Physical Activity In Daily Life Research Articles

Towards Automated Assessment of Frailty Status Using a Wrist-Worn Device.

Wearable sensors potentially enable monitoring the user's physical activity in daily life. Therefore, they are particularly appealing for the evaluation of older subjects in their environment, to capture early signs of frailty and mobility-related problems. This study explores the use of body-worn accelerometers for automated assessment of frailty during walking activity. Experiments involved 34 volunteers aged 70+, who were initially screened by geriatricians for the presence of frailty according to Fried's criteria. After screening, the volunteers were asked to walk 60 m at preferred speed, while wearing two accelerometers, one positioned on the lower back and the other on the wrist. Sensor-derived signals were analyzed independently to compare the ability of the two signals (wrist vs. lower back) in frailty status assessment. A gait detection technique was applied to identify segments made of four gait cycles. These segments were then used as input to compute 25 features in time and time-frequency domains, the latter by means of the Wavelet Transform. Finally, five machine learning models were trained and evaluated to classify subjects as robust or non-robust (i.e., pre-frail or frail). Gaussian naive Bayes applied to the features derived from the wrist sensor signal identified non-robust subjects with 91% sensitivity and 82% specificity, compared to 87% sensitivity and 64% specificity achieved with the lower back sensor. Results demonstrate that a wrist-worn accelerometer provides valuable information for the recognition of frailty in older adults, and could represent an effective tool to enable automated and unobtrusive assessment of frailty.

Baseline Body Composition and Physical Activity Level Recommended for Optimal Bone Mineral Density in Young Women

Aim:This study examined the influence of body composition and physical activity level (PAL) on bone mineral density (BMD) to determine the baseline values necessary for maintaining healthy trabecular bone and improving bone health in young women.Materials and Methods:The subjects, consisting of healthy young women, were assigned to either a BMD-low (BMD-L) or BMD-high (BMD-H) group using the osteosonic index. PAL was measured for 1 week and rated on a scale from PAL-1 to 8 according to intensity levels (metabolic equivalents [METs]). The Wilcoxon rank-sum test was performed for intergroup comparisons.Results:The BMD-H group had significantly higher fat-free muscle mass, skeletal muscle index, and basic metabolic rate than the BMD-L group (p < 0.001, each). Regarding the timing of physical activity in daily life according to intensity, PAL-6 (p < 0.01), PAL-7 (p < 0.001), and PAL-8 (p < 0.01) for the BMD-H group were significantly longer than those for the BMD-L group.Discussion and Conclusion:For young women in their early 20s, BMD may be associated with baseline physical fitness and strength, as determined by body composition, but it is not influenced by the duration of physical activity. A PAL ≥6.0 METs may improve or maintain the effect on BMD.

Impact of community-based rehabilitation on the physical functioning and activity of daily living of stroke patients: a systematic review and meta-analysis

Purpose This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS). Materials and methods Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous. Results Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= −0.473, 95% CI (−0.926, −0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)). Conclusions CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683 Implication for rehabilitation Community-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals. CBR is effective in improving the physical functioning and activity of daily living of PWS. Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals.

Hidden association of knee-related disability with physical activities among community-dwelling older male Saudi Arabians with knee osteoarthritis

Introduction: The impact of knee osteoarthritis (OA) on physical activities of daily life was studied extensively among the elderly across the globe but not well understood in the Saudi Arabian populace with cultural consideration. This paper assessed the association between knee flexion range of motion (ROM) and ritual physical activities among elderly males due to knee OA.Methods: A cross-sectional study with a sample of 139 males aged 56–74 years diagnosed with knee OA recruited at prayer places. The subjective evaluation was carried using a disease-specific Arabic knee physical functional questionnaire Knee injury and OA Outcome Score-Physical Function Short form (KOOS-PS), and the anthropometric measure of knee flexion ROM was objectively measured by a manual goniometer.Results: The mean and standard deviation of the study sample age, height, weight, and body mass index were 66.9 ± 4.09 years, 158.4 ± 6.1 cm, 74.6 ± 7.1 kg, and 29.6 ± 1.9 kg/m2, respectively. The mean, standard deviation and median of the knee flexion ROM and Arabic-KOOS-PS Questionnaire score were 100.7 ± 7.9, 101.5 and 12.9 ± 13.7, 13.4. The non-parametric Spearman correlation coefficient between the knee stiffness and KOOS-PS physical activities resulted very strong positively correlation, r = 0.967.Conclusion: A strong positive correlation has been found between hidden knee disability and ritual physical activities among male cohorts in Saudi cultural community with knee OA

The Effectiveness Of Aerobic Exercise In Improving Functional Status : A Case Report

Chronic obstructive pulmonary disease (COPD) is a lung disease that causes ventilation abnormalities of respiratory tract obstruction that is progressive and not fully reversible. The disease is associated with a switch from a self­limiting inflammatory response, mainly initiated by smoke inhalation, to a chronic persistent inflammatory response after prolonged interaction with cigarette smoke. The pathological mechanisms and clinical manifestations of COPD are not restricted only to pulmonary inflammation and airway remodeling. The known systemic manifestations of COPD include systemic inflammation, cardiovascular comorbidities, and muscle dysfunction, leading to the decreased functional status of COPD. Chronic inflammation in the pulmonary tissue is also associated with systemic effects. Systemic inflammation may then lead to skeletal muscle atrophy and cachexia. It may also initiate and worsen comorbidities.1 It limits the patient’s exercise capacity and the ability to perform activities of daily living (ADL), leading to a reduced quality of life. Quantification of physical ADL revealed that COPD patients spend less time standing and walking daily than healthy elderly individuals.2 Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention designed to reduce symptoms, increase functional status and quality of life, and focus on the primary and secondary impairments associated with respiratory disease in COPD patients. Strategies include exercise training, self-management education, nutritional intervention and psychosocial support.3

Association between illness perception and clinical control, quality of life, physical activity, and psychosocial status in subjects with moderate to severe asthma: a cluster analysis

Background: Illness perception (IP) is a psychosocial factor involved in several chronic diseases and is associated with relevant clinical outcomes. However, the relationship between IP and health-related quality of life (HRQoL), psychosocial status, and physical activity in daily life (PADL) in subjects with asthma is poorly understood.Objective: To identify groups of subjects with asthma based on their IPs and to assess their association with clinical control, HRQoL, psychosocial disturbances, and PADL.Methods: This cross-sectional study included 149 subjects with moderate to severe asthma. IP, anthropometric data, Asthma Control Questionnaire-7, Asthma Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, PADL (accelerometry), and general self-efficacy (GSE) were assessed. Cluster analysