The relationship between outdoor activity and health in older adults using GPS

Long-term exposure to wildfire smoke PM2.5 and mortality in the contiguous United States

Despite the growing evidence on the health effects of short-term exposure to wildfire smoke fine particles (PM2.5), the impacts of long-term wildfire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildfire smoke PM2.5 and all-cause mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous U.S., 2007-2020. Monthly county-level mortality data were collected from the National Center for Health Statistics. Wildfire smoke PM2.5 concentration was derived from a 10×10 km2 resolution spatiotemporal model. Controlling for non-smoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a non-linear association between 12-month moving average concentration of smoke PM2.5 and monthly all-cause mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 μg/m3, all-cause mortality increased by 0.40-1.54 and 3.65 deaths per 100,000 people per month when the 12-month moving average of PM2.5 concentration was of 0.1-5 and 5+ μg/m3, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, suicide, and chronic kidney disease mortality were all found to be associated with long-term wildfire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 30,180 all-cause deaths/year (95% CI: 21,449, 38,910) in the contiguous U.S. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 above and racial minority populations. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildfire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communication to prepare communities and individuals to mitigate smoke exposure.

Systematic review of best practices for GPS data usage, processing, and linkage in health, exposure science and environmental context research

Global Positioning System (GPS) technology is increasingly used in health research to capture individual mobility and contextual and environmental exposures. However, the tools, techniques and decisions for using GPS data vary from study to study, making comparisons and reproducibility challenging.

OBJECTIVES

The objectives of this systematic review were to (1) identify best practices for GPS data collection and processing; (2) quantify reporting of best practices in published studies; and (3) discuss examples found in reviewed manuscripts that future researchers may employ for reporting GPS data usage, processing and linkage of GPS data in health studies.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases searched (24 October 2023) were PubMed, Scopus and Web of Science (PROSPERO ID: CRD42022322166).

ELIGIBILITY CRITERIA

Included peer-reviewed studies published in English met at least one of the criteria: (1) protocols involving GPS for exposure/context and human health research purposes and containing empirical data; (2) linkage of GPS data to other data intended for research on contextual influences on health; (3) associations between GPS-measured mobility or exposures and health; (4) derived variable methods using GPS data in health research; or (5) comparison of GPS tracking with other methods (eg, travel diary).

DATA EXTRACTION AND SYNTHESIS

We examined 157 manuscripts for reporting of best practices including wear time, sampling frequency, data validity, noise/signal loss and data linkage to assess risk of bias.

RESULTS

We found that 6% of the studies did not disclose the GPS device model used, only 12.1% reported the per cent of GPS data lost by signal loss, only 15.7% reported the per cent of GPS data considered to be noise and only 68.2% reported the inclusion criteria for their data.

CONCLUSIONS

Our recommendations for reporting on GPS usage, processing and linkage may be transferrable to other geospatial devices, with the hope of promoting transparency and reproducibility in this research.

PROSPERO REGISTRATION NUMBER

CRD42022322166.

Individual and environmental variables related to outdoor walking among older adults: Verifying a model to guide the design of interventions targeting outdoor walking

OBJECTIVE

To estimate the relationships between individual and environmental variables and outdoor walking (OW) in older adults with OW limitations through verifying a conceptual model.

METHODS

Baseline data from 205 older adults participating in a randomized trial of a park-based OW program were analyzed using structural equation modeling. We evaluated a three latent factor model: OW (accelerometry and self-report); individual factors (balance; leg strength; walking self-confidence, speed and endurance; mental health; education; income; car access); and environmental factors (neighbourhood walkability components).

RESULTS

Mean age was 75 years; 73% were women. Individual factors was significantly associated with OW (β = 0.39, p < .01). Environmental factors was not directly associated with OW but was indirectly linked to OW through its significant covariance with the individual factors (β = 0.22, p < .01). The standardized factor loadings from the individual factors on walking self-confidence and walking capacity measures exceeded 0.65.

CONCLUSIONS

Better walking capacity and more confidence in the ability to walk outdoors are associated with higher OW in older adults. Better neighbourhood walkability is indirectly associated with more OW. The conceptual model demonstrates an individual and environment association; if the capacity of the individual is increased (potentially through walking interventions), they may be able to better navigate environmental challenges.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.

METHODS

GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.

RESULTS

All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.

CONCLUSIONS

This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Primary school children's health and its association with physical fitness development and health-related factors

The health status (HS) of children is influenced by a variety of factors, including physical fitness (PF) or social and environmental characteristics. We present a 4-year longitudinal study carried out with 263 primary school children. PF was assessed yearly using the German Motor Performance Test 6-18. Demographic data, leisure time behavior and socioeconomic factors were collected using questionnaires for children and parents. Based on parents' ratings in year 4, children were categorized as either "very good health status" (VGHS) or "good health status or below" (GHSB). Children with VGHS (73%) showed a larger improvement of global PF (p < 0.001), a significantly higher proportion of being/playing outside (p < 0.001), significantly lower proportions of overweight (p < 0.001), of media availability in the bedroom (p = 0.011) and of daily media consumption > 2 h (p = 0.033) compared to children with GHSB. Regarding socio-economic factors, children with VGHS revealed significantly fewer parents with lower education (p = 0.002), lower physical activity levels (p = 0.030) and lower migration background (p < 0.001). Physical fitness (p = 0.019) and outdoors exercising (p = 0.050) were the only variables to provide significantly higher chances of perceiving one's own health as very good when tested within a complex model including all the variables studied in this work. Considering the little focus on PF in the current Austrian physical education curriculum and the favorable environmental features of the Tyrolean region, more emphasis should be given to promoting didactical and pedagogical approaches that allow schoolers to be active in the nature.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between instrumental activities of daily living decline during hospitalization and one-year mortality in elderly patients with heart failure: A multi-center prospective cohort study

BACKGROUND

It remains unclear whether instrumental activities of daily living (IADL) decline during hospitalization is related to mortality rates. This study examined the relationship between IADL decline during hospitalization and the one-year mortality rate in elderly heart failure (HF) patients.

METHODS

Five hundred seventy-six consecutive patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into groups based on changes in IADL during hospitalization: IADL maintained and IADL decline. IADL was assessed by the National Center for Geriatrics and Gerontology-Activities of Daily Living Scale (NCGG-ADL). IADL decline was defined as Δ NCGG-ADL ≤ -1 point. The primary outcome was one-year all-cause mortality rate after discharge. Outcomes were examined using the Kaplan-Meier method with the log-rank test and Cox proportional hazards models using the existing prognostic risk factors for HF.

