Physical Activity In Daily Life Research Articles

DASC-21 score and the risk of in-hospital death in elderly patients with heart failure.

We investigated whether the Dementia Assessment Sheet for Community-based Integrated Care System-21 Items (DASC-21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in-hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. We retrospectively assessed the DASC-21 score at the time of admission, in-hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC-21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC-21 score was associated with an increased risk of in-hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010-1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B-type natriuretic peptide. Difficulties (3 or 4) with the self-management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05-10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19-11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00-20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49-25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85-19.35, P = 0.003) were identified as risk factors for in-hospital death. Patients in the highest tertile of the DASC-21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). In elderly patients hospitalized for heart failure, higher DASC-21 scores were associated with an increased risk of in-hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; ••: ••-••.

Abstract PO5-11-07: Short- and long-term treatment-related effects on physical health in breast cancer survivors

Abstract Background. Breast cancer (BC) survivors experience greater physical health declines compared to cancer-free women of the same age, which is thought to be caused by their cancer and its treatment. However, the short- and long-term effects of different types of treatment on physical health are not well understood, especially for hormone therapy. Moreover, whether specific aspects of physical health, such as activities of daily living (ADL), are affected by treatment is unknown. Methods. This analysis was conducted in the Cancer Prevention Study 3 (CPS-3), a prospective cohort study with approximately 300,000 participants enrolled between 2006-2013. Participants returned a baseline survey and triennial follow-up surveys beginning in 2015. Incident, non-metastatic, female BC patients were included in this analysis if they returned a survey at least 90 days after their diagnosis through June 30, 2020, the end of follow-up for this analysis. All 2,551 BC patients included in this study had pre- and post-diagnostic surveys and underwent breast surgery if they were diagnosed with invasive disease. They were matched to up to five cancer-free women on age and year of survey returns (N=12,704). Self-reported physical health and ADL were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale instrument. Treatment information was obtained from cancer registries and self-report and included surgery, chemotherapy, radiation and hormonal therapy. Odds Ratios (OR) and 95% confidence intervals (CI) between treatment received and self-reported physical function were estimated using multivariable ordinal logistic regression models at three time points relative to the case’s diagnosis date: before diagnosis, within 90 days to 5 years after diagnosis, and more than 5 years after diagnosis. Results. Median age at diagnosis was 56 years (interquartile range (IQR): 50-62). Approximately 82% of the tumors were hormone-receptor positive. The median times from the three physical health measurements to diagnoses were 1.7 years before diagnosis (IQR: 0.9 – 2.7), 1.7 years (IQR: 0.9 – 2.5) from 90 days to 5 years post-diagnosis and 6.6 years (IQR: 5.5-7.0) for more than 5 years post-diagnosis. There was a significant risk of physical decline within 5 years of diagnosis for women who received chemotherapy or hormonal therapy compared to cancer-free women (Table 1). However, more than 5 years after diagnosis, the risk of physical decline was only observed among those who received chemotherapy. Treatment combinations that included chemotherapy were also associated with a decline in the ability to carry out ADL during the first 5 years. Patients who received hormonal therapy without chemotherapy were comparable to cancer-free women in their ability to carry out ADL during the post-diagnosis period. BC patients who received surgery only or surgery and radiation reported physical health and ADLs similar to cancer-free women within 5 and &amp;gt;5 years after diagnosis. Conclusions. Post-diagnosis physical health decline is time and treatment dependent. Patients receiving chemotherapy have the greatest overall physical health decline and it is long-lasting. Beyond five years from diagnosis, physical health of breast cancer patients who did not receive chemotherapy were similar to cancer-free women. Strategies are needed to help BC patients receiving chemotherapy overcome the long-term physical function limitations of their cancer treatment. Table. Associations between treatment received and physical health and ability to carry out activities of daily living. OR: Odds Ratio; CI: confidence interval; chemo: chemotherapy; radio: radiation therapy; horm: hormonal therapy. *Associations were adjusted for matching factors, which included age and time from diagnosis to measurement of physical health. Citation Format: Clara Bodelon, Matthew Masters, Lauren McCullough, Alpa Patel, Lauren Teras. Short- and long-term treatment-related effects on physical health in breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-07.

