Objectively Measured Physical Activity in Older Adults With and Without Diabetes

Health-related quality of life associated with fatigue, physical activity and activity pacing in adults with chronic conditions

BACKGROUND

Fatigue and inactivity are linked to decreased health-related quality of life (HRQoL) in chronic conditions. A multidimensional approach to activity pacing may improve HRQoL by promoting physical activity (PA) and alleviating fatigue. Addressing fatigue across chronic conditions is crucial, especially when underlying causes are unknown. This study aimed to (1) examine associations between HRQoL, fatigue, pacing, risk of overactivity, PA, and self-regulation of PA in adults with chronic conditions and (2) examine if these associations differ across HRQoL domains: physical, social, emotional, and functional well-being.

METHODS

Sixty-six adults with chronic conditions were recruited from UK fatigue clinics and the community. HRQoL, pacing, risk of overactivity, PA, and self-regulation of PA were assessed with standardised questionnaires and Actigraph monitor. Associations were analysed with linear mixed models, correcting for confounders.

RESULTS

HRQoL was significantly associated with fatigue (B=-7.82), pacing (B=-0.23), and self-regulation of PA (B = 0.11). Interaction effects revealed fatigue's impact on HRQoL varied significantly in physical (β=-13.49), social (β=-6.81), and emotional (β=-4.10) domains. Pacing showed significant differences in physical (β=-0.49), social (β=-7.12), and emotional (β=-7.45) domains. Perceived overactivity differed in social domain (β=-6.27), while device-based PA differed in physical (β = 0.35) and social (β = 5.73).

CONCLUSION

The negative association between fatigue and HRQoL underscores the importance of effective fatigue management. Higher pacing engagement and lower HRQoL may indicate higher fatigue. Positive associations between self-regulation and PA with HRQoL emphasise benefits of appropriate PA behaviours. The stronger impact of decreased fatigue, increased pacing, and PA on physical well-being suggests a multidimensional fatigue management approach.

Assessing the level of device-measured physical activity according to insomnia symptoms in 1,354 individuals with diabetes: the HUNT Study, Norway

Background

Insomnia symptoms that influence daytime functioning are common among adults with type 2 diabetes. However, no previous study has examined if levels of physical activity differ among adults with diabetes with and without insomnia symptoms. Thus, the aim of this study was to assess the difference in total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) levels in individuals with diabetes with and without insomnia symptoms.

Methods

This cross-sectional study included 1,354 participants with any type of diabetes who participated in the Norwegian HUNT4 Study, 2017-19. Participants were defined to have 'insomnia symptoms' if they reported difficulty initiating and/or maintaining sleep ≥ 3 nights/week during the last 3 months. MVPA (defined as moderate/brisk walking [> 4.0 km/h], running, and cycling), and TPA (MVPA including slow walking [≤ 4.0 km/h]) were determined from two accelerometers worn on the thigh and lower back. Analyses were stratified by age and sex.

Results

The median age was 67 years and 491 (36%) had insomnia symptoms and 37 (3%) had insomnia disorder. Among women, 28% with one or more insomnia symptoms fulfilled the recommended minimum level of physical activity, as compared to 34% in women without insomnia symptoms. The corresponding proportions in men were 48% and 45%. Women above 65 years with insomnia symptoms performed less TPA (-73 min/week, 95% CI -122 to -24) and MVPA (-33 min/week, 95% CI -50 to -15), compared to women without insomnia symptoms in the same age group. There was no clear difference in physical activity levels according to insomnia symptoms in men or women below 65 years. Women and men with insomnia disorder had substantially lower TPA (women: -192 min/week, 95% CI -278 to -106; men: -276 min/week, 95% CI -369 to -193) and MVPA (women: -37 min/week, 95% CI -63 to -11; men: -67 min/week, 95% CI -83 to -50) than those without insomnia symptoms.

Conclusions

This study showed that women above 65 years with insomnia symptoms and individuals with insomnia disorder performed less physical activity, suggesting that these subgroups may suffer from additional challenges that prevent them from engaging in regular physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00066-4.

Device-measured physical activity and sedentary time in the Nordic countries: A scoping review of population-based studies

PURPOSE

The purpose of this scoping review was to summarize and describe the methodology and results from population-based studies of physical activity and sedentary time measured with devices in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) and published in 2000 or later.

METHODS

A systematic search was carried out in PubMed and Web of Science in June 2023 using predefined search terms.

