1
|
Zheng P, Jeng B, Huynh TLT, Aguiar EJ, Motl RW. Free-Living Peak Cadence in Multiple Sclerosis: A New Measure of Real-World Walking? Neurorehabil Neural Repair 2023; 37:716-726. [PMID: 37864454 DOI: 10.1177/15459683231206741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Physical function and walking performance have become important outcomes in clinical trials and rehabilitation involving persons with multiple sclerosis (MS). However, assessments conducted in controlled settings may not reflect real-world capacity and movement in a natural environment. Peak cadence via accelerometry might represent a novel measure of walking intensity and prolonged natural effort under free-living conditions. OBJECTIVE We compared peak 30-minute cadence, peak 1-minute cadence, and time spent in incremental cadence bands between persons with MS and healthy controls, and examined the associations between peak cadence and laboratory-assessed physical function and walking performance. METHODS Participants (147 MS and 54 healthy controls) completed questionnaires on disability status and self-reported physical activity, underwent the Short Physical Performance Battery, Timed 25-Foot Walk, Timed Up and Go, and 6-Minute Walk, and wore an accelerometer for 7 days. We performed independent samples t-tests and Spearman bivariate and partial correlations adjusting for daily steps. RESULTS The MS sample demonstrated lower physical function and walking performance scores, daily steps, and peak cadence (P < .001), and spent less time in purposeful steps and slow-to-brisk walking (40-119 steps/minutes), but accumulated more incidental movement (1-19 steps/minutes) than healthy controls. The associations between peak cadence and performance outcomes were strong in MS (|rs| = 0.59-0.68) and remained significant after controlling for daily steps (|prs| = 0.22-0.44), P-values < .01. Peak cadence was inversely correlated with age and disability, regardless of daily steps (P < .01). CONCLUSIONS Our findings provide preliminary evidence for the potential use of peak cadence with step-based metrics for comprehensively evaluating free-living walking performance in MS.
Collapse
Affiliation(s)
- Peixuan Zheng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Brenda Jeng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Trinh L T Huynh
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elroy J Aguiar
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Bernstein JPK, Dorociak K, Mattek N, Leese M, Trapp C, Beattie Z, Kaye J, Hughes A. Unobtrusive, in-home assessment of older adults' everyday activities and health events: associations with cognitive performance over a brief observation period. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:781-798. [PMID: 33866939 PMCID: PMC8522171 DOI: 10.1080/13825585.2021.1917503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/11/2021] [Indexed: 12/22/2022]
Abstract
In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.
Collapse
Affiliation(s)
| | - Katherine Dorociak
- Department of Psychology, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Nora Mattek
- Oregon Center for Aging & Technology, Portland, OR, USA
| | - Mira Leese
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Chelsea Trapp
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | | | - Jeffrey Kaye
- Oregon Center for Aging & Technology, Portland, OR, USA
| | - Adriana Hughes
- Oregon Center for Aging & Technology, Portland, OR, USA
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
3
|
Harding EM, Gibson AL, Kang H, Zuhl MN, Sharma H, Blair CK. Self-Selected Walking Cadence after 16-Week Light-Intensity Physical Activity Intervention for Older Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084768. [PMID: 35457633 PMCID: PMC9027651 DOI: 10.3390/ijerph19084768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/25/2023]
Abstract
In this secondary analysis of a light-intensity physical activity intervention, we hypothesized that older cancer survivors would self-select a faster walking cadence to meet their daily step goals. Average steps/day and free-living walking cadence were measured in 41 participants (age 69 ± 3.1 years) with an ActivPAL monitor worn 7 days pre- and post-intervention. Besides peak and average walking cadence, stepping patterns associated with ambulatory intensity were sorted in cadence bands of 20 steps/min from 40−59 (incidental movement) to ≥120 steps/min (fast locomotor movement). Compared to the waitlist Control group (n = 17), the Intervention group (n = 24) increased their peak 30-min cadence (4.3 vs. 1.9 steps/minute; p = 0.03), average 10-min cadence (4.1 vs. −6.6 steps/minute; p = 0.04), and average 30-min cadence (5.7 vs. −0.8 steps/minute, p = 0.03). Steps taken in cadence bands denoting moderate-intensity physical activity (100−119 steps/min) increased by 478 (interquartile range (IQR): −121 to 1844) compared to decreasing by 92 (IQR: −510 to 181) steps/day for the intervention and Control groups, respectively (p < 0.01). Evaluation of free-living walking cadence and patterns of ambulatory behavior can inform future interventions targeting behavior change, especially in those populations most at risk for reduced physical activity and vulnerable to mobility deficits and loss of independence.