Intermonitor Variability of Garmin Vivofit® Jr. Wristband

The main objective of this study was to evaluate the reliability of Garmin Vivofit® Jr. physical activity (PA) wristbands during daily life physical activities. Six wristbands were randomly selected from a stock of twenty-four. The wristbands were worn by a single four-year-old participant, with three on the right wrist area and three on the left wrist area. To assess device reliability under laboratory conditions on a treadmill (Powerjog, model JM200, Sport Engineering Ltd., Birmingham, UK), the participant wore the six wristbands while performing five work conditions: sitting and standing (30 times per minute, controlled by a metronome), walking at 3 km/h, walking at 4 km/h, running at 5 km/h, and running at 6 km/h. Throughout the six minutes, variables related to physical activity provided by the device, step volume, and minutes of physical activity were recorded using the specific application of the wristband (Garmin International Inc., Olathe, KS, USA). The intraclass correlation coefficients (ICCs) were high for all six wristbands with each other, for both the number of steps taken (ICC = 0.991–0.998) and the number of minutes of PA (ICC = 0.892–0.977). The critical alpha value of the Cusum test was highest at.050 for all wristband associations. In conclusion, good reliability was found among the six wristbands, which could be adopted for field-based research to quantify physical activities.

Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta-Analysis.

The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence. We searched six databases, from inception to January 28, 2023, for randomized controlled trials comparing land-based, resistance exercise-only interventions with no intervention, or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3 to 6 months, >6 to <12 months, ≥12 months. The between-group effect was calculated for immediate postintervention pain and physical function (activities of daily living [ADL] and sports/recreation [SPORT]). For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose.

Association between chronic disease, sensory impairment, walking limitation, and activities of daily living of community-dwelling older Indians.

Due to the paucity of existing evidence, this study aims to investigate the relationship between chronic disease, sensory impairment, walking limitation, and difficulty in activities of daily living (ADLs) in community-dwelling older Indians. This cross-sectional study included data from 31,394 individuals aged ≥ 60 years from the 2017 to 2018 Longitudinal Ageing Study in India. Participants were divided into 2 groups: 12,993 with chronic disease, sensory impairment, and a walking limitation, and 18,401 healthy individuals without such conditions. Participants with any chronic disease were further divided into 2 groups: sensory impairment (n = 12,462), and a walking limitation (n = 4745). Self-reported close-ended questionnaires with yes or no were used to assess each chronic disease (such as hypertension, diabetes, lung disorders, joint disorders, or heart disease), sensory impairment (vision or hearing), and walking limitation. A walking limitation was defined as being when a person could only walk at their usual pace for less than 500 meters on a flat surface. ADLs were assessed and classified as physical ADLs including basic physical requirements like dressing. Instrumental ADLs (IADLs) included more complicated community-based tasks like meal preparation. Findings showed that older Indians with chronic disease, sensory impairment, and a walking limitation were more likely to be significantly associated with physical ADLs (adjusted odds ratio [aOR] = 1.85, 95% confidence interval [CI] = 1.34-1.57, P < .0001) and IADLs (aOR = 1.45, 95% CI = 1.70-2.03, P < .0001) than those without such conditions. Among older Indians with chronic disease, sensory impairment was more likely associated with physical ADLs (aOR = 1.98, 95% CI = 1.82-2.16, P < .0001) and IADLs (aOR = 1.26, 95% CI = 1.15-1.37, P < .0001) followed by a walking limitation (aOR = 1.53, 95% CI = 1.42-1.65, P < .0001; aOR = 1.27, 95% CI = 1.17-1.38, P < .0001, respectively). These findings suggest that older Indians with chronic disease, sensory impairment, and walking limitation, can experience increased difficulty in overall and individual physical ADL and IADL than those without these conditions. Older Indians with any chronic condition who had sensory impairment or a walking limitation were also more likely to have difficulty with physical ADLs and IADLs.

Real-life behavioral and neural circuit markers of physical activity as a compensatory mechanism for social isolation

Social isolation and loneliness pose major societal challenges accelerated by the coronavirus disease 2019 pandemic, especially for mental health. In this cohort study using accelerometry, electronic diaries and neuroimaging in a community-based sample of 317 young adults, we show that people felt affectively worse when lacking social contact, but less so when engaging in physical activity. This putative compensatory mechanism was present even at small physical activity doses and was pronounced in individuals with higher brain functional connectivity within the default mode network signaling risk for depression. Social-affective benefits of movement were higher in people showing exacerbated loneliness and were replicated throughout the pandemic. These findings extend the state of knowledge on the dynamic interplay of social contact and physical activity in daily life identifying an accessible protective strategy to mitigate the negative effects of social isolation, particularly among at-risk individuals, which comes with the potential to improve public health in the post-pandemic world.

The DizzyQuest Combined with Accelerometry: Daily Physical Activities and Limitations among Patients with Bilateral Vestibulopathy Due to DFNA9.

DFNA9 is a genetic disease of the inner ear, causing progressive bilateral sensorineural deafness and bilateral vestibulopathy (BV). In this study, DizzyQuest, a mobile vestibular diary, and the MOX accelerometer were combined to assess the daily life functional limitations and physical activity of patients with DFNA9 suffering from BV. These parameters might be appropriate as potential candidacy criteria and outcome measures for new therapeutic interventions for BV. Fifteen DFNA9 patients with BV and twelve age-matched healthy controls were included. The DizzyQuest was applied for six consecutive days, which assessed the participants' extent of functional limitations, tiredness, types of activities performed during the day, and type of activity during which the participant felt most limited. The MOX accelerometer was worn during the same six days of DizzyQuest use, measuring the participants intensity and type of physical activity. Mixed-effects linear and logistic regression analyses were performed to compare the DFNA9 patients and control group. DFNA9 patients with BV felt significantly more limited in activities during the day compared to the age-matched controls, especially in social participation (p < 0.005). However, these reported limitations did not cause adjustment in the types of activities and did not reduce the intensity or type of physical activity measured with accelerometry. In addition, no relationships were found between self-reported functional limitations and physical activity. This study demonstrated that self-reported functional limitations are significantly higher among DFNA9 patients with BV. As a result, these limitations might be considered as part of the candidacy criteria or outcome measures for therapeutic interventions. In addition, the intensity or type of physical activity performed during the day need to be addressed more specifically in future research.

PHYSICAL RESERVE MEASURES AS PREDICTORS OF RESILIENCE IN OLDER ADULTS UNDERGOING TOTAL KNEE REPLACEMENT

Abstract Measures of physical reserve have been shown to predict resilience following surgery in older adults. The objective of this study was to evaluate the utility of gait speed, hand grip strength, and 3-minute walk distance to predict resilience in older adults scheduled for total knee arthroplasty (TKA), in whom preoperative gait and mobility may be limited by pain or reduced range of motion. We conducted an interim analysis of data from PRIME-KNEE, an ongoing prospective study following participants age ≥60 years undergoing TKA recruited from Duke hospitals. We determined the change in self-reported Lower Extremity Physical Activities of Daily Living (LE PADL) score from pre-surgery baseline to 4 months following TKA in 133 participants (mean age = 72, 59% female). Gait speed, hand grip, and 3-minute walk were collected at baseline. A total of 110 (83%) participants exhibited “resilience,” defined dichotomously as any improvement in LE PADL score (occurred in 38 participants) or return to a non-disabled state (occurred in 72 participants). Logistic regression analysis adjusted for age and sex revealed that 3-minute walk distance was significantly associated with resilience at 4 months (OR=1.012 [CI 1.002-1.022]) with an area under the curve of 0.634. The presentation will review the implications of these results and present findings with an updated sample, as well as discuss the need for other predictive measures, such as provocative tests (i.e., tests that measure response to an experimental stressor) and biomarkers.

