02 (95% CI, 0.81-1.28) for minutes per day total PA; 0.74 (95% CI, 0.63-0.88), 0.71 (95% CI, 0.57-0.88), and 0.83 (95% CI, 0.62-1.12) for steps per day; and 1.17 (95% CI, 1.04-1.33), 1.29 (95% CI, 1.10-1.51), and 0.94 (95% CI, 0.75-1.18) for minutes per day total sedentary. Cubic spline curves for overall HF and HFpEF were significant inverse for total PA and steps per day and positive for total sedentary. Light PA and MVPA were inversely associated with overall HF (HR per 1 SD: 0.88; 95% CI, 0.78-0.98 and 0.84; 95% CI, 0.73-0.97) and HFpEF (0.80; 95% CI, 0.70-0.93 and 0.85; 95% CI, 0.72-1.01) but not HFrEF. Associations did not meaningfully differ when stratified by age, race and ethnicity, body mass index, physical function, or comorbidity score. Results for sedentary bout duration were inconsistent.

Conclusions and Relevance

Higher accelerometer-measured PA (MVPA, light PA, steps per day) was associated with lower risk (and greater total sedentary time with higher risk) of overall HF and HFpEF in a racially and ethnically diverse cohort of older women. Increasing PA and reducing sedentary time for primary HFpEF prevention may have relevant implications for cardiovascular resilience and healthy aging in later life.

Prospective Associations of Accelerometer-Measured Machine-Learned Sedentary Behavior With Death Among Older Women: The OPACH Study

BACKGROUND

Sedentary behavior is a recognized mortality risk factor. The novel and validated convolutional neural network hip accelerometer posture algorithm highly accurately classifies sitting and postural changes compared with accelerometer count cut points. We examined the prospective associations of convolutional neural network hip accelerometer posture-classified total sitting time and mean sitting bout duration with all-cause and cardiovascular disease (CVD) death.

METHODS AND RESULTS

Women (n=5856; mean±SD age, 79±7 years; 33% Black women, 17% Hispanic or Latina women, 50% White women) in the Women's Health Initiative Objective Physical Activity and Cardiovascular Health (OPACH) Study wore the ActiGraph GT3X+ for ~7 days from May 2012 to April 2014 and were followed through February 19, 2022 for all-cause and CVD death. The convolutional neural network hip accelerometer posture algorithm classified total sitting time and mean sitting bout duration from GT3X+ output. Over follow-up (median, 8.4 years; range, 0.1-9.9), there were 1733 deaths (632 from CVD). Adjusted Cox regression hazard ratios (HRs) comparing women in the highest total sitting time quartile (>696 min/d) to those in the lowest (<556.0 min/d) were 1.57 (95% CI; 1.35-1.83; P-trend<0.001) for all-cause death and 1.78 (95% CI; 1.36-2.31; P-trend<0.001) for CVD death. HRs comparing women in the longest mean sitting bout duration quartile (>15 minutes) to the shortest (<9.3 minutes) were 1.43 (95% CI; 1.23-1.66; P-trend<0.001) for all-cause death and 1.52 (95% CI; 1.18-1.96; P-trend<0.001) for CVD death. Apparent nonlinear associations for total sitting time suggested higher all-cause death (P nonlinear=0.009) and CVD death (P nonlinear=0.008) risk after ~660 to 700 min/d.

CONCLUSIONS

Higher total sitting time and longer mean sitting bout duration are associated with higher all-cause and CVD mortality risk among older women. These data support interventions aimed at reducing both total sitting time and interrupting prolonged sitting.

Improving Health Outcomes in Coronary Artery Disease Patients with Short-Term Protocols of High-Intensity Interval Training and Moderate-Intensity Continuous Training: A Community-Based Randomized Controlled Trial

Studies have shown that the higher the aerobic capacity, the lower the risk of cardiovascular mortality and morbidity. In the case of cardiac patients, high-intensity interval training (HIIT) seems to be more effective than moderate-intensity continuous training (MICT) in improving aerobic capacity. The aim of this study was to investigate the effects of two community-based exercise programs using two short-term protocols (HIIT and MICT) on physical fitness and physical activity (PA) levels in coronary artery disease (CAD) patients. Methods. In this randomized controlled trial, body composition, aerobic capacity, muscle strength, and daily PA levels were assessed before and after 6 weeks of intervention in 69 patients diagnosed with CAD. All patients were randomly (1 : 1 : 1) assigned to two exercise groups (HIIT or MICT) or a control group (no exercise). Both training programs consisted of 6 weeks of supervised treadmill exercise, three sessions per week. MICT targeted ≈70-75% of peak heart rate (HR), while HIIT aimed for ≈85-95% of peak HR. The control group only followed the medical recommendations. Results. Community-based exercise programs showed more positive effects on physical fitness variables and physical activity levels compared to control. HIIT could significantly improve waist circumference, body fat mass, VO2peak, sedentary behavior, and moderate-to-vigorous PA compared to MICT. Moreover, the control group showed poorer results. Conclusion. HIIT can improve health outcomes more positively than MICT and control. These findings indicate that HIIT may be an alternative and effective training method in community-based exercise programs for CAD patients. This trial is registered with NCT03538119.

Multimorbidity is associated with lower total 24-hour movement activity among US adults

Objective

Having chronic conditions may result in reduced physical and cognitive function but less is known about multimorbidity with daily movement. We examined the association of multimorbidity and device-measured total daily movement in a nationally representative sample of US adults aged ≥ 30 years from the 2011-2014 National Health and Nutrition Examination Surveys.

Methods

Any multimorbidity (≥2 conditions) and complex multimorbidity (≥3 conditions across ≥ 3 body systems) were quantified using 16 chronic conditions via self-report and/or clinical thresholds. Total movement over 24-hours (Monitor-Independent Movement Summary units [MIMS-units]) was measured using a wrist-worn device (ActiGraph GT3X). Multivariable linear regression examined the association of 1) each chronic condition, 2) number of conditions, 3) any multimorbidity, and 4) complex multimorbidity with total movement. Covariates included age, gender, race/ethnicity, educational attainment, and smoking status.

Results

Among US adults (N = 7304, mean age: 53.2 ± 0.34 years, 53.2% female, 69.4% Non-Hispanic White), 62.2% had any multimorbidity with 34.2% having complex multimorbidity. After adjustment, a higher number of chronic conditions was associated with incrementally lower total movement (β MIMS-units [95% CI] compared to those with no chronic conditions; one: -419 [-772, -66], two: -605 [-933, -278], three: -1201 [-1506, -895], four: -1908 [-2351, -1465], 5+: -2972 [-3384, -2560]). Complex multimorbidity presence was associated with -1709 (95% CI: -2062, -1357) and -1269 (-1620, -918) lower total movement compared to those without multimorbidity and multimorbidity but not complex, respectively.

