1
|
Soltanisarvestani M, Lynskey N, Gray S, Gill JMR, Pell JP, Sattar N, Welsh P, Ho FK, Celis-Morales C, Peterman-Rocha F. Associations of grip strength and walking pace with mortality in stroke survivors: A prospective study from UK Biobank. Scand J Med Sci Sports 2023; 33:1190-1200. [PMID: 36932055 DOI: 10.1111/sms.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Although stroke is an emerging cause of disability and mortality globally, associations between physical capability markers and mortality in stroke survivors are elusive. This study investigated the individual and combined associations of walking pace and grip strength with all-cause and stroke mortality in stroke survivors. METHODS Individual and combined associations of walking pace and grip strength with stroke deaths and all-cause mortality were investigated using Cox proportional-hazard models adjusted for sociodemographic, lifestyle, and health-related variables. RESULTS Seven thousand four hundred eighty-six stroke survivors from the UK Biobank study (aged 40-70 years; 42.4% women) were included in this prospective study. Over a median follow-up of 12.6 (IQR: 11.9-13.3) years, 1490 (19.9%) participants died, of whom 222 (3.0%) died from stroke. After adjusting for confounding factors, and compared to individuals in the average/brisk walking pace category, those who reported a slow walking pace had 2.00 (95% CI: 1.50-2.68) and 1.99 (95% CI: 1.78-2.23) times higher risk of stroke mortality and all-cause mortality, respectively. Similar associations were identified for participants with low grip strength compared with those with normal levels. For combined associations, those with both slow walking pace and low grip strength showed the highest risk of stroke mortality (hazard ratio: 2.86 [95% CI: 1.93-4.22]). Similar results were found for all-cause mortality. CONCLUSIONS Low grip strength and slow walking pace were associated with a higher risk of stroke and all-cause mortality in stroke survivors. If these associations are causal, improving physical capability among stroke survivors might potentially prolong survival.
Collapse
Affiliation(s)
- Maryam Soltanisarvestani
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nathan Lynskey
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Stuart Gray
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile
| | - Fanny Peterman-Rocha
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| |
Collapse
|
2
|
Boonpor J, Parra‐Soto S, Gore J, Talebi A, Lynskey N, Raisi A, Welsh P, Sattar N, Pell JP, Gill JMR, Gray SR, Ho FK, Celis‐Morales CA. Association between walking pace and incident type 2 diabetes by adiposity level: A prospective cohort study from the UK Biobank. Diabetes Obes Metab 2023; 25:1900-1910. [PMID: 36951683 PMCID: PMC10947435 DOI: 10.1111/dom.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
AIMS To investigate the combined association of adiposity and walking pace with incident type 2 diabetes. METHODS We undertook a prospective cohort study in 194 304 White-European participants (mean age 56.5 years, 55.9% women). Participants' walking pace was self-reported as brisk, average or slow. Adiposity measures included body mass index (BMI), waist circumference (WC) and body fat percentage (BF%). Associations were investigated using Cox proportional hazard models, with a 2-year landmark analysis. A four-way decomposition analysis was used for mediation and additive interaction. RESULTS The median (interquartile range) follow-up was 5.4 (4.8-6.3) years. During the follow-up period, 4564 participants developed type 2 diabetes. Compared to brisk-walking participants with normal BMI, those with obesity who walked briskly were at an approximately 10- to 12-fold higher risk of type 2 diabetes (hazard ratio [HR] 9.64, 95% confidence interval [CI] 7.24-12.84, in women; HR 11.91, 95% CI 8.80-16.12, in men), whereas those with obesity and walked slowly had an approximately 12- to 15-fold higher risk (HR 12.68, 95% CI 9.62-16.71, in women; HR 15.41, 95% CI 11.27-21.06, in men). There was evidence of an additive interaction between WC and BF% and walking pace among women, explaining 17.8% and 47.9% excess risk respectively. Obesity mediated the association in women and men, accounting for 60.1% and 44.9%, respectively. CONCLUSIONS Slow walking pace is a risk factor for type 2 diabetes independent of adiposity. Promoting brisk walking as well as weight management might be an effective type 2 diabetes prevention strategy given their synergistic effects.