RESULTS

Fourteen unique research projects or surveillance studies were identified. Additionally, 2 surveillance studies published by national agencies were included, resulting in a total of 16 studies for inclusion. National surveillance systems exist in Finland and Norway, with regular survey waves in school-aged children/adolescents and adults. In Denmark, recent nationally representative data have been collected in school children only. So far, Sweden has no regular national surveillance system using device-based data collection. No studies were found from Iceland. The first study was conducted in 2001 and the most recent in 2022, with most data collected from 2016 to date. Five studies included children/adolescents 6-18 years, no study included preschoolers. In total 11 studies included adults, of which 8 also covered older adults. No study focused specifically on older adults. The analytical sample size ranged from 205 to 27,890. Detailed methodology is presented, such as information on sampling strategy, device type and placement, wear protocols, and physical activity classification schemes. Levels of physical activity and sedentary time in children/adolescents, adults, and older adults across the Nordic countries are presented.

CONCLUSION

A growing implementation of device-based population surveillance of physical activity and sedentary behavior in the Nordic countries has been identified. The variety of devices, placement, and data procedures both within and between the Nordic countries highlights the challenges when it comes to comparing study outcomes as well as the need for more standardized data collection.

Seasonal changes in daily steps of community-dwelling older individuals with and without lifestyle-related diseases: a retrospective cohort study

[Purpose] Physical activity helps prevent diseases and mitigate their severity in older individuals with lifestyle-related conditions. We investigated whether seasonal factors and existing diseases affect physical activity in this demographic to identify lifestyle guidance indicators for health maintenance. [Participants and Methods] We compared the daily steps of older individuals (age of ≥65 years) by month, sex, and disease status from August to January by using three-way analysis of covariance. We evaluated a total of 115 participants (83 females and 32 males). [Results] Females with diseases had significantly fewer monthly daily steps than females without diseases in November (mean difference=1,138 ± 220) and December (mean difference=1,578 ± 239). Throughout, males with diseases completed significantly fewer monthly daily steps than did males without diseases. Furthermore, monthly daily steps never differed significantly between females with diseases and their male counterparts. [Conclusion] Compared with healthy older individuals, in older persons with diseases, physical activity was lower year-round among males and in November and December among females. Separate daily step count goals may be required for health maintenance in both sexes. It is important to determine the daily steps necessary to prevent various diseases and mitigate their severity while maintaining physical activity among older persons with diseases.

Associations between number and type of conditions and physical activity levels in adults with multimorbidity - a cross-sectional study from the Danish Lolland-Falster health study

Aim

To provide detailed descriptions of the amount of daily physical activity (PA) performed by people with multimorbidity and investigate the association between the number of conditions, multimorbidity profiles, and PA.

Methods

All adults (≥18 years) from The Lolland-Falster Health Study, conducted from 2016 to 2020, who had PA measured with accelerometers and reported medical conditions were included (n=2,158). Sedentary behavior and daily PA at light, moderate, vigorous, and moderate to vigorous intensity and number of steps were measured with two accelerometers. Associations were investigated using multivariable and quantile regression analyses.

Results

Adults with multimorbidity spent nearly half their day sedentary, and the majority did not adhere to the World Health Organization's (WHO) PA recommendations (two conditions: 63%, three conditions: 74%, ≥four conditions: 81%). Number of conditions was inversely associated with both PA for all intensity levels except sedentary time and daily number of steps. Participants with multimorbidity and presence of mental disorders (somatic/mental multimorbidity) had significantly lower levels of PA at all intensity levels, except sedentary time, and number of daily steps, compared to participants with multimorbidity combinations of exclusively somatic conditions.

Conclusion

Levels of sedentary behavior and non-adherence to PA recommendations in adults with multimorbidity were high. Inverse associations between PA and the number of conditions and mental multimorbidity profiles suggest that physical inactivity increases as multimorbidity becomes more complex.

Detailed descriptions of physical activity patterns among individuals with diabetes and prediabetes: the Lolland-Falster Health Study

INTRODUCTION

This study aimed to describe objectively measured physical activity patterns, including daily activity according to day type (weekdays and weekend days) and the four seasons, frequency, distribution, and timing of engagement in activity during the day in individuals with diabetes and prediabetes and compared with individuals with no diabetes.