Conclusions

Multimorbidity was associated with lower 24-h movement among US adults and may be helpful for identifying adults at risk for low movement.

Accelerometer-measured absolute versus relative physical activity intensity: cross-sectional associations with cardiometabolic health in midlife

BACKGROUND

Observational studies investigating the association between accelerometer-measured physical activity and health all use absolute measures of physical activity intensity. However, intervention studies suggest that the physical activity intensity required to improve health is relative to individual fitness. The aim of this study was to investigate the associations between accelerometer-measured absolute and relative physical activity intensity and cardiometabolic health, and what implications these associations may have on the interpretation of health-associated physical activity.

METHODS

A sample of the cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) consisting of 4,234 men and women aged 55-64 years was studied. Physical activity intensity was measured by accelerometry and expressed as absolute (e.g., metabolic equivalents of task) or relative (percentage of maximal oxygen consumption). Fitness was estimated by the submaximal Ekblom-Bak test. A composite ('metabolic syndrome') score combined measures of waist circumference, systolic blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin. Associations of absolute and relative physical activity intensity with the health indicators (i.e., fitness and metabolic syndrome score) were studied by partial least squares regression. Analyses were stratified by fitness level.

RESULTS

Both absolute and relative physical activity intensity associated with the health indicators. However, the strongest associations for absolute intensity varied depending on fitness levels, whereas the associations for relative intensity were more synchronized across fitness groups. The dose-response relationship between moderate-to-vigorous intensity and the health indicators was stronger for relative than for absolute intensity. The absolute and relative moderate-to-vigorous intensity cut-offs intersected at the 5th fitness percentile, indicating that the absolute intensity cut-off is too low for 95% of individuals in this sample. While 99% of individuals fulfilled the general physical activity recommendations based on absolute intensity measures, only 21% fulfilled the recommendations based on relative intensity measures. In relation to a "sufficient" fitness level, 9% fulfilled the recommendations.

CONCLUSIONS

Accelerometer-measured relative physical activity intensity represents the intensity related to health benefits regardless of fitness level. Traditional absolute moderate intensity accelerometer cut-offs are too low for most individuals and should be adapted to the fitness level in the sample studied. Absolute and relative physical activity intensity cannot be used interchangeably.

Accelerometer-measured physical activity and sitting with incident mild cognitive impairment or probable dementia among older women

INTRODUCTION

Physical activity (PA) is prospectively inversely associated with dementia risk, but few studies examined accelerometer measures of PA and sitting with rigorously-adjudicated mild cognitive impairment (MCI) and dementia risk.

METHODS

We examined the associations of accelerometer measures (PA and sitting) with incident MCI/probable dementia in the Women's Health Initiative (n = 1277; mean age = 82 ± 6 years) RESULTS: Over a median follow-up of 4.2 years, 267 MCI/probable dementia cases were identified. Adjusted Cox regression HRs (95% CI) across moderate-to-vigorous PA (MVPA) min/d quartiles were 1.00 (reference), 1.28 (0.90 to 1.81), 0.79 (0.53 to 1.17), and 0.69 (0.45 to 1.06); P-trend = 0.01. Adjusted HRs (95% CI) across steps/d quartiles were 1.00 (reference), 0.73 (0.51 to 1.03), 0.64 (0.43 to 0.94), and 0.38 (0.23 to 0.61); P-trend < 0.001. The HR (95% CI) for each 1-SD increment in MVPA (31 min/d) and steps/d (1865) were 0.79 (0.67 to 0.94) and 0.67 (0.54 to 0.82), respectively. Sitting was not associated with MCI/probable dementia.

DISCUSSION

Findings suggest ≥ moderate intensity PA, particularly stepping, associates with lower MCI and dementia risk.

HIGHLIGHTS

Few studies have examined accelerometer-measured physical activity, including steps, and sitting with incident ADRD. Moderate-to-vigorous physical activity and steps, but not light physical activity or sitting, were inversely associated with lower ADRD risk. Among older women, at least moderate intensity physical activity may be needed to reduce ADRD risk.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Cardiovascular disease risk and all-cause mortality associated with accelerometer-measured physical activity and sedentary time ‒ a prospective population-based study in older adults

Background

Low levels of physical activity (PA) and high sedentary time (ST) are common in older adults and lack of PA is a risk factor for cardiovascular disease (CVD). Knowledge about associations with accelerometer-measured PA, ST and CVD risk in older adults is insufficient. This study examines the associations of accelerometer-measured PA and ST with cardiovascular risk measured using the Framingham risk score (FRS) and all-cause mortality in older adults.

Methods

A population-based sample of 660 (277 men, 383 women) older people (mean age 68.9) participated in the Oulu45 cohort study from 2013‒2015. PA and ST were measured with wrist-worn accelerometers at baseline for two weeks. Ten-year CVD risk (%) was estimated with FRS. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. The associations between moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and FRS were analyzed using the multivariable linear regression analysis. Associations between LPA, ST and mortality were analyzed using the Cox proportional-hazard regression models.

Results

Each 10 min increase in MVPA (β = -0.779, 95% CI -1.186 to -0.371, p < 0.001) and LPA (β = -0.293, 95% CI -0.448 to -0.138, p < 0.001) was negatively associated with FRS while a 10 min increase in ST (β = 0.290, 95% CI 0.158 to 0.421, p < 0.001) was positively associated with FRS. After adjustment for waist circumference, only ST was significantly associated with FRS. Each 10 min increase in LPA was associated with 6.5% lower all-cause mortality risk (HR = 0.935, 95% CI 0.884 to 0.990, p = 0.020) and each 10 min increase in ST with 5.6% increased mortality risk (HR = 1.056, 95% CI 1.007 to 1.108, p = 0.025).

Conclusion

A higher amount of daily physical activity, at any intensity level, and avoidance of sedentary time are associated with reduced cardiovascular disease risk in older people. Higher time spent in light physical activity and lower sedentary time are associated with lower all-cause mortality.

Calibration of an Accelerometer Activity Index among Older Women and Its Association with Cardiometabolic Risk Factors

Purpose

Traditional summary metrics provided by accelerometer device manufacturers, known as counts, are proprietary and manufacturer specific, making them difficult to compare studies using different devices. Alternative summary metrics based on raw accelerometry data have been introduced in recent years. However, they were often not calibrated on ground truth measures of activity-related energy expenditure for direct translation into continuous activity intensity levels. Our purpose is to calibrate, derive, and validate thresholds among women 60 years and older based on a recently proposed transparent raw data based accelerometer activity index (AAI), and to demonstrate its application in association with cardiometabolic risk factors.

