Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study

Age-related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife. Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright-to-sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF-36 physical functioning subscale (SF-36pf). Cross-sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count). Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF-36pf in females. Step-weighted cadence was positively associated with SF-36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations. Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes.

Background: In an aging population, regular physical activity (PA) and exercise have been recognized as important factors in maintaining physical function and thereby preventing loss of independence and disability. However, (older) adults spent the majority of their day sedentary and therefore insight into the consequences of sedentary behavior on physical function, independent of PA, is warranted.Objective: To examine the associations of objectively measured sedentary time (ST), patterns of sedentary behavior, overall PA, and higher intensity PA (HPA) with objective measures of physical function.Methods: This is a cross-sectional study in 1,932 men and women (aged 40–75 years) participating in The Maastricht Study. The activPAL3 was used to assess daily sedentary behavior: ST (h), sedentary breaks (n), prolonged (≥30 min) sedentary bouts (n), and to assess time spent in (H)PA (h). Measures of physical function included: covered distance during a 6 min walk test [6MWD (meters)], timed chair rise stand test performance [TCSTtime (seconds)], grip strength (kg kg−1), and elbow flexion and knee extension strength (Nm kg−1). Linear regression analyses were used to examine associations between daily sedentary behavior and PA with physical function.Results: Every additional hour ST was associated with shorter 6MWD [B = −2.69 m (95% CI = −4.69; −0.69)] and lower relative elbow extension strength (B = −0.01 Nm kg−1 (−0.02; 0.00). More sedentary breaks were associated with faster TCSTtime: B = −0.55 s (−0.85; −0.26). Longer average sedentary bout duration was associated with slower TCSTtime [B = 0.17 s (0.09; 0.25)] and lower knee extension strength [B = −0.01 Nm kg−1 (−0.02; 0.00)]. Every hour of PA and HPA were associated with greater 6MWD [BPA = 15.88 m (9.87; 21.89), BHPA = 40.72 m (30.18; 51.25)], faster TCSTtime [BPA = −0.55 s (−1.03; −0.07), BHPA = −2.25 s (−3.09; −1.41)], greater elbow flexion strength [BPA = 0.03 Nm kg−1 (0.01; 0.07)], [BHPA = 0.05 Nm kg−1 (0.01; 0.08)], and greater knee extension strength [BPA = 0.04 Nm kg−1 (0.01; 0.07)], [BHPA = 0.13 Nm kg−1 (0.06; 0.20)].Conclusion: In adults aged 40–75 years, sedentary behavior appeared to be marginally associated with lower physical function, independent of HPA. This suggests that merely reducing sedentary behavior is insufficient to improve/maintain physical function. In contrast, engaging regularly in PA, in particular HPA, is important for physical function.

ObjectivesTo objectively assess light physical activity (PA), moderate-to-vigorous PA (MVPA), step counts and number of 10 min MVPA bouts and their association with physical function among older adults.DesignCross-sectional design.SettingUrban community...

Background/Aims Survivors of critical illness often face significant morbidity, including challenges in resuming daily activities and physical function after hospital discharge. Evaluating physical activity and physical function has the potential to provide insights into morbidity and quality of life following critical illness, and this has been described as a research priority. The aim of this study was to assess and describe physical activity, sedentary behaviour and physical function in survivors of critical illness over a 1-year period following discharge from intensive care units. Methods A total of 14 patients discharged from hospital following intensive care unit admission were invited to attend up to four assessments: within 2 weeks, at 6 weeks, 6 months and 1 year, following hospital discharge. Seven-day accelerometer-based physical activity (mean daily step counts, different intensities of physical activity and sedentary behaviour), modified shuttle walk test and handgrip strength were assessed at each timepoint. Results were compared against research guidelines, normative data and minimal clinically important differences for the specific tests. Results Out of 165 eligible ICU survivors, 19 individuals were recruited and 14 provided data (median age: 54 years (interquartile range [IQR] 20 years); eight men, six women; median intensive care unit length of stay: 9.00 [IQR: 4.50] days; median mechanical ventilation duration: 58.50 [IQR: 132.75] hours; median Acute Physiologic Chronic Health Evaluation score: 15.50 [IQR 15.50]). They all performed below population norms or research guidelines for mean daily step counts (763–7744 steps), Modified Shuttle Walk Test (40–800 metres) and handgrip strength (8–52 kg) across the 12-month study period, with most improvements below minimal clinically important differences. Conclusions Physical activity and physical function varied among patients after discharge from hospital following critical illness, and remained low during the first year post-discharge. While accelerometry and handgrip dynamometry appear to be safe and feasible assessments, there were challenges with data collection; for example, participants using mobility aids could not perform the Modified Shuttle Walk Test. The findings could be used to inform strategies that could support patients to appropriately increase their physical activity levels during recovery after critical illness. Implications for practice Measurement of physical activity, sedentary behaviour, and physical function can provide valuable insight into the recovery trajectory in survivors of critical illness following hospital discharge. Researchers and allied health professionals should work together to develop and test interventions to improve physical activity, sedentary behaviour and physical function across the recovery trajectory in this population.

