Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey

Gender-dependent effect of physical activity on the risk of incident multimorbidity during the COVID-19 pandemic: Findings from the PAMPA cohort, Brazil

OBJECTIVES

We aimed to investigate the association between physical activity (PA) and the risk of incident multimorbidity in adults from southern Brazil during the COVID-19 pandemic.

STUDY DESIGN

Prospective Study.

METHODS

We analyzed data from the Prospective Study about Physical and Mental Health (PAMPA) cohort, a longitudinal study of adults living in southern Brazil. The baseline assessment occurred in June/July 2020, and further data collection occurred 6 and 12 months later. Participants with no multimorbidity (2 or more simultaneous chronic conditions) at baseline were included in the present analysis. PA weekly volume, status, type, and place were also assessed at baseline.

RESULTS

Over one year, 30.8 % of participants developed multimorbidity. Men participants, classified as physically active before or during the pandemic, had reduced risk of multimorbidity. Practicing PA at home reduced the risk in both genders, while PA at and out of home only reduced the risk in women participants. Endurance and combined activities reduced the risk among women, while strength activities reduced the risk in both genders.

CONCLUSIONS

PA reduced the risk of incident multimorbidity among adults in southern Brazil, with different parameters moderating this effect between genders.

Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors

OBJECTIVE

Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions.

METHODS

Using Baseline (2011-2015), Follow-up One (2015-2018), and Follow-up Two (2018-2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health.

RESULTS

Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster.

DISCUSSION

This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.

Physical activity and mental health in individuals with multimorbidity during COVID-19: an explanatory sequential mixed-method study

OBJECTIVE

To understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic.

DESIGN

A sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and phase 2: qualitative follow-up interviews.

SETTING

For the quantitative phase, an online survey was launched in March 2021, using Microsoft Forms. For the qualitative phase, in-depth semistructured interviews were conducted via online.

PARTICIPANTS

368 adults over 18 years old living in the UK with at least one long-term condition completed the survey. Interviews were conducted in a subsample of participants from the previous quantitative phase, with 26 people. Data were analysed using thematic analysis.

RESULTS

Responses from the survey showed that people with one long-term condition were significantly more physically active and spent less time sitting, than those with two or more conditions, presenting with significantly higher well-being (p<0.0001), and lower levels of anxiety (p<0.01), and depression (p<0.0001). Interviews found that people developed a range of strategies to cope with the impact of changeability and the consequences of their long-term condition on their physical activity.

CONCLUSIONS

The number of long-term conditions influenced physical activity and how people coped with their condition during COVID-19. Findings will inform policy developments in preparation for future pandemics to support and remain people to remain physically active and mental health.

Physical activity among older adults with multimorbidity: Evidence from a population-based health survey

INTRODUCTION

The promotion of physical activity has been recognized as an important component in the management and prevention of multimorbidity, a condition that is increasing prevalent worldwide, including in Brazil. However, there is a scarcity of studies exploring the disparity in physical activity levels between individuals with and without multimorbidity. Therefore, the study aimed to estimate the prevalence of multimorbidity and physical activity among older adults, as well as analyze the relationship of a sufficient level of physical activity and multimorbidity, while considering sociodemographic characteristics of residents in São Paulo, Brazil.

MATERIALS AND METHODS

Data from 1.019 participants aged 60 years or older (59.7% female; mean age 69.7±7.7) were collected from the Health Survey (ISA-Capital, 2015) conducted in the city of São Paulo, Brazil. We defined multimorbidity as the presence of two or more chronic conditions, and for physical activity, classified a sufficient level (≥150 min/week). Prevalence Ratios (PR) with 95% Confidence Intervals (95%CI) were estimated using univariate and multivariate Poisson regression to examine the relationship between multimorbidity and sufficient level of physical activity.

RESULTS

67.7% of the participants lived with multimorbidity, while 30.1% had achieved a sufficient level of physical activity. There was a higher prevalence of sufficient level of physical activity among older adults with two (PR = 1.38; 95%CI 1.02-1.88) and four (PR = 1.37; 95%CI 1.00-1.87) chronic conditions. Older adults with multimorbidity who were 70 years or older (PR = 1.77; 95%IC 1.13-2.77), female (PR = 1.65; 95%CI 1.16-2.36), without a partner (PR = 1.43; 95%IC 1.03-1.99), and had a per capita income of 1 to 2.5 (PR = 1.83; 95%IC 1.00-3.33) were more likely to achieve a sufficient level of physical activity compared to their peers without multimorbidity.

CONCLUSIONS

The study highlights sociodemographic disparities in the sufficient level of physical activity among multimorbidity, suggesting the importance of considering these factors when planning public policies aimed at promoting physical activity.

Relationships between Physical Activity and Selected Chronic Diseases among Functionally Independent Long-Term Care Residents during the Post-Lockdown Period in Croatia

The aim of this observational study was to investigate the level and association of physical activity and selected chronic diseases in functionally independent LTC residents after prolonged physical and social isolation during COVID-19 in Croatia. Adhering to the inclusion criteria, 180 functionally independent residents were included in the study. Assessment of physical activity was carried out by 7-day motor monitoring. Prolonged physical and social isolation negatively affected the achieved level of physical activity of LTC residents (x¯ = 5058.74). Major depressive disorder resulted in significantly lower residents' physical activity scores, demonstrating a shrinking effect ranging from 0.42 to 0.45. A significant negative impact on the residents' physical activity was also found in the presence of osteoarthritis and iron deficiency anemia, where a downward effect was present in the range from 0.66-0.72 and 0.64 to 0.66. The presence of comorbidities has a significant negative impact on the residents' physical activity, where a downward effect is present in the range from 0.91-0.92.

Patterns and Predictors of Multimorbidity in the Azar Cohort

BACKGROUND

The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort.

METHODS

We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires.

RESULTS

The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM.

CONCLUSION

The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

Epidemiology and predictors of multimorbidity in Kharameh cohort study: A population-based cross-sectional study in southern Iran

Background and Aim

Multimorbidity is one of the problems and concerns of public health. The aim of this study was to estimate the prevalence and identify the risk factors associated with multimorbidity based on the data of the Kherameh cohort study.

Methods

This cross-sectional study was performed on 10,663 individuals aged 40-70 years in the south of Iran in 2015 to 2017. Demographic and behavioral characteristics were investigated. Multimorbidity was defined as the coexistence of two or more of two chronic diseases in a person. In this study, the prevalence of multimorbidity was calculated. Logistic regression was used to identify the predictors of multimorbidity.

Results

The prevalence of multimorbidity was 24.4%. The age-standardized prevalence rate was 18.01% in males and 29.6% in females. The most common underlying diseases were gastroesophageal reflux disease with hypertension (33.5%). Multiple logistic regression results showed that the age of 45-55 years (adjusted odds ratio [ORadj]] = 1.22, 95% confidence interval [CI], 1.07-1.38), age of over 55 years (ORadj = 1.21, 95% CI, 1.06-1.37), obesity (ORadj = 3.65, 95% CI, 2.55-5.24), and overweight (ORadj = 2.92, 95% CI, 2.05-4.14) were the risk factors of multimorbidity. Also, subjects with high socioeconomic status (ORadj = 1.27, 95% CI, 1.1-1.45) and very high level of socioeconomic status (ORadj = 1.53, 95% CI, 1.31-1.79) had a higher chance of having multimorbidity. The high level of education, alcohol consumption, having job, and high physical activity had a protective role against it.

Conclusion

The prevalence of multimorbidity was relatively high in the study area. According to the results of our study, age, obesity, and overweight had an important effect on multimorbidity. Therefore, determining interventional strategies for weight loss and control and treatment of chronic diseases, especially in the elderly, is very useful.

Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging

Objective

There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters.

Methods

Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health.

Results

Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR.

Discussion

Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.

A combination of moderate and vigorous physical activities reduces the burden of multimorbidity: findings from Longitudinal Ageing Study in India

Background

Physical inactivity is a significant factor contributing to the prevalence of non-communicable diseases (NCDs). The objective of this study is to examine the association between physical activity and multimorbidity among Indian adults aged 45 years and above by residence.

