"Can Do" vs. "Do Do" in Older Adults: A Cross-Sectional Analysis of Sensor-Derived Physical Activity Patterns

(1) Background: Identifying groups with a misaligned physical capacity (PC) and physical activity (PA) is potentially relevant for health promotion. Although an important health determinant, deeper knowledge of underlying walking behavior patterns in older adults is currently missing. We aim to identify specific PA signatures of misaligned groups and determine PA variables discriminating between groups. (2) Methods: In total, 294 community-dwelling older adults (≥70 years) were divided into four quadrants based on thresholds for PA (≥ or <5000 steps/day) and PC (≤ or >12 s, Timed Up and Go test). Kruskal-Wallis and effect sizes were calculated to compare quadrants' PA variables and to determine the discriminative power of PA parameters on walking duration, frequency, and intensity. (3) Results: We identified quadrant-specific PA signatures. Compared with "can do-do do", the "cannot do-do do" group performs shorter continuous and lower-intensity walks; the "can do-do not do" group takes fewer steps and walks with less intensity. The "cannot do-do not do" group presents lower values in all PA variables. "Walking duration greater or equal 3 METs" was the strongest discriminative PA variable. (4) Conclusion: We provide distinct PA signatures for four clinically different groups of older adults. Walking intensity is most useful to distinguish community-dwelling older adults, which is relevant for developing improved customized health promotion interventions.

The Associations between Physical Activity, Functional Fitness, and Life Satisfaction among Community-Dwelling Older Adults

Previous studies showed physical activity had benefits for older adults’ life satisfaction, but the mechanism was unclear. This study aimed to investigate whether older adults with more physical activity had better functional fitness and life satisfaction, and whether functional fitness mediated the relationship between physical activity and life satisfaction. A cross-sectional study design was employed, and 623 older adults (73.71 ± 5.91 years) were recruited. Physical activity, functional fitness, life satisfaction, and demographic characteristics were collected. Compared with older adults with low physical activity, those with high (B = 0.41, p = 0.025) and moderate (B = 0.40, p = 0.041) physical activity had better life satisfaction; those with high physical activity had better lower limb muscle strength (B = 1.71, p = 0.001), upper (B = 2.91, p = 0.032) and lower (B = 3.12, p = 0.006) limb flexibility, cardiorespiratory endurance (B = 6.65, p = 0.008), and dynamic balance ability (B = −1.12, p < 0.001). Functional fitness did not mediate the relationship between physical activity and life satisfaction. Promoting physical activity may be useful for increasing older adults’ functional fitness and life satisfaction, but the effects on functional fitness only occurred at a high level of physical activity, and the effect of physical activity on life satisfaction was not mediated by functional fitness.

The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis

BACKGROUND

Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and mortality. Whether benefits extend to key determinants of disability and mortality, namely muscle strength and muscle power, is unclear.

AIMS

This systematic review aimed to describe the association of objective measures of PA and SB with measures of skeletal muscle strength and muscle power in community-dwelling older adults.

METHODS

Six databases were searched from their inception to June 21^st, 2020 for articles reporting associations between objectively measured PA and SB and upper body or lower body muscle strength or muscle power in community dwelling adults aged 60 years and older. An overview of associations was visualized by effect direction heat maps, standardized effect sizes were estimated with albatross plots and summarized in box plots. Articles reporting adjusted standardized regression coefficients (β) were included in meta-analyses.

RESULTS

A total of 112 articles were included representing 43,796 individuals (range: 21 to 3726 per article) with a mean or median age from 61.0 to 88.0 years (mean 56.4 % female). Higher PA measures and lower SB were associated with better upper body muscle strength (hand grip strength), upper body muscle power (arm curl), lower body muscle strength, and lower body muscle power (chair stand test). Median standardized effect sizes were consistently larger for measures of PA and SB with lower compared to upper body muscle strength and muscle power. The meta-analyses of adjusted β coefficients confirmed the associations between total PA (TPA), moderate-to-vigorous PA (MVPA) and light PA (LPA) with hand grip strength (β = 0.041, β = 0.057, and β = 0.070, respectively, all p ≤ 0.001), and TPA and MVPA with chair stand test (β = 0.199 and β = 0.211, respectively, all p ≤ 0.001).

CONCLUSIONS

Higher PA and lower SB are associated with greater skeletal muscle strength and muscle power, particularly with the chair stand test.

Objectively assessed physical activity patterns and physical function in community-dwelling older adults: a cross-sectional study in Taiwan

OBJECTIVES

To objectively assess light physical activity (PA), moderate-to-vigorous PA (MVPA), step counts and number of 10 min MVPA bouts and their association with physical function among older adults.

DESIGN

Cross-sectional design.

SETTING

Urban community setting in Taiwan.

