Dataset Information

Physical Activity and Falls in Older Men: The Critical Role of Mobility Limitations.

ABSTRACT:

Background

Physical activity (PA) has many health benefits but may increase falls risk among older adults. We study how objectively measured habitual daily PA is related to falls by exploring the modifying effect of mobility limitations and the mediating roles of fitness and lower-limb strength.

Methods

One thousand six hundred fifty-five (53%) of 3137 surviving participants (men age 71-91 yr) in an ongoing UK-population-based cohort study wore an ActiGraph GT3x accelerometer over the hip for 1 wk in 2010-2012 to measure PA (exposure) and reported demographic and health status, including mobility limitations. One year later, 825 men reported falls history (outcome).

Results

Seven hundred of 825 men had ?600 min·d of accelerometer wear for ?3 d. Nineteen percent (n = 128) reported falls 1 yr later. Associations between PA and falls differed by presence of mobility limitations. Among 66% (n = 471) of men without mobility limitations, number of falls increased incrementally (for every 30 min of moderate to vigorous PA [MVPA]: incidence rate ratio [IRR], 1.50; 95% confidence interval [CI], 1.10-2.03, adjusted for falls risk factors). Step count was not related to number of falls below 9000 steps per day but was related to number of falls ?9000 steps per day (for every additional 1000 steps per day: IRR, 1.59; 95% CI, 1.16-2.18). Among 33% (n = 229) of men with mobility limitations, falls risk declined with increasing activity (for every 1000 steps per day: IRR, 0.80; 95% CI, 0.70-0.91; for every 30 min of MVPA: IRR, 0.61; 95% CI, 0.42-0.89; for every additional 30 min of sedentary behavior ?600 min·d: IRR, 1.22; 95% CI, 1.07-1.40).

Conclusions

Interventions to promote MVPA in older men should incorporate falls prevention strategies. Among adults with mobility limitations, trials should investigate whether increasing MVPA levels can reduce falls risk.

SUBMITTER: Jefferis BJ

PROVIDER: S-EPMC5131688 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Publications

Physical Activity and Falls in Older Men: The Critical Role of Mobility Limitations.

Jefferis Barbara J BJ Merom Dafna D Sartini Claudio C Wannamethee S Goya SG Ash Sarah S Lennon Lucy T LT Iliffe Steve S Kendrick Denise D Whincup Peter H PH

Medicine and science in sports and exercise 20151001 10

<h4>Background</h4>Physical activity (PA) has many health benefits but may increase falls risk among older adults. We study how objectively measured habitual daily PA is related to falls by exploring the modifying effect of mobility limitations and the mediating roles of fitness and lower-limb strength.<h4>Methods</h4>One thousand six hundred fifty-five (53%) of 3137 surviving participants (men age 71-91 yr) in an ongoing UK-population-based cohort study wore an ActiGraph GT3x accelerometer over ...[more]

PMID: 25668406

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Project description:BACKGROUND: The purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence. METHODS: Prospective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed. RESULTS: Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices. CONCLUSIONS: There is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.

Project description:To evaluate the effect of structured physical activity on respiratory outcomes in community-dwelling elderly adults with mobility limitations.Multicenter, randomized trial of physical activity vs health education, with respiratory variables prespecified as tertiary outcomes over an intervention period of 24-42 months. Physical activity included walking (goal of 150 min/week) and strength, flexibility, and balance training. Health education included workshops on topics relevant to older adults and upper extremity stretching exercises.Lifestyle Interventions and Independence in Elders (LIFE) Study.Community-dwelling persons aged 70-89 with Short Physical Performance Battery scores less than 10 (N = 1,635).Dyspnea severity (defined as moderate to severe according to a Borg index >2 immediately after a 400-m walk), forced expiratory volume in 1 second (FEV1) (<lower limit of normal (LLN) defined low breathing capacity), and maximal inspiratory pressure (MIP) (<LLN defined respiratory muscle weakness) were assessed at baseline and 6, 18, and 30 months. Hospitalization for exacerbation of obstructive airways disease (EOAD) and pneumonia was also ascertained over the 42-month follow-up period.The randomized groups were similar in baseline demographics, including mean age (79) and sex (67% female). The effect of physical activity on dyspnea severity, FEV1, and MIP was no different from that of health education but was associated with higher likelihood of respiratory hospitalization, significantly for EOAD (hazard ratio (HR) = 2.34, 95% confidence interval (CI) = 1.19-4.61, P = .01) and marginally for pneumonia (HR = 1.54, 95% CI = 0.98-2.42, P = .06).In older persons with mobility limitations, physical activity was associated with higher likelihood of respiratory hospitalization than health education, but differences in dyspnea severity, FEV1, and MIP did not accompany this effect-indicating that higher hospital use could be attributable to greater participant contact.

Project description:ObjectivesTo evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education.DesignSecondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013.ParticipantsSedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341).MeasurementsParticipants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment.ResultsHospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26).ConclusionParticipating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization. J Am Geriatr Soc 67:261-268, 2019.

Dataset Information

Physical Activity and Falls in Older Men: The Critical Role of Mobility Limitations.

Background

Methods

Results

Conclusions

Publications

Physical Activity and Falls in Older Men: The Critical Role of Mobility Limitations.

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