Methods

Data from Longitudinal Ageing Study in India (LASI) 2017–2018, wave 1, a nationally representative study, are used to examine the above objective. A total of 59,073 adults aged 45 years and above are enlisted in the study. Physical activities and other demographic and socioeconomic variables have been used to describe the distribution of multimorbidity and investigate their relationship. Logistic regression is employed to examine the adjusted impact of physical activity on multimorbidity among Indian adults (45 + years) by residence.

Results

The level of physical activity is inversely related to the prevalence of multimorbidity in India. The rate of multimorbidity ranges from 4 to 12% among moderately active individuals in rural areas, whereas it ranges from 9 to 34% in urban areas across the age groups of 45 to 75+ years. Notably, the individuals who engage in both moderate and vigorous activities have a lower prevalence of multimorbidity than those who engage in only moderate activities.

Conclusion

Our study shows that physical inactivity has an association with the rise in multimorbidity in both rural and urban areas; however, the intensity of multimorbidity is higher in urban areas. The policymakers should consider the influence of moderate and vigorous physical activity as a key prevention measure of non-communicable disease and multimorbidity.

Association between physical activity and life satisfaction among adults with multimorbidity in Canada

OBJECTIVE

Maintaining life satisfaction may aid in multimorbidity resilience. As the prevalence of multimorbidity continues to rise in Canada, understanding modifiable factors that can influence life satisfaction among people with multimorbidity is warranted. This study aimed to examine the relationship between physical activity and life satisfaction among adults affected by multimorbidity.

METHODS

Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey were used; 22,851 respondents with multimorbidity aged 20 years and older were included. Multiple linear regression models were used to investigate the relationship between physical activity (sedentary, somewhat active, moderately active, active) and life satisfaction for the whole population and for those having specific types of chronic conditions, controlling for self-perceived health status and sociodemographic factors.

RESULTS

Respondents affected by multimorbidity who were somewhat active (β = 0.20, 95% CI: 0.08, 0.32), moderately active (β = 0.28, 95% CI: 0.13, 0.44), and active (β = 0.29, 95% CI: 0.17, 0.41) were more satisfied with life than respondents who had a sedentary lifestyle. The relationship between physical activity and life satisfaction was also found to be statistically significant in sub-populations of respondents affected by cancer, diabetes, chronic respiratory diseases, and mental health disorders but not cardiovascular diseases.

CONCLUSION

Physical activity may contribute to better life satisfaction among adults with multimorbidity. As multimorbidity increases in Canada, further investigation on the relationship between physical activity and life satisfaction is warranted to help improve interventions to cope with the effects of multimorbidity.

Morbidity status and changes in difficulty in activities of daily living among older adults in India: A panel data analysis

Introduction

The study explored the socioeconomic and demographic factors that determine the onset of difficulty, recovery from difficulty and difficulty remaining in functional activity in later years of life. Additionally, the study examined the effects of several combinations of chronic diseases on the changes in later-life functional difficulty.

Methods

We used data from two rounds of India Human Development Survey (IHDS) conducted during 2004–2005 and 2011–2012. A sample of 13,849 respondents aged 55 years and above with a seven year follow-up was considered for this study. The Katz Index of Independence in activities of daily living (ADL) was used to measure the functional disability as an outcome variable. Multinomial logistic regression has been conducted to fulfil the study objectives.

Results

The overall functional difficulty among older adults was 27.3% and onset of functional difficulty (23.5%) was higher than the recovery from difficulty (2.1%) and remaining with difficulty (1.7%). Onset of functional difficulty in second round was higher among women (27.3%) than men (19.3%). Bivariate and multivariate analyses showed that single and multi-morbidity had a positive significant association with all categories of functional difficulty. Female sex, increasing age and rural place of residence had positive association with onset of difficulty and difficulty remaining in second round. The combinations of morbidities were also found to have positive significant association with functional difficulty i.e., the relative risk (RR) of onset of difficulty in second round is higher among those who had diabetes with high blood pressure (RR-1.7; CI: 1.4–2.0), cataracts with high blood pressure (RR-2.0; CI: 1.5–2.6) and cataracts with asthma (RR-3.1; CI: 2.1–4.6) compared to those with no diabetes and cataract but with high blood pressure or asthma, respectively.

Conclusion

The findings suggest that the risk of onset of functional difficulty is higher among older individuals with single and multiple morbidities compared to their healthy counterparts. It is also found that functional difficulty increased with age and was more prevalent in older women and rural residents, suggesting the need for appropriate policy interventions with special focus on the vulnerable senior adults.

Association of multimorbidity and physical activity among older adults in India: an analysis from the Longitudinal Ageing Survey of India (2017-2018)

OBJECTIVE

To examine the association of multimorbidity and physical activity among older adults in India.

DESIGN

A cross-sectional study was conducted using large representative survey data.

SETTING AND PARTICIPANTS

The study used data from the nationally representative 'Longitudinal Ageing Study in India (LASI),' conducted during 2017-2018. The study included a total sample of 65 336 older adults aged 45 years and above in India.

METHODS

Moderate and vigorous physical activities were measured separately by self-reported questionnaires. Physical activity was calculated as minutes of metabolic equivalent tasks per week. The outcome variable was a categorical variable where 2=the prevalence of more than one morbidity, 1=presence of one morbidity and 0=none. Bivariate analysis and multinomial logistic regression were applied to fulfil the objectives.

RESULTS

27.39% of older adults in India had multimorbidity. 31.02% of older adults did not engage in any moderate physical activities. Also, 59.39% of older adults did not engage in any vigorous physical activities. Older adults reporting low (adjusted relative risk ratio (A RRR): 1.10, 95% CI 1.03 to 1.18) and moderate (A RRR): 1.05, 95% CI 0.98 to 1.13) level of moderate physical activity were significantly more likely to suffer from multimorbidity compared with no involvement in moderate physical activity. However, older adults who reported high (A RRR: 0.79, 95% CI 0.75 to 0.84), moderate (A RRR: 0.88, 95% CI 0.80 to 0.98) and low level of vigorous physical activity (A RRR: 0.94, 95% CI 0.86 to 1.02) had significantly less multimorbidity in comparison to those who never engaged in vigorous physical activity.

CONCLUSION

Lack of physical activity is associated with multimorbidity among older adults. Physical activity promotion should be adopted as a primary strategy in reducing the burden of morbidity and multimorbidity.

Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative Longitudinal Aging Study in India (LASI)

OBJECTIVE

This study examines the prevalence, patterns and factors of chronic disease-related multimorbidity. Also, this study examines the inequality in the prevalence of multimorbidity among older adults in India.

DESIGN

Cross-sectional study; large nationally representative survey data.

SETTING AND PARTICIPANTS

We have used the first wave of a Longitudinal Ageing Study in India conducted in 2017-2018 across all the 35 states (excluded Sikkim) and union territories in India. This study used information from 31 373 older people aged 60+years in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable for this study is multimorbidity. The study used multinomial logistic regression to examine the risk factors for multimorbidity among older adults. To measure the inequality in multimorbidity, the slope of index inequality and relative index of inequality have been used to understand the ranked-based inequality.

RESULTS

Almost one-fourth (24.1%) reported multimorbidity. The relative risk ratio (RRR) of multimorbidity (RRR=2.12; 95% CI=1.49 to 3.04) was higher among higher educated older adults than uneducated older adults. Furthermore, the RRR of multimorbidity (RRR=2.35; 95% CI=2.02 to 2.74) was higher among urban older adults than their rural counterparts. Older adults in the richest wealth quintile were more likely to report multimorbidities (RRR=2.86; 95% CI=2.29 to 3.55) than the poorest older adults. Good self-rated health and no activities of daily living disability were associated with a lower risk of multimorbidities.

CONCLUSIONS

This study contributes to the comprehensive knowledge of the prevalence, factors and inequality of the chronic disease-related multimorbidity among older adults in India. Considering India's ageing population and high prevalence of multimorbidity, the older adults must be preferred in disease prevention and health programmes, however, without compromising other subpopulations in the country. There is a need to develop geriatric healthcare services in India. Additionally, there is a need to disseminate awareness and management of multimorbidity among urban and highly educated older adults.