Collapse
Affiliation(s)
- Elizabeth M. Harding
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA;
| | - Ann L. Gibson
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Huining Kang
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (H.K.); (H.S.)
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Micah N. Zuhl
- Exercise Science Division, School of Health Sciences, Central Michigan University, Mt Pleasant, MI 48859, USA;
| | - Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (H.K.); (H.S.)
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (H.K.); (H.S.)
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87131, USA
- Correspondence: ; Tel.: +1-505-925-7907
| |
Collapse
|
4
|
Wang Y, Zhang Y, Bennell K, White DK, Wei J, Wu Z, He H, Liu S, Luo X, Hu S, Zeng C, Lei G. Physical Distancing Measures and Walking Activity in Middle-aged and Older Residents in Changsha, China, During the COVID-19 Epidemic Period: Longitudinal Observational Study. J Med Internet Res 2020; 22:e21632. [PMID: 33027035 PMCID: PMC7592463 DOI: 10.2196/21632] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Physical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. OBJECTIVE The objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. METHODS We used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression. RESULTS Among 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction<.001) were both associated with a higher prevalence of frequent low daily steps and were more pronounced during the epidemic period. More education was associated with a lower prevalence of frequent low daily steps during the reference period but not the epidemic period (P for interaction=.34). Body mass index or comorbidity were not associated with frequent low daily steps during either period. CONCLUSIONS Daily steps of Changsha residents aged ≥40 years dropped significantly during the COVID-19 period, especially among older adults and females. Although successful physical distancing, measured by the rapid downward trend in daily step counts of residents, played a critical role in the containment of the COVID-19 epidemic, our findings of an increase in the prevalence of frequent low daily steps raise concerns about unintended effects on physical activity.
Collapse
Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Daniel Kenta White
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyi He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shaohui Liu
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xianghang Luo
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| |
Collapse
|
5
|
Predy M, Holt N, Carson V. Examining correlates of outdoor play in childcare centres. Canadian Journal of Public Health 2020; 112:292-303. [PMID: 32940870 DOI: 10.17269/s41997-020-00404-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Childcare centres are an important setting for young children to engage in outdoor play. The objectives for this study were to (1) determine the average outdoor play duration and frequency for toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres, (2) determine if duration and frequency differed across winter (December-March) and non-winter (April-November) months, and (3) determine correlates of outdoor play duration and frequency. METHODS Childcare centre directors (n = 240) in Alberta, Canada, completed a questionnaire adapted from the Nutrition and Physical Activity Self-Assessment for Child Care (GO NAP SACC) Outdoor Play Tool that measured outdoor play separately for toddlers/preschoolers and winter/non-winter months. Consistent with the tool, centres were categorized as meeting or not meeting best practices for outdoor play duration and frequency. The questionnaire also measured demographic, socio-cultural, environmental, and policy correlates. Chi-squared tests and multiple logistic regression models were conducted. RESULTS More centres met the outdoor play duration and frequency best practices in non-winter than in winter months for toddlers (duration: 79.2% vs 24.9%; frequency: 11.4% vs 1.4%) and preschoolers (duration: 55.7% vs 14.6%; frequency: 20.2% vs 3.4%). Correlates of outdoor play duration and frequency varied across age groups and seasons. However, educator certification, educator professional development, and play areas were most consistent across final models. CONCLUSIONS Findings from this study suggest correlates of outdoor play may differ across age groups and seasons. Interventions aimed at increasing outdoor play in childcare centres appear warranted, especially in winter months for northern locations.
Collapse
Affiliation(s)
- Madison Predy
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Nick Holt
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
6
|
Normative Peak 30-Min Cadence (Steps per Minute) Values for Older Adults: NHANES 2005-2006. J Aging Phys Act 2019; 27:625–632. [PMID: 30676186 DOI: 10.1123/japa.2018-0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Walking cadence (steps per minute) is associated with the intensity of ambulatory behavior. This analysis provides normative values for peak 30-min cadence, an indicator of "natural best effort" during free-living behavior. A sample of 1,196 older adults (aged from 60 to 85+) with accelerometer data from the National Health and Nutrition Examination Survey 2005-2006 was used. Peak 30-min cadence was calculated for each individual. Quintile-defined values were computed, stratified by sex and age groups. Smoothed sex-specific centile curves across the age span were fitted using the LMS method. Peak 30-min cadence generally trended lower as age increased. The uppermost quintile value was >85 steps/min (men: 60-64 years), and the lowermost quintile value was <22 steps/min (women: 85+). The highest 95th centile value was 103 steps/min (men: 64-70 years), and the lowest 5th centile value was 15 steps/min (women: 85+). These normative values may be useful for evaluating older adults' "natural best effort" during free-living ambulatory behavior.