PARTICIPANTS

127 Taiwanese older adults aged over 65 years (mean age=70.8±5.3 years; 72% women).

PRIMARY AND SECONDARY OUTCOME MEASURES

Triaxial accelerometers were used to measure PA variables for 10 hours/day for seven consecutive days. Then, five physical function components (handgrip strength, single-leg stance, 5-metre walk speed, timed up and go and sit-to-stand test) were measured. Multiple linear regressions were used to perform separate analyses for older men and women.

RESULTS

For older women, daily MVPA time (β: 0.39, 95% CI: 0.12, 0.64; p=0.004), daily step counts (β: 0.46, 95% CI: 0.12, 0.78; p=0.009) and number of 10 min MVPA bouts (β: 0.27, 95% CI: 0.001, 0.53; p=0.049) were positively associated with handgrip strength after adjusting for accelerometer wear time, sedentary time and other confounders. Furthermore, daily MVPA time was positively associated with a single-leg stance (β: 0.25, 95% CI: 0.02, 0.49; p=0.036) and higher daily step counts were associated with shorter walking speed performance (β: -0.31, 95% CI: -0.57, -0.001; p=0.049). None of the variables of the objectively assessed PA patterns was associated with physical function outcomes among older men due to their small sample size.

CONCLUSIONS

Daily MVPA, MVPA bouts of at least 10 min and accumulated daily steps are important for improving physical function among older women. Future prospective research should establish causal associations between PA patterns and functional ability among older adults.

Diurnal Profiles of Locomotive and Household Activities Using an Accelerometer in Community-Dwelling Older Adults with Musculoskeletal Disorders: A Cross-Sectional Survey

The present study investigates the diurnal profiles of locomotive and household activities in older adults with musculoskeletal disorders (MSDs) using an accelerometer. Furthermore, we examined the effect of chronic pain on their diurnal profiles in both activities. Seventy-one older adults with MSDs (73–89 years) were included in this cross-sectional survey, and 25 age-matched older adults (75–86 years) were selected as healthy older adults. The daily physical activities, including steps walked and locomotive and household activity intensities, were recorded using a triaxial accelerometer in terms of metabolic equivalent task-hours per week (MET-h/week). The diurnal profiles of steps and locomotive activities in older adults with MSDs were considerably lower than those of healthy older adults. In contrast, there was no significant decline in household activity. However, the locomotive and household activities were reduced by severe chronic pain. This survey demonstrated that the diurnal profiles of household activity in older people with MSDs as well as those in age-matched healthy older adults were maintained. Furthermore, severe chronic pain influenced both activities. Therefore, the maintenance of household activity throughout the day, as well as the management of chronic pain, may be important strategies for the promotion of physical activity in older people with MSDs.

Association Between Toe Flexor Strength and Activity Levels in Community-Dwelling Japanese Older Women

This study aimed to explore the relationship between toe flexor strength and the daily activity levels in 56 Japanese older women aged between 70 and 88 years. The activity levels were measured as the average number of steps/day using a pedometer and the life space assessment (LSA) scores. The Mann-Whitney U test was used to compare toe flexor muscle strength and the LSA scores between those with fewer than and more than 6,000 steps/day. Spearman's correlation coefficient was used to investigate the relationship between toe grip strength according to age and each variable. The LSA scores were significantly higher in the group with >6,000 steps/day (β = 0.188, p < .05). A correlation was found between the number of steps/day and toe flexor strength (r = .424, β = 0.419, p < .05) and the LSA scores (r = .417, β = 0.435, p < .05) in the participants in their 80s. Increasing the number of steps/day may benefit women in their 80s.

Everyday occupations prioritised by older adults participating in reablement. A cross-sectional study

Background: Little knowledge exists regarding which occupations older adults prioritize as rehabilitation goals in reablement and what factors are associated with their preferences.Objectives: To explore which occupations older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities.Materials and methods: A cross-sectional study was undertaken with a sample of 738 older adults from a nationwide trial evaluating the effects of reablement in Norway. The nine occupational sub-areas of the Canadian Occupational Performance Measure were used as a framework for analyses.Results: Participants identified a multitude of occupations as challenging. Functional mobility was the most frequently identified and prioritized sub-area. Significant associations were found between prioritized occupations and health condition, sex, living status, education, walking speed and motivation.Conclusions: This study found both abundance and diversity in the occupational problems and prioritized goals of older adults, with mobility being a key priority regardless of health condition.Significance: It is important that reablement continues to be a person-centered intervention embracing the possibility to choose meaningful occupations. Occupational Therapists and other health professionals should address mobility when improving occupational performance in older adults.

Hypogastric artery coverage during endovascular aneurysm repair in octogenarian and younger patients

AIM

To report our experience about hypogastric artery coverage during endovascular aneurysm repair (EVAR) for aortoiliac aneurysms in patients younger than 80 years (group A) compared with octogenarian patients (group B).

METHODS

Data of consecutive EVAR with hypogastric artery coverage from 01/1998 to 12/2016 were retrospectively analyzed. Primary outcomes were the occurrence of ischemic colitis, type II endoleak and buttock claudication both at 30 days and in the long term. P values less than 0.05 were considered statistically significant.