To the Editor: Anemia is a common condition among older adults, affecting up to 50% of centenarians.1 Physical function limitations are also common among older individuals, affecting 42% of those 65 years and older, and are more likely to occur with advancing age.2 Functional status is often measured by how well an individual can complete activities common to daily life, which reflects muscular strength and mobility. Studies have shown an association between anemia and both physical function and strength.3-6 However, most studies of anemia and physical function have focused on older adults collectively, and have not made distinctions between those who are in their sixties and seventies and those in their nineties and one-hundreds. Thus, the question remains as to whether or not the association between anemia and physical function holds true in the very old. Considering the high prevalence of anemia and disability among the very old and the association between these two conditions, a better understanding of this association could help in characterizing the potential disability in the very old, as well as encouraging the assessment and treatment of preventable forms of anemia in order to increase performance and promote independence. Therefore, we recently conducted a secondary analysis of data from the Georgia Centenarian Study (GCS)7, to examine differences between levels of physical function, among centenarians, with and without anemia. The study, approved by the University of Georgia institutional review board on human subjects was a population-based sampling that including 244 centenarians and near centenarians (98+ years) from Georgia, USA. More thorough details of recruitment, sampling procedures, and participant characteristics have been described elsewhere.1,7 For the present analysis, anemia was defined as hemoglobin <13 g/dl for males and <12 g/dl for females1. Measures of physical function and strength included average grip strength, knee extensor strength, activities of daily living (basic and instrumental), Short Physical Performance Battery, and GCS composite score.8 Chi-Square and Wilcoxon-Rank Sum analysis were used to determine differences in descriptive characteristics between centenarians with and without anemia. Multivariable regression analysis was performed for each measure of strength and physical function and excluded only those missing data for covariates and the dependent physical function variable for each individual analysis. Covariates included body mass index, Mini Mental State Examination score, estimated creatinine clearance, and sum of chronic disease present at time of interview (osteoporosis, chronic kidney disease, diabetes, chronic airway obstruction, cancer, hypertension, Parkinson’s, and peripheral vascular disease). The average age of the participants was 100.5 years, and similar for those with and without anemia (Table 1). Eighty-three percent of the study participants were female, 81.1% were white, and 41.9% lived in a skilled nursing facility. The prevalence of anemia was greater in males than females (66.6% vs. 48.6%, p < 0.05) and tended to be greater in African Americans than in white participants (63.4% vs. 48.8%, p = 0.09), but did not differ by residence. Bivariate analysis indicated that centenarians with anemia had 3.5 kg (approximately 27%) lower average hand grip strength than those without anemia. In partially (demographics; Table 1) and fully adjusted (demographics and disease states; data not shown) multiple regression models, centenarians with anemia were found to have both lower grip strength and leg strength than centenarians without anemia. Anemia was not associated with lower scores on other measures of physical function in either bivariate or multiple regression analyses. The lack of association between anemia and other measures of physical function, requiring multiplicity of function, may be partly explained by chronic disease, specifically chronic kidney disease. Den Elzen et al. found that among those 85+ years, there were no differences in physical function ability between those with anemia and those without, when controlled for inflammatory markers and creatinine clearance.3 Previously, decreased kidney function was found to be a predictor of anemia in GCS participants.1 Table 1 Measures of Physical Function in Georgia Centenarians with and without Anemia and Results of a Series of Linear Regression Analyses Examining Associations Between Measures of Physical Function or Strength (Dependent Variable) and Anemia Status (Independent ... In conclusion, anemia in this population-based sampling of centenarians is associated with lower hand-grip and leg strength, but not physical function in everyday activities. These observations support the findings of Penninx et al.5 who also found associations of anemia with grip strength and leg strength, but in a “younger” older adult population. Maintenance of muscle strength is especially important for older people, as poor grip strength has been identified as a predictor of future disability.9 The robust association of anemia with hand grip strength suggests that treating anemia, when possible, may be important for preserving strength in the very old, thus potentially minimizing the decline in physical function and disability.