RESULTS

Of 576 patients, 20% (n = 113) had IADL decline during hospitalization, and 9.2% (n = 35) and 6.0% (n = 18) died of all-cause and cardiovascular disease within one year after discharge, respectively. The IADL-decline group had significantly higher one-year all-cause mortality rates after adjusting for risk factors (hazard ratio: 1.923, 95% confidence interval 1.085-3.409; P = 0.023). Among the IADL subcategories, outdoor activity items such as "go out by oneself," "take a bus or train," and "shop for necessities" were more likely to change from independent to dependent during hospitalization.

CONCLUSION

IADL decline during hospitalization was associated with an increased all-cause mortality rate at one-year after discharge in elderly HF patients.

Smartphone Global Positioning System-Based System to Assess Mobility in Health Research: Development, Accuracy, and Usability Study

BACKGROUND

As global positioning system (GPS) measurement is getting more precise and affordable, health researchers can now objectively measure mobility using GPS sensors. Available systems, however, often lack data security and means of adaptation and often rely on a permanent internet connection.

OBJECTIVE

To overcome these issues, we aimed to develop and test an easy-to-use, easy-to-adapt, and offline working app using smartphone sensors (GPS and accelerometry) for the quantification of mobility parameters.

METHODS

An Android app, a server backend, and a specialized analysis pipeline have been developed (development substudy). Parameters of mobility by the study team members were extracted from the recorded GPS data using existing and newly developed algorithms. Test measurements were performed with participants to complete accuracy and reliability tests (accuracy substudy). Usability was examined by interviewing community-dwelling older adults after 1 week of device use, followed by an iterative app design process (usability substudy).

RESULTS

The study protocol and the software toolchain worked reliably and accurately, even under suboptimal conditions, such as narrow streets and rural areas. The developed algorithms had high accuracy (97.4% correctness, F₁-score=0.975) in distinguishing dwelling periods from moving intervals. The accuracy of the stop/trip classification is fundamental to second-order analyses such as the time out of home, as they rely on a precise discrimination between the 2 classes. The usability of the app and the study protocol was piloted with older adults, which showed low barriers and easy implementation into daily routines.

CONCLUSIONS

Based on accuracy analyses and users' experience with the proposed system for GPS assessments, the developed algorithm showed great potential for app-based estimation of mobility in diverse health research contexts, including mobility patterns of community-dwelling older adults living in rural areas.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12877-021-02739-0.

Designing digital nature for older adults: A mixed method approach

Objective

Loneliness and social isolation are pressing issues that can seriously impact the mental health and well-being of older adults. Interacting with nature can stimulate a feeling of connectedness. However, for older adults, access to nature is often troublesome because of physical limitations and mobility restrictions.

Methods

In the present mixed-method study, 37 older adults (62-99 years old) with varying care needs and mobility restrictions watched a video presenting a walkthrough of a simulated digital nature landscape.

Results

Quantitative results show a significant increase in social connectedness scores and enhanced peacefulness after experiencing a digital nature. Qualitative results stress the importance of variations in nature scenery and highlight the influence of contextual and person-related factors including nature experiences throughout the life span and mobility constraints that older adults may face.

Conclusion

These findings testify to the potential of using digital nature as a complementary strategy when interactions with outdoor nature become increasingly difficult due to old age.

The Relationship between Social Frailty and Depressive Symptoms in the Elderly: A Scoping Review

BACKGROUND

Various studies have highlighted the correlation between social frailty and depressive symptoms in the elderly. However, evidence of how these two domains influence each other is not clear. The purpose of this scoping review is to summarize the current literature examining social frailty and depressive symptoms.

METHOD

We conducted a scoping review allowing for the inclusion of multiple methodologies to examine the extent and range of this research topic.

RESULT

The search initially yielded 617 results, 14 of which met the inclusion criteria. Five studies were identified from China, six were identified from Japan, two were identified from Korea, one was identified from Ghana, and one was from Asia. The evidence reviewed indicated that five studies met category 5 criteria, and the others met level 3 criteria. The findings from these studies showed that there is a significant relationship between social frailty and depressive symptoms.

CONCLUSION

This scoping review shows that worse social frailty contributes to a significant degree of depression. Further research on screening social frailty and possible interventions in community and medical settings to prevent the elderly from developing depressive symptoms is needed.

Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

BACKGROUND

Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity.

OBJECTIVE

The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported.

DESIGN

Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over.

PARTICIPANTS/SETTING

Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021.

INTERVENTION

Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens.

MAIN OUTCOME MEASURES

Although the RCT's primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19.

STATISTICAL ANALYSES PERFORMED

χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations.

RESULTS

Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022.

CONCLUSIONS

This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors-one with capacity for sustainability and widespread dissemination.

Comparison of GPS imputation methods in environmental health research

Assessment of personal exposure in the external environment commonly relies on global positioning system (GPS) measurements. However, it has been challenging to determine exposures accurately due to missing data in GPS trajectories. In environmental health research using GPS, missing data are often discarded or are typically imputed based on the last known location or linear interpolation. Imputation is said to mitigate bias in exposure measures, but methods used are hardly evaluated against ground truth. Widely used imputation methods assume that a person is either stationary or constantly moving during the missing interval. Relaxing this assumption, we propose a method for imputing locations as a function of a person's likely movement state (stop, move) during the missing interval. We then evaluate the proposed method in terms of the accuracy of imputed location, movement state, and daily mobility measures such as the number of trips and time spent on places visited. Experiments based on real data collected by participants (n=59) show that the proposed approach outperforms existing methods. Imputation to the last known location can lead to large deviation from the actual location when gap distance is large. Linear interpolation is shown to result in large errors in mobility measures. Researchers should be aware that the different treatment of missing data can affect the spatiotemporal accuracy of GPS-based exposure assessments.

GPS-based activity space exposure to greenness and walkability is associated with increased accelerometer-based physical activity

INTRODUCTION

Built and natural environments may provide opportunities for physical activity. However, studies are limited by primarily using residential addresses to define exposure and self-report to measure physical activity. We quantified associations between global positioning systems (GPS)-based activity space measures of environmental exposure and accelerometer-based physical activity.

METHODS

Using a nationwide sample of working female adults (N = 354), we obtained seven days of GPS and accelerometry data. We created Daily Path Area activity spaces using GPS data and linked these activity spaces to spatial datasets on walkability (EPA Smart Location Database at the Census block group level) and greenness (satellite vegetation at 250 m resolution). We utilized generalized additive models to examine nonlinear associations between activity space exposures and accelerometer-derived physical activity outcomes adjusted for demographic characteristics, socioeconomic factors, and self-rated health.