MULTIPLE MEASURES OF FITNESS ASSOCIATION WITH MUSCLE MRNA SPLICING VARIANTS IN THE GESTALT STUDY

Abstract Regular physical activity has been associated with higher skeletal muscle mass and strength as well as better mitochondrial function. Previous studies in master octogenarian athletes found a higher content of mitochondrial- and reduced spliceosome proteins compared to non-athlete age/sex-matched controls. These findings suggest that higher mitochondrial function is associated with down-regulation of the spliceosome. In this study we aimed to detect mitochondrial respiration associations with expression of specific genes and differentially spliced isoforms. We performed RNA-seq from vastus lateralis skeletal muscle biopsies in 82 male/female participants in the GESTALT study (Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing). We correlated gene expression, transcript usage and splicing events with I) self-reported level of physical activity in daily life, II) peak oxygen consumption assessed during an incremental treadmill stress testing, III) muscle oxidative capacity assessed by p31 MR Spectroscopy and IV) mitochondrial-respirometry assessed on permeabilized muscle fibers, using regression models adjusted for age, gender, and batch. Except for IV), all three mitochondrial measures positively correlated with each other, and were downregulated along the Aging axis. We detected 423, 219, 178 and 226 differentially expressed genes (p-value&amp;lt;0.01), respectively for the 4 mitochondrial fitness measures. Gene-set-enrichment analysis (GSEA) detected up-top TCA cycle and mitochondrial respiration kPCr and mito-respirometry detected the highest number of AS events (448 and 412). Dissimilarities among transcriptomic profile associated to these four bioenergetic outcomes provide insight into the biological mechanisms that connect them to mitochondrial function and suggest that mitochondrial function is not the only correlate of movement behaviors.

CENTENARIAN PHYSICAL FUNCTION EVOLUTION AND COVID-19 IMPACT: A STUDY IN JAPAN

Abstract Studies show that centenarians’ physical function and ADL levels improved in the recent cohort. However, it is unclear whether this positive trend has altered due to the COVID-19 pandemic. Recent studies indicated that physical function decreased even in younger older adults because of the limited daily activity during the pandemic period. Is this true for centenarians? This study has two aims: firstly, to investigate whether the physical function of Japanese centenarians has improved over the years; secondly, to examine the impact of COVID-19. We used the data collected from 2014 to the present day in Kyotango City. The City Hall has been collecting data including the functional status of all centenarians who turned 100 years old every year. In this study, we divided nine years into three periods: 2014-2016 (P1), 2017-2019 (P2), and 2020-2022 (P3). For each period the number of participants was 122, 116, and 153. The results revealed that the prevalence of bedridden centenarians showed an upward trend over the years. Concurrently, the proportion of centenarians capable of unrestricted mobility exhibited an upward trajectory from P1 to P2, followed by a subsequent decrease from P2 to P3. In conclusion, if there was no COVID-19 pandemic, the functional level of Japanese centenarians could be improved over the years. At the same time, the gradually increasing trend of bedridden centenarians might indicate intensive medical and institutional care enables centenarians with fragile conditions to survive.