Physical Activity Intensity Measurement and Association With Adolescent Health: Chartering New Frontiers

In April 2020, the spread of COVID-19 infectious disease in Japan issued a state of emergency, making it impossible for people to go out except for unnecessary and urgent matters. It has been reported that the declaration of self-restraint will significantly reduce the volume of physical activity (PA). However, since the volume of change in the volume of PA after 6 months or more after the declaration of self-control was lifted is unknown, the volume of PA was compared. The participants were 13 elderly people living in Hiroshima City. In October 2020, an activity meter with a 3-axis accelerometer was attached to the participant's waist, and PA and physical function were measured for one week and compared with the PA measured in October 2019. Six months after the declaration was issued, there was changes volume of moderate intensity walking PA, were no changes in the number of steps, activity time, volume of light intensity PA, and volume of total PA (p ≥ 0.07%). Six months have passed since the self-restraint of activities due to the state of emergency, and now that the number of infected people has decreased, it is possible that the volume of PA in the elderly has improved due to the improvement in the sense of security and happiness. This suggests that it is important to continue daily activities, hobbies, and exercises as much as possible while taking measures against infection in order to reduce the risk of cardiovascular events.

The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.

BACKGROUND The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support–based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. OBJECTIVE This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. METHODS We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. RESULTS The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, &lt;i&gt;P&lt;/i&gt;=.04; duration of MVPA, &lt;i&gt;P&lt;/i&gt;=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. CONCLUSIONS The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.

BackgroundResearch supports that moderate-to-vigorous intensity physical activity (MVPA) is key to prolonged health and function. Among older adults, substantial changes to MVPA may be infeasible, thus a growing literature suggests a shift in focus to whole-day activity patterns.MethodsWith data from 795 older adults aged 65–100 in the Adult Changes in Thought Activity Monitoring study, we used linear regression to estimate associations between ActiGraph and activPAL measured activity patterns – including light intensity physical activity, steps, standing, and sedentary behaviors – and physical function as measured by a short Performance-based Physical Function (sPPF) score (range 0–12), a composite score based on three standardized physical performance tasks: gait speed, timed chair stands, and grip strength. We examined whether relationships persisted when controlling for MVPA or differed across age, gender, or quartiles of MVPA.ResultsIn models unadjusted for MVPA, a 1-standard deviation (SD) increment of daily sitting (1.9 h more), mean sitting bout duration (8 min longer average), or time spent in sedentary activity (1.6 h more) was associated with ~ 0.3–0.4 points lower mean sPPF score (all p < 0.05). A 1-SD increment in daily steps (~ 3500 more steps) was associated with ~ 0.5 points higher mean sPPF score (95% CI: 0.22 to 0.73). MVPA adjustment attenuated all relationships. The association between physical function and steps was strongest among adults aged 75+; associations of worse function with greater sedentary behavior were more pronounced in participants with the lowest levels of MVPA.ConclusionsWe found associations between function and activity metrics other than MVPA in key subgroups, findings that support research on broader activity patterns and may offer ideas regarding practical intervention opportunities for improving function in older adults.

To examine the association between aging and physical function in men by testing a theoretically based model of aging, hormones, body composition, strength, and physical function with data obtained from men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey. Cross-sectional, observational survey. Population-based. Eight hundred ten black, Hispanic, and white randomly selected men from the Boston area aged 30 to 79. Testosterone, estradiol, sex hormone-binding globulin, lean and fat mass, grip strength, and summated index of physical function (derived from walk and chair stand tests). Measures of grip strength and physical function declined strongly with age. For instance, 10 years of aging was associated with a 0.49-point difference (scale 0-7) in physical function. Age differences in total testosterone and estradiol concentrations were smaller than age differences in their free fractions. Weak or nonsignificant age-adjusted correlations were observed between hormones and measures of physical function, although path analysis revealed a positive association between testosterone and appendicular lean mass and a strong negative association between testosterone and total fat mass. Lean and fat mass, in turn, were strongly associated with grip strength and physical function, indicating the possibility that testosterone influences physical function via indirect associations with body composition. The age-related decline in serum testosterone concentration in men has a weak association with physical strength and functional outcomes through its associations with lean and fat mass.

Impairment caused by stroke is a major cause of disablement in older adults. Physical activity has been shown to improve physical functioning; however, little research has been done to explore how physical activity of different intensities may affect physical function among stroke survivors. The purpose of this study was to examine the patterns of accelerometer-measured physical activity and the relationship between physical activity intensities and objective physical functioning and perceived functional limitations in stroke survivors. Stroke survivors (N = 30, mean age = 61.77 ± 11.17) completed the Short Physical Performance Battery and the Late-Life Function and Disability Instrument. Physical activity intensities were measured objectively using a 7-day actigraph accelerometer wear period and scored using the National Health and Nutrition Examination Survey cutoffs for sedentary (counts/minute ≤100), light (counts/minute 101-2019), and moderate to vigorous (moderate to vigorous physical activity counts/minute ≥2020) activity. Multiple linear regressions controlling for age and time since stroke demonstrated that higher levels of moderate to vigorous physical activity predicted better Short Physical Performance Battery performance (β = .43, P = 0.04). For self-reported physical function, light physical activity predicted better basic lower limb function (β = .45, P = 0.009), better advanced lower limb function (β = .53, P = 0.003), better upper limb function (β = .37, P = 0.04), and higher total function score (β = .52, P = 0.002) on the Late-Life Function and Disability Instrument. These findings suggest that light activity as well as moderate to vigorous physical activity may contribute to better physical functioning in stroke survivors. Although moderate to vigorous physical activity significantly predicted the objective measure of physical function (Short Physical Performance Battery), light physical activity consistently predicted higher scores on all subscales of the Late-Life Function and Disability Instrument. Disabilities resulting from stroke may limit this population from engaging in moderate to vigorous physical activity, and these findings highlight the importance of light physical activity, which may offer similar perceived functional benefits. Future studies should focus on development of effective exercise interventions for stroke survivors by incorporating and comparing both moderate to vigorous physical activity and light-intensity physical activity.