RESEARCH DESIGN AND METHODS

This cross-sectional study included data from the Danish household-based, mixed rural-provincial population study, The Lolland-Falster Health Study from 2016 to 2020. Participants were categorized into diabetes, prediabetes, and no diabetes based on their glycated hemoglobin level and self-reported use of diabetes medication. Outcome was physical activity in terms of intensity (time spent in sedentary, light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) intensities), adherence to recommendations, frequency and distribution of highly inactive days (<5 min MVPA/day), and timing of engagement in activity assessed with a lower-back worn accelerometer.

RESULTS

Among 3157 participants, 181 (5.7 %) had diabetes and 568 (18.0 %) had prediabetes. Of participants with diabetes, 63.2% did not adhere to the WHO recommendations of weekly MVPA, while numbers of participants with prediabetes and participants with no diabetes were 59.5% and 49.6%, respectively. Around a third of participants with diabetes were highly inactive daily (<5 min MVPA/day) and had >2 consecutive days of inactivity during a 7-days period. Mean time spent physically active at any intensity (light, moderate, and vigorous) during a day was lower among participants with diabetes compared with participants with no diabetes and particularly from 12:00 to 15:00 (mean difference of -6.3 min MVPA (95% CI -10.2 to -2.4)). Following adjustments, significant differences in physical activity persisted between diabetes versus no diabetes, but between participants with prediabetes versus no diabetes, results were non-significant after adjusting for body mass index.

CONCLUSIONS

Inactivity was highly prevalent among individuals with diabetes and prediabetes, and distinct daily activity patterns surfaced when comparing these groups with those having no diabetes. This highlights a need to optimize current diabetes treatment and prevention to accommodate the large differences in activity engagement.

Objectively measured physical activity levels and adherence to physical activity guidelines in people with multimorbidity-A systematic review and meta-analysis

Objective

To determine levels of objectively measured physical activity (PA) and the proportion of adults with multimorbidity that adheres to PA guidelines.

Methods

All studies, where PA was measured at baseline using an activity monitor in an adult (≥18 years) multimorbid (≥80% of the population had ≥2 chronic conditions) population. A systematic literature search was performed in Medline, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, opengrey.eu and google.com from inception up until 18^th of January 2022. Risk of bias was assessed with a modified version of the Quality Assessment Tool for Quantitative Studies. A random-effects meta-analyses was performed to estimate daily minutes of sedentary behavior (SB), light PA (LPA), moderate PA (MPA), moderate to vigorous PA (MVPA) and steps. Proportions adhering to PA guidelines was narratively synthesized. Certainty of evidence was determined using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Fifteen studies (2,172 participants) were included. The most frequent combination of conditions were type 2 diabetes and hypertension (six studies). Participants spent a daily average of 500.5 (95% CI: 407.1 to 593.9) minutes in SB, 325.6 (95% CI: 246.4 to 404.7 minutes in LPA and 32.7 (95% CI: 20.2 to 45.3) minutes in MVPA. The mean daily number of steps was 5,145 (95% CI: 4264 to 6026) for people in free-living conditions. The proportion adhering to PA guidelines ranged widely (7.4% to 43%). All studies were rated as at high risk of bias and the certainty of evidence was very low.

Conclusions

PA levels and adherence varied from low to above guideline recommended levels for adults with chronic conditions, depending on PA intensity. The very low certainty of evidence calls for high quality studies focusing on detailed descriptions of PA behavior in people with multimorbidity.

PROSPERO registration number

CRD42020172456.

Association of dog ownership with accelerometer-measured physical activity and daily steps in 70-year-old individuals: a population-based cross-sectional study

Background

Dog ownership (DO) has been associated with higher levels of self-reported walking and physical activity. However, compared to device-based measures, self-reported measures of physical activity may suffer from bias due to recall and social desirability. They are also incapable of quantifying light-intensity physical activity (LPA) and step volume, both of which may have important health benefits, especially for older adults. In this study, we investigated the association of DO with accelerometer-measured physical activity of different intensities and daily steps in 70-year-old individuals.

Methods

This was a population-based cross-sectional study including 1406 participants aged 70 years [54.1% female] who participated in a health survey in Umeå, Sweden between February 2017–November 2019. All participants self-reported DO [yes/no]. Daily averages of LPA, moderate-to-vigorous-intensity physical activity (MVPA), and steps per day [steps/d] were measured for 1 week using hip-mounted Actigraph GT3X+ accelerometers. Associations were investigated using linear- and logistic regression models, adjusted for sociodemographic and health-related factors, date of examination, and accelerometer wear time.