Collapse
|
7
|
Adams B, Fidler K, Demoes N, Aguiar EJ, Ducharme SW, McCullough AK, Moore CC, Tudor-Locke C, Thomas D. Cardiometabolic thresholds for peak 30-min cadence and steps/day. PLoS One 2019; 14:e0219933. [PMID: 31374078 PMCID: PMC6677301 DOI: 10.1371/journal.pone.0219933] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/03/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To provide empirically-supported thresholds for step-based intensity (i.e., peak 30-min cadence; average of the top 30 steps/min in a day) and steps/day in relation to cardiometabolic health outcomes. METHODS Receiver operating characteristic curve analysis was applied to the National Health and Nutrition Examination Survey (NHANES) 2005-2006 accelerometer-derived step data to determine steps/day and peak 30-min cadence as risk screening values (i.e., thresholds) for fasting glucose, body mass index, waist circumference, high blood pressure, triglycerides, and HDL cholesterol. Thresholds for peak 30-min cadence and steps/day were derived that, when exceeded, classify the absence of each cardiometabolic risk factor. Additionally, logistic regression models that included the influence of age and smoking were developed using the sample weights, primary sampling units (PSUs), and stratification variables provided by the NHANES survey. Finally, a decision tree analysis was performed to delineate criteria for at-risk versus healthy populations using cadence bands. RESULTS Peak 30-min cadence thresholds across cardiometabolic outcomes ranged from 66-72 steps/min. Steps/day thresholds ranged from 4325-6192 steps/day. Higher thresholds were observed in men compared to women. In men, higher steps/day thresholds were observed in age ranges of 30-39, while in women, higher thresholds were observed in the age-range 50-59 years. Decision trees for classifying being at low risk for metabolic syndrome contained one risk-free leaf at higher cadence bands, specifically for any time accumulated at ≥120 steps/min. CONCLUSIONS Minimum thresholds representing absence of cardiometabolic risk range from 4325-6192 steps/day and 66-72 steps/min for peak 30-min cadence. Any time accumulated at ≥120 steps/min was associated with an absence of cardiometabolic risk. Although based on cross-sectional data, these thresholds represent potentially important and clinically interpretable daily physical activity goals.
Collapse
Affiliation(s)
- Bryan Adams
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, United States of America
| | - Katie Fidler
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, United States of America
| | - Noah Demoes
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, United States of America
| | - Elroy J. Aguiar
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Scott W. Ducharme
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Aston K. McCullough
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Christopher C. Moore
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Catrine Tudor-Locke
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Diana Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, United States of America
| |
Collapse
|
8
|
Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med 2019; 179:1105-1112. [PMID: 31141585 PMCID: PMC6547157 DOI: 10.1001/jamainternmed.2019.0899] [Citation(s) in RCA: 359] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE A goal of 10 000 steps/d is commonly believed by the public to be necessary for health, but this number has limited scientific basis. Additionally, it is unknown whether greater stepping intensity is associated with health benefits, independent of steps taken per day. OBJECTIVE To examine associations of number of steps per day and stepping intensity with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 18 289 US women from the Women's Health Study who agreed to participate by wearing an accelerometer during waking hours for 7 days between 2011 and 2015. A total of 17 708 women wore and returned their devices; data were downloaded successfully from 17 466 devices. Of these women, 16 741 were compliant wearers (≥10 h/d of wear on ≥4 days) and included in the analyses, which took place between 2018 and 2019. EXPOSURES Steps per day and several measures of stepping intensity (ie, peak 1-minute cadence; peak 30-minute cadence; maximum 5-minute cadence; time spent at a stepping rate of ≥40 steps/min, reflecting purposeful steps). MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS Of the 16 741 women who met inclusion criteria, the mean (SD) age was 72.0 (5.7) years. Mean step count was 5499 per day, with 51.4%, 45.5%, and 3.1% of time spent at 0, 1 to 39 (incidental steps), and 40 steps/min or greater (purposeful steps), respectively. During a mean follow-up of 4.3 years, 504 women died. Median steps per day across