Collapse
Affiliation(s)
- Jirapitcha Boonpor
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
- Faculty of Public HealthKasetsart University, Chalermphrakiat Sakon Nakhon Province CampusSakon NakhonThailand
| | - Solange Parra‐Soto
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
- Department of Nutrition and Public HealthUniversidad del Bío‐BíoChillanChile
| | - Jasunella Gore
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Atefeh Talebi
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Nathan Lynskey
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Andrea Raisi
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
- Center for Exercise Science and Sport, Department of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
| | - Paul Welsh
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Jill P. Pell
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Stuart R. Gray
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Frederick K. Ho
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Carlos A. Celis‐Morales
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
- Research Group on Education, Physical Activity and Health (GEEAFyS)University Católica del MauleTalcaChile
| |
Collapse
|
3
|
Boonpor J, Parra-Soto S, Petermann-Rocha F, Lynskey N, Cabanas-Sánchez V, Sattar N, Gill JMR, Welsh P, Pell JP, Gray SR, Ho FK, Celis-Morales C. Dose-response relationship between device-measured physical activity and incident type 2 diabetes: findings from the UK Biobank prospective cohort study. BMC Med 2023; 21:191. [PMID: 37226202 DOI: 10.1186/s12916-023-02851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Most studies investigating the association between physical activity (PA) and the risk of type 2 diabetes are derived from self-reported questionnaires, with limited evidence using device-based measurements. Therefore, this study aimed to investigate the dose-response relationship between device-measured PA and incident type 2 diabetes. METHODS This prospective cohort study included 40,431 participants of the UK Biobank. Wrist-worn accelerometers were used to estimate total, light, moderate, vigorous and moderate-to-vigorous PA. The associations between PA and incident type 2 diabetes were analysed using Cox-proportional hazard models. The mediating role of body mass index (BMI) was tested under a causal counterfactual framework. RESULTS The median follow-up period was 6.3 years (IQR: 5.7-6.8), with 591 participants developing type 2 diabetes. Compared to those achieving < 150 min/week of moderate PA, people achieving 150-300, 300-600 and > 600 min/week were at 49% (95% CI 62-32%), 62% (95% CI 71-50%) and 71% (95% CI 80-59%) lower risk of type 2 diabetes, respectively. For vigorous PA, compared to those achieving < 25 min/week, individuals achieving 25-50, 50-75 and > 75 min/week were at 38% (95% CI 48-33%), 48% (95% CI 64-23%) and 64% (95% CI 78-42%) lower type 2 diabetes risk, respectively. Twelve per cent and 20% of the associations between vigorous and moderate PA and type 2 diabetes were mediated by lower BMI, respectively. CONCLUSIONS PA has clear dose-response relationship with a lower risk of type 2 diabetes. Our findings support the current aerobic PA recommendations but suggest that additional PA beyond the recommendations is associated with even greater risk reduction. TRIAL REGISTRATION The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee (Ref 11/NW/0382 on June 17, 2011).
Collapse
Affiliation(s)
- Jirapitcha Boonpor
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand
| | - Solange Parra-Soto
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillan, Chile
| | - Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Nathan Lynskey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Verónica Cabanas-Sánchez
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile.