Methods

We first built calibration equations for estimating metabolic equivalents (METs) continuously using AAI and personal characteristics using internal calibration data (n=199). We then derived AAI cutpoints to classify epochs into sedentary behavior and intensity categories. The AAI cutpoints were applied to 4,655 data units in the main study. We then utilized linear models to investigate associations of AAI sedentary behavior and physical activity intensity with cardiometabolic risk factors.

Results

We found that AAI demonstrated great predictive accuracy for METs (R2=0.74). AAI-based physical activity measures were associated in the expected directions with body mass index (BMI), blood glucose, and high density lipoprotein (HDL) cholesterol.

Conclusion

The calibration framework for AAI and the cutpoints derived for women older than 60 years can be applied to ongoing epidemiologic studies to more accurately define sedentary behavior and physical activity intensity exposures which could improve accuracy of estimated associations with health outcomes.

Physical activity and sedentarism among seniors in France, and their impact on health

Background

In the context of the ageing of the French population, physical activity becomes a principal means for maintaining good health. International organisations are thus giving increasing importance to physical activity in programmes of disease-prevention. In parallel with these concerns, studies have shown the impact of sedentary activities (in particularly as a result of the seated position and screen time) on health.

Objective

To show the links between physical activity, sedentarism and health indicators and to identify the socio-demographic variables by which they are influenced (particularly gender).

Study design

This is a transversal epidemiological study conducted among the French population between 2014 and 2016 by Santé publique France, the national public health agency.

Methods

The RPAQ (Recent Physical Activity Questionnaire) was used to measure the physical activity and sedentary lifestyle of individuals. The analyses focus on the behaviours among the population of older adults (55–74 years old, n = 1155).

Results

A third of French older adults does not meet the WHO recommended physical activity levels, particularly so among women. The results of this survey point to significant links between health indicators (especially overweight and obesity) and the physical activity level and sedentarity of older adults. From the age of 60, energy expenditure linked to physical activity increases before decreasing from the age of 65. Older adults spend almost 6 hours per day in sedentary activities. The combinations between physical activity and sedentarism highlight four profiles of older adults. The most active profile is the one with the best health indicators.

Conclusion

The links between health, sedentarity and physical activity are unequivocal: people who achieve the WHO recommendations for physical activity and spend less than 7 hours each day in sedentary activities are those who also have the best health indicators. These results vary with sociographic characteristics and reveal significant links with health indicators.

Higher 24-h Total Movement Activity Percentile Is Associated with Better Cognitive Performance in U.S. Older Adults

PURPOSE

This study aimed to assess the association of a wrist-worn, device-based metric of 24-h movement with cognitive function and subjective cognitive complaints among older adults, 60 yr and older.

METHODS

This is a cross-sectional analysis of the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycles. A wrist-worn ActiGraph GT3X+ accelerometer captured total 24-h movement activity, analyzed as Monitor-Independent Movement Summary units (MIMS-units), and quantified into placement based on an age- and sex-standardized percentile. Cognitive tests in the domains of memory, language/verbal fluency, and executive performance were administered. Test-specific cognitive z -scores were generated. Subjective cognitive complaints included perceived difficulty remembering and confusion/memory loss.

RESULTS

The analytical sample included 2708 U.S. older adults (69.5 ± 0.2 yr, 55% female, 20.9% non-White). Multivariable linear regressions revealed those in quartiles 3 (50th-74th percentile) and 4 (≥75th percentile) for their age and sex had higher cognitive function z -scores across all domains compared with those in quartile 1. Logistic regressions demonstrated those in quartiles 3 and 4 also had lower odds of reporting difficulty remembering (adjusted odds ratio [AOR] = 0.52, 95% confidence interval [CI] = 0.31-0.89; AOR = 0.57, 95% CI = 0.37-0.88) and confusion/memory loss (AOR = 0.49, 95% CI = 0.27-0.91; AOR = 0.49, 95% CI = 0.27-0.98), respectively, compared with those in quartile 1.

CONCLUSIONS

In a representative sample of U.S. older adults, higher cognitive functioning occurs among those that perform total 24-h movement activity at or above the 50th percentile for their age and sex. Future studies should consider movement behaviors across a 24-h period on cognitive health outcomes in older adults. More research exploring prospective associations of MIMS-units and time-use behaviors across midlife and older adulthood that may affect cognitive functioning across diverse populations is needed.

Daily and hourly patterns of physical activity and sedentary behavior of older adults: Atherosclerosis risk in communities (ARIC) study

This cross-sectional study of older adults ≥ 65 years describes daily and hourly patterns of accelerometer-derived steps, sedentary, and physical activity behaviors and examines differences by day of the week and sociodemographic and health-related factors to identify time-use patterns. Data were from 459 Atherosclerosis Risk in Communities (ARIC) study participants (60% female; mean ± SD age = 78.3 ± 4.6 years; 20% Black) who wore a hip accelerometer ≥ 4 of 7 days, for ≥ 10 h/day in 2016. We used linear mixed models to examine daily patterns of steps, sedentary, low light, high light, and moderate-to-vigorous intensity physical activity (MVPA). Differences by sex, median age ( Collapse

Key Words

• Accelerometer
• Elderly
• Movement
• Steps
• Time-use

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Affiliation(s)

Erin E. Dooley The University of Alabama at Birmingham, Birmingham, AL, USA
Lisa A. Pompeii Baylor College of Medicine, Houston, TX, USA
Priya Palta Columbia University Irving Medical Center, New York, NY, USA
Pablo Martinez-Amezcua Columbia University Irving Medical Center, New York, NY, USA
Bjoern Hornikel The University of Alabama at Birmingham, Birmingham, AL, USA
Kelly R. Evenson Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Jennifer A. Schrack Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Kelley Pettee Gabriel The University of Alabama at Birmingham, Birmingham, AL, USA

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Light intensity physical activity is beneficially associated with brain volume in older adults with high cardiovascular risk

Background

Older people with high cardiovascular risk, including those without cardiovascular diseases, are an at-risk population for dementia. Regular physical activity is generally recommended to maintain brain health; however, the optimal intensity of physical activity for maintaining brain volume in older adults with cardiovascular risk remains unclear. We examined the associations between intensity-specific physical activity and brain volume stratified by absolute cardiovascular risk level in older adults without cardiovascular diseases.

Methods and results

This cross-sectional study involved 725 community-dwelling older Japanese adults without cardiovascular diseases. We estimated absolute cardiovascular risk using the World Health Organization risk estimation charts, which include variables such as age, sex, diabetes mellitus, smoking, systolic blood pressure, and total cholesterol, and stratified cardiovascular risk level into three risk categories: low (≤ 9%), moderate (10–14%), and high (≥15%). We measured daily physical activity using a triaxial accelerometer, and calculated the average time spent in moderate-to-vigorous intensity physical activity (MVPA) and light intensity physical activity (LPA). We performed brain T1-weighted magnetic resonance imaging and calculated the volume of the cortical gray matter, subcortical gray matter, and cerebral white matter, using the FreeSurfer software. In the overall sample, multivariable linear regression analysis showed that greater MVPA was significantly associated with greater volume of the cortical gray matter and cerebral white matter, and greater LPA was significantly associated with greater volume of the cerebral white matter. Additionally, in the analysis of the sample stratified by absolute cardiovascular risk level, cerebral white matter volume was significantly associated with both MVPA and LPA in the high cardiovascular risk group.