Decomposing urban-rural differences in multimorbidity among older adults in India: a study based on LASI data

BACKGROUND

Multimorbidity is defined as the co-occurrence of two or more than two diseases in the same person. With rising longevity, multimorbidity has become a prominent concern among the older population. Evidence from both developed and developing countries shows that older people are at much higher risk of multimorbidity; however, urban-rural differential remained scarce. Therefore, this study examines urban-rural differential in multimorbidity among older adults by decomposing the risk factors of multimorbidity and identifying the covariates that contributed to the change in multimorbidity.

METHODS

The study utilized information from 31,464 older adults (rural-20,725 and urban-10,739) aged 60 years and above from the recent release cross-sectional data of the Longitudinal Ageing Study in India (LASI). Descriptive, bivariate, and multivariate decomposition analysis techniques were used.

RESULTS

Overall, significant urban-rural differences were found in the prevalence of multimorbidity among older adults (difference: 16.3; p < 0.001). The multivariate decomposition analysis revealed that about 51% of the overall differences (urban-rural) in the prevalence of multimorbidity among older adults was due to compositional characteristics (endowments). In contrast, the remaining 49% was due to the difference in the effect of characteristics (Coefficient). Moreover, obese/overweight and high-risk waist circumference were found to narrow the difference in the prevalence of multimorbidity among older adults between urban and rural areas by 8% and 9.1%, respectively. Work status and education were found to reduce the urban-rural gap in the prevalence of multimorbidity among older adults by 8% and 6%, respectively.

CONCLUSIONS

There is a need to substantially increase the public sector investment in healthcare to address the multimorbidity among older adults, more so in urban areas, without compromising the needs of older adults in rural areas.

Energy Intake of Men With Excess Weight During Normobaric Hypoxic Confinement

Due to the observations of weight loss at high altitude, normobaric hypoxia has been considered as a method of weight loss in obese individuals. With this regard, the aim of the present study was to determine the effect of hypoxia per se on metabolism in men with excess weight. Eight men living with excess weight (125.0 ± 17.7 kg; 30.5 ± 11.1 years, BMI: 37.6 ± 6.2 kg⋅m-2) participated in a randomized cross-over study comprising two 10-day confinements: normobaric (altitude of facility ≃ 940 m) normoxia (NORMOXIA; P I O2 = 133 mmHg), and normobaric hypoxia (HYPOXIA). The P I O2 in the latter was reduced from 105 (simulated altitude of 2,800 m) to 98 mmHg (simulated altitude of 3,400 m over 10 days. Before, and at the end of each confinement, participants completed a meal tolerance test (MTT). Resting energy expenditure (REE), circulating glucose, GLP-1, insulin, catecholamines, ghrelin, peptide-YY (PYY), leptin, gastro-intestinal blood flow, and appetite sensations were measured in fasted and postprandial states. Fasting REE increased after HYPOXIA (+358.0 ± 49.3 kcal⋅day-1, p = 0.03), but not after NORMOXIA (-33.1 ± 17.6 kcal⋅day-1). Postprandial REE was also significantly increased after HYPOXIA (p ≤ 0.05), as was the level of PYY. Furthermore, a tendency for decreased energy intake was concomitant with a significant body weight reduction after HYPOXIA (-0.7 ± 0.2 kg) compared to NORMOXIA (+1.0 ± 0.2 kg). The HYPOXIA trial increased the metabolic requirements, with a tendency toward decreased energy intake concomitant with increased PYY levels supporting the notion of a hypoxia-induced appetite inhibition, that could potentially lead to body weight reduction. The greater postprandial blood-glucose response following hypoxic confinement, suggests the potential development of insulin resistance.

Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits

BACKGROUND

The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy.

METHODS

This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents' PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA.

RESULTS

About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest.

CONCLUSIONS

The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil: a cross-sectional study

BACKGROUND

Being active has been shown to have beneficial effects for the health of individuals with chronic diseases. However, data on the association between multimorbidity and physical activity are limited.

OBJECTIVE

To investigate the association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil, according to sex.

DESIGN AND SETTING

Cross-sectional population-based and household-based study derived from the second wave (2013-2014) of the EpiFloripa Aging Cohort Study.

METHODS

Insufficiency of physical activity (outcome) was ascertained using the long version of the International Physical Activity Questionnaire (≤ 150 minutes/week). Eleven self-reported chronic diseases were identified. Multimorbidity was defined from the number of chronic diseases (none; 2 or 3; or 4 or more). The adjustment variables were age, schooling, marital status, income, smoking, alcohol consumption and cognition. Additionally, each chronic disease was adjusted for the others. Associations were tested using logistic regression (crude and adjusted).

RESULTS

Among the 1197 participants (≥ 63 years), women (54.0%) were more likely than men (39.6%) to be insufficiently active. In the adjusted analysis, women and men with depressive symptoms, and men with diabetes, were more likely to be insufficiently active than those without symptoms. Multimorbid women were more likely to be insufficiently active, and the magnitude of the effect was strongest for 4 or more diseases.

CONCLUSION

This study indicates that the associations were sex-specific. Depressive symptoms and multimorbidity were associated with insufficient physical activity among women, while diabetes was associated with insufficient physical activity among men.

Multimorbidity, Function, and Cognition in Aging

Multimorbidity is a global health challenge. Here, we define multimorbidity, describe ways multimorbidity is measured, discuss the prevalence of multimorbidity and how it differs across different populations, examine mechanisms of disease and disability, and discuss the effects of multimorbidity on outcomes such as survival and function.

Patterns of Physical Activity and Self-rated Health Among Adult Populations in South Asia

Introduction:

Although South Asians are considered to be at high risk for cardiovascular diseases, research evidence on the health impacts of physical activity (PA) remains very limited. In this study we aimed to explore the patterns of PA and to investigate whether engaging in regular PA is associated with better Self-Rated Health (SRH) among South Asians.

Methods:

Cross-sectional data on population health were drawn from the World Health Survey of WHO. Subjects were 28,020 male and female South Asians (from Bangladesh, India, Nepal, and Sri Lanka) aged 18 years and above. Data were analysed using descriptive and multivariable logistic regression analyses.

Results:

The proportion of the sample population reported good SRH was 44.3%, 58.7%, 37.7%, and 73.7% in Bangladeshis, Indians, Nepalese, and Sri Lankans, respectively. Regular engagement in moderate PA was highest in Nepal (69.7%) and lowest in Bangladesh (37.4%). Vigorous PA was highest in India (29.9%) and lowest in Bangladesh (17.9%). In Bangladesh, compared to those never engaged in MPA, those who engaged for 1-2, 3-4, 5-6, or 7 days a week were 30% [AOR=1.306; 95%CI 1.085-1.572], 33% [AOR=1.326; 95%CI 1.093-1.609], 39% [AOR=1.389; 95%CI 1.125-1.716], and 46% [AOR=1.459; 95%CI 1.249-1.705] more likely to report being in good health, respectively.

Conclusions:

We found that self-reported engagement in physical activities varies in South Asian countries. Since engaging in PA may help improve subjective and objective health status, health policy makers need to focus on designing exercise-friendly neighbourhoods in an attempt to promote population health.

The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis

The prevalence of non-communicable diseases is increasing worldwide. Multimorbidity and long-term medical conditions is common among these patients. This study aimed to investigate the patterns of non-communicable disease multimorbidity and their risk factors at the individual and aggregated level. Data was inquired from the nationwide survey performed in 2011, according to the WHO stepwise approach on NCD risk factors. A latent class analysis on multimorbidity components (11 chronic diseases) was performed and the association of some individual and aggregated risk factors (urbanization) with the latent subclasses was accessed using multilevel multinomial logistic regression. Latent class analysis revealed four distinct subclasses of multimorbidity among the Iranian population (10069 participants). Musculoskeletal diseases and asthma classes were seen in both genders. In males, the odds of membership in the diabetes class was 41% less by increasing physical activity; but with increased BMI, the odds of membership in the diabetes class was 1.90 times higher. Tobacco smoking increased the odds of membership in the musculoskeletal diseases class, 1.37 and 2.30 times for males and females, respectively. Increased BMI and low education increased the chances of females' membership in all subclasses of multimorbidity. At the province level, with increase in urbanization, the odds of membership in the diabetes class was 1.28 times higher among males (P = 0.027). Increased age, higher BMI, tobacco smoking and low education are the most important risk factors associated with NCD multimorbidity among Iranians. Interventions and policies should be implemented to control these risk factors.