Power training in older adults: A pilot and feasibility study

Background: Previous research shows that power training can increase power output in older adults and may also improve physical performance, physical functioning, and independence. However, power training interventions have not been optimized for older adults. The aim of this study was to assess the feasibility and preliminary effectiveness of a power training program called Powerful Ageing in older adults. Methods: A total of 28 older adults participated in a 12-week power training intervention at an intensity of 20-30% 1RM. The primary outcome, feasibility, was assessed through intervention retention, adherence (attendance and compliance), and safety. Secondary outcomes were measured in health domains of the ICF. In the function domain, muscle power and anaerobic power were assessed using a weighted squat and Wingate test, respectively. In the activities domain, physical performance was measured using the 6-minute walk test, and in the participation domain, physical activity in daily life and health status were evaluated using an accelerometer and the SF-36 questionnaire, respectively. Results: With intervention retention and adherence at 100%, and 0% drop-out due to injuries, Powerful Ageing was considered feasible and safe for older adults. Power training significantly improved muscle power, anaerobic power, and physical performance in older adults, but did not have a significant effect on physical activity in daily life or health status. Conclusions: Preliminary results suggest that Powerful Ageing is a feasible and safe intervention that may improve muscle power, anaerobic power, and physical performance in older adults. Randomized clinical trials are necessary to fully assess the potential of power training as an exercise intervention for older adults.

Relationship between Physical Activity, Handgrip Strength, Depressive Symptoms, and Cognitive Impairment in Korean older adults

AbstractBackgroundPhysical activity, muscle strength, depressive symptoms, and cognitive function are intertwined in later life. This study aimed to investigate the association physical activity (PA), relative handgrip strength (RHGS), depressive symptoms, and cognitive impairment in Korean older adults.MethodThis study consisting of 512 community‐dwelling Korean older adults (417 female, 95 male) aged 65 years and older (74.8±5.4 years) in S‐city, Gyeonggi‐do. PA and handgrip strength were assessed with the Global Physical Activity Questionnaire and using a dynamometer (GRIP‐D; Takei Ltd, Niigata, Japan). Depressive symptoms were evaluated using the Korean form of the Center for Epidemiologic Studies Depression (CES‐D) Scale. Cognitive impairment was assessed with the Mini‐Mental State Examination for Dementia Screening (MMSE‐DS) of Korean version. The PROCESS V3.4 macro for SPSS based on the bootstrap method was used to determine the mediating effects of PA and RHGS on the relationship between depressive symptoms and cognitive impairment.ResultMultiple logistic regression showed that insufficient PA was associated with high odds of a cognitive impairment ((OR = 2.972, 95%CI = 1.749‐5.052, p = .002) compared with sufficient PA (OR = 1). Weak RHGS (OR = 3.540, 95%CI = 2.156‐5.814, p&lt;.001) was associated with high odds of the cognitive impairment compared with normal RHGS (OR = 1). Depressive symptoms (OR = 2.676, 95%CI = 1.594‐4.492, p&lt;.001) were associated with higher odds of the cognitive impairment compared with normal depression status (OR = 1). Particularly, depressive symptoms were found to have both direct and indirect effects on cognitive impairment. As predicted, PA and RHGS partially mediated the relationship between depressive symptoms and cognitive impairment (PA: B = –0.017, 95%CI = –0.028 ‐ –0.009, p&lt;.001; RHGS: B = –0.005, 95%CI = –0.007 ‐ –0.003, p&lt;.001). In addition, serial mediation analysis indicates that the association between depressive symptoms and cognitive impairment was partially mediated by PA and RHGS in a sequential manner (B = –0.004, 95%CI = –0.006 ‐ –0.002, p&lt;.001).ConclusionAccording to the results of the serial multiple mediation model, the elderly should be encouraged to continue their physical activity in daily life, which not only improves and maintaining muscular strength but also reduces the negative impact of depressive symptoms on cognitive impairment.