PurposeThe primary goal of this scoping review was to summarize the literature published after the 2018 National Cancer Institute think tank, “Measuring Aging and Identifying Aging Phenotypes in Cancer Survivors,” on physical and cognitive functional outcomes among cancer survivors treated with chemotherapy. We focused on the influence of chemotherapy on aging-related outcomes (i.e., physical functional outcomes, cognitive functional outcomes, and frailty), given the known associations between chemotherapy and biologic mechanisms that affect aging-related physiologic processes.MethodsA search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, for manuscripts published between August 2018 and July 2023. Eligible studies: 1) included physical function, cognitive function, and/or frailty as outcomes; 2) included cancer survivors (as either the whole sample or a subgroup); 3) reported on physical or cognitive functional outcomes and/or frailty related to chemotherapy treatment (as either the whole sample or a subgroup); and 4) were observational in study design.ResultsThe search yielded 989 potentially relevant articles, of which 65 met the eligibility criteria. Of the 65 studies, 49 were longitudinal, and 16 were cross-sectional; 30 studies (46%) focused on breast cancer, 20 studies (31%) focused on the age group 60 + years, and 17 (26%) focused on childhood cancer survivors. With regards to outcomes, 82% of 23 studies reporting on physical function showed reduced physical function, 74% of 39 studies reporting on cognitive functional outcomes found reduced cognitive function, and 80% of 15 studies reporting on frailty found increasing frailty among cancer survivors treated with chemotherapy over time and/or compared to individuals not treated with chemotherapy. Fourteen studies (22%) evaluated biologic mechanisms and their relationship to aging-related outcomes. Inflammation was consistently associated with worsening physical and cognitive functional outcomes and epigenetic age increases. Further, DNA damage was consistently associated with worse aging-related outcomes.ConclusionChemotherapy is associated with reduced physical function, reduced cognitive function, and an increase in frailty in cancer survivors; these associations were demonstrated in longitudinal and cross-sectional studies. Inflammation and epigenetic age acceleration are associated with worse physical and cognitive function; prospective observational studies with multiple time points are needed to confirm these findings.Implications for cancer survivorsThis scoping review highlights the need for interventions to prevent declines in physical and cognitive function in cancer survivors who have received chemotherapy.

This systematic review and meta-analysis aimed to examine the association between device-measured physical activity (PA) and performance-based measures of physical function (PF). Databases searched included CINAHL, Embase, MEDLINE/PubMed, SPORTDiscus, and...

To examine the independent and joint associations between physical activity (PA) timing and volume patterns in relation to metabolic syndrome (MetS). Data from the NHANES 2011-2014 cycles, involving 5065 participants, were used. PA was measured using triaxial accelerometers. PA timing patterns were determined using the K-means clustering algorithm, and PA volumes were categorized based on tertiles (low, moderate, and high). Logistic regression models were used to assess the associations between PA patterns and MetS and its components. We also used restricted cubic spline curves to fit the PA to the MetS and its component non-linear associations. Three distinct PA timing patterns were identified using K-means clustering (morning, midday-afternoon, and late afternoon-evening). Independent analyses indicated that engaging in PA during the morning or midday-afternoon PA was with lower odds of MetS compared to late afternoon-evening. The adjusted odds ratios (95% confidence intervals) were 0.79 (0.63-0.99) and 0.78 (0.62-0.98), respectively. In joint analyses, compared with the late afternoon-evening/low PA pattern, the morning and midday-afternoon PA timing patterns were associated with lower odds of MetS when combined with moderate or high PA volume. In contrast, the late afternoon-evening PA pattern was significantly associated with lower odds of MetS only at high PA volumes. Additionally, a nonlinear association with MetS was identified in the morning PA pattern, whereas dose-dependent associations with MetS were observed in the midday-afternoon and late afternoon-evening PA patterns. Our study shows that morning and midday-afternoon PA patterns are associated with lower odds of MetS compared to late afternoon-evening PA. Higher total PA volume is also linked with lower odds of MetS. Conversely, prolonged PA during the late evening or nighttime is associated with higher odds of poorer metabolic outcomes.