RESULTS

Higher activity space walkability was associated with higher levels of moderate-vigorous physical activity, and higher activity space greenness was associated with greater numbers of steps per week. No strong relationships were observed for sedentary behavior or light physical activity. Highest levels of moderate-vigorous physical activity were observed for participants with both high walkability and high greenness in their activity spaces.

CONCLUSION

This study contributes evidence that higher levels of physical activity occur in environments with more dense, diverse, and well-connected built environments, and with higher amounts of vegetation. These data suggest that urban planners, landscape architects, and policy makers should implement and evaluate environmental interventions to encourage higher levels of physical activity.

Assessment of Subjective Well-Being in a Cohort of University Students and Staff Members: Association with Physical Activity and Outdoor Leisure Time during the COVID-19 Pandemic

Time spent outdoors and physical activity (PA) promote mental health. To confirm this relationship in the aftermath of COVID-19 lockdowns, we explored individual levels of anxiety, depression, stress and subjective well-being (SWB) in a cohort of academic students and staff members and tested their association with sport practice, PA at leisure time and time spent outdoors. Our cross-sectional study collected data during the COVID-19 outbreak (April−May 2021) on 939 students and on 238 employees, who completed an online survey on sociodemographic and lifestyle features, depression, anxiety, stress, and SWB. Results showed that the students exhibited higher levels of anxiety, depression, and stress, and lower levels of SWB (p < 0.001 for all domains) compared to the staff members. Correlation analysis confirmed that PA and time spent in nature were associated to high mental health scores among staff and, more consistently, among students. Finally, mediation analyses indicated that the time spent in nature, social relationships, and levels of energy play a mediator role in the relationship between sport practice and SWB. Our evidence reinforces the protective role of time spent in nature in improving mental health, and provides support for policymakers to make appropriate choices for a better management of COVID-19 pandemic consequences.

Spend time outdoors for your brain - an in-depth longitudinal MRI study

OBJECTIVES

The effects of nature on physical and mental health are an emerging topic in empirical research with increasing influence on practical health recommendations. Here we set out to investigate the association between spending time outdoors and brain structural plasticity in conjunctions with self-reported affect.

METHODS

We established the Day2day study, which includes an unprecedented in-depth assessment of variability of brain structure in a serial sequence of 40-50 structural magnetic resonance imaging (MRI) acquisitions of each of six young healthy participants for 6-8 months (n = 281 MRI scans in total).

RESULTS

A whole-brain analysis revealed that time spent outdoors was positively associated with grey matter volume in the right dorsolateral prefrontal cortex and positive affect, also after controlling for physical activity, fluid intake, free time, and hours of sunshine.

CONCLUSIONS

Results indicate remarkable and potentially behaviorally relevant plasticity of cerebral structure within a short time frame driven by the daily time spent outdoors. This is compatible with anecdotal evidence of the health and mood-promoting effects of going for a walk. The study may provide the first evidence for underlying cerebral mechanisms of so-called green prescriptions with possible consequences for future interventions in mental disorders.

How Long Should GPS Recording Lengths Be to Capture the Community Mobility of An Older Clinical Population? A Parkinson's Example

Wearable global position system (GPS) technology can help those working with older populations and people living with movement disorders monitor and maintain their mobility level. Health research using GPS often employs inconsistent recording lengths due to the lack of a standard minimum GPS recording length for a clinical context. Our work aimed to recommend a GPS recording length for an older clinical population. Over 14 days, 70 older adults with Parkinson's disease wore the wireless inertial motion unit with GPS (WIMU-GPS) during waking hours to capture daily "time outside", "trip count", "hotspots count" and "area size travelled". The longest recording length accounting for weekend and weekdays was ≥7 days of ≥800 daily minutes of data (14 participants with 156, 483.9 min recorded). We compared the error rate generated when using data based on recording lengths shorter than this sample. The smallest percentage errors were observed across all outcomes, except "hotspots count", with daily recordings ≥500 min (8.3 h). Eight recording days will capture mobility variability throughout days of the week. This study adds empirical evidence to the sensor literature on the required minimum duration of GPS recording.

The Association of Objectively Measured Physical Activity and Sedentary Behavior with (Instrumental) Activities of Daily Living in Community-Dwelling Older Adults: A Systematic Review

Up to 60% of older adults have a lifestyle characterized by low physical activity (PA) and high sedentary behavior (SB). This can amplify age-related declines in physical and cognitive functions and may therefore affect the ability to complete basic and instrumental activities of daily living (ADL and IADL, respectively), which are essential for independence. This systematic review aims to describe the association of objectively measured PA and SB with ADL and IADL in community-dwelling older adults. Six databases (PubMed, Embase, the Cochrane library, CINAHL, PsychINFO, SPORTDiscuss) were searched from inception to 21/06/2020 for articles meeting our eligibility criteria: 1) observational or experimental study, 2) participants’ mean/median age ≥60 years, 3) community-dwelling older adults, 4) PA and SB were measured with a(n) accelerometer/pedometer, 5) PA and SB were studied in relation to ADL and/or IADL. Risk of bias was assessed in duplicate using modified versions of the Newcastle–Ottawa scale. Effect direction heat maps provided an overview of associations and standardized regression coefficients (βs) were depicted in albatross plots. Thirty articles (6 longitudinal; 24 cross-sectional) were included representing 24,959 (range: 23 to 2749) community-dwelling older adults with mean/median age ranging from 60.0 to 92.3 years (54.6% female). Higher PA and lower SB were associated with better ability to complete ADL and IADL in all longitudinal studies and overall results of cross-sectional studies supported these associations, which underscores the importance of an active lifestyle. The median [interquartile range] of βs for associations of PA/SB with ADL and IADL were, respectively, 0.145 [0.072, 0.280] and 0.135 [0.093, 0.211]. Our strategy to address confounding may have suppressed the true relationship of PA and SB with ADL or IADL because of over-adjustment in some included studies. Future research should aim for standardization in PA and SB assessment to unravel dose–response relationships and inform guidelines.

Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: a systematic review

BACKGROUND

Higher physical activity (PA) and lower sedentary behaviour (SB) are associated with better muscle strength, balance, and functional ability, which are imperative for avoiding falls. This systematic review aimed to describe the association between objectively measured PA and SB with falls, fear of falling, and fractures.