Conclusions

The association between physical activity and brain volume differed according to cardiovascular risk level in community-dwelling older adults. In a population at high cardiovascular risk, maintaining or increasing LPA might be a practical and achievable strategy for healthy brain aging.

Associations between Objectively Determined Physical Activity and Cardiometabolic Health in Adult Women: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis was to qualitatively synthesize and quantitatively assess the evidence of the relationship between objectively determined volumes of physical activity (PA) and cardiometabolic health in women. Four databases (PubMed, Web of Science, Scopus, and the Cochrane library) were searched and, finally, 24 eligible studies were included, with a total of 2105 women from eight countries. A correlational meta-analysis shows that moderate-to-vigorous intensity physical activity (MVPA) was favorably associated with high-density lipoprotein (r = 0.16; 95% CI: 0.06, 0.25; p = 0.002); however, there was limited evidence for the effects of most of the other cardiometabolic biomarkers recorded from steps, total physical activity, light- and moderate-intensity physical activity and MVPA. It is most compelling and consistent that being more physically active is beneficial to the metabolic syndrome. Overall, PA levels are low in adult women, suggesting that increasing the total volume of PA is more important than emphasizing the intensity and duration of PA. The findings also indicate that, according to the confounding effects of body composition and cardiorespiratory fitness, meeting the minimal level of 150 min of moderate-intensity physical activity recommended is not enough to obtain a significant improvement in cardiometabolic indicators. Nonetheless, the high heterogeneity between studies inhibits robust conclusions.

Cross-Sectional and Longitudinal Associations of Lifestyle Behaviors with Pericardial Adipose Tissue: The MESA Study

PURPOSE

We examined associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) with pericardial adipose tissue (PAT).

METHODS

Adults from the Multi-Ethnic Study of Atherosclerosis were included from exam years 1 (2000-2002; N = 6057; mean age, 62.2 yr; 52.9% female, 38.0% White; 12.8% Chinese American, 26.7% African American, 22.5% Hispanic American), 2 (2002-2004), and 3 (2004-2005). Weekly volume of SB, LPA, and MVPA (in MET-hours per week) was reported using a questionnaire. PAT volume (in cubic centimeters) was quantified using computed tomography, analysis of covariance, and repeated-measures linear mixed models with adjustment for covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) tested cross-sectional and longitudinal associations, respectively.

RESULTS

In cross-sectional analysis, the highest tertile of SB (β = 2.71; 95% confidence interval (CI), 0.69 to 4.73; P < 0.01) and the middle tertile of MVPA (β = -1.97; 95% CI, -3.92 to -0.02; P < 0.05) were associated with PAT, whereas no association was observed for LPA in fully adjusted models. In longitudinal models, SB, LPA, and MVPA were not associated with PAT in the full study sample; however, LPA was inversely associated with PAT among Whites in stratified analysis (β = -0.54; 95% CI, -0.95 to -0.13; P < 0.05).

CONCLUSIONS

Lower SB and higher LPA (among Whites only) and MVPA may be associated with lower PAT, but additional longitudinal research is needed.

Green Walkability and Physical Activity in UK Biobank: A Cross-Sectional Analysis of Adults in Greater London

Urban greenspace provides opportunities for outdoor exercise and may increase physical activity, with accompanying health benefits. Areas suitable for walking (walkability) are also associated with increased physical activity, but interactions with greenspace are poorly understood. We investigated associations of walkability and green walkability with physical activity in an urban adult cohort. We used cross-sectional data from Greater London UK Biobank participants (n = 57,726) and assessed walkability along roads and footpaths within 1000 m of their residential addresses. Additionally, we assessed green walkability by integrating trees and low-lying vegetation into the walkability index. Physical activity outcomes included self-reported and accelerometer-measured physical activity and active transport. We assessed associations using log-linear, logistic and linear regression models, adjusted for individual- and area-level confounders. Higher green walkability was associated with favourable International Physical Activity Questionnaire responses and achievement of weekly UK government physical activity guideline recommendations. Participants living in the highest versus lowest quintile of green walkability participated in 2.41 min (95% confidence intervals: 0.22, 4.60) additional minutes of moderate-and-vigorous physical activity per day. Higher walkability and green walkability scores were also associated with choosing active transport modes such as walking and cycling. Our green walkability approach demonstrates the utility in accounting for walkability and greenspace simultaneously to understand the role of the built environment on physical activity.

Physical activity intensity profiles associated with cardiometabolic risk in middle-aged to older men and women

Accelerometers provide detailed data about physical activity (PA) across the full intensity spectrum. However, when examining associations with health, results are often aggregated to only a few summary measures [e.g. time spent "sedentary" or "moderate-to-vigorous" intensity PA]. Using multivariate pattern analysis, which can handle collinear exposure variables, we examined associations between the full PA intensity spectrum and cardiometabolic risk (CMR) in a population-based sample of middle-aged to older adults. Participants (n = 3660; mean ± SD age = 69 ± 8y and BMI = 26.7 ± 4.2 kg/m²; 55% female) from the EPIC-Norfolk study (UK) with valid accelerometry (ActiGraph-GT1M) data were included. We used multivariate pattern analysis with partial least squares regression to examine cross-sectional multivariate associations (r) across the full PA intensity spectrum [minutes/day at 0-5000 counts-per-minute (cpm); 5 s epoch] with a continuous CMR score (reflecting waist, blood pressure, lipid, and glucose metabolism). Models were sex-stratified and adjusted for potential confounders. There was a positive (detrimental) association between PA and CMR at 0-12 cpm (maximally-adjusted r = 0.08 (95%CI 0.06-0.10). PA was negatively (favourably) associated with CMR at all intensities above 13 cpm ranging between r = -0.09 (0.07-0.12) at 800-999 cpm and r = -0.14 (0.11-0.16) at 75-99 and 4000-4999 cpm. The strongest favourable associations were from 50 to 800 cpm (r = 0.10-0.12) in men, but from ≥2500 cpm (r = 0.18-0.20) in women; with higher proportions of model explained variance for women (R² = 7.4% vs. 2.3%). Most of the PA intensity spectrum was beneficially associated with CMR in middle-aged to older adults, even at intensities lower than what has traditionally been considered "sedentary" or "light-intensity" activity. This supports encouragement of PA at almost any intensity in this age-group.