RESULTS

The hypogastric artery was covered in 107 patients. Twenty-three (21.5%) were octogenarian (group B). At 30 days, one type II endoleak occurred in group B, whereas 16 patients of group A experienced buttock claudication. There were no cases of ischemic colitis. During follow-up (median 63.5 months), no cases of ischemic colitis occurred. Six new type II endoleaks were recorded (five in group B and one in group A, P = 0.0001). Buttock claudication persisted in four patients of group A. No new cases of buttock claudication were observed.

CONCLUSION

Unilateral hypogastric artery coverage during EVAR for aortoiliac aneurysms can be performed with an acceptable rate of postoperative complication. Postoperative buttock claudication was more frequent in younger patients, whereas a type II endoleak occurred mostly in octogenarian patients during follow-up.

Hip abductor strength and fatigue are associated with activity levels more than 1 year after total hip replacement

Despite improvements in pain and function, people who undergo total hip arthroplasty (THR) may not always return to desired levels of physical activity (PA). The factors associated with low activity levels are not fully understood. Abductor weakness and fatigue have both been proposed as factors that limit activity in older adults or people with hip osteoarthritis, but have not been investigated after THR. We hypothesized that abductor weakness and fatigue are associated with lower activity levels in people who have undergone a THR and that fatigue mediates the association between abductor strength and activity. We evaluated 16 subjects (24 ± 10 months post-THR; age 56.8 ± 8.4 yrs; BMI 31 ± 7 kg/m² ). Fatigue was assessed using the PROMIS fatigue short-form 7a. Peak isometric hip abductor torque was assessed using a dynamometer with subjects in a sidelying position. We assessed activity level using the UCLA activity score. We used Pearson correlations to explore the associations among the variables. Next we used a three-step linear regression procedure to test whether or not fatigue acted as a mediator between abductor torque and UCLA activity scores. Higher abductor torque was associated with less fatigue (R²  = 0.275; p = 0.037) and with higher UCLA scores (R²  = 0.488, p = 0.003). Higher fatigue was associated with lower UCLA scores (R²  = 0. 307, p = 0.017), however there was no evidence of mediation. This suggests that addressing both abductor strength and fatigue may increase physical activity. Statement of Clinical Significance: Fatigue and abductor weakness should be evaluated in sedentary THR patients presenting for long-term follow-up. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1519-1525, 2018.

Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study

OBJECTIVES

To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability.

DESIGN

Secondary analysis.

SETTING

Multicenter institutions.

PARTICIPANTS

A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9.

INTERVENTIONS

Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information.

MAIN OUTCOME MEASURES

Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months.

RESULTS

Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002).

CONCLUSIONS

Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.

Musculoskeletal fitness and balance in older individuals (65-85 years) and its association with steps per day: a cross sectional study

Background

There is limited normative, objective data combining musculoskeletal fitness (MSF), balance and physical activity (PA) among older adults. The aims were therefore to; 1) describe MSF and balance in older Norwegian adults focusing on age- and sex-related differences; 2) investigate the associations among MSF, balance and objectively-assessed PA levels.

Methods

This was part of a national multicenter study. Participants (65–85 years) were randomly selected from the national population registry. We used ActiGraph GT1M accelerometers to measure PA. Balance and MSF were assessed using: one leg standing (OLS), handgrip strength (HG), static back extension (SBE), sit and reach (SR), back scratch right, left arm over (BSR, BSL). Univariate analyses of variance were used to assess sex differences within the different MSF and balance tests and for comparisons among multiple age groups. Linear regression analysis was used to investigate how PA (expressed in 1000 steps increments) was associated with MSF and balance.

Results

85 women and 76 men were included. Mean age (standard deviation (SD)) was 73.2 (5.4) years for women and 72.3 (4.8) years for men. The youngest participants (65–69 years) had significantly better mean OLS- and SBE results compared with older participants. Women (65–85 years) had significantly better mean SR, BSR, BSL and SBE results compared with men (65–85 years). Men had significantly better mean HG results compared with women. No sex differences in mean OLS results were observed. A daily increment of 1000 steps was associated with better mean test scores for OLS- and SBE tests (b = 1.88, 95 % CI: 0.85 to 2.90 (p ≤ 0.001) and b = 4.63, 95 % CI: 1.98 to 7.29 (p = 0.001), respectively).

Conclusion

The youngest (65–69 years) had better static balance and muscular endurance in trunk extensors compared with older participants. Older women (65–85 years) had better joint flexibility than older men (65–85 years), whereas older men had better handgrip strength than older women. A higher PA level was associated with better static balance and muscular endurance in trunk extensors in older individuals. This study provides important normative data, and further investigation of trunk endurance and static balance as key foci for PA interventions in elderly is warranted.

Self-Selected Walking Speed is Predictive of Daily Ambulatory Activity in Older Adults

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.