Changes in plasma biochemistry in breeding ring-billed gulls: Effects of anthropogenic habitat use and contaminant exposure

Gulls (Larids) have become successful at exploiting anthropogenic areas for foraging. However, little is known on the health implications of using anthropogenic habitats and on the associated exposure to environmental contaminants, particularly with respect to plasma biochemistry that is routinely used to diagnose physiological disorders and diseases. The objective of the present study was to investigate the effects of anthropogenic habitat use and exposure to ubiquitous halogenated flame retardants (HFRs) on plasma biochemistry of urban-breeding ring-billed gulls (Larus delawarensis) from one of the largest colonies in North America. Miniature GPS dataloggers were used to characterize foraging habitat use of individual gulls (n = 39) at the regional scale (urban, waste management facilities, agricultural fields, and St. Lawrence River) in the Montreal area (QC, Canada), and plasma was analyzed for a suite of biochemical measures (waste products, lipids, glucose, ions, proteins, and enzymes) and HFRs. Several confounding biological and environmental variables were also assessed including sex, body condition, time spent fasting while incubating, plasma thyroid hormone levels, time of day, capture date, and ambient temperature. As ring-billed gulls (males and females combined) spent more time foraging in urban areas, their plasma concentrations of cholesterol, albumin and activity of alkaline phosphatase increased significantly. Moreover, as the gulls spent more time foraging in agricultural fields, their plasma concentrations of phosphorous and activity of aspartate aminotransferase increased significantly. Only the activity of aspartate aminotransferase was significantly positively related to plasma HFR concentrations (PBDEs and dechlorane-related compounds). Time spent fasting while incubating, plasma thyroid hormone levels, body condition, time of day, and capture date were significantly related to certain plasma biochemical measures. The present results suggest that both the use of anthropogenic habitats for foraging and exposure to HFRs may affect the plasma biochemistry of ring-billed gulls breeding in the densely-populated Montreal area, suggesting potential adverse health effects for avian wildlife living in highly urbanized environments.

Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population

BACKGROUND

The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the level of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore.

METHODS

This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3 L). Data on clinical parameters including hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively.

RESULTS

In all, 932 respondents with multimorbidity were recruited for the study. Of these, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1-1.9, p = 0.01) as compared to those who were sufficiently physically active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index score (β = - 0.05, p <  0.001) and the visual analogue scale (β = - 4.4, p <  0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity.

CONCLUSIONS

The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.

Health behaviour, social support, socio-economic status and the 5-year progression of multimorbidity: Results from the MultiCare Cohort Study

Background:

Multimorbidity in elderly patients is a major challenge for physicians, because of a high prevalence of and associations with many adverse outcomes. However, the mechanisms of progressing multimorbidity are not well-understood. The aim of our study was to determine if the progression of multimorbidity is influenced by health behaviour and social support and to analyse if the patients’ socio-economic status had an effect on these prognostic factors.

Methods:

The study was designed as prospective cohort study based on interviews of 158 GPs and 3189 patients randomly selected from GP records (response rate: 46.2%). Patients were aged 65–85 years at recruitment and observed in four waves of data collection (dropout rate: 41.5%). Statistical analyses of the ‘hot deck’ imputed data included multilevel mixed-effects linear regression allowing for random effects at the study centre and GP practice within study centre level.

Results:

Regarding cardiovascular and metabolic diseases, multimorbidity progressed more rapidly in patients who reported less physical activity (ß = −0.28; 95% confidence interval = −0.35 to −0.20), had more tobacco-related pack years (0.15; 0.07–0.22) and consumed less alcohol (−0.21; −0.31 to −0.12) at baseline. Multimorbidity related to psychiatric and pain-related disorders progressed more rapidly if the patients had less perceived social support (−0.31; −0.55 to −0.07) and reported less physical activity (−0.08; −0.15 to −0.02) at baseline. Education and income only slightly modified the effects of these variables.

Conclusion:

Depending on the multimorbidity cluster, different strategies should be used for slowing down the progression of multimorbidity. Changing lifestyle and increasing social support are beneficial for the entire group of elderly multimorbid patients – regardless of their socio-economic status.

Registration:

ISRCTN89818205

Do Older Adults with Multimorbidity Meet the Recommended Levels of Physical Activity? An Analysis of Scottish Health Survey

There is a positive association between physical activity (PA) and improved health in older adults. The objective of this study was to assess the prevalence and determinants of meeting recommended levels of PA among older adults with multimorbidity. Data has been derived from the nationally representative Scottish Health Surveys (2014–2017). A sub-sample of 2230 older adults (aged 65+) with multimorbidity were the study participants. Physical activity was evaluated using current recommended guidelines. Overall, 32.3% of the participants met the recommended levels of PA. Independent predictors of meeting the recommended levels of PA include male gender [odds ratio (OR) 2.00 (95% confidence interval (CI) 1.58–2.54)], living in the least deprived areas [OR 1.79 (95% CI 1.20–2.69)]; being a non-smoker [OR 2.22 (95% CI 1.48–3. 34)]. Also, meeting recommended PA decreased with age [OR 0.92 (95% CI 0.90–0.94)] and body mass index [OR 0.93 (95% CI 0.91–0.95]; but increased per additional portion of fruit and vegetables taken [OR 1.19 (95% CI 1.12–1.25)] and with increase in well-being scale score [OR 1.05 (95% CI 1.03 to 1.06)]. Adherence to PA guidelines seems to be more related to age, BMI, gender (i.e. higher PA adherence in men vs. women), social support (i.e. social deprivation), dietary habits (i.e. fruit and vegetable intake) and social isolation among the elderly. In the one-third of older population, adherence to PA was associated to better mental health. Therefore, adaptation of PA guideline to suit theses determinants factors would reduce the gap difference among older adults with multimorbidity and enhance their mental well-being.

What Is the Impact of Physical Activity and Physical Function on the Development of Multimorbidity in Older Adults Over Time? A Population-Based Cohort Study

Background

Multimorbidity is recognized internationally as having a serious impact on health outcomes. It is associated with reduced quality of life, increased health care utilization, and future functional decline. Physical activity is associated with good health and psychological well-being. The aim of this study was to identify the impact of physical activity and physical function on the development and worsening of multimorbidity over time.

Methods

Using The Irish Longitudinal Study on Ageing (TILDA), we analyzed 4,823 participants ≥50 years with and without multimorbidity. Multimorbidity was defined as the presence of ≥2 chronic conditions. Development of multimorbidity was measured as the accrual of additional conditions over a 2-year period. Physical activity and physical function were measured using the International Physical Activity Questionnaire (IPAQ), gait speed (m/sec), and grip strength (kg).

Results

Sixteen groups of chronic conditions were included in analyses. 53.7% of included participants had multimorbidity at baseline and 71.7% at follow-up. Six hundred and thirty-eight of 2,092 (30.4%) participants without multimorbidity and 1,005 of 2,415 (41.6%) with existing multimorbidity developed new condition/s. Gait speed (relative risk [RR] = 0.67, confidence interval [CI]: 0.49–0.90), grip strength (RR = 0.98, CI: 0.97–0.99), and age (compared to 50–59 years, 60–69: RR = 1.30, CI: 1.11–1.52; ≥70: RR = 1.35, CI: 1.03–1.77) were significantly associated with the development of multimorbidity and accrual of additional conditions.

Conclusion

These results show that physical function is associated with the development and worsening of multimorbidity over time. They support the recent National Institute for Health & Care Excellence (NICE) Guidance on multimorbidity that suggests that patients with multimorbidity and reduced gait speed should be identified and targeted for interventions to improve health outcomes.

Association of physical performance and self-rated health with multimorbidity among older adults: Results from a nationwide survey in Japan

OBJECTIVES

To examine the association of physical performance measures and self-rated health with multimorbidity among older Japanese adults aged ≥60 years using cross-sectional data from a nationwide longitudinal survey.