Accelerometer-Derived Daily Life Movement Classified by Machine Learning and Incidence of Cardiovascular Disease in Older Women: The OPACH Study

Background Current physical activity guidelines focus on volume and intensity for CVD prevention rather than common behaviors responsible for movement, including those for daily living activities. We examined the associations of a machine-learned, accelerometer-measured behavior termed daily life movement (DLM) with incident CVD. Methods and Results Older women (n=5416; mean age, 79±7 years; 33% Black, 17% Hispanic) in the Women's Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study without prior CVD wore ActiGraph GT3X+ accelerometers for up to 7 days from May 2012 to April 2014 and were followed for physician-adjudicated incident CVD through February 28th, 2020 (n=616 events). DLM was defined as standing and moving in a confined space such as performing housework or gardening. Cox models estimated hazard ratios (HR) and 95% CI, adjusting for age, race and ethnicity, education, alcohol use, smoking, multimorbidity, self-rated health, and physical function. Restricted cubic splines examined the linearity of the DLM-CVD dose-response association. We examined effect modification by age, body mass index, Reynolds Risk Score, and race and ethnicity. Adjusted HR (95% CIs) across DLM quartiles were: 1.00 (reference), 0.68 (0.55-0.84), 0.70 (0.56-0.87), and 0.57 (0.45-0.74); p-trend<0.001. The HR (95% CI) for each 1-hour increment in DLM was 0.86 (0.80-0.92) with evidence of a linear dose-response association (p non-linear>0.09). There was no evidence of effect modification by age, body mass index, Reynolds Risk Score, or race and ethnicity. Conclusions Higher DLM was independently associated with a lower risk of CVD in older women. Describing the beneficial associations of physical activity in terms of common behaviors could help older adults accumulate physical activity.

Objectively Measured Physical Activity Is Inversely Associated With Nonalcoholic Fatty Liver Disease: The Rotterdam Study

INTRODUCTION

The disease burden of nonalcoholic fatty liver disease (NAFLD) increases rapidly, in line with the obesity pandemic. Physical activity has been linked to a lower risk of NAFLD. However, the impact of different intensities of activity and sedentary behavior and whether their effects on NAFLD are explained by metabolic health remain unclear.

METHODS

We performed cross-sectional analyses within the population-based Rotterdam Study cohort. Abdominal ultrasound and accelerometry data were collected between 2009 and 2014. NAFLD was defined as hepatic steatosis diagnosed by ultrasound, in the absence of secondary causes for steatosis: viral hepatitis, steatogenic drugs, and excessive alcohol. We categorized accelerometry data into sedentary time and light, moderate, and vigorous physical activities.

RESULTS

We included 667 participants (aged 63.3 ± 6.3 years, 53% female individuals), and 34.3% had NAFLD. Total physical activity was associated with lower NAFLD prevalence adjusted for demographic, lifestyle, and socioeconomic factors (odds ratio: 0.958 per 10 min/d, 95% confidence interval [CI]: 0.929-0.986). More intensive physical activity was more strongly associated with lower NAFLD prevalence: odds ratios for light, moderate, and vigorous physical activities were 0.931 (95% CI: 0.882-0.982), 0.891 (95% CI: 0.820-0.967), and 0.740 (95% CI: 0.600-0.906) per 10 min/d, respectively. These associations were explained by metabolic health, particularly homeostatic model assessment of insulin resistance (proportion mediated: 0.59, P < 0.001) and waist circumference (proportion mediated: 1.08, P < 0.001). Beyond this indirect effect, no direct effect could be demonstrated (P = 0.282-0.827).

DISCUSSION

Physical activity at each intensity is inversely associated with NAFLD prevalence, with larger effects for higher intensities of physical activity. This association is mediated by better metabolic health, mainly lower insulin resistance and waist circumference. Physical activity should therefore be incorporated into NAFLD disease management and prevention programs.

Understanding influences on physical activity participation by older adults: A qualitative study of community-dwelling older adults from the Hertfordshire Cohort Study, UK

BACKGROUND

The health benefits of physical activity (PA) participation in later life are widely recognised. Understanding factors that can influence the participation of community-dwelling older adults in PA is crucial in an ageing society. This will be paramount in aiding the design of future interventions to effectively promote PA in this population. The main aim of this qualitative study was to explore influences on PA among community-dwelling older people, and the secondary aim was to explore gender differences.

METHODS

Qualitative data were collected in 2014 by conducting focus group discussions using a semi-structured discussion guide with older people resident in Hertfordshire, UK. Discussions were audio-recorded, transcribed verbatim and transcripts analysed thematically.

RESULTS

Ninety-two participants were recruited to the study (47% women; 74-83 years) and a total of 11 focus groups were conducted. Findings indicated six themes that appeared to affect older adults' participation in PA: past life experiences; significant life events; getting older; PA environment; psychological/personal factors; and social capital. Overall, the findings emphasised the role of modifiable factors, namely psychological factors (such as self-efficacy, motivation, outcome expectancy) and social factors (such as social support and social engagement). These factors exerted their own influence on physical activity participation, but also appeared to mediate the effect of other largely non-modifiable background and ageing-related factors on participants' engagement with PA in later life.

CONCLUSION

In view of these findings, intervention designers could usefully work with behavioural scientists for insight as to how to enhance psychological and social factors in older adults. Our data suggest that interventions that aim to build self-efficacy, motivation and social networks have the potential to indirectly promote PA participation in older adults. This would be best achieved by developing physical activity interventions through working with participants in an empowering and engaging way.

Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2)

OBJECTIVE

In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week-1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day-1), and light-intensity PA (LPA) (+0.8 h ⋅ day-1) and decrease in sedentary time (SED-time) (-0.8 h ⋅ day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm.

RESULTS

Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL ⋅ min-1 ⋅ kg-1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships, and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately.

CONCLUSIONS

Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.

The short physical performance battery and incident heart failure among older women: the OPACH study

OBJECTIVE

Reduced functional capacity is a hallmark of early pre-clinical stages of heart failure (HF). The Short Physical Performance Battery (SPPB) is a valid measure of lower extremity physical function, has relatively low implementation burden, and is associated with cardiovascular disease and mortality. However, the SPPB-HF association is understudied in older women among whom HF burden is high.

METHODS

Women (n = 5325; mean age 79 ± 7 years; 34% Black, 18% Hispanic, and 49% White) without prior HF completed the SPPB consisting of standing balance, strength, and walking tests that were summarized as a composite score from 0 (lowest) to 12 (highest), categorized as very low (0-3), low (4-6), medium (7-9), or high (10-12). Participants were followed for up to 8 years for incident HF (306 cases identified). Cox proportional hazards regression estimated hazard ratios (HR) adjusting for age, race/ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, systolic blood pressure, lipids, glucose, and accelerometer-measured moderate-vigorous physical activity (MVPA) and sedentary time.