2516. Development of a de novo Patient-Reported Outcome (PRO) Measure to Assess the Impacts of Disseminated Coccidioidomycosis [Valley Fever] on Patients Living with the Condition

Abstract Background Extrapulmonary or disseminated coccidioidomycosis (cocci) is a rare, severe form of fungal disease acquired by inhaling spores of Coccidioides spp., a dimorphic fungus endemic in the southwest United States (US) and parts of Central/South America. Currently, there are no measures that assess the patient experience of health-related quality of life (HRQL) impacts associated with disseminated cocci. Preliminary work to develop a disease-specific PRO has been completed (i.e., literature review, conceptual model development [fig 1], clinician interviews). The focus of this research was to gather qualitative evidence directly from patients living with disseminated cocci. Initial draft of a Patient-Centered Conceptual Model of Coccidioidomycosis A conceptual model of the symptoms and impacts of coccidioidomycosis was developed by analyzing 29 online patient stories after a literature review revealed qualitative, patient experience research was nonexistent in fungal infections. Methods Concept elicitation (CE) interviews were conducted with 25 patients with chronic, symptomatic disseminated cocci. Audio recordings of 60–110-minute telephone interviews were transcribed and qualitatively analyzed using NVivo 1.6. Saturation analysis was performed to determine if all concepts had emerged such that additional interviews would not add to the findings. Item generation meetings were then held between F2G, COS and a patient advocate to develop draft items reflecting the HRQL impacts of the condition. Results Thirteen (52.0%) CNS/multi-site and 12 (48.0%) non-CNS/multi-site patients participated; 18 (72.0%) were English-speakers and 7 (28.0%) were native Spanish-speakers; 3 (12.0%) were Black and 12 (48.0%) were Hispanic. Key impacts were identified across 5 domains, all reaching saturation (fig 2,3): physical function (physical activity, walking, climbing stairs, standing), activities of daily living (household chores, self-care), cognitive function (memory, focus), social-role impacts (work/school, socializing) and emotional (depression, anxiety). No major differences were found between CNS/non-CNS and English/Spanish patient experiences. Physical function and ADL Impacts Reported by Patients with Disseminated Cocci: Subgroup Analyses 1 CE interview results showed disseminated patients were significantly impacted in their physical functioning and activities of daily living. A surprising result was that in general, CNS and non-CNS patients had similar impact experiences as a result of disseminated cocci. (Total number of patients who experienced the impact is shown at the top of the column and the number of patients within each subgroup who experienced the impact is shown within the column). Social/Role, Emotional and Cognitive Impacts Reported by Patients with Disseminated Cocci: Subgroup Analyses 2 Disseminated patients were also affected socially, cognitively and emotionally, as well as in their roles professionally, and as caregivers and providers. Impact on communication consisted of difficulty retrieving words and following conversation. Cognitive impacts experienced by non-CNS patients were more prevalent than anticipated. Conclusion The CE interviews provided rich qualitative data on symptom and impact experiences of patients with disseminated cocci. The findings were used to draft a disease-specific PRO measure assessing HRQL impacts of disseminated cocci, consisting of 19 items across 5 domains (fig 4). Cognitive debrief interviews are now planned with disseminated cocci patients and clinicians to further evaluate the validity of the measure. Hypothesized Conceptual Framework of PRO measure 'Patient-Reported Impacts of Disseminated Coccidioidomycosis (Valley Fever)' Conceptual frameworks represent how a PRO measure may generate a score, broadly illustrating which patient experiences will be measured and how they will be measured. Disclosures Emma L. Harvey, BSc, MBBS, MRCP, FFPM, F2G Ltd: Employee|F2G Ltd: Stocks/Bonds Mark Bresnik, MD, F2G, Ltd.: Stocks/Bonds Elliott Blatt, MPH, F2G Ltd: Advisor/Consultant Rob Purdie, n/a, Clinical Outcomes Solutions: Consulting

Clinical Characteristics of Individuals with Interstitial Lung Diseases and Indication of End-of-Life Care