METHODS

Six databases were searched from inception to July 21, 2020 for articles reporting the association of objectively measured PA/SB with falls, fear of falling, and/or fractures in community-dwelling older adults ≥60 years old. Results were synthesized in effect-direction heat maps and albatross plots expressed as Pearson's correlation coefficients (R).

RESULTS

A total of 43 articles were included, representing 27,629 (range 26 to 5,545) community-dwelling older adults (mean [SD] age 76.6 [8.4] years, 47% female). Longitudinal associations were reported in 13 articles and cross-sectional associations in 30. Falls were reported in 11 articles, fear of falling in 18 and fractures in 2. Higher PA and lower SB were associated with less fear of falling (median [interquartile range] Rs = steps: -0.214 [0.249; -0.148], total PA: -0.240 [0.267; -0.144], and moderate-to-vigorous PA: -0.180 [0.382; -0.121]), but these associations did not extend to falls or fractures, which showed inconsistent effect directions.

CONCLUSION

Fear of falling is associated with less engagement in PA and more SB, thus indicating that it is a psychological barrier to an active lifestyle. Varying effect directions for associations between PA and SB with falls and fractures may provide evidence for non-linear associations and require further research considering details of the fall or fracture incident.

PROSPERO REGISTRATION NUMBER

CRD42018103910.

Examining the role of driven-game shooting as a psycho-social resource for older adults in rural areas: a mixed-methods study

This paper explores whether regular involvement in a rural, country sport, frequently practised by older individuals, builds social capital and friendships, reduces loneliness, and positively impacts individuals’ health and wellbeing. Taking a critical realist, mixed-methods approach, using a recognised social impact assessment methodology theoretically underpinned by social capital theory, this study identifies that driven-game shooting participation creates social impact via social capital creation and identity reinforcement. Results indicate a statistically significant, positive impact on mental health and wellbeing (N = 2,424), which varies by shoot size and/or type. The results are discussed in relation to implications for managing elderly health and wellbeing in rural areas.

Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers

BACKGROUND AND PURPOSE

The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers.

METHODS

Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed.

RESULTS

People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity.

CONCLUSIONS

Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.

Change in GPS-assessed walking locations following a cluster-randomized controlled physical activity trial in older adults, results from the MIPARC trial

This study employed novel GPS methods to assess the effect of a multilevel physical activity (PA) intervention on device-measured walking locations in 305 community dwelling older adults, ages 65+ (mean age = 83, 73% women). Retirement communities were randomized to a 1-year PA intervention that encouraged neighborhood walking, or to a healthy aging control condition. Total time and time spent walking in four life-space domains were assessed using GPS and accelerometer devices. The intervention increased the time spent walking as a proportion of total time spent in the Campus, Neighborhood and Beyond Neighborhood domains. Intervention effects on walking location were observed in both genders and across physical and cognitive functioning groups. Results demonstrate that an intervention providing individual, social and environmental support for walking can increase PA in larger life-space domains for a broad spectrum of older adults.

Validation of an Adapted Questionnaire for Outdoor Walking Among Older Adults: The CHAMPS-OUTDOORS

The aim of this study was to examine the construct and known-groups validity of the total score of five items adapted from the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure outdoor walking (CHAMPS-OUTDOORS) in older adults. Data from the baseline assessment of the Getting Older Adult OUTdoors (GO-OUT) trial were used. Construct validity of the CHAMPS-OUTDOORS used objective measures of outdoor walking (accelerometry-GPS), Ambulatory Self-Confidence Questionnaire, RAND-36, 6-min walk test, 10-m walk test, and Mini-Balance Evaluation System Test. For known-groups validity, we compared the CHAMPS-OUTDOORS of those who walked < or ≥1.2 m/s. Sixty-five participants had an average age of 76.5 ± 7.8 years. The CHAMPS-OUTDOORS was moderately correlated with total outdoor walking time (r = .33) and outdoor steps (r = .33) per week measured by accelerometry-GPS, and weakly correlated with Mini-Balance Evaluation System Test score (r = .27). The CHAMPS-OUTDOORS did not distinguish known groups based on crosswalk speed (p = .33). The CHAMPS-OUTDOORS may be used to assess outdoor walking in the absence of accelerometry GPS. Further research examining reliability is needed.

Becoming One with Nature: A Nature Intervention for Individuals Living with Cancer Participating in a Ten-Week Group Exercise and Wellness Program

Positive outcomes for psychological and physiological health have resulted from a nature experience. However, evidence is limited for nature-based interventions and their effect on a cancer population. The purpose of this mixed-methods study was to determine if incorporating the One Nature Challenge (ONC) into a ten-week group exercise program (WE-Can) for individuals living with cancer could offer additional psychological and/or physiological benefits to those previously observed in WE-Can. For this study, two separate ONCs were implemented throughout two seasons (summer and winter) to formulate a ONC group (n = 18; 60 ± 12yrs). Previous WE-Can graduates were used as a control group (n = 160; 59 ± 11yrs) for this study. Psychological and physiological assessments were administered in a pre- and post-test. In addition, nature relatedness (NR; ones' relationship with nature) was measured at the beginning, middle, and end of WE-Can. Following five weeks, the ONC began and participants tracked the days they experienced nature for at least thirty-minutes (24 ± 6 days), for a thirty-day period. The ONC finished concurrently with WE-Can where post-evaluations and focus groups were administered immediately following. No additional gain in overall health was found between groups. However, aerobic fitness and fatigue significantly improved for the ONC group. This was supported by frequent activities and self-reported restoration of the mind while experiencing nature. In conclusion, the lack of overall improvement could be limited by sample size and the high level of NR prior to ONC, indicating participants were already 'one with nature.'

Environmental stressors and well-being on middle-aged and elderly people: the mediating role of outdoor leisure behaviour and place attachment

This study develops a relational model of how environmental stressors, place attachment and outdoor leisure are related to urban green zones and, accordingly, Fujian Province in China is studied as our case problem. The research is participated by primarily middle-aged and elderly residents. In total, 871 valid questionnaires are retrieved. Structural equation modelling and path analysis are used to verify the model's fitness. The results indicate that environmental stressors and outdoor leisure are significantly negatively correlated. In addition, the outdoor leisure and place attachment are significantly positively correlated. As such, the place attachment and well-being are significantly positively correlated. However, the place attachment and outdoor leisure mediated the relationship between environmental stressors and well-being. The mediating path indicated that middle-aged and elderly residents face severe environmental stressors and will engage in a few outdoor leisure activities, resulting in low well-being. Furthermore, when middle-aged and elderly residents face severe environmental stressors, they have increased place attachment, thereby increasing their well-being. The findings can serve as a reference for environmental management agencies and future researchers.