RESULTS

Incident HF cases (crude rate per 1000 person-years) in the four SPPB categories (very low to high) were 34 (26.0), 79 (14.5), 128 (9.3), and 65 (5.6). Corresponding multivariable-adjusted HRs (95% CIs) were 2.22 (1.34-3.66), 1.63 (1.11-2.38), 1.39 (1.00-1.94), and 1.00 (referent; P-trend<0.001). Higher HF risk was associated with lower SPPB in women with major modifiable HF risk factors including obesity (HR per 3-unit SPPB decrement: present HR = 1.41, absent HR = 1.41), hypertension (present HR = 1.45, absent HR = 1.30), diabetes (present HR = 1.32, absent HR = 1.44), and lower accelerometer-measured MVPA (<45 min/day HR = 1.29, ≥45 min/day HR = 1.60); all P-interaction>0.10.

CONCLUSION

Lower SPPB scores were associated with greater risk of incident HF in older women even after accounting for differences in HF risk factors and objectively measured PA. Implementing the SPPB in clinical settings could potentially enhance individual-level HF risk assessment, which should be further explored.

The Impact of a 12-Month Activity Tracker Intervention on Activity Behavior Across Body Mass Index Subgroups Among Recent Retirees: Post Hoc Analysis of a Randomized Controlled Trial

BACKGROUND

This study examined the effectiveness of a 12-month activity tracker-based intervention on activity behavior among recent retirees (Enhancing physical ACTivity and healthy aging among recent REtirees [REACT]) in subgroups based on body mass index.

METHODS

REACT trial randomized 231 participants (mean age 65.2) into intervention and control groups. Main outcomes were accelerometer-measured moderate-to-vigorous (MVPA) and light physical activity (LPA) and sedentary time (SED) measured at baseline and 3-, 6-, and 12-month follow-ups. As a post hoc analysis, the intervention effect was examined among participants with normal weight (n = 77), overweight (n = 89), and obesity (n = 61).

RESULTS

An intervention effect was observed among participants with obesity in LPA (time × group P = .045) mirrored by a similar, albeit nonsignificant, effect in SED (P = .067), but not in MVPA (P = .92). A transient increase of 41 minutes per day (95% confidence interval, 14 to 68) in LPA was observed at 6 months among the intervention group, with a concomitant decrease of 42 minutes per day (-72 to -12) in SED. However, these changes were not maintained at 12 months. No between-group differences in changes over time were observed among participants with normal or overweight.

CONCLUSIONS

Activity trackers may be particularly suitable for promoting changes in LPA and SED among older adults with obesity. However, their long-term effectiveness might be limited.

Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants

Sheltering-in-place, social distancing, and other strategies to minimize COVID-19 transmission may impact physical activity (PA) and well-being in older adults. To assess self-reported PA changes, well-being, and priorities of older women across the USA early in the COVID-19 pandemic. In May 2020, a 10-question survey was emailed to 5,822 women, aged over 70 years, who had been assigned to the Women’s Health Initiative (WHI) Strong and Healthy (WHISH) trial PA intervention and had provided email addresses. The survey assessed general and physical well-being, current priorities, and PA levels before and during the COVID-19 pandemic. Demographic and physical function data were collected previously. Descriptive analyses characterized participants’ priorities and PA changes from before the pandemic to the time of data collection during the pandemic. Differences in PA change by age, physical function, and geographic region were assessed by Kruskal-Wallis and post hoc Dunn tests. Among 2,876 survey respondents, 89% perceived their general well-being as good, very good, or excellent, despite 90% reporting at least moderate (to extreme) concern about the pandemic, with 18.2% reporting increased PA levels, 27.1% reporting no changes, and 54.7% reporting decreased PA levels. Top priorities “in the midst of the COVID-19 outbreak” were staying in touch with family/friends (21%) and taking care of one’s body (20%). Among priorities related to physical well-being, staying active was selected most frequently (33%). Support for maintaining PA in older populations should be a priority during a pandemic and similarly disruptive events.

Association between accelerometer-measured physical activity, glucose metabolism, and waist circumference in older adults

AIMS

To examine the association of physical activity (PA) and sedentary time (ST) with glucose metabolism according to waist circumference (WC) in older people.

METHODS

A population-based sample of 702 individuals (aged 67-70 years) wore wrist-worn accelerometers for two weeks and underwent an oral glucose tolerance test. The associations between moderate-to-vigorous (MVPA) and light (LPA) PA, ST, and glucose metabolism across the tertiles of WC were analysed using general linear regression.

RESULTS

Among highest WC tertile, LPA negatively associated with fasting insulin (β =  - 0.047, 95% CI - 0.082 to - 0.012), HOMA-IR (β =  - 0.098, 95% CI - 0.184 to - 0.012), and HOMA-β (β =  - 3.367, CI - 6.570 to - 0.783). ST associated with 120 min glucose (β = 0.140, CI 0.021 to 0.260). Among lowest WC tertile, MVPA negatively associated with 30 min insulin (β =  - 0.086, 95% CI - 0.168 to - 0.004) and 120 min insulin (β =  - 0.160, 95% CI - 0.257 to - 0.063) and positively associated with Matsuda index (β = 0.076, 95% CI 0.014 to 0.139). Light PA negatively associated with 120 min insulin (β =  - 0.054, 95% CI - 0.104 to - 0.005).

CONCLUSION

With the limitation of the cross-sectional study, reducing ST and increasing LPA may be beneficial for glucose metabolism among abdominally obese older adults. Lean older adults could benefit more from increasing MVPA.

Low-volume cycling training improves body composition and functionality in older people with multimorbidity: a randomized controlled trial

Physical exercise, when practiced regularly and in adequate doses, is a proven nonpharmacological measure that helps to prevent and reverse noncommunicable diseases, as well as reduce mortality rates from any cause. In general, older adults perform insufficient physical activity and do not meet the doses recommended by the World Health Organization for the improvement of health through physical activity. However, there is little evidence on adequate doses of exercise in older people, especially in those with multimorbidity. Our main aim was to evaluate the effect of a 6-week intervention on health-related outcomes (body composition, hemodynamic and functionality changes) in 24 individuals aged 65 and older with multimorbidity in a randomized controlled trial. The intervention consisted of a very low volume (60 min per week) of low-to-moderate intensity exercise training (perception of effort from 3 to 6 on an 11-point scale). After the intervention, blood pressure was significantly (p = 0.038) reduced in the exercise group (EG), with a higher reduction in men. Furthermore, the EG decreased their waist circumference (p = 0.005), a proxy of abdominal adiposity, and demonstrated an increased likelihood (73%) that a randomly selected change in muscle mass score from the EG would be greater than a randomly selected change score from the control group. The exercise intervention was particularly effective in enhancing the functionality of older adults with multimorbidity, especially in walking speed and balance skills. Perceptually regulated intensity during exercise training seemed to be a very interesting strategy to train individuals with low physical fitness and comorbidities. This study is registered with Clinicaltrials.gov (NCT04842396).