End-of-life care (EOLC) is palliative support provided in the last 6 months to 1 year of a patient’s life. Although there are established criteria for its indication, few studies describe the clinical and functional characteristics of individuals with interstitial lung diseases (ILD) in EOLC. ILD individuals underwent various assessments, including lung function, exercise capacity (6 min walk test), physical activity in daily life (PADL), peripheral muscle strength, maximal respiratory pressures, body composition, quality of life (SGRQ-I), symptoms of anxiety and depression, dyspnea (MRC scale), and sleep quality. Fifty-eight individuals were included and divided into two groups according to the indication for commencing EOLC (ILD with an indication of EOLC (ILD-EOLC) or ILD without an indication of EOLC (ILD-nEOLC). There were differences between the groups, respectively, for steps/day (2328 [1134–3130] vs. 5188 [3863–6514] n/day, p = 0.001), time spent/day carrying out moderate-to-vigorous physical activities (1 [0.4–1] vs. 10 [3–19] min/day, p = 0.0003), time spent/day in standing (3.8 [3.2–4.5] vs. 4.8 [4.1–6.7] h/day, p = 0.005), and lying positions (5.7 [5.3–6.9] vs. 4.2 [3.6–5.1] h/day, p = 0.0004), the sit-to-stand test (20 ± 4 vs. 26 ± 7 reps, p = 0.01), 4 m gait speed (0.92 ± 0.21 vs. 1.05 ± 0.15 m/s, p = 0.02), quadriceps muscle strength (237 [211–303] vs. 319 [261–446] N, p = 0.005), SGRQ-I (71 ± 15 vs. 50 ± 20 pts, p = 0.0009), and MRC (4 [3–5] vs. 2 [2–3] pts, p = 0.001). ILD individuals with criteria for commencing EOLC exhibit reduced PADL, functional performance, peripheral muscle strength, quality of life, and increased dyspnea.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand

ObjectivesThe aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand.MethodsWe analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE).ResultsThe proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight).ConclusionWe found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

The association between morning pleasant anticipation and daily positive incidental affect on adults’ daily steps: An ecological momentary assessment study

ObjectiveThis study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry. MethodsA total of 152 adults in Taiwan (female = 67.1 %, age range = 18–59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February–July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates’ potential effects on the study outcomes. ResultsThe study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation. ConclusionOn days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the “anticipatory” affective processes on movement behaviors with the goal of promoting physical activity in daily life.

Elastic tape reduces dyspnea and improves health status in the short term in nonobese COPD males: A randomized controlled trial

Introduction and objectivesThe elastic tape (ET) is a novel intervention that acutely improves exercise capacity in laboratory tests; however, its effect on a patient's daily life remains unknown. This randomized controlled trial evaluated the effects of ET on daily life physical activity (DLPA), dyspnea symptoms, health status, and health-related quality of life (HRQoL) in individuals with COPD. MethodsFifty males with moderate to very severe COPD were randomly assigned to an intervention group (ETG, n = 25), receiving ET on the chest wall and abdomen, or a control group (CG, n = 25). The intervention was for 14 days. DLPA (accelerometry; steps per day, and sedentary time), dyspnea symptoms (transition dyspnea index, TDI; and modified Medical Research Council, mMRC), health status (COPD assessment test, CAT), and health-related quality of life (HRQoL, CRQ) were evaluated at baseline and on Day 21 after the intervention. ResultsNo change in the DLPA was observed in between-group comparison. CG presented a reduction in step counts after 21days (-707,p <0.05) while ETG. maintained (-114,p > 0.94). However, ET reduced dyspnea symptoms in all TDI domains (functional, task, and effort) and on the mMRC scale after 14 days compared with CG (p < 0.01). Also, the ETG improved CAT score compared to the CG, reaching minimal clinical important difference (MCID) (-4.4 score, p <0.01). The ETG also improved in most CRQ domains reaching MCID after 21 days. ConclusionsET does not modify DLPA but reduces dyspnea and improves health status and HRQoL in nonobese males with moderate to very severe COPD in the short term. This novel and low-cost intervention improves COPD symptoms.

Comparison of Physical Activity Patterns among Three Major Chronic Respiratory Diseases.