low-to-high quartiles of distribution were 2718, 4363, 5905, and 8442, respectively. The corresponding quartile hazard ratios (HRs) associated with mortality and adjusted for potential confounders were 1.00 (reference), 0.59 (95% CI, 0.47-0.75), 0.54 (95% CI, 0.41-0.72), and 0.42 (95% CI, 0.30-0.60), respectively (P < .01). In spline analysis, HRs were observed to decline progressively with higher mean steps per day until approximately 7500 steps/d, after which they leveled. For measures of stepping intensity, higher intensities were associated with significantly lower mortality rates; however, after adjusting for steps per day, all associations were attenuated, and most were no longer significant (highest vs lowest quartile for peak 1-minute cadence, HR = 0.87 [95% CI, 0.68-1.11]; peak 30-minute cadence, HR = 0.86 [95% CI, 0.65-1.13]; maximum 5-minute cadence, HR = 0.80 [95% CI, 0.62-1.05]; and time spent at a stepping rate of ≥40 steps/min, HR = 1.27 [95% CI, 0.96-1.68]; P > .05). CONCLUSIONS AND RELEVANCE Among older women, as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.
Collapse
Affiliation(s)
- I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Baltimore, Maryland
| | - Masamitsu Kamada
- Department of Health and Social Behavior, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - David R Bassett
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
9
|
Steeves JA, Shiroma EJ, Conger SA, Van Domelen D, Harris TB. Physical activity patterns and multimorbidity burden of older adults with different levels of functional status: NHANES 2003-2006. Disabil Health J 2019; 12:495-502. [PMID: 30871954 DOI: 10.1016/j.dhjo.2019.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/02/2018] [Accepted: 02/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical function and physical activity decrease with age, but differences in physical activity patterns within different physical functioning groups are unknown. OBJECTIVES To describe physical activity patterns and multimorbidity burden by physical function group and age. METHODS Actigraph accelerometer-derived physical activity patterns were compared by physical function (high functioning, activity limitations, activity of daily living disabled) determined by questionnaire and age among 2174 older adults (mean age = 70.9, sd = 0.2 years) from the cross-sectional 2003-2006 National Health and Nutrition Examination Survey. Associations between physical function, physical activity, and multimorbidity were examined. RESULTS Reduced physical function and increased age were associated with lower physical activity, increased sedentary time and a compressed activity profile. During the most active hour of the day (11:00 a.m.), the oldest, lowest physical functioning group was 82% less active than the youngest, highest physical functioning group. High functioning had over 30% more total activity counts, over 56% more time in moderate-to-vigorous activity, about 8% less time sedentary and took approximately one more sedentary break/hour than lower physical functioning groups. Gender differences in physical activity variables were prevalent for high functioning, but limited within reduced physical functioning groups. Physical function, age, total activity counts/day, and breaks in sedentary time/day were independently associated with multimorbidity (p < 0.005). CONCLUSIONS Reduced physical function and increased age are associated with physical activity levels, and all three are associated with multimorbidity. Understanding physical activity differences by physical function is important for designing interventions for older individuals at increased risk for mobility disability.
Collapse
Affiliation(s)
- Jeremy A Steeves
- Division of Education, Maryville College, Maryville, TN, 502 E. Lamar Alexander Parkway, 37804, USA.
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA.
| | - Scott A Conger
- Department of Kinesiology, Boise State University, Boise, ID, USA.
| | - Dane Van Domelen
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA.
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA.
| |
Collapse
|
10
|
|
11
|
Cavero-Redondo I, Tudor-Locke C, Álvarez-Bueno C, Cunha PG, Aguiar EJ, Martínez-Vizcaíno V. Steps per Day and Arterial Stiffness. Hypertension 2019; 73:350-363. [DOI: 10.1161/hypertensionaha.118.11987] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Iván Cavero-Redondo
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
| | - Catrine Tudor-Locke
- Department of Kinesiology, University of Massachusetts Amherst, MA (C.T.-L., E.J.A.)
| | - Celia Álvarez-Bueno
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
| | - Pedro G. Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Guimarães, Portugal (P.G.C.)
| | - Elroy J. Aguiar
- Department of Kinesiology, University of Massachusetts Amherst, MA (C.T.-L., E.J.A.)