Associations of Objectively Measured Physical Activity and Sedentary Time with the Risk of Stroke, Myocardial Infarction or All-Cause Mortality in 70-Year-Old Men and Women: A Prospective Cohort Study

Objective

To study the associations of objectively measured physical activity (PA) and sedentary time (ST) with the combined outcome of incident stroke, myocardial infarction (MI) or all-cause mortality in older adults.

Methods

N = 3343 men and women aged 70 who participated in a health survey between 2012 and 2017 were included. Actigraph GT3X+ accelerometers were used to measure light-intensity PA (LPA), moderate-intensity PA (MPA) and ST for 1 week. Incident cases of cardiovascular disease (CVD) in terms of stroke or MI, and all-cause mortality were identified using national registers. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox regressions.

Results

During a mean follow-up of 2.7 years (0.1–5.6), there were 124 events of CVD or all-cause mortality. After adjusting for potential confounders and mediators, every 30-min/day increment in LPA was associated with 11% lower risk of CVD or all-cause mortality (HR 0.89, 95% CI 0.82–0.97), and every 30-min/day increment in MPA was associated with 36% lower risk (HR 0.64, 95% CI 0.48–0.84). Every 1-h/day increment in ST increased the risk of the outcomes by 33% (HR 1.33, 95% CI 1.14–1.56), although there was no significant association among participants who performed ≥ 30 min/day MPA (HR 1.11, 95% CI 0.82–1.50, P = 0.034 for interaction). None of the associations were modified by sex (P > 0.4 for all).

Conclusion

Objectively measured LPA and MPA are each associated with lower risk of stroke, MI or all-cause mortality in 70-year-old individuals, while ST is associated with increased risk. The greatest risk reduction is observed for MPA, which also appears to attenuate some of the increased risks associated with ST.

A Personalized, Dynamic Physical Activity Intervention Is Feasible and Improves Energetic Capacity, Energy Expenditure, and Quality of Life in Breast Cancer Survivors

Purpose

Despite survival and quality of life benefits associated with physical activity, many breast cancer survivors remain inactive. Effective, sustainable interventions must account for individual differences in capability, motivation, and environment. Here, we evaluate the feasibility, mechanics, and efficacy of delivering an individualized, dynamic intervention to increase energetic capacity and energy expenditure.

Methods

Stage 0–III breast cancer patients who had completed primary treatment were enrolled. Prior to the intervention, detailed movement data was collected with a wearable GPS and accelerometer for 3 weeks to establish baseline activity. Movement data was collected continuously throughout the 12-week intervention, during which patients received electronically delivered, tailored, dynamic activity “prescriptions”, adjusted based on demonstrated individual capability, daily movement in their environment, and progress.

Results

Of 66 enrolled, 57 participants began and completed the intervention. The intervention resulted in significant improvements in average steps (+558 steps/day, p = 0.01), energetic capacity measured by power generation on a stationary bicycle (1.76 to 1.99 W/kg lean mass, p < 0.01), and quality of life (FACT-B TOI, 72.8 to 74.8, p = 0.02). The greatest improvement in functional energetic capacity was seen in the lowest performing tertile at baseline (0.76 to 1.12 W/kg, p < 0.01).

Discussion

Wearable technology delivery of personalized activity prescriptions based on individual capability and movement behaviors demonstrates feasibility and early effectiveness. The high variability seen in baseline activity and function, as well as in response to the intervention, supports the need for future work in precision approaches to physical activity (NCT03158519).

The Association Between Light Physical Activity and Cognition Among Adults: A Scoping Review

BACKGROUND

The physical and cognitive benefits of moderate-vigorous intensity physical activity (MVPA) for adults have been well documented. Recently, there has been increasing interest in the independent health benefits of light-intensity physical activity (LPA). This research has primarily focused on the relationship between LPA and morbidity and mortality risk, with few studies investigating cognitive associations. The purpose of this scoping review was to catalog existing evidence on the association between device-based or technologically measured LPA and cognition among adults, identify trends in the literature, and recommend future areas for research.

METHODS

Six electronic databases were searched between January and June 2020. Forty published studies met the inclusion criteria, which included both healthy and clinical young and older adult populations. Among the 40 articles were 14 acute exercise studies, 4 randomized control trials (RCTs), 18 cross-sectional studies, and 4 longitudinal studies.

RESULTS

7/14 (50%) acute, 3/4 (75%) RCT, 10/18 (56%) cross-sectional, and 2/4 (50%) longitudinal studies reported a significant, positive relationship between LPA and one or more cognitive outcomes. These heterogeneous findings can largely be attributed to the diverse study designs and populations, as well as the numerous assessments used to test the cognitive domains.

CONCLUSION

These collective findings suggest LPA may be a potential lifestyle intervention to improve cognition across adulthood. However, the inconsistent approaches used among these studies suggest a more concerted, unified scientific approach is needed to further understand the LPA-cognition relationship.

Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study

Background To determine if accelerometer measured sedentary behavior (SED), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function. Methods and Results Participants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38-50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01-0.14), SD 0.09 (95% CI, 0.02-0.17), and SD -0.11 (95% CI, -0.19 to -0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD -0.05 (95% CI, -0.06 to -0.03), SD -0.03 (95% CI, -0.05 to -0.01), and SD 0.05 (95% CI, 0.03- 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women. Conclusions Our findings support the idea that for men, higher-intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.

Effect of Adherence to Physical Exercise on Cardiometabolic Profile in Postmenopausal Women

Background: Menopause is associated with negative cardiovascular adaptations related to estrogen depletion, which could be counteracted by physical exercise (PhE). However, the impact of total adherence-rate (TA) to PhE and sedentary time (SedT) on cardiometabolic profile in this population has not been elucidated. Methods: For 13-weeks, 43 women (57.1 ± 4.7 years) participated in a 4-days-a-week moderate-intensity walking training. They underwent laboratory, anthropometric and echocardiographic assessment, before and after training (T0-T1). Spontaneous physical activity (PhA) was assessed with a portable multisensory device. The sample was divided according to TA to PhE program: <70% (n = 17) and ≥70% (n = 26). Results: TA ≥ 70% group experienced a significant T1 improvement of relative wall thickness (RWT), diastolic function, VO2max, cortisol, cortisol/dehydroandrostenedione-sulphate ratio and serum glucose. After adjusting for SedT and 10-min bouts of spontaneous moderate-to-vigorous PhA, TA ≥ 70% showed the most significant absolute change of RWT and diastolic function, body mass index, weight and cortisol. TA ≥ 70% was major predictor of RWT and cortisol improvement. Conclusions: In a group of untrained, postmenopausal women, a high TA to a 13-weeks aerobic PhE program confers a better improvement in cardiometabolic profile, regardless of SedT and PhA levels.