METHODS

Using respondents' self-reported data from the 2012 National Survey of the Japanese Elderly, we analyzed multimorbidity involving nine major chronic diseases (heart disease, arthralgia, hypertension, diabetes, stroke, cataract, cancer, respiratory disease, and low back pain). Respondents who reported having two or more of these diseases were identified as having multimorbidity. Multivariate logistic regression analysis was used to examine if physical performance (grip strength and walking speed) and self-rated health were independently associated with multimorbidity after adjusting for potential confounders (e.g., demographic, physiological, and lifestyle-related variables).

RESULTS

The responses of 2525 participants who responded to the survey by themselves (i.e., without proxies) were analyzed (response rate: 57.9%). Among the chronic diseases examined, hypertension had the highest prevalence (44.1%), followed by low back pain (25.7%) and cataract (24.7%). Approximately 44.4% of the respondents had multimorbidity. The regression analysis revealed that multimorbidity was significantly associated with both poor grip strength (P = 0.006) and self-rated health (P < 0.001), but not with walking speed (P = 0.479).

CONCLUSIONS

Multimorbidity is prevalent in older Japanese adults, and poor grip strength and self-rated health were independently and significantly associated with multimorbidity. Health assessments that include these indicators may provide insight into the health status patterns of older adults with multimorbidity and inform the development of health management strategies.

Perception of parks and trails as mobility facilitators and transportation walking in older adults: a study using digital geographical maps

BACKGROUND

Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults' choice of transportation mode for a routine activity such as walking to the grocery store.

AIMS

To (1) evaluate associations between older adults' perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people's home, perceived facilitator and store was relevant for their transportation choice.

METHODS

Cross-sectional data were collected in a subsample of the 'Life-space mobility in old age' cohort. Multivariable logistic regression analysis on the binary outcome 'transportation walking' (vs. 'motorized transportation') was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account.

RESULTS

Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11-31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking.

CONCLUSIONS

Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people's transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults' transportation walking on a population level.

John P, Menec V. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data

BACKGROUND

Multimorbidity can be defined as the presence of more than one chronic condition in an individual. Research on multimorbidity has predominantly focused on older adults and few studies have examined multimorbidity in middle-aged people. The objectives of this study were to: 1) examine the prevalence of multimorbidity among middle-aged Canadians; and 2) examine the association between lifestyle factors (smoking, alcohol intake, physical activity) and multimorbidity in this age group.

METHODS

In this analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data, we extracted data from 29,841 participants aged 45-64 years from a database of 51,338 people aged 45-85 years. Self-reported data on 27 chronic physical health conditions were used to derive different multimorbidity definitions. We estimated the prevalence of 3+ to 5+ chronic physical health conditions in different subgroups for descriptive purposes. Multivariable logistic regression analyses were performed to determine the association between socio-demographic and lifestyle factors, and multimorbidity using a 3+ multimorbidity case definition.

RESULT

We found that 39.6% (99% CI 38.4-40.7) of participants had three or more chronic conditions with a mean number of chronic condition of 2.41 (99% CI 2.37-2.46). The prevalence of multimorbidity increased with age from 29.7% in the 45-49-year-old age group to 52% in individuals aged 60-64 years. The prevalence of 4+ and 5+ chronic conditions was 24.5 and 14.2% respectively. Analyses indicated that female sex and low income were associated with higher odds of multimorbidity, whereas daily or weekly alcohol intake were associated with lower odds of multimorbidity. Exercise was not associated with multimorbidity. Results were similar when analyses were conducted separately for women and men.

CONCLUSIONS

Multimorbidity is not limited to older adults, but is a common phenomenon among middle-aged people. Longitudinal research is needed to better understand the temporal relationship between lifestyle factors and multimorbidity.

Factors associated with multimorbidity in the elderly: an integrative literature review

Abstract Objective: The objective of the present study was to identify factors associated with multimorbidity in the elderly through an integrative literature review. Method: The “Cochrane Library”, “MEDLINE”, “Web of Science”, “Scopus” and “LILACS” databases were used, as well as the “SciELO” virtual library and the electronic search engine “Google Academic”. The following search terms were applied: “multimorbidity”; “multi-morbidity”; “comorbidity; “multiple diseases”; “elderly”; “major adults”, “older people”, “older persons”, “aged”, “associated factors”, “correlated factors”, “socioeconomic factors” and “demographic factors.” The inclusion criterion was that the object of the study was the elderly population with multimorbidity. Studies in which multimorbidity was not the dependent variable were excluded. Results: a total of seven articles were included in this review. A prevalence of multimorbidity in the elderly ranging from 30.7% to 57% was found. The associated factors were smoking, alcohol consumption, lived in rural areas, low levels of schooling, the female gender, older elderly persons and not living with children. In the majority of articles a low level of family income was also associated with multimorbidity. Conclusion: The results suggest that multimorbidity in the elderly is a common condition and that it is influenced by socioeconomic and demographic factors, lifestyle and family structure.

Multimorbidity patterns and 5-year overall mortality: Results from a claims data-based observational study

Background:

Multimorbidity is prevalent and related to adverse outcomes. The effect on mortality is disputed, possibly because studies show differences in the diseases which operationalize multimorbidity. The aim of this study is to analyze the effects of three multimorbidity patterns (representing subgroups of diseases) on mortality.

Methods:

We conducted a longitudinal observational study based on insurance claims data of ambulatory care from 2005 to 2009. Analyses are based on 46 chronic conditions with a prevalence ≥1%. We included 52,217 females and 71,007 males aged 65+ and insured by the Gmünder ErsatzKasse throughout 2004. Our outcome was 5-year overall mortality documented as exact time of death. We calculated hazard ratios by Cox regression analyses with time-dependent covariates. Three statistical models were analyzed: (a) the individual diseases, (b) the number of diseases in multimorbidity patterns, and (c) a count of all diseases, all calculated separately for genders and adjusted for age.

Results:

During the study period, 12,473 males (17.6%) and 7,457 females (14.3%) died. The general effect of multimorbidity on mortality was small (females: 1.02, 1.01–1.02; males: 1.04, 1.03–1.04). The number of neuropsychiatric disorders was related to higher mortality (1.33, 1.30–1.36; 1.46, 1.43–1.50). Cardiovascular and metabolic disorders had inconsistent effects (0.99, 0.97–1.01; 1.08, 1.07–1.09). Psychiatric, psychosomatic, and pain-related disorders were related to higher life expectancy (0.87, 0.86–0.89; 0.88, 0.87–0.90).

Conclusions:

Chronic diseases have heterogeneous effects on mortality and generalized measures of multimorbidity reflect and even out the effects of the single diseases. In multimorbidity studies, a careful selection of diseases is therefore important.

The Disease Burden Morbidity Assessment in older adults and its association with mortality and other health outcomes

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan-Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan-Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.

Movement through Active Personalised engagement (MAP) - a self-management programme designed to promote physical activity in people with multimorbidity: study protocol for a randomised controlled trial

Background

Multimorbidity, defined as two or more concurrent chronic diseases within the same individual, is becoming the clinical norm within primary care. Given the burden of multimorbidity on individuals, carers and health care systems, there is a need for effective self-management programmes. Promoting active participation within their clinical care and following a healthy lifestyle will help empower patients and target lifestyle factors that are exacerbating their conditions. The aim of this study is to establish whether a tailored, structured self-management programme can improve levels of physical activity at 12 months, in people with multimorbidity.

Methods/design

This study is a single-centre randomised controlled trial, with follow-up at 6 and 12 months. The primary outcome is change in objectively assessed average daily physical activity at 12 months. Secondary outcomes include medication adherence, lifestyle behaviours, quality of life, chronic disease self-efficacy and self-efficacy for exercise. Anthropometric and clinical measurements include blood pressure, muscle strength, lipid profile, kidney function and glycated haemoglobin (HbA1c). Participants are recruited from primary care. Those between 40 and 85 years of age with multimorbidity, with a good understanding of written and verbal English, who are able to give informed consent, have access to a mobile phone for use in study activities and are able to walk independently will be invited to participate. Multimorbidity is defined as two or more of the chronic conditions listed in the Quality and Outcomes Framework. A total of 338 participants will be randomly assigned, with stratification for gender and ethnicity, to either the control group, receiving usual care, or the intervention group, who are invited to the Movement through Active Personalised engagement programme. This involves attending four group-based self-management sessions aimed at increasing physical activity, mastering emotions, managing treatments and using effective communication. The sessions are delivered by trained facilitators, and regular text messages during the study period provide ongoing support. Changes in primary and secondary outcomes will be assessed, and an economic evaluation of the intervention undertaken.

