Abstract
BackgroundFear of falling (FoF) is predictive of decreased physical activity. This study sought to determine if FoF mediates the relationship between decreased vision and physical activity restriction in individuals with glaucoma and age-related macular degeneration (AMD).MethodsAccelerometers were used to measure physical activity over 1 week in 59 control, 83 glaucoma, and 58 AMD subjects. Subjects completed the University of Illinois at Chicago Fear of Falling Questionnaire, and the extent of FoF was estimated using Rasch analysis. In negative binomial models adjusting for demographic, health, and social factors, FoF was investigated as a potential mediator between the severity of visual field (VF) loss (in glaucoma patients) or the severity of contrast sensitivity (CS) loss (in AMD patients) and decreased engagement in physical activity, defined as minutes spent in moderate-to-vigorous physical activity (MVPA) per day.ResultsIn multivariate negative binomial regression models, 5-decibels worse VF mean deviation was associated with 26 % less engagement in MVPA [rate ratio (RR) = 0.74, p < 0.01] amongst glaucoma subjects. When FoF was added to the model, the RR increased from 0.74 to 0.78, and VF loss severity remained associated with less MVPA at a statistically significant level (p < 0.01). Likewise, 0.1 log units worse CS was associated with 11 % less daily MVPA (RR = 0.89, p < 0.01) amongst AMD subjects. When FoF was added to the model, the RR increased from 0.89 to 1.02, and CS loss was no longer associated with MVPA at a statistically significant level (p = 0.53).ConclusionsFoF may mediate the relationship between vision loss and physical activity restriction amongst patients with AMD. Future work should determine optimal strategies for reducing FoF in individuals with vision loss in order to prevent the deleterious effects of physical activity restriction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0062-8) contains supplementary material, which is available to authorized users.
Highlights
Fear of falling (FoF) is predictive of decreased physical activity
Fifty-nine control, 83 glaucoma, and 58 age-related macular degeneration (AMD) subjects describing the association between severity of visual field (VF) loss were enrolled in the study and included in the analysis and moderate-to-vigorous physical activity (MVPA) decreased from 0.74 to 0.70, and VF loss on the basis of having at least 2 valid study days. severity remained associated with less MVPA at a statis
When FoF was added to the model, the jects differed significantly from control subjects with rate ratio (RR) describing the association of contrast sensitivity (CS) and MVPA increased regard to sex, education, employment, living arran- from 0.89 to 1.02, and CS loss was no longer associated gements, body mass index (BMI), grip strength, number of comorbid with MVPA at a statistically significant level (p = 0.53)
Summary
For all the negative binomial analyses in this study, each person-day was analyzed as a separate observation and generalized estimating equations were used to account for correlation of physical activity measures across different study days of the same subject. To demonstrate that VF loss and CS are associated was 6 minutes/day among subjects with mild-to-absent with engagement in MVPA in glaucoma and AMD, re- FoF (IQR = 1.7 to 41.5 minutes/day), as compared with spectively, negative binomial models were constructed in 0.5 minutes/day (IQR = 0.0 to 2.8 minutes/day p < 0.01). Vation and generalized estimating equations were used Greater VF loss was associated with less MVPA to account for correlation of physical activity measures amongst glaucoma subjects in univariate and multivariacross different study days of the same subject. 0.74 to 0.78, and VF loss severity remained associated with less MVPA at a statistically significant level (p < 0.01)
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