Associations of Light, Moderate to Vigorous, and Total Physical Activity With the Prevalence of Metabolic Syndrome in 4,652 Community-Dwelling 70-Year-Olds: A Population-Based Cross-Sectional Study

In this cross-sectional study, the authors investigated the associations of objectively measured physical activity (PA) with the prevalence of metabolic syndrome (MetS) in older adults. Accelerometer-derived light-intensity PA, moderate to vigorous PA, and steps per day were measured in (N = 4,652) 70-year-olds in Umeå, Sweden, during May 2012-November 2019. The MetS was assessed according to the American Heart Association/ National Heart, Lung and Blood Institute criteria. The prevalence of MetS was 49.3%. Compared with the reference, the odds ratios for MetS in increasing quartiles of light-intensity PA were 0.91 (0.77-1.09), 0.75 (0.62-0.89), and 0.66 (0.54-0.80). For moderate to vigorous PA, the corresponding odds ratios were 0.79 (0.66-0.94), 0.67 (0.56-0.80), and 0.56 (0.46-0.67). For steps per day, the odds ratios were 0.65 (0.55-0.78), 0.55 (0.46-0.65), and 0.45 (0.36-0.55). In summary, this study shows that greater amounts of PA, regardless of intensity, are associated with lower odds of MetS. With the limitation of being an observational study, these findings may have implications for the prevention of MetS in older adults.

Impact of Physical Activity and Weight Loss on Fat Mass, Glucose Metabolism, and Inflammation in Older African Americans with Osteoarthritis

(1) Background: There are currently very few interventions performed within a community setting that compare the effects of physical activity (PA) versus PA plus weight loss on cancer and chronic disease risk in older African Americans. Therefore, we investigated the impact of an 8 week (24 session) PA intervention compared to a PA plus weight loss intervention on fat mass, glucose metabolism, and markers of inflammation in older, overweight and obese African Americans. (2) Methods: Subjects were randomized to a PA (n = 83) or PA plus weight loss (n = 72) intervention that met three times weekly for 8 weeks. At baseline and post-intervention, anthropometrics, body composition, systemic inflammation (high-sensitivity C-reactive protein, tumor necrosis factor-α, and interleukin 6), fasting glucose, insulin and homeostasis model assessment-insulin resistance (HOMA-IR) were determined. (3) Results: Subjects had a mean age of 67 years (SD = 5.3) and were mostly women (88%). The PA plus weight loss group lost more total and visceral fat than the PA group (−4.0% vs. +0.6% and −4.1% vs. +3.7%, respectively, p < 0.01 for both). Changes in inflammation and glucose metabolism were similar between groups post-intervention. Within the PA plus weight loss group only, serum insulin and HOMA-IR decreased significantly. (4) Conclusions: PA combined with weight loss can decrease total and visceral fat mass and improve insulin sensitivity, confirming that these cancer- and chronic disease-related risk factors are influenced by relatively modest lifestyle changes in the short term.

Accelerometer-Measured Sleep Duration and Clinical Cardiovascular Risk Factor Scores in Older Women

BACKGROUND

Evidence suggests that short and long sleep durations are potential lifestyle factors associated with cardiovascular disease (CVD). Research on sleep duration and CVD risk is limited by use of self-report sleep measures, homogeneous populations, and studies on individual CVD risk factors. For women, risk of CVD and inadequate sleep duration increases with age. We hypothesized that accelerometer-measured sleep duration was associated with 10-year predicted probability of future CVD risk in a cohort of aging women.

METHODS

This cross-sectional analysis included 3,367 older women (mean age 78.9 years; 53.3% White), from the Objective Physical Activity and Cardiovascular Health Study, ancillary study to the Women's Health Initiative. Women wore ActiGraph GT3X+ accelerometers on the hip for 24 hours/7 days. A 10-year predicted probability of future CVD risk, the Reynolds Risk Score (RRS), was computed using age, systolic blood pressure, high-sensitivity C-reactive protein (CRP), total and HDL cholesterol, diabetes mellitus status, smoking status, and family history of CVD. Average nightly sleep duration was derived from accelerometer data. Adjusted linear regression models investigated the association between sleep duration and RRS.

RESULTS

Results suggested a U-shaped relationship between sleep duration and RRS, with both short and long sleep associated with higher RRS (p < .001). The association remained significant after adjustments for race/ethnicity, education, lifestyle factors, and health status indicators.

CONCLUSION

In older women, actigraphy-ascertained sleep duration was associated with a 10-year predicted probability of future CVD risk. This study supports sleep duration as a modifiable risk factor for CVD in older women.

Short Physical Performance Battery and Incident Cardiovascular Events Among Older Women

Background The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy-to-implement measure of lower-extremity physical function. Strong evidence links SPPB scores with all-cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD). Methods and Results Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments-standing balance, strength (5 chair stands), and usual gait speed (4 m walk)-yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with Very Low (0-3), Low (4-6), Moderate (7-9), and High (10-12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health-related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person-years were 41.0, 24.3, 16.1, and 8.6 for Very Low, Low, Moderate, and High SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50-3.48), 1.70 (1.23-2.36) 1.49 (1.12-1.98), and 1.00 (referent); P-trend <0.001. The dose-response relationship was linear (linear P<0.001; nonlinear P>0.38). Conclusions Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test-retest reliability and low administrative burden, the SPPB should be a routine part of office-based CVD risk assessment.

Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women's Health Initiative

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds.

METHODS

A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women's Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity.

RESULTS

High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15-1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7-9) (1.36 (1.28-1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1-7 days per week) (1.28 (1.20-1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03).

CONCLUSION

Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.

Wearable devices can predict the outcome of standardized 6-minute walk tests in heart disease

Wrist-worn devices with heart rate monitoring have become increasingly popular. Although current guidelines advise to consider clinical symptoms and exercise tolerance during decision-making in heart disease, it remains unknown to which extent wearables can help to determine such functional capacity measures. In clinical settings, the 6-minute walk test has become a standardized diagnostic and prognostic marker. We aimed to explore, whether 6-minute walk distances can be predicted by wrist-worn devices in patients with different stages of mitral and aortic valve disease. A total of n = 107 sensor datasets with 1,019,748 min of recordings were analysed. Based on heart rate recordings and literature information, activity levels were determined and compared to results from a 6-minute walk test. The percentage of time spent in moderate activity was a predictor for the achievement of gender, age and body mass index-specific 6-minute walk distances (p < 0.001; R 2 = 0.48). The uncertainty of these predictions is demonstrated.