Although the level of physical activity in daily life (PADL) plays a vital role concerning the health of subjects with chronic lung diseases, it remains uncertain how PADL patterns compare among different conditions. This study's objective was to compare the PADL levels of subjects with COPD, asthma and idiopathic pulmonary fibrosis (IPF); and to investigate PADL behaviour in different diseases' severity. Stable subjects who had not undergone pulmonary rehabilitation in the previous year were included. Subjects were divided into two subgroups according to disease severity: mild/moderate and severe/very severe. The primary outcome was time spent in moderate-to-vigorous physical activities (MVPA) (Actigraph GT3x) measured during one week over 12 h/day; other assessments included pulmonary function, peripheral muscle strength and exercise capacity. Comparisons among subgroups were corrected for age, BMI and sex. The analysis involved 119 subjects (47 asthma, 48 COPD and 24 IPF). Subjects with asthma had higher PADL levels than those with COPD and IPF (MVPA 18(14-22) vs. 8(4-12) vs. 7(1-12) min/day, respectively; p ancova = 0.002). Subjects with severe/very severe IPF had the lowest PADL level among all subgroups. Adult subjects with asthma have higher PADL levels than those with COPD and IPF, whereas patients with severe and very severe IPF are the most physically inactive subjects.

Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation

ObjectivesMany older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. DesignSecondary analysis of a prospective observational cohort study. Setting and ParticipantsAcross 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. MethodsPhysical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. ResultsHigher cognitive scores [standardized β (βSTD) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (βSTD = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (βSTD = −0.26, 95% CI: −0.35, −0.14) predicted smaller SPPB change. Higher ADL independence at admission (βSTD = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (βSTD = −0.30, 95% CI: −0.44, −0.15) predicted smaller gait speed change. Conclusions and ImplicationsAdmission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation.

Unraveling the interplay between daily life fatigue and physical activity after subarachnoid hemorrhage: an ecological momentary assessment and accelerometry study

BackgroundFatigue is one of the most commonly reported symptoms after subarachnoid hemorrhage (SAH) and is indirectly associated with physical activity (PA). Associations between fatigue and PA are primarily examined based on conventional measures (i.e. a single fatigue score or average PA levels), thereby assuming that fatigue and PA do not fluctuate over time. However, levels of fatigue and PA may not be stable and may interrelate dynamically in daily life. Insight in direct relationships between fatigue and PA in daily life, could add to the development of personalized rehabilitation strategies. Therefore we aimed to examine bidirectional relationships between momentary fatigue and PA in people with SAH.MethodsPeople (n = 38) with SAH who suffer from chronic fatigue were included in an observational study using Ecological Momentary Assessment (EMA) and accelerometry. Momentary fatigue was assessed on a scale from 1 to 7 (no to extreme fatigue), assessed with 10–11 prompts per day for 7 consecutive days using EMA with a mobile phone. PA was continuously measured during this 7-day period with a thigh-worn Activ8 accelerometer and expressed as total minutes of standing, walking, running and cycling in a period of 45 min before and after a momentary fatigue prompt. Multilevel mixed model analyses including random effects were conducted.ResultsMean age was 53.2 years (SD = 13.4), 58% female, and mean time post SAH onset was 9.5 months (SD = 2.1). Multilevel analyses with only time effects to predict fatigue and PA revealed that fatigue significantly (p < 0.001) increased over the day and PA significantly (p < 0.001) decreased. In addition, more PA was significantly associated with higher subsequent fatigue (β = 0.004, p < 0.05) and higher fatigue was significantly associated with less subsequent PA (β=-0.736, p < 0.05). Moreover, these associations significantly differed between participants (p < 0.001).ConclusionsBy combining EMA measures of fatigue with accelerometer-based PA we found that fatigue and PA are bidirectionally associated. In addition, these associations differ among participants. Given these different bidirectional associations, rehabilitation aimed at reducing fatigue should comprise personalized strategies to improve both fatigue and PA simultaneously, for example by combining exercise therapy with cognitive behavioral and/or energy management therapy.