Discussion

This study will provide new evidence on whether physical activity can be promoted alongside other self-management strategies in a multimorbid population and whether this leads to improvements in clinical, biomedical, psychological and quality of life outcomes.

Trial registration

ISRCTN, ISRCTN 42791781. Registered on 14 March 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2939-2) contains supplementary material, which is available to authorized users.

Trajectories of functional decline in older adults with neuropsychiatric and cardiovascular multimorbidity: A Swedish cohort study

BACKGROUND

Functional decline is a strong health determinant in older adults, and chronic diseases play a major role in this age-related phenomenon. In this study, we explored possible clinical pathways underlying functional heterogeneity in older adults by quantifying the impact of cardiovascular (CV) and neuropsychiatric (NP) chronic diseases and their co-occurrence on trajectories of functional decline.

METHODS AND FINDINGS

We studied 2,385 people ≥60 years (range 60-101 years) participating in the Swedish National study of Aging and Care in Kungsholmen (SNAC-K). Participants underwent clinical examination at baseline (2001-2004) and every 3 or 6 years for up to 9 years. We grouped participants on the basis of 7 mutually exclusive clinical patterns of 0, 1, or more CV and NP diseases and their co-occurrence, from a group without any CV and NP disease to a group characterised by the presence of CV or NP multimorbidity, accompanied by at least 1 other CV or NP disorder. The group with no CV and/or NP diseases served as the reference group. Functional decline was estimated over 9 years of follow-up by measuring mobility (walking speed, m/s) and independence (ability to carry out six activities of daily living [ADL]). Mixed-effect linear regression models were used (1) to explore the individual-level prognostic predictivity of the different CV and NP clinical patterns at baseline and (2) to quantify the association between the clinical patterns and functional decline at the group level by entering the clinical patterns as time-varying measures. During the 9-year follow-up, participants with multiple CV and NP diseases had the steepest decline in walking speed (up to 0.7 m/s; p < 0.001) and ADL independence (up to three impairments in ADL, p < 0.001) (reference group: participants without any CV and NP disease). When the clinical patterns were analyzed as time varying, isolated CV multimorbidity impacted only walking speed (β -0.1; p < 0.001). Conversely, all the clinical patterns that included at least 1 NP disease were significantly associated with decline in both walking speed (β -0.21--0.08; p < 0.001) and ADL independence (β -0.27--0.06; p < 0.05). Groups with the most complex clinical patterns had 5%-20% lower functioning at follow-up than the reference group. Key limitations of the study include that we did not take into account the specific weight of single diseases and their severity and that the exclusion of participants with less than 2 assessments may have led to an underestimation of the tested associations.

CONCLUSIONS

In older adults, different patterns of CV and NP morbidity lead to different trajectories of functional decline over time, a finding that explains part of the heterogeneity observed in older adults' functionality. NP diseases, alone or in association, are prevalent and major determinants of functional decline, whereas isolated CV multimorbidity is associated only with declines in mobility.

Multimorbidity in Atlantic Canada and association with low levels of physical activity

Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors. The study drew data from a prospective cohort in Atlantic Canada (2009-2015). The sample included 18,709 participants between the ages of 35-69. Eighteen chronic diseases were identified. Physical activity levels were estimated based on the long form of the International Physical Activity Questionnaire. Using logistic regression analysis, we found that multimorbid individuals were significantly more likely to be physically inactive (OR=1.26; 95% CI 1.10, 1.44) after adjusting for key sociodemographic and lifestyle characteristics. Additional stratified analyses suggest that the magnitude of the effect between multimorbidity and physical activity was stronger for men (OR=1.41; 95% CI 1.12, 1.79) than women (OR=1.18; CI 1.00, 1.39) and those living in rural (OR=1.43; CI 1.10, 1.85) versus urban (OR=1.20; CI 1.02, 141) areas. Given the generally low levels of physical activity across populations and a growing prevalence of multimorbidity, there is a need for a prospective study to explore causal associations between physical activity, multimorbidity, and health outcomes.

The new measuring multimorbidity index predicted mortality better than Charlson and Elixhauser indices among the general population

OBJECTIVES

The aim of the study was to develop and validate an updated morbidity index for short-term mortality risk, using chronic conditions identified from routine hospital admission ICD-10 data.

STUDY DESIGN AND SETTING

Retrospective cohort study of all adult New Zealand (NZ) residents at January 1, 2012. Adult NZ residents aged 18 years and over, defined by enrollment with a Primary Healthcare Organisation or accessing public health care in preceding year. Data were split into two data sets for index development (70%, n = 2,331,645) and validation (30%, n = 1,000,166).

RESULTS

The M3 index was constructed using log hazard ratios for 1-year mortality modeled from presence of 61 chronic conditions. Validation results were improved for the M3 index for predicting 1-year mortality compared to Charlson and Elixhauser on the c-statistic (M3: 0.931, Charlson: 0.921, Elixhauser: 0.922; difference M3 vs. Charlson = 0.010, 95% confidence interval [CI]: 0.008, 0.012; M3 vs. Elixhauser = 0.009, 95% CI: 0.007, 0.012) and integrated discriminative improvement (M3 vs. Charlson = 0.024, 95% CI: 0.021, 0.026; M3 vs. Elixhauser = 0.024, 95% CI: 0.022, 0.027).

CONCLUSION

The M3 index had improved predictive performance for 1-year mortality risk over Charlson and Elixhauser indices, allowing better adjustment for mortality risk from chronic conditions. This provides an important tool for population-level analyses of health outcomes.

Risky Lifestyle Behaviors among Gastric Cancer Survivors Compared with Matched Non-cancer Controls: Results from Baseline Result of Community Based Cohort Study

Purpose

This study investigated the prevalence of smoking, drinking, and physical inactivity and the associated factors of these behaviors in gastric cancer survivors.

Materials and Methods

The baseline data from the nationwide cohort study was used. Four hundred thirty-seven gastric cancer survivors who survived ≥ 2 years from diagnosis and reported completion of treatment were matched with 4,370 controls according to age, sex, education, and household income.

Results

The prevalence rates of current smoking and drinking among gastric cancer survivors were 8.7% and 38.3%, which were significantly lower than those among matched controls (p ≤ 0.001), but the prevalence rates of physical inactivity were not significantly different (55.8% vs. 59.9%, p=0.248). In gastric cancer survivors, ≥ 5 years since cancer diagnosis and current drinking contributed to more current smoking; otherwise, age increment and femalewere associatedwith lower current smoking. Thosewith household income ≥ $2,000 and current smokers were more likely to drink and female showed less drinking. Female, currently employed state, and self-rated health status were associated with more physical inactivity.

Conclusion

Although gastric cancer survivors showed better health behaviors than controls, suggesting that the diagnosis of cancer may motivate individuals towards healthy behaviors, their current prevalence rates of smoking and drinking were still high, and more than 50% of them were physically inactive. Tailored interventions to improve their health behaviors considering associated factors for the gastric cancer survivors are necessary.

Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia

OBJECTIVES

To investigate the impact of gender on multimorbidity in northern Iran.

DESIGN

A cross-sectional analysis of the Golestan cohort data.

SETTING

Golestan Province, Iran.

STUDY POPULATION

49 946 residents (age 40-75 years) of Golestan Province, Iran.

MAIN OUTCOME MEASURES

Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors.

RESULTS

Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40-49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01).

CONCLUSION

Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women.

Physical inactivity and self-reported depression among middle- and older-aged population in South Asia: World health survey

Background

With the increase in the understanding of the influence of various lifestyle factors such as sedentary behaviour and level of physical activity (PA) on physical and mental health, there has been a growing research interest on how physical inactivity correlates with depressive outcomes across countries. The present study aimed to examine 1) the pattern of engaging in PA among middle- and older-aged population in four South Asian countries, and 2) whether PA is associated with higher prevalence of depression.