Results

The prevalence of DO was 14.1% [N = 199]. After adjustment for all covariates, DO was associated with 19.2 more minutes/d of LPA [95% CI, 8.8–29.6], 11.4 more minutes/d of MVPA [95% CI, 8.0–14.9] and 1738 more steps/d [95% CI, 1326–2149]. DO was also associated with twice the odds of meeting the physical activity recommendations [OR, 2.07, 95% CI, 1.48–2.90]. Exploratory interaction analyses showed that the association between DO and steps/d was stronger [P_interaction = 0.030] in female [β = 2165, 95% CI, 1585–2744] than in male [β =1255, 95% CI, 664–1845], with a similar trend for MVPA [P_interaction = 0.082].

Conclusions

In this study of community-dwelling 70-year-old individuals, DO was associated with higher levels of daily LPA, MVPA, and steps. With the limitation of the observational design of the study, these findings add knowledge regarding the beneficial role that DO may play for promoting physical activity in the older population. In turn, these findings could support the development and evaluation of targeted interventions seeking to promote dog-friendly environments and facilitate dog walking in the community.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12401-4.

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

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

Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study

Background

Older adults with diabetes take fewer steps per day than those without diabetes. The purpose of the present study was to investigate the association of daily step count with incident diabetes in community-dwelling 70-year-olds.

Methods

This prospective cohort study included N = 3055 community-dwelling 70-year-olds (52% women) who participated in a health examination in Umeå, Sweden during 2012–2017, and who were free from diabetes at baseline. Daily step count was measured for 1 week using Actigraph GT3X+ accelerometers. Cases of diabetes were collected from the Swedish National Patient Register. The dose-response association was evaluated graphically using a flexible parametric model, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regressions.

Results

During a mean follow-up of 2.6 years, diabetes was diagnosed in 81 participants. There was an inverse nonlinear dose-response association between daily step count and incident diabetes, with a steep decline in risk of diabetes from a higher daily step count until around 6000 steps/day. From there, the risk decreased at a slower rate until it leveled off at around 8000 steps/day. A threshold of 4500 steps/day was found to best distinguish participants with the lowest risk of diabetes, where those taking ≥ 4500 steps/day, had 59% lower risk of diabetes, compared to those taking fewer steps (HR, 0.41, 95% CI, 0.25–0.66). Adjusting for visceral adipose tissue (VAT) attenuated the association (HR, 0.64, 95% CI, 0.38–1.06), which was marginally altered after further adjusting for sedentary time, education and other cardiometabolic risk factors and diseases (HR, 0.58, 95% CI, 0.32–1.05).

Conclusions

A higher daily step count is associated with lower risk of incident diabetes in community-dwelling 70-year-olds. The greatest benefits occur at the lower end of the activity range, and much earlier than 10,000 steps/day. With the limitation of being an observational study, these findings suggest that promoting even a modest increase in daily step count may help to reduce the risk of diabetes in older adults. Because VAT appears to partly mediate the association, lifestyle interventions targeting diabetes should apart from promoting physical activity also aim to prevent and reduce central obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09929-2.

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.

Physical Activity Frequency Among Older Adults With Diabetes or Prediabetes: Associations With Sociodemographics, Comorbidity, and Medical Advice

To examine the differences in physical activity (PA) between older adults with and without diabetes/prediabetes and the correlates of PA frequency and associations between medical advice on PA and/or diet/weight loss and increasing PA among those with diabetes/prediabetes. Multinomial and binary logistic regression models using 2016-2017 National Health Interview Survey data (N = 4,860 aged 65+ years with diabetes/prediabetes). About 44.2% of those with diabetes/prediabetes, compared with 48.1% of a matched sample without, engaged in any PA three plus times a week. The low PA group (PA frequency was zero to two times a week) was more socioeconomically disadvantaged and had more chronic illnesses than the medium (three to four times a week) or high (five plus times a week) PA groups. Any PA and/or diet/weight loss medical advice was associated with two to three times higher odds of increasing PA. Health care providers should consider prescribing PA and/or diet/weight loss for patients with diabetes/prediabetes.

Diabetes Technology and Exercise

Advances in technologies such as glucose monitors, exercise wearables, closed-loop systems, and various smartphone applications are helping many people with diabetes to be more physically active. These technologies are designed to overcome the challenges associated with exercise duration, mode, relative intensity, and absolute intensity, all of which affect glucose homeostasis in people living with diabetes. At present, optimal use of these technologies depends largely on motivation, competence, and adherence to daily diabetes care requirements. This article discusses recent technologies designed to help patients with diabetes to be more physically active, while also trying to improve glucose control around exercise.