| |
Collapse
|
4
|
Chu W, Lynskey N, Iain-Ross J, Pell JP, Sattar N, Ho FK, Welsh P, Celis-Morales C, Petermann-Rocha F. Identifying the Biomarker Profile of Pre-Frail and Frail People: A Cross-Sectional Analysis from UK Biobank. Int J Environ Res Public Health 2023; 20:2421. [PMID: 36767787 PMCID: PMC9915970 DOI: 10.3390/ijerph20032421] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study aimed to compare the biomarker profile of pre-frail and frail adults in the UK Biobank cohort by sex. METHODS In total, 202,537 participants (67.8% women, aged 37 to 73 years) were included in this cross-sectional analysis. Further, 31 biomarkers were investigated in this study. Frailty was defined using a modified version of the Frailty Phenotype. Multiple linear regression analyses were performed to explore the biomarker profile of pre-frail and frail individuals categorized by sex. RESULTS Lower concentrations of apoA1, total, LDL, and HDL cholesterol, albumin, eGFRcys, vitamin D, total bilirubin, apoB, and testosterone (differences ranged from -0.30 to -0.02 per 1-SD change), as well as higher concentrations of triglycerides, GGT, cystatin C, CRP, ALP, and phosphate (differences ranged from 0.01 to 0.53 per 1-SD change), were identified both in pre-frail and frail men and women. However, some of the associations differed by sex. For instance, higher rheumatoid factor and urate concentrations were identified in pre-frail and frail women, while lower calcium, total protein, and IGF-1 concentrations were identified in pre-frail women and frail women and men. When the analyses were further adjusted for CRP, similar results were found. CONCLUSIONS Several biomarkers were linked to pre-frailty and frailty. Nonetheless, some of the associations differed by sex. Our findings contribute to a broader understanding of the pathophysiology of frailty as currently defined.
Collapse
Affiliation(s)
- Wenying Chu
- BHF Cardiovascular Research Centre, School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Nathan Lynskey
- BHF Cardiovascular Research Centre, School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - James Iain-Ross
- BHF Cardiovascular Research Centre, School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Jill P. Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Naveed Sattar
- BHF Cardiovascular Research Centre, School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Frederick K. Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Paul Welsh
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Carlos Celis-Morales
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
- Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca 3466706, Chile
| | - Fanny Petermann-Rocha
- BHF Cardiovascular Research Centre, School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago 8370068, Chile
| |
Collapse
|
5
|
Diaz-Toro F, Petermann-Rocha F, Lynskey N, Nazar G, Cigarroa I, Troncoso Y Concha-Cisternas C, Leiva-Ordoñez AM, Martinez-Sanguinetti MA, Parra-Soto S, Celis-Morales C. Frailty in Chile: Development of a Frailty Index Score Using the Chilean National Health Survey 2016-2017. J Frailty Aging 2023; 12:97-102. [PMID: 36946704 DOI: 10.14283/jfa.2023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Frailty Index (FI) is used to quantify and summarize vulnerability status in people. In Chile, no development and assessment of a FI have been explored. OBJECTIVE To develop and evaluate a FI using representative data from Chilean adults aged 40 years and older stratified by sex. DESIGN Cross-sectional study. SETTING National representative data from the Chilean National Health Survey 2016-2017 (CNHS 2016-2017). PARTICIPANTS 3,036 participants older than 40 years with complete data for all variables. MEASUREMENTS A 49-item FI was developed and evaluated. This FI included deficits from comorbidities, functional limitations, mental health status, physical activity, anthropometry, medications, and falls. A score between 0 and 1 was calculated for each person. Descriptive statistics and linear regression models were employed to evaluate the FI's performance in the population. Comparative analyses were carried out to evaluate the FI score by age (1<60 and ≥ 60 years). RESULTS The mean FI score was 0.15 (SD:0.09), with a 99% upper limit of 0.46. Scores were greater in women than men (0.17 [SD:0.09]) vs. 0.12 [0.08]); in people older than 80 years (0.22 [0.11]), and in people with ≤8 years of education (0.18 [0.10]) compared with those with >12 years (0.12 [0.08]). The average age-related increase in the FI was 2.3%. When a cut-off point ≥ 0.25 was applied, the prevalence of frail individuals was 11.8% (95% CI: 10.0 to 13.8) in the general population. The prevalence was higher in women 15.9% [95% CI: 13.3 to 18.9] than men 7.4% [95% CI: 5.3 to 10.1]. In a comparative analysis by age, higher FI mean scores and prevalence of frail were observed in people ≥ 60 than younger than 60. CONCLUSIONS The mean FI score and frailty prevalence were higher in women than men, in people with fewer years of formal education, and incremented markedly with age. This FI can be used for early detection of frailty status focusing on women and middle-aged people as a strategy to delay or prevent frailty-related consequences.
