Accelerometry assessed physical activity of older adults hospitalized with acute medical illness - an observational study
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SUBMITTER: Tasheva P
PROVIDER: S-EPMC7532621 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Project description:Background:Higher physical activity is associated with lower chronic disease risk among older adults. However, less is known about the optimal balance between daily physical activity and sedentary time and their correlates among older adults. We described objectively measured physical activity patterns using 7 day hip-accelerometry and assessed its correlates in a large cross-sectional sample of the Longitudinal Aging Study Amsterdam, a population-based cohort of older Dutch adults. In addition, we examined different combined profiles of sedentary time and physical activity across strata of sex, age, education and BMI groups. Results:Mean age was 71 (SD 8) years and 51% (n = 615) were women. The majority of wear time was spent sedentary (65%) followed by light (33%), and MVPA (2%). Higher age and higher BMI were related to more time spent sedentary, while female sex and lower education were related lower sedentary time. The combination of high sedentary time (≥65.4% of waking time) and low physical activity (< 9.1% of waking time) was significantly associated with higher age, higher BMI, and slower walking speed compared to the combination of low sedentary time and high physical activity P < 0.001. Conclusions:Dutch older adults spend on average 65% of their waking time sedentary. Older adults' sedentary time differs by age, sex, education and BMI groups. The combination of high sedentary time and low physical was associated with higher age, higher BMI, and slower walking speed compared to the combination of low sedentary time and high MVPA. This suggests that increasing light activity might be an effective and feasible strategy in older persons to reduce sedentary time. Future studies should assess whether low- sedentary and high-light physical activity are associated with improved long-term health outcomes (also independent of MVPA).
| S-EPMC6379946 | biostudies-literature
Project description:BACKGROUND:Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults' during hospitalisation for an acute medical illness. METHODS:A 4-Round online Delphi consensus survey was conducted. International researchers, medical/nursing/physiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2-3, participants rated the importance of items using a Likert scale (1-9); consensus was defined a priori as: ?70% of respondents rating an item as "critical" (score???7) and???15% of respondents rating an item as "not important" (score???3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1-3; Round 4 responses subsequently informed final drafting of recommendations. RESULTS:Forty-nine people from nine countries were invited to each Round; response rates were 94, 90, 85 and 81% from Rounds 1-4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Examples of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: "some PA is better than none", "older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised", "when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults' physical and mental capabilities" and "opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living". CONCLUSIONS:These world-first consensus-based statements from expert and stakeholder consultation provide the starting point for recommendations to address PA and SB for older adults hospitalised with an acute medical illness. Further consultation and evidence review will enable validation of these draft recommendations with examples to improve their specificity and translation to clinical practice.
| S-EPMC7249667 | biostudies-literature
Project description:Physical activity (PA) is associated with greater fatigability in older adults; little is known about magnitude, shape, timing and variability of the entire 24-h rest-activity rhythm (RAR) associated with fatigability. We identified which features of the 24-h RAR pattern were independently and jointly associated with greater perceived physical fatigability (Pittsburgh Fatigability Scale, PFS, 0-50) in older adults (n = 181, 71.3 ± 6.7 years). RARs were characterized using anti-logistic extended cosine models and 4-h intervals of PA means and standard deviations across days. A K-means clustering algorithm approach identified four profiles of RAR features: "Less Active/Robust", "Earlier Risers", "More Active/Robust" and "Later RAR". Quantile regression tested associations of each RAR feature/profile on median PFS adjusted for age, sex, race, body mass index and depression symptomatology. Later rise times (up mesor; β = 1.38, p = 0.01) and timing of midpoint of activity (acrophase; β = 1.29, p = 0.01) were associated with higher PFS scores. Lower PA between 4 a.m. and 8 a.m. was associated with higher PFS scores (β = -4.50, p = 0.03). "Less Active/Robust" (β = 6.14, p = 0.01) and "Later RAR" (β = 3.53, p = 0.01) patterns were associated with higher PFS scores compared to "Earlier Risers". Greater physical fatigability in older adults was associated with dampened, more variable, and later RARs. This work can guide development of interventions aimed at modifying RARs to reduce fatigability in older adults.
| S-EPMC7958607 | biostudies-literature
Project description:OBJECTIVES:To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. DESIGN:Observational. SETTING:Tertiary care hospital, community teaching hospital. PARTICIPANTS:Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998). MEASUREMENTS:Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. RESULTS:By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. CONCLUSION:For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.
| S-EPMC2717728 | biostudies-literature
Project description:BackgroundElderly people obtain significant health benefits from physical activity (PA), but the role of activity patterns has scarcely been researched. The present study aims to describe the patterns of PA among different intensities of activity in elderly people. We assess how patterns differ between more and less active groups ('rare', 'average', and 'frequent'), and explore whether and how various PA parameters are associated with functional exercise capacity (FEC).MethodsPA was measured in 168 subjects (78 males; 65-89 years of age), using a triaxial GT3X accelerometer for ten consecutive days. Subjects were divided into three groups by activity and the groups were compared. A multiple linear regression model was used to predict FEC.ResultsParticipants greater than or equal to 80 years are most prone to being sedentary for long periods, while women and the obese are the groups most likely to spend insufficient time in moderate to vigorous PA (MVPA). Rarely active elderly people had a decreased proportion of long bouts of MVPA and light PA and of short bouts in sedentary behavior than frequently active subjects did (p<0.001). As predictors of FEC, younger age, lower BMI, male sex, better lung function, absence of multimorbidity, longer times and longer bouts of MVPA emerged as significant parameters (r(2)=0.54). Patterns of MVPA explained most of the variance.ConclusionsPA patterns provide information beyond reports of activity alone. MVPA in elderly people may be increased by increasing the proportion of long bouts, in order to increase FEC as well as average PA. However, health conditions may limit PA. In rarely active people (often with reduced FEC, worse lung function, and diagnosis of multimorbidity or disability), longer periods of time in light PA may be sufficient to increase the overall level of activity.