Methods

This cross-sectional study is based on country-representative data obtained from WHO’s World Health Survey (WHS). Subjects were 7204 men and women aged above 50 years from Bangladesh, India, Nepal and Sri Lanka, all of which are classified as Low-and-middle-income countries (LMICs) in World Bank reports. Outcome variables were self-ported depression (SRD) and ever being diagnosed with depression. Association between frequency of moderate (MPA) and vigorous physical activity (VPA) and depression was analysed by multivariable regression methods.

Result

Prevalence of self-reported depression was respectively 47.7%, 40.3%, 40.4% and 11.4% in Bangladesh, India, Nepal and Sri Lanka. Prevalence of being ever diagnosed with depression was highest in Nepal (38.7%), followed by India (17.7%), Bangladesh (2.5%) and Sri Lanka (2%). Multivariable analysis shown statistically significant association between PA and diagnosed depression in Bangladesh and India, but not with SRD. In Bangladesh, compared to those who reported engaging in MPA on daily basis, the odds of reporting diagnosed depression were more than five times higher [AOR = 5.512; 95% CI = 1.159–26.21] for those who never took MPA. In India, those never took VPA had 44% higher [AOR = 1.442; 95% CI = 1.046–1.987] odds of being diagnosed with depression compared those who never engaged in VPA.

Conclusion

Lower frequency of vigorous physical activity were significantly associated with higher rates of depression diagnosed. Based on the findings, it is recommendable that health programs targeting mental health among middle- and older-aged population take steps to promote the level of PA within a multi-dimensional depression prevention framework. Longitudinal studies are needed to understand the role of vigorous and moderate physical activity on the onset and intervention of depression among elderly population in the region.

Multimorbidity, mortality, and physical activity

OBJECTIVES

Multimorbidity and physical inactivity are individually associated with increased mortality risk, but the possibility for physical activity to moderate the multimorbidity-mortality relationship has yet to be investigated.

METHODS

Data from the 1999-2006 NHANES were employed, with 16,091 participants constituting the analytic sample. Participants were followed through 2011, including a median follow-up of 99 months. Physical activity was assessed via self-report with multimorbidity assessed from physician diagnosis.

RESULTS

After adjustment, for every 1 morbidity increase, participants had a 23% increased risk of all-cause mortality (HR = 1.23; 95% CI: 1.19-1.28; p < 0.001). Multimorbidity mostly remained associated with all-cause mortality across all levels of physical activity, with the exception of those achieving four times the dose of the government guidelines.

DISCUSSION

With the exception of those who engaged in high levels of self-reported physical activity, physical activity had a minimal effect on the multimorbidity-mortality relationship.

Physical activity of workers with and without chronic diseases

OBJECTIVE

To contribute to the development of measures that increase physical activity (PA) levels in workers with and without chronic diseases, insight into workers' PA level is needed. Therefore, this study examined the association between the number of chronic diseases and PA in a Dutch working population.

METHODS

Data of 131,032 workers from the Dutch Public Health Monitor 2012 were used in this cross-sectional study conducted in 2015 in the Netherlands. PA was operationalized as adherence (yes/no) to three PA guidelines. One of these was the American College of Sports Medicine (ACSM) guideline (≥ 3 days/week, ≥ 20 min/day of vigorous-intensity activities). Also, the amount of moderate- and vigorous-intensity PA in min/week for those who were physically active for > 0 min/week was calculated. Associations between chronic diseases (0, 1, ≥ 2 chronic diseases) and PA were examined using logistic regression and Generalized Estimating Equations stratified for age (19-54 years/55-64 years).

RESULTS

Workers aged 19-54 years with one (OR = 0.90 (99% CI = 0.84-0.95)) and multiple chronic diseases (OR = 0.76 (99% CI = 0.69-0.83)) had lower odds of adhering to the ACSM-guideline than workers without chronic diseases. Similar patterns were found for older workers. Younger workers with one (B = 24.44 (99% CI = 8.59-40.30)) and multiple chronic diseases (B = 49.11 (99% CI = 26.61-71.61)) had a higher amount of moderate PA than workers without chronic diseases.

CONCLUSION

Workers with chronic diseases adhered less often to the ACSM-guideline, but among workers aged 19-54 years who were physically active for > 0 min/week, those with chronic diseases spent more time in moderate-intensity PA than those without chronic diseases.

The Association Between Multimorbidity and Quality of Life, Health Status and Functional Disability

INTRODUCTION

Approximately 50% of adults have multimorbidity (MM) that is associated with greater disability, poorer quality of life (QOL) and increased psychological distress. This study assessed the association between MM and QOL, health status and functional disability in U.S. adults.

METHODS

Cross-sectional study of 23,789 patients from 2011 Medical Expenditure Panel Survey was conducted. Mean scores were calculated for QOL (physical component score [PCS] and mental component score [MCS]) and proportions for functional limitation (activities of daily living [ADL]; instrumental ADL [IADL] and physical functioning). Health status was assessed by depression and serious psychological distress. Regression models evaluated associations between MM and QOL, functional health status and functional limitations, while adjusting for confounders.

RESULTS

Approximately 53% of 45-64-year-olds and 84% of those ≥65-years-old had MM. In adjusted models, ≥3 conditions were significantly associated with poorer outcomes-PCS QOL (β = -9.15; 95% CI: -9.69 to -8.61), MCS QOL (β = -1.98; 95% CI: -2.43 to -1.52), ADL (odds ratio [OR] = 5.80; 95% CI: 2.27-14.8), IADL (OR = 3.99; 95% CI: 2.31-6.88) and physical functioning (OR = 16.8; 95% CI: 12.0-23.6) compared with 1-2 conditions. Depression (PCS QOL: β = -4.02; 95% CI: -4.89 to -3.15; MCS QOL: β = -12.5; 95% CI: -13.2 to -10.9; ADL: OR = 2.49; 95% CI: 1.65-3.76; IADL: OR = 2.65; 95% CI: 1.88-3.72; physical functioning: OR = 2.44; 95% CI: 1.99-2.99) and serious psychological distress (PCS QOL: β = -3.16; 95% CI: -4.30 to -2.03; MCS QOL: β = -11.8; 95% CI: -12.8 to -10.8; ADL: OR = 1.57; 95% CI: 0.95-2.60; IADL: OR = 1.13; 95% CI: 0.80-1.59 and physical functioning: OR = 1.41; 95% CI: 1.11-1.78) were significantly associated with adverse outcomes.

CONCLUSIONS

In this nationally representative sample of U.S. adults, MM was significantly associated with poorer QOL, functional health status and physical functioning, when adjusting for relevant confounders. A holistic view of the complexities associated with MM must dictate comprehensive care.

Disease Combinations Associated with Physical Activity Identified: The SMILE Cohort Study

In the search of predictors of inadequate physical activity, an investigation was conducted into the association between multimorbidity and physical activity (PA). So far the sum of diseases used as a measure of multimorbidity reveals an inverse association. How specific combinations of chronic diseases are associated with PA remains unclear. The objective of this study is to identify clusters of multimorbidity that are associated with PA. Cross-sectional data of 3,386 patients from the 2003 wave of the Dutch cohort study SMILE were used. Ward's agglomerative hierarchical clustering was executed to establish multimorbidity clusters. Chi-square statistics were used to assess the association between clusters of chronic diseases and PA, measured in compliance with the Dutch PA guideline. The highest rate of PA guideline compliance was found in patients the majority of whom suffer from liver disease, back problems, rheumatoid arthritis, osteoarthritis, and inflammatory joint disease (62.4%). The lowest rate of PA guideline compliance was reported in patients with heart disease, respiratory disease, and diabetes mellitus (55.8%). Within the group of people with multimorbidity, those suffering from heart disease, respiratory disease, and/or diabetes mellitus may constitute a priority population as PA has proven to be effective in the prevention and cure of all three disorders.