Collapse
Affiliation(s)
- F Diaz-Toro
- Fanny Petermann-Rocha, Ph.D, Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile, , Phone number: +56 2 26768968
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Cabanas-Sánchez V, Lynskey N, Ho FK, Pell J, Celis-Morales C. Physical activity and risk of depression: does the type and number of activities matter? Lancet 2022; 400 Suppl 1:S27. [PMID: 36929970 DOI: 10.1016/s0140-6736(22)02237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is ranked as the leading cause of global disability. Physical activity has been identified as a relevant strategy to reduce the incidence of depression. However, specific aspects of physical activity (eg, type of activity or combination) in decreasing the risk of depression have been underexplored. We aimed to investigate the associations of the type of activity, the number of activities participated in, and the combination of different activity types with the risk of depression onset. METHODS We included 161 023 participants aged 38-70 years from the UK Biobank study. At baseline, participants reported their participation in walking, light do-it-yourself (DIY) activities, heavy DIY activities, sports, and other exercises. Depression onset was extracted from primary care and hospital admission records. Cox proportional models were performed, with a 2-year landmark analysis. Analyses were controlled by sociodemographic, lifestyle, and health-related covariables, as well as by total time in physical activity and frequency of physical activity. FINDINGS A total of 88 723 (55·1%) of 161 023 participants were women and 72 300 (44·9%) were men. 5401 (3·4%) of 161 023 participants developed depression over a median follow-up of 10·01 years (IQR 9·30-10·83). Compared with no physical activity, the hazard ratio (HR) for depression onset was 0·79 (95% CI 0·71-0·88) for participation in walking, 0·81 (0·72-0·91) for light DIY, 0·72 (0·63-0·82) for heavy DIY, 0·62 (0·49-0·78) for sports, and 0·73 (0·65-0·82) for others exercises. The risk of depression decreased by 19% (95% CI 10-27) in those who engaged in one activity, 25% (16-33) in two activities, 31% (21-39) in three activities, 41% (31-49) in four activities, and 58% (44-69) in five activities. Among the ten most frequent combinations, walking for pleasure, light DIY, heavy DIY, and other exercises showed the lowest risk for depression onset (HR 0·57 [95% CI 0·48-0·68]). INTERPRETATION Participation in low-intensity activities, such as walking or light DIY, was associated with a lower risk of depression in comparison with no physical activity participation. Encouraging people to combine different physical activities could lower the risk of depression further. FUNDING UK Biobank.
Collapse
Affiliation(s)
- Verónica Cabanas-Sánchez
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; IMDEA Food Institute, The Campus of International Excellence UAM+CSIC, Madrid, Spain
| | - Nathan Lynskey
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile.
| |
Collapse
|
7
|
Abstract
OBJECTIVE To use the known association of idiopathic osteoarthritis with contracture as a means of searching for its cause. There are currently two theories concerning this association, one assuming that the contracture is a consequence of the osteoarthritis and the other that it precedes and causes the osteoarthritis. This study tested both theories. METHODS Flexion ranges in the 12 finger joints were obtained by goniometric measurement in two samples of normal female subjects, one group with a mean age of 22 years (25 subjects) and one with a mean age of 45 years (50 subjects). The results were compared with the known regional prevalence of osteoarthritis in the finger joints of women. RESULTS The older group showed evidence of reduced flexion range consistent with development of contracture in the extensor mechanism of the fingers. The distribution of the contracture showed a strong negative correlation with the regional prevalence of osteoarthritis. CONCLUSIONS An early dorsal contracture develops in the fingers of normal subjects, but it is neither a consequence of nor the cause of digital osteoarthritis. The most parsimonious explanation for the association is that both contracture and idiopathic osteoarthritis are independent consequences of failure to use the full movement range. If this hypothesis is correct, the disease could be preventable.
Collapse
Affiliation(s)
- P Jones
- Department of Rheumatology, Queen Elizabeth Hospital, PO Box 1342, Whakaue Street, Rotorua, New Zealand
| | | | | | | |
Collapse
|