| | - Vicente Martínez-Vizcaíno
- From the Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain (I.C.-R., C.A.-B., V.M.-V.)
| |
Collapse
|
12
|
Webber SC, St John PD. Changes in Intensity and Duration of Walking among Older Adults from In-Patient Geriatric Rehabilitation to Home. Physiother Can 2018; 70:341-348. [PMID: 30745719 DOI: 10.3138/ptc.2017-55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: We compared walking in hospital and on discharge from in-patient geriatric rehabilitation. Method: Participants included 28 adults (22 women) with a mean age of 85.4 (SD 6.8) years, ambulating independently with planned discharge to the community. Steps per day, short and long walking bouts, and cadence (steps per minute) were measured using an ActiGraph GT3X+ activity monitor (5 d in hospital, 5 d at home). Results: Steps per day did not differ between hospital and home (median difference=401; 95% CI: -364, 1,215; p=0.10). Long walking bouts (≥5 min) were infrequent in both locations (1/d) but lasted longer in hospital. Short walking bouts (≥15 s) were more frequent and shorter at home. Daily peak 1-minute cadence and peak 30-minute cadence were greater in hospital. Conclusions: Older adults in geriatric rehabilitation take longer walks and walk at faster paces in hospital, and they engage in more frequent, shorter walks at home. Although further research is needed, older adults would benefit from the opportunity to walk at different paces and different distances on discharge. Outpatient rehabilitation or other community-based programmes and initiatives may provide these experiences and appropriate environments to enable individuals to maintain mobility and independent functioning in the long term.
Collapse
Affiliation(s)
- Sandra C Webber
- Department of Physical Therapy, College of Rehabilitation Sciences.,Section of Geriatric Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences
| | - Philip D St John
- Section of Geriatric Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences.,Centre on Aging, University of Manitoba, Winnipeg, Man
| |
Collapse
|
13
|
Tudor-Locke C, Han H, Aguiar EJ, Barreira TV, Schuna JM, Kang M, Rowe DA. How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review. Br J Sports Med 2018; 52:776-788. [PMID: 29858465 PMCID: PMC6029645 DOI: 10.1136/bjsports-2017-097628] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/04/2022]
Abstract
Background Cadence (steps/min) may be a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point of reference) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process. Objective To review how fast, in terms of cadence, is enough, with reference to crafting public health recommendations in adults. Methods A comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for adults. Identified studies (n=38) included controlled (n=11), free-living observational (n=18) and intervention (n=9) designs. Results There was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged interindividual variability, ≥100 steps/min is a consistent heuristic (e.g, evidence-based, rounded) value associated with absolutely defined moderate intensity (3 metabolic equivalents (METs)). Epidemiological studies report notably low mean daily cadences (ie, 7.7 steps/min), shaped primarily by the very large proportion of time (13.5 hours/day) spent between zero and purposeful cadences (<60 steps/min) at the population level. Published values for peak 1-min and 30-min cadences in healthy free-living adults are >100 and >70 steps/min, respectively. Peak cadence indicators are negatively associated with increased age and body mass index. Identified intervention studies used cadence to either prescribe and/or quantify ambulatory intensity but the evidence is best described as preliminary. Conclusions A cadence value of ≥100 steps/min in adults appears to be a consistent and reasonable heuristic answer to ’How fast is fast enough?' during sustained and rhythmic ambulatory behaviour. Trial registration number NCT02650258
Collapse
Affiliation(s)
- Catrine Tudor-Locke
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Ho Han
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Elroy J Aguiar
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Tiago V Barreira
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - John M Schuna
- School of Biological and Population Health Sciences, Oregon State University, Corvalis, Oregon, USA
| | - Minsoo Kang
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Mississippi, USA
| | - David A Rowe
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| |
Collapse
|
14
|
Sander C, Ueck P, Mergl R, Gordon G, Hegerl U, Himmerich H. Physical activity in depressed and non-depressed patients with obesity. Eat Weight Disord 2018; 23:195-203. [PMID: 28188598 PMCID: PMC5862930 DOI: 10.1007/s40519-016-0347-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Obesity and depression have both been shown to be associated with reduced physical activity (PA). However, most studies have not applied objective measures to determine PA in patients. Moreover, to our knowledge, no studies are available comparing depressed and non-depressed patients with regard to PA. METHODS We investigated PA in 47 patients with both obesity and depression, 70 non-depressed patients with obesity, and 71 non-depressed and non-obese healthy control participants using the SenseWear™ Armband (SWA) with walked steps per day and metabolic equivalents (MET) as parameters for PA. RESULTS Depressed as well as non-depressed patients with obesity showed a significantly reduced PA as reflected by walked steps as well as reduced METs. Healthy controls walked a mean of 11,586 ± 3731 (SD) steps per day, whereas non-depressed patients with obesity accumulated 7283 ± 3547 and patients with both obesity and depression recorded only 6177 ± 3291 steps per day. However, the difference between depressed and non-depressed patients with obesity did not reach statistical significance either in terms of walked steps or with regard to METs. CONCLUSIONS Obesity seems to be associated with a substantial reduction of PA and energy expenditure, whereas the effect of an additional depressive disorder was comparably small. Even though depression did not have any statistically significant effect on steps and METs per day in this study with obese patients, it could be clinically relevant for an individual patient.