Neighborhood Urban Design and Outdoor Later Life: An Objective Assessment of Out-of-Home Time and Physical Activity Among Older Adults in Barcelona

This study explores how older adults' time out-of-home and physical activity (PA) are associated with the provision of urban open spaces (green spaces, plazas, and boulevards) and microelements (street trees and benches) in their neighborhoods. The authors used data from 103 residents in Barcelona and matched it to official geospatial data. The authors adjusted a set of mixed-effects linear regressions, both for the entire sample and also stratified by age and gender. For the entire sample, the percentage of green spaces showed a positive association with neighborhood time out-of-home and PA, while participants' PA also showed a positive association with the presence of benches. Outdoor time among older women was not associated with any of the measured exposures. For men, the provision of green spaces and benches was positively associated with time out-of-home and PA. These results could inform the design of urban spaces that aim to encourage outdoor activity among older adults.

Health Promotion as a Motivational Factor in Alpine Cycling

The present study examines motives for cycling in the alpine region and focuses on the relative importance of health promotion with respect to other motives. Furthermore, the influences of person-specific characteristics on the rank of the motives are examined, and possibilities for advertising bike tourism based on these motives and characteristics are derived. By applying a quantitative approach, a total of 175 cyclists were surveyed using questionnaires on person-specific characteristics, motives, and their relevance for alpine cycling. Data analysis revealed that health promotion is the most important motive for alpine cycling after fun and action as well as nature experience. Further health-related motives such as stress reduction are also perceived as important. The social component, on the other hand, was given the least priority. The results also showed that person-specific characteristics influence the relative importance of motives. For example, elderly persons and people with children perceive the motive of health promotion as the most important. The study shows that the health-promoting effect of alpine cycling is noticed and may be further encouraged. This study demonstrates that alpine cyclists are a heterogeneous group and that health benefits are perceived by various sub-groups therein. Therefore, any marketing for alpine cycling needs to reflect the diversity of cyclists, and approaches need to be adapted according to the respective target group.

Outdoor Walking Test With a Global Positioning System Device as an Additional Tool for Functional Assessment of Older Women

The primary aim was to assess the test-retest reliability of an outdoor walking test with a global positioning system device in older women in a community setting. In addition, correlations between the suggested test and various tests recommended to evaluate muscle strength, walking speed, and self-perceived health status in older adults were studied. The study included 40 women aged 68 (SD = 5) years. The primary outcomes were total walked distance and mean walking speed. The secondary outcomes were lower-body strength, heart rate, speed in a 4-m walk test, and self-perceived health status. The intraclass correlation coefficients calculated for the total walked distance, mean walking speed, and mean heart rate were .94, .92, and .37, respectively. Thus, the suggested outdoor walking test with the application of a global positioning system device may be considered a reliable test tool, which can be recommended for the evaluation of walking ability among older women in a community setting.

Wearable light data logger for studying physiological and psychological effects of light data

Light sensors can provide valuable information about environmental exposure; however, current light sensing packages are limited. This work presents the development of an open-source hardware device capable of logging light measurements. Due to its lightweight, wearable construction, it is well-suited to human subject research in naturalistic conditions. Its low cost makes it a viable option for population studies. This work offers an example application of objectively determining whether a person is indoors or outdoors based on the light measurements. This application has practical value within disciplines such as environmental and health psychology, which seek to relate psychological outcomes to environmental exposure.

Wearable Sensors Quantify Mobility in People With Lower Limb Amputation During Daily Life

It is necessary to effectively assess functional mobility for appropriate prosthetic prescription and post-amputation rehabilitation. As part of this process, patients' ability for variable cadence and community ambulation are assessed in-clinic, often through visual assessments and without objective standards. The purpose of this study was to explore the clinical viability of using wearable sensors to characterize the functional mobility of people with lower limb amputation. We collected inertial measurement unit (IMU) and global positioning system (GPS) data over two weeks, from 17 individuals with lower limb amputation and 14 healthy non-amputee controls. We calculated stride-by-stride cadence, walking speed and stride lengths, along with whether they occurred in or out of the home. Self-selected walking speed was also assessed in the lab. Compared to the lab, both groups walked slower and with a lower cadence during their daily lives. There were no differences in cadence variability between groups or between strides taken in and out of the home. Both groups walked faster and with greater stride lengths away from the homes. The results suggest that functional capacity measured in the lab was not necessarily reflected in routine walking during daily life. The walking measures derived in this approach can be used to aid in the prosthetic prescription process or in the assessment of different interventions.

The impact of place and legacy framing on climate action: A lifespan approach

Despite several decades of research on more effectively communicating climate change to the general public, there is only limited knowledge about how older adults engage with an issue that will shape and define future generations. We focus on two key factors that may motivate younger and older adults to engage in climate change action, legacy concern and place attachment, and assess whether older adults differ in any appreciable way from the general population in this domain. We randomly exposed participants of different ages to either a Legacy, Place, or control writing induction task before they completed various self-report measures. Both induction conditions were associated with significantly greater pro-environmental behavioral intentions and donations for all age groups when compared to the control condition. Legacy motivation and biophilia were used as manipulation checks and found to partially mediate these effects. Findings suggest that legacy and place message framing may be useful in prompting adults of all ages to take action to help combat climate change.

Purpose, Frequency, and Mode of Transport by Which Older Adults Leave Their Home-A Cross-Sectional Analysis

Time spent out-of-home can increase physical activity (PA) levels. However, the association between the purpose for leaving home and the mode of transport on time out-of-home and PA are not straightforward. In a large sample of community-dwelling older adults (≥65 years), daily walking duration was measured prospectively over 1 week using body-fixed sensors and time-out-of-home questionnaires. Data from 1,277 participants yielded 6,500 full days for analysis. The following statistically significant associations were seen: public transport use increased the time spent out-of-home by 88 min and daily walking duration by 16 min. Social contacts or the use of a car increased the time out-of-home, but decreased PA. Shopping or "going by foot" decreased the time spent out-of-home by 19 and 62 min, respectively, while both increased the daily walking duration by 5 min. The association between time out-of-home and PA (daily walking duration) is strongly dependent on the activity and mode of transport.

Public toilets in parklands or open spaces in international cities using geographic information systems

INTRODUCTION AND HYPOTHESIS

Availability of public toilets in parklands and open spaces is a community resource for all persons and may support self-management of incontinence. The purpose of this study was to describe and map the availability of public toilets in parklands and open spaces in major international cities by city population and area.