Long terms trends of multimorbidity and association with physical activity in older English population

Background

Multimorbidity has become one of the main challenges in the recent years for patients, health care providers and the health care systems globally. However, literature describing the burden of multimorbidity in the elderly population, especially longitudinal trends is very limited. Physical activity is recommended as one of the main lifestyle changes in the prevention and management of multiple chronic diseases worldwide; however, the evidence on its association with multimorbidity remains inconclusive. Therefore, we aimed to assess the longitudinal trends of multimorbidity and the association between multimorbidity and physical activity in a nationally representative cohort of the English population aged ≥50 years between 2002 and 2013.

Methods

We used data on 15,688 core participants from six waves of the English Longitudinal Study of Ageing, with complete information on physical activity. Self-reported physical activity was categorised as inactive, mild, moderate and vigorous levels of physical activity. We calculated the number of morbidities and the prevalence of multimorbidity (more than 2 chronic conditions) between 2002 and 2013 overall and by levels of self-reported physical activity. We estimated the odds ratio (OR) and 95 % confidence intervals (CI) for multimorbidity by each category of physical activity, adjusting for potential confounders.

Results

There was a progressive decrease over time in the proportion of participants without any chronic conditions (33.9 % in 2002/2003 vs. 26.8 % in 2012/2013). In contrast, the prevalence of multimorbidity steadily increased over time (31.7 % in 2002/2003 vs. 43.1 % in 2012/2013). Compared to the physically inactive group, the OR for multimorbidity was 0.84 (95 % CI 0.78 to 0.91) in mild, 0.61 (95 % CI 0.56 to 0.66) in moderate and 0.45 (95 % CI 0.41 to 0.49) in the vigorous physical activity group.

Conclusion

This study demonstrated an inverse dose-response association between levels of physical activity and multimorbidity, however, given the increasing prevalence of multimorbidity over time, there is a need to explore causal associations between physical activity and multimorbidity and its impact as a primary prevention strategy to prevent the occurrence of chronic conditions later in life and reduce the burden of multimorbidity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0330-9) contains supplementary material, which is available to authorized users.

Chronic diseases and geriatric syndromes: The different weight of comorbidity

BACKGROUND

Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province.

METHODS

Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC. We assessed 14 different diagnoses and 8 GS (pain, urinary incontinence, falls, disability, dizziness, weight loss, pressure ulcers and delirium). Adjusted mean number of GS per participant was calculated for groups of participants with each disease when occurring alone or with comorbidity.

RESULTS

The mean age of the 6903 participants was 82.2±7.4 years and 4750 (69%) were women. Participants presented with an average of 2.6 diseases and 2.0 GS: pain (48%), urinary incontinence (47%) and falls (33%) were the most prevalent. Parkinson's disease, cerebrovascular disease and peripheral artery disease were associated with the highest number of GS (2.5, 2.3 and 2.2, respectively). Conversely, hypertension, diabetes, dementia, cancer and thyroid dysfunction were associated with the lowest number of GS (2.0 on average). For 9/14 examined diseases (hypertension, diabetes, dementia, COPD, heart failure, ischemic heart disease, atrial fibrillation, cancer and thyroid dysfunction) the number of GS increased with the degree of comorbidity.

CONCLUSIONS

Comorbidity and GS are prevalent in older adults receiving home care. Different diseases have a variable impact on occurrence of GS. Comorbidity is not always associated with an increased number of GS.

Aging and Multimorbidity: New Tasks, Priorities, and Frontiers for Integrated Gerontological and Clinical Research

Aging is characterized by rising susceptibility to development of multiple chronic diseases and, therefore, represents the major risk factor for multimorbidity. From a gerontological perspective, the progressive accumulation of multiple diseases, which significantly accelerates at older ages, is a milestone for progressive loss of resilience and age-related multisystem homeostatic dysregulation. Because it is most likely that the same mechanisms that drive aging also drive multiple age-related chronic diseases, addressing those mechanisms may reduce the development of multimorbidity. According to this vision, studying multimorbidity may help to understand the biology of aging and, at the same time, understanding the underpinnings of aging may help to develop strategies to prevent or delay the burden of multimorbidity. As a consequence, we believe that it is time to build connections and dialogue between the clinical experience of general practitioners and geriatricians and the scientists who study aging, so as to stimulate innovative research projects to improve the management and the treatment of older patients with multiple morbidities.

Körperliche Aktivität bei multimorbiden Patienten

Große Teile insbesondere der älteren Bevölkerung leiden an Multimorbidität. In der Therapie zahlreicher Erkrankungen spielt körperliche Aktivität eine anerkannte Rolle. Eine wesentliche Aufgabe in der Vermittlung körperlicher Aktivität an multimorbide Patienten kommt dem Hausarzt zu. Zur Gestaltung und Umsetzung von Aktivitätsprogrammen auf Grundlage einer umfassenden Gesundheitsbeurteilung bedarf es allerdings der engen Kooperation mit spezialisierten Berufsgruppen.

Association between physical activity, multimorbidity, self-rated health and functional limitation in the Spanish population

Background

Physical activity (PA) has been shown to improve the general health of patients with chronic diseases and to prevent the onset of such conditions. However, the association between multimorbidity and PA has not been investigated in detail, and recent studies of this topic yield dissenting results. The objective of this study was to examine whether PA levels were associated with multimorbidity, self-rated health and functional limitation.

Methods

This was a cross-sectional study based on data from the 2009 European Health Interview Survey for Spain. The sample population included 22,190 adults over 15 years of age. The independent variables were multimorbidity (measured as the number of chronic diseases), activity limitations, and self-rated health status. The dependent variable was PA level, measured as a) a continuous variable in metabolic equivalents (METs) and b) a dichotomous variable based on international recommendations (</≥500 MET-minutes per week). The associations between the dependent and independent variables were evaluated across sex and age groups (16–24, 25–44, 45–64, 65–74, >74 years), using multivariate linear and logistic regression models that were adjusted for age, educational level and employment status.

Results

An inverse association was found between PA and multimorbidity among older males and young females between 16–24 years. This negative association was also observed among males aged 25–44 years when analysing PA as a dichotomous variable. Self-rated health status was directly related to the achievement of minimum PA levels among middle-aged and older individuals, but the opposite happened among the youngest group of females. Significant associations between the existence of activity limitations and the performance of lower volumes of PA were consistently observed among subjects over 44 years.

Conclusions

There is an inverse association between multimorbidity and PA in the youngest and oldest age groups. In addition, both low self-rated health status and the presence of functional limitations were related to lower PA in most of the examined population groups. These features should be considered in the design and implementation of community-based approaches to promoting PA, if further corroborated in longitudinal studies.

Associations between multiple accelerometry-assessed physical activity parameters and selected health outcomes in elderly people--results from the KORA-age study

Introduction

Accelerometry is an important method for extending our knowledge about intensity, duration, frequency and patterns of physical activity needed to promote health. This study has used accelerometry to detect associations between intensity levels and related activity patterns with multimorbidity and disability. Moreover, the proportion of people meeting the physical activity recommendations for older people was assessed.

Methods

Physical activity was measured in 168 subjects (78 males; 65–89 years of age), using triaxial GT3X accelerometers for ten consecutive days. The associations between physical activity parameters and multimorbidity or disability was examined using multiple logistic regression models, which were adjusted for gender, age, education, smoking, alcohol consumption, lung function, nutrition and multimorbidity or disability.

Results

35.7% of the participants met the physical activity recommendations of at least 150 minutes of moderate to vigorous activity per week. Only 11.9% reached these 150 minutes, when only bouts of at least 10 minutes were counted. Differences in moderate to vigorous activity between people with and without multimorbidity or disability were more obvious when shorter bouts instead of only longer bouts were included. Univariate analyses showed an inverse relationship between physical activity and multimorbidity or disability for light and moderate to vigorous physical activity. A higher proportion of long activity bouts spent sedentarily was associated with higher risk for multimorbidity, whereas a high proportion of long bouts in light activity seemed to prevent disability. After adjustment for covariates, there were no significant associations, anymore.

Conclusions

The accumulated time in moderate to vigorous physical activity seems to have a stronger relationship with health and functioning when shorter activity bouts and not only longer bouts were counted. We could not detect an association of the intensity levels or activity patterns with multimorbidity or disability in elderly people after adjustment for covariates.