Collapse
Affiliation(s)
- Christian Sander
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Patrick Ueck
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Roland Mergl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Gemma Gordon
- Department of Psychological Medicine, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany.,Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany. .,Department of Psychological Medicine, King's College London, 103 Denmark Hill, London, SE5 8AF, UK. .,Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany.
| |
Collapse
|
15
|
Ferrari GLDM, Araújo T, Oliveira LC, Matsudo VKR, Mire E, Barreira T, Tudor-Locke C, Katzmarzyk PT. Accelerometer-determined peak cadence and weight status in children from São Caetano do Sul, Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:3689-3698. [PMID: 29211174 DOI: 10.1590/1413-812320172211.21962015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/31/2016] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to determine the relationship between peak cadence indicators and body mass index (BMI) and body fat percentage (BF%)-defined weight status in children. The sample comprised 485 Brazilian children. Minute-by-minute step data from accelerometry were rank ordered for each day to identify the peak 1-minute, 30-minute and 60-minute cadence values. Data were described by BMI-defined and bioelectrical impedance-determined BF% weight status. BMI-defined normal weight children had higher peak 1-minute (115.5 versus 110.6 and 106.6 steps/min), 30-minute (81.0 versus 77.5 and 74.0 steps/min) and 60-minute cadence (67.1 versus 63.4 and 60.7 steps/min) than overweight and obese children (p<.0001), respectively. Defined using %BF, normal weight children had higher peak 1-minute (114.5 versus 106.1 steps/min), 30-minute (80.4 versus 73.1 steps/min) and 60-minute cadence (66.5 versus 59.9 steps/min) than obese children (p<.0001). Similar relationships were observed in boys; however, only peak 1- minute cadence differed significantly across BMI and %BF-defined weight status categories in girls. Peak cadence indicators were negatively associated with BMI and BF% in these schoolchildren and significantly higher among normal weight compared to overweight or obese children.
Collapse
Affiliation(s)
- Gerson Luis de Moraes Ferrari
- Centro de Estudos, Laboratório de Aptidão Física de São Caetano do Sul. R. Heloísa Pamplona 269, Fundação. 09520-320 São Caetano do Sul SP Brasil. .,Centro de Atendimento e Apoio ao Adolescente, Departamento de Pediatria da Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Timóteo Araújo
- Centro de Estudos, Laboratório de Aptidão Física de São Caetano do Sul. R. Heloísa Pamplona 269, Fundação. 09520-320 São Caetano do Sul SP Brasil.
| | - Luis Carlos Oliveira
- Centro de Estudos, Laboratório de Aptidão Física de São Caetano do Sul. R. Heloísa Pamplona 269, Fundação. 09520-320 São Caetano do Sul SP Brasil.
| | - Victor Keihan Rodrigues Matsudo
- Centro de Estudos, Laboratório de Aptidão Física de São Caetano do Sul. R. Heloísa Pamplona 269, Fundação. 09520-320 São Caetano do Sul SP Brasil.