METHODS

Observational/descriptive design. Twelve cities in nine countries with available data about toilets in parklands (Minneapolis-St. Paul (MSP), New York City, Philadelphia, Toronto, and Osaka) or open spaces (Greater London, Greater Sydney, Paris, Berlin, Brussels, and Seoul) were included in the analysis. Data were from online open/free data sets. Availability of publicly owned and/or operated permanent toilet facilities was measured/analyzed as number, density (calculated by population and area (km²)), and distribution (visualized using Geographic Information Systems).

RESULTS

Density of public toilets/area (km²) in parklands was highest in Osaka. MSP had the most toilets per 100,000 residents. In open spaces, the density of public toilets/area (km²) was highest in Paris. Sydney had the most toilets in open spaces per 100,000 residents. The distribution of public toilets across parklands was fairly even in MSP, Philadelphia, and Toronto. The distribution of public toilets in open spaces was highly concentrated in one area in Brussels. Sydney has a low population density but a high toilet density in open spaces.

CONCLUSIONS

Availability of public toilets in parklands or open spaces varies among international cities. Toilet availability should be considered in urban planning and community healthcare programs to promote continence, health, and quality of life.

A theory-based, task-oriented, outdoor walking programme for older adults with difficulty walking outdoors: protocol for the Getting Older Adults Outdoors (GO-OUT) randomised controlled trial

INTRODUCTION

A theory-based, task-oriented, community walking programme can increase outdoor walking activity among older adults to optimise functional independence, social participation and well-being. The study objective is to determine if there is a difference in the change in outdoor walking activity from baseline to 10 weeks, 5.5 months and 12 months after receiving a 1-day interactive workshop and outdoor walking programme (Getting Older Adults Outdoors (GO-OUT)) compared with the workshop and weekly reminders (WR) in older adults with difficulty walking outdoors.

METHODS AND ANALYSIS

A randomised controlled trial is being conducted in four urban Canadian communities. We will stratify 240 individuals by site and participant type (ie, individual vs spousal/friend pair) and randomise to either the GO-OUT or WR intervention. The GO-OUT intervention involves a 1-day workshop, where participants complete eight interactive stations to build knowledge and skills to walk outside, followed by a 10-week group outdoor walking programme (two 1-hour sessions/week) led by a physiotherapist or kinesiologist in parks. The WR intervention consists of the same workshop and 10 weekly telephone reminders to facilitate outdoor walking. The primary outcome measure is mean outdoor walking time in minutes/week derived from accelerometry and global positioning system data. GO-OUT is powered to detect an effect size of 0.4, given α=0.05, β=0.20, equal number of participants/group and a 20% attrition rate. Secondary outcomes include physical activity, lifespace mobility, participation, health-related quality of life, balance, leg strength, walking self-efficacy, walking speed, walking distance/endurance and mood.

ETHICS AND DISSEMINATION

GO-OUT has received ethics approval at all sites. A Data Safety Monitoring Board will monitor adverse events. We will disseminate findings through lay summaries, conference presentations and journal articles.

TRIAL REGISTRATION NUMBER

NCT03292510 (Pre-results).

Challenges in using wearable GPS devices in low-income older adults: Can map-based interviews help with assessments of mobility?

Daily mobility, defined as the ability to move oneself within one's neighborhood and regions beyond, is an important construct, which affects people as they age. Having a feasible and valid measure of daily mobility is essential to understand how it affects older adults' everyday life. Given the limitations of existing measures, new tools may be needed. The purpose of the study is to assess the feasibility and practicality of using the map-based questionnaire system VERITAS and GPS devices to measure daily mobility in older adults living in a deprived neighborhood in Denmark. Older adults were recruited from two senior housing areas, completed an interview using VERITAS and wore a GPS for 7 days. Feasibility of both methods was assessed by looking at practicalities, recruitment and compliance, and ability to measure daily mobility.Thirty-four older adults completed the VERITAS questionnaire, of which 23 wore the GPS device. Remembering to wear and charge the GPS was difficult for 48% participants, whereas remembering street names and drawing routes in VERITAS was difficult for two. Both the GPS and VERITAS were able to measure 10 out of the 13 identified components of mobility; however, VERITAS seemed more qualified at measuring daily mobility for this target population. The feasibility of assessing mobility may vary by specific context and study population being investigated. Wearable technology like a GPS may not be acceptable to low socioeconomic older adults, whereas interview led self-reported measurements like VERITAS might be more suitable for a low socioeconomic elderly population.

Video Games and Outdoor Physical Activity for the Elderly: Applications of the HybridPLAY Technology

The incorporation of the elderly into digital leisure has been especially driven by the development of games and applications that link the experience of play with beneficial effects for the user. Some of these benefits arise at a cognitive level, fostering intellectual activity of adults through playful experiences that combine audio-visual entertainment with brain training. Seniors are also engaged by active video games that use control interfaces to perform physical actions or activities, encouraging motor play. In this paper, we present the application of HybridPLAY for the elderly, a self-developed technology initially thought to transform playgrounds into scenarios for a set of interactive digital games. In this paper, we show that, although HybridPLAY was initially developed for children and teenagers, the versatile features of this technology make it appropriate also for the elderly. After having tested HybridPLAY with a small group of seniors who completed a usability test and a satisfaction questionnaire, we show that it is possible to combine playful entertainment with physical and mental activities in outdoor environments for the elderly.

Collecting Mobility Data with GPS Methods to Understand the HIV Environmental Riskscape Among Young Black Men Who Have Sex with Men: A Multi-city Feasibility Study in the Deep South

While research increasingly studies how neighborhood contexts influence HIV among gay, bisexual and other men who have sex with men (MSM) populations, to date, no research has used global positioning system (GPS) devices, an innovative method to study spatial mobility through neighborhood contexts, i.e., the environmental riskscape, among a sample of Black MSM. The purpose of this study was to examine the feasibility of collecting two-week GPS data (as measured by a pre- and post-surveys as well as objectively measured adherence to GPS protocol) among a geographically-diverse sample of Black MSM in the Deep South: Gulfport, MS, Jackson, MS, and New Orleans LA (n = 75). GPS feasibility was demonstrated including from survey items, e.g. Black MSM reported high ratings of pre-protocol acceptability, ease of use, and low levels of wear-related concerns. Findings from this study demonstrate that using GPS methods is acceptable and feasible among Black MSM in the Deep South.

Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors

Introduction: Understanding determinants of community mobility disability is critical for developing interventions aimed at preventing or delaying disability in older adults. In an effort to understand these determinants, capturing and measuring community mobility has become a key factor. The objectives of this paper are to present and illustrate the signal processing workflow and outcomes that can be extracted from an activity and community mobility measurement approach based on GPS and accelerometer sensor data and 2) to explore the construct validity of the proposed measurement approach using data collected from healthy older adults in free-living conditions. Methods: Personal, functional impairment and environmental variables were obtained by self-report questionnaires in 75 healthy community-living older adults (mean age = 66 ± 7 years old) living on the island of Montreal, QC, Canada. Participants wore, for 14 days during waking hours on the hip, a data logger incorporating a GPS receiver with a 3-axis accelerometer. Time at home ratio (THR), Trips out (TO), Destinations (D), Maximal distance of destinations (MDD), Active time ratio (ATR), Steps (S), Distance in a vehicle (DV), Time in a vehicle (TV), Distance on foot (DF), Time on foot (TF), Ellipse area (EA), and Ellipse maximum distance (EMD) were extracted from the recordings. Results: After applying quality control criteria, the original data set was reduced from 75 to 54 participants (28% attrition). Results from the remaining sample show that under free-living conditions in healthy older adults, location, activity and community mobility outcomes vary across individuals and certain personal variables (age, income, living situation, professional status, vehicle access) have potential mitigating effects on these outcomes. There was a significant (yet small) relationship (rho < 0.40) between self-reported life space and MDD, DV, EA, and EMD. Conclusion: Wearability and usability of the devices used to capture free-living community mobility impact participant compliance and the quality of the data. The construct validity of the proposed approach appears promising but requires further studies directed at populations with mobility impairments.

Are disadvantaged children more likely to be excluded from analysis when applying global positioning systems inclusion criteria?

Objective

When using global positioning systems (GPS) to assess an individual’s exposure to their environment, a first step in data cleaning is to establish minimum GPS ‘inclusion criteria’ (a set of rules used to determine which GPS data are able to be included in analyses). Care is needed at this stage to avoid any data exclusion (data loss) systematically biasing results in terms of characteristics of the environment and participants. The extent of potential systematic bias in sample retention due to GPS data loss and application of GPS inclusion criteria is unknown. The aim of this study was to describe differences in sample size and socio-demographic characteristics of the retained sample when applying three different GPS inclusion criteria. The study assessed 7-day GPS data collected from children (aged 9–13 years) recruited from nine schools in Auckland, New Zealand as part of the Kids in the City study.

Results

Participants from ethnic minorities and those attending schools in lower socioeconomic areas were disproportionately excluded from the retained samples. This highlights potential equity implications in basing the assessment of exposure—which ultimately influences research results on the relationship between environment and health—on non-representative GPS data.

Mapping Movement: Applying Motion Measurement Technologies to the Psychiatric Care of Older Adults

PURPOSE OF REVIEW

Recent advances in technology have changed the landscape of treatment for adults with mental illness. This review highlights technological innovations that may improve care for older adults with mental illness and neurocognitive disorders through the measurement and assessment of physical motion. These technologies include wearable sensors (such as smart watches and Fitbits), passive motion sensors, and smart home models that incorporate both active and passive motion technologies.

RECENT FINDINGS

Clinicians have evaluated motion measurement technologies in older adults with depression, dementia, anxiety, and schizophrenia. Results from studies in dementia populations suggest that motion measurement technologies can assist clinicians in diagnosing dementia earlier through the evaluation of gait, balance, and postural kinematics. Motion detection technologies can also be used to identify mood episodes at an earlier stage by detecting subtle behavioral changes. Clinicians may use the objective data provided by technologies such as accelerometers to identify illnesses earlier, which may inform treatment decisions. The data may be used as a suitable surrogate marker for detecting depression in older adults, predicting the likelihood of falls, or quantifying physical activity in older adults with chronic mental illnesses or anxiety. Motion-based technologies also have the potential to detect physical activity for older adults residing in nursing homes. Wearable technologies are generally well tolerated in older adults, although the use of new technology and electronic health data could involve privacy and security concerns among this vulnerable population.

Sports therapy and recreation exercise program in type 2 diabetes: randomized controlled trial, 3-month follow-up

BACKGROUND

A sports therapy program in type 2 diabetes helps in glucose control, but little is known how a long-term structured exercise intervention affects the parameters in this disease. Our aim was to measure the impact of a 24-week-long sports therapy program in type 2 diabetes on the concentration of glucose in blood, body composition, and physical fitness level.

METHODS

In this prospective longitudinal study, 208 type II diabetic patient (80 male, 128 female, aged: 61±6.86 years) were selected and randomly assigned to a control or an intervention group. The intervention group took part in a sports therapy and recreation sports program for 6 months. Taking into account the rules of training theory and physiotherapy, fitness material of exercising (aerobics, resistance training, muscle strengthening, stretching) and outdoor elements were used during the 3-month sports program, after which it became a 3-month recreation exercise program. In the control group, there was no intervention.

RESULTS

The intervention group showed significant decrease in concentration of glucose in blood (mean differences [MD]:-3.23; Confidence Interval [CI] lowest: -3.50; CI highest: -2.95]; P<0.01), weight (MD: -1.68; [-0.82, -0.52] P=0.01), BMI (MD: -0.37; [-0.82; 0.08]; P=0.01), body fat percentage (MD:-1.74; [-2.15, -1.34]; P=0.05) and visceral fat (MD:-0.37; [-0.67, -0.07; P=0.01); right (MD: 5.33; [4.98, 5.68]; P<0.01) and left arm curl (MD: 5.23; [4.87, 5.60]; P<0.01) test, chair stand test (MD: 2.95; [2.65, 3.25]; P=0.00) and the 6-minute walk test (MD: 111.21; [101.12; 121.31]; P<0.01) showed significant improvement.

CONCLUSIONS

A 24-week-long sports therapy program is a successful intervention for improving parameters affected by type 2 diabetes.

Ethical and regulatory challenges of research using pervasive sensing and other emerging technologies: IRB perspectives

Vast quantities of personal health information and private identifiable information are being created through mobile apps, wearable sensors, and social networks. While new strategies and tools for obtaining health data have expanded researchers' abilities to design and test personalized and adaptive health interventions, the deployment of pervasive sensing and computational techniques to gather research data is raising ethical challenges for Institutional Review Boards (IRBs) charged with protecting research participants. To explore experiences with, and perceptions about, technology-enabled research, and identify solutions for promoting responsible conduct of this research we conducted focus groups with human research protection program and IRB affiliates. Our findings outline the need for increased collaboration across stakeholders in terms of: (1) shared and dynamic resources that improve awareness of technologies and decrease potential threats to participant privacy and data confidentiality, and (2) development of appropriate and dynamic standards through collaboration with stakeholders in the research ethics community.

Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents

Exposures to outdoor environments have great potential to be protective factors for the mental health of young people. In a national analysis of Canadian adolescents, we explored how such exposures, as well as self-perceptions of connectedness with nature, each related to the prevalence of recurrent psychosomatic symptoms. The data source for this cross-sectional study, consisting of a weighted sample of 29,784 students aged 11-15 years from 377 schools, was the 2013/2014 cycle of the Health Behaviour in School-aged Children (HBSC) study. We modeled reports of exposure to the outdoors and then perceived connection(s) to nature as correlates of reduced psychosomatic symptoms. Associations varied by sex. Among girls, spending on average >0.5 h/week outdoors was associated with a 24% (95% CI: 5%, 40%) lower prevalence of high psychosomatic symptoms, compared to those who averaged no time playing outdoors. No such relationship was observed among boys. Perception of connection to nature as 'important' was similarly associated with a 25% (95% CI: 9%, 38%) reduction in the prevalence of high psychosomatic symptoms; this association did not differ by sex or age. Our analysis highlights the potential importance of adolescent engagement with nature as protective for their psychological well-being. It also emphasizes the importance of accounting for differences between boys and girls when researching, planning, and implementing public mental health initiatives that consider exposure to the outdoors.

Time spent outdoors, activity levels, and chronic disease among American adults

Chronic diseases-including cancer, cardiovascular diseases, and metabolic conditions such as diabetes and obesity-account for over 60% of overall global mortality. Sedentary time increases the risk for chronic disease incidence and mortality, while moderate to vigorous physical activity is known to decrease risk. Most Americans spend at least half of their time sedentary, with a trend toward increasingly sedentary lifestyles, and few Americans achieve recommended levels of physical activity. Time spent outdoors has been associated with reduced sedentary time and increased physical activity among children/youth and the elderly, but few population-based studies have examined this relationship among working age adults who may face greater constraints on active, outdoor time. This study examines the relationship between time spent outdoors, activity levels, and several chronic health conditions among a population-based sample of working age American adults in the National Health and Nutrition Examination Survey (NHANES) for 2009-2012. Findings provide evidence that time spent outdoors, on both work days and non-work days, is associated with less time spent sedentary and more time spent in moderate to vigorous physical activity. Further, findings indicate that time spent outdoors is associated with lower chronic disease risk; while these associations are partially explained by activity levels, controlling for activity levels does not fully attenuate the relationship between time outdoors and chronic disease risk. While cross-sectional, study findings support the notion that increasing time spent outdoors could result in more active lifestyles and lower chronic disease risk. Future work should examine this relationship longitudinally to determine a causal direction. Additional work is also needed to identify mechanisms beyond physical activity, such as psychosocial stress, that could contribute to explaining the relationship between time spent outdoors and chronic disease risk.

Does home neighbourhood supportiveness influence the location more than volume of adolescent's physical activity? An observational study using global positioning systems

Background

Environmental characteristics of home neighbourhoods are hypothesised to be associated with residents’ physical activity levels, yet many studies report only weak or equivocal associations. We theorise that this may be because neighbourhood characteristics influence the location of activity more than the volume. Using a sample of UK adolescents, we examine the role of home neighbourhood supportiveness for physical activity, both in terms of volume of activity undertaken and a measure of proximity to home at which activity takes place.

Methods

Data were analysed from 967 adolescents living in and around the city of Bristol, UK. Each participant wore an accelerometer and a GPS device for 7 days during school term time. These data were integrated into a Geographical Information System containing information on the participants’ home neighbourhoods and measures of environmental supportiveness. We then identified the amount of out-of-school activity of different intensities that adolescents undertook inside their home neighbourhood and examined how this related to home neighbourhood supportiveness.

Results

We found that living in a less supportive neighbourhood did not negatively impact the volume of physical activity that adolescents undertook. Indeed these participants recorded similar amounts of activity (e.g. 20.5 mins per day of moderate activity at weekends) as those in more supportive neighbourhoods (18.6 mins per day). However, the amount of activity adolescents undertook inside their home neighbourhood did differ according to supportiveness; those living in less supportive locations had lower odds of recording activity inside their home neighbourhood. This was observed across all intensities of activity including sedentary, light, moderate, and vigorous.

Conclusions

Our findings suggest that the supportiveness of the neighbourhood around home may have a greater influence on the location of physical activity than the volume undertaken. This finding is at odds with the premise of the socio-ecological models of physical activity that have driven this research field for the last two decades, and has implications for future research, as by simply measuring volumes of activity we may be underestimating the impact of the environment on physical activity behaviours.

Use of global positioning system for physical activity research in youth: ESPAÇOS Adolescentes, Brazil

The built environment is an important factor associated with physical activity and sedentary behavior (SB) during adolescence. This study presents the methods for objective assessment of context-specific moderate to vigorous physical activity (MVPA) and SB, as well as describes results from the first project using such methodology in adolescents from a developing country. An initial sample of 381 adolescents was recruited from 32 census tracts in Curitiba, Brazil (2013); 80 had their homes geocoded and wore accelerometer and GPS devices for seven days. Four domains were defined as important contexts: home, school, transport and leisure. The majority of participants (n=80) were boys (46; 57.5%), with a normal BMI (52; 65.0%) and a mean age (SD) of 14.5 (5.5) years. Adolescents spent most of their time at home, engaging in SB. Overall, the largest proportion of MVPA was while in transport (17.1% of time spent in this context) and SB while in leisure (188.6min per day). Participants engaged in MVPA for a median of 28.7 (IQR 18.2-43.2) and 17.9 (IQR 9.2-32.1) minutes during week and weekend days, respectively. Participants spent most of their day in the leisure and home domains. The use of Geographic Information System (GIS), Global Positioning System (GPS) and accelerometer data allowed objective identification of the amount of time spent in MVPA and SB in four different domains. Though the combination of objective measures is still an emerging methodology, this is a promising and feasible approach to understanding interactions between people and their environments in developing countries.

Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail

Background

Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI.

Methods

A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness.

Discussion

Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI.

Trial registration

International Standard Randomized Controlled Trial (#ISRCTN82378327). Registered: August 10, 2015.