| S-EPMC4016218 | biostudies-literature
Project description:IntroductionAccelerometers are increasingly used in research. Four to 7 days of monitoring is preferred to estimate average activity but may be burdensome for older adults. We aimed to investigate: 1) 7-day accelerometry protocol adherence, 2) demographic predictors of adherence, 3) day of the week effect, and 4) average activity calculated from 7 versus fewer days among older adults.MethodsWe used the 2003-2006 older adult hip accelerometry data from the National Health and Nutrition Examination Survey (NHANES) sample. We determined proportions with 1-7 valid (10-20 hours) wear days and identified wear day correlates using ordinal logistic regression. We determined the day of week effect on 5 accelerometry measures (counts per minute, CPM; % sedentary behavior; % light-lifestyle activity; % moderate-vigorous activity, MVPA; total activity counts) using multivariate linear regression and compared averages estimated over 2 or 3 versus 7 days using correlations, linear regression, and Bland-Altman plots.ResultsAmong 2,208 participants aged 65+, 85% of participants had ?2 and 44% had 7 valid wear days. Increasing age (p = 0.01) and non-white race (p < 0.001) were associated with fewer days. Daily CPM, % MVPA, and total daily activity counts were similar Monday through Saturday, but significantly lower on Sundays (p < 0.001). Daily % sedentary behavior and % light-lifestyle activity were significantly different on Saturdays (p = 0.04-0.045) and Sundays (p < 0.001) compared to weekdays. Among participants with 7 valid days, 2 or 3 day averages were highly correlated with 7 day averages for all 5 accelerometry measures (2 versus 7 days: r = 0.90-0.93, 3 versus 7 days: r = 0.94-0.96).ConclusionsProtocols of 2-3 days, adjusting for Sundays (average CPM, % moderate-vigorous activity, and average total daily activity counts) or weekends (% sedentary behavior and % light-lifestyle activity), give reliable estimates of older adult activity.
| S-EPMC5231361 | biostudies-literature
Project description:We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1-3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them-particularly those with a better functional/health status at admission and longer hospitalization-are at higher risk of being adverse responders, which can have negative short/middle-term consequences.
| S-EPMC7141266 | biostudies-literature
Project description:Background/objectivesAccelerometry measures older adult (in)activity with high resolution. Most studies summarize activity over the entire wear time. We extend prior work by analyzing hourly activity data to determine how frailty and other characteristics relate to activity among older adults.MethodsUsing wrist accelerometry data collected from the National Social Life, Health and Aging Project (n = 651), a nationally-representative probability sample of older adults, we used mixed effects linear regression to model the logarithm of hourly counts per minute as a function of an adapted phenotypic frailty score, adjusting for demographic and health characteristics, season, day of week and time of day.ResultsHigher frailty scores were associated with modestly lower activity; each frailty point (0-4) corresponded to a 7% lower mean hourly counts per minute. Older age, more comorbidities, male gender, and higher BMI were also associated with lower activity, though the latter was not evident among frail respondents. After adjusting for differences associated with frailty and other covariates, a substantial amount of between-individual variability in activity remained, as well as within-individual variability across days.ConclusionOur findings indicate that frail elders, men, those who are older, overweight or have multiple comorbidities are most likely to have low activity. However, residual differences between individuals remain larger than the differences associated with frailty and other covariates. We suggest defining individual-specific activity goals and further research to identify the sources of between-individual variability to better understand how activity reflects health status and to permit the development of more effective interventions.
| S-EPMC5905616 | biostudies-literature
Project description:Background:Physical activity (PA) prevents disease and promotes longevity; yet, few older adults meet the recommended daily guidelines. Wearable PA and heart rate monitors provide the opportunity to define age-related differences in the absolute and relative intensity of daily activities, and provide insight into the underlying factors influencing PA in older adults. Methods:Participants in the Baltimore Longitudinal Study of Aging (n = 440, 52% male, aged 31 to 88 years) completed a clinical assessment and wore an Actiheart monitor in the free-living environment. The association between age and minutes per day in sedentary, light, moderate, and vigorous PA was assessed using relative intensity, as defined by heart rate reserve, and absolute intensity using activity count thresholds. Results:In cross-sectional analyses, time spent in sedentary and light activities as defined by relative intensity did not differ across age (p > 0.05), whereas time spent in moderate and vigorous relative PA was higher for each 1 year increase in age (p < .01). Using absolute intensity PA thresholds, older adults registered fewer activity counts per day with more sedentary time and lesser amounts of light, moderate, and vigorous PA (p < .05). Persons with higher relative and lower absolute PA intensity had poorer functional performance and higher subclinical disease indicators. Conclusions:These findings suggest that time spent in moderate or higher intensity activities may not be lower with age after considering changes in physiology, functional ability, and subclinical disease burden and highlight the need for more age- and ability-specific PA research to inform future interventions and public health guidelines.
| S-EPMC5905658 | biostudies-literature
Project description:[This corrects the article DOI: 10.1371/journal.pone.0170082.].
| S-EPMC5362229 | biostudies-literature