| | - Emily Mire
- Pennington Biomedical Research Center. Baton Rouge LA EUA
| | - Tiago Barreira
- Pennington Biomedical Research Center. Baton Rouge LA EUA.,Syracuse University. New York NY EUA
| | | | | |
Collapse
|
16
|
Gonzales JU. Do older adults with higher daily ambulatory activity have lower central blood pressure? Aging Clin Exp Res 2016; 28:965-71. [PMID: 25998953 DOI: 10.1007/s40520-015-0384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS We aimed to test the hypothesis that central blood pressure (BP) would be lower in healthy older adults with greater daily ambulatory activity. METHODS Forty-three (24 women, 19 men) older adults wore a triaxial accelerometer at the hip for 1 week. The volume of ambulatory activity was estimated by average steps per day. As a proxy of intensity of ambulatory activity, 1-min peak step accumulation, or the maximum number of steps taken within a minute was averaged from each day. Participants were considered "active" if they had >7500 steps per day or >105 steps per min. Radial arterial tonometry was used to estimate central (aortic) BP from pulse wave analysis. RESULTS After adjusting for age and sex, adults with higher steps per day (n = 18) tended to have lower central pulse pressure (p = 0.08). Interestingly, adults with higher peak step accumulation (n = 25) had significantly lower central pulse pressure (40.4 ± 1.6 vs. 46.8 ± 2.0 mmHg; p = 0.02) after adjusting for age and sex. Stepwise regression including age, sex, body mass index, and peak step accumulation found body mass index to be the strongest predictor of central systolic BP [β = 0.42, 95 % CI (0.13, 0.70), p = 0.004] while peak step accumulation was the strongest predictor of central pulse pressure [β = -0.31, 95 % CI (-0.01, -0.60), p = 0.043]. CONCLUSIONS These results find older adults with an "active" daily walking pattern, particularly having a higher number of maximal steps in a minute, have lower central pulse pressure than older adults with lower daily ambulatory activity.
Collapse
Affiliation(s)
- Joaquin U Gonzales
- Department of Health, Exercise and Sport Sciences, Texas Tech University, Box 43011, Lubbock, TX, 7409-3011, USA.
| |
Collapse
|
17
|
Calamia M, Bernstein JPK, Keller JN. I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study. PLoS One 2016; 11:e0159664. [PMID: 27438465 PMCID: PMC4954686 DOI: 10.1371/journal.pone.0159664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.
Collapse
Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail:
| | - John P. K. Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jeffrey N. Keller
- Pennington Biomedical Research Center, Institute for Dementia Research and Prevention, Baton Rouge, Louisiana, United States of America
| |
Collapse
|
18
|
Self-Selected Walking Speed is Predictive of Daily Ambulatory Activity in Older Adults. J Aging Phys Act 2015; 24:214-22. [PMID: 26371593 DOI: 10.1123/japa.2015-0104] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R2 = .51), MWS (R2 = .35), and WSR calculated as a ratio (R2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 -LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 -LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.
Collapse
|
19
|
Feasibility, reliability, and validity of a smartphone based application for the assessment of cognitive function in the elderly. PLoS One 2013; 8:e65925. [PMID: 23776570 PMCID: PMC3679011 DOI: 10.1371/journal.pone.0065925] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
While considerable knowledge has been gained through the use of established cognitive and motor assessment tools, there is a considerable interest and need for the development of a battery of reliable and validated assessment tools that provide real-time and remote analysis of cognitive and motor function in the elderly. Smartphones appear to be an obvious choice for the development of these “next-generation” assessment tools for geriatric research, although to date no studies have reported on the use of smartphone-based applications for the study of cognition in the elderly. The primary focus of the current study was to assess the feasibility, reliability, and validity of a smartphone-based application for the assessment of cognitive function in the elderly. A total of 57 non-demented elderly individuals were administered a newly developed smartphone application-based Color-Shape Test (CST) in order to determine its utility in measuring cognitive processing speed in the elderly. Validity of this novel cognitive task was assessed by correlating performance on the CST with scores on widely accepted assessments of cognitive function. Scores on the CST were significantly correlated with global cognition (Mini-Mental State Exam: r = 0.515, p<0.0001) and multiple measures of processing speed and attention (Digit Span: r = 0.427, p<0.0001; Trail Making Test: r = −0.651, p<0.00001; Digit Symbol Test: r = 0.508, p<0.0001). The CST was not correlated with naming and verbal fluency tasks (Boston Naming Test, Vegetable/Animal Naming) or memory tasks (Logical Memory Test). Test re-test reliability was observed to be significant (r = 0.726; p = 0.02). Together, these data are the first to demonstrate the feasibility, reliability, and validity of using a smartphone-based application for the purpose of assessing cognitive function in the elderly. The importance of these findings for the establishment of smartphone-based assessment batteries of cognitive and motor function in the elderly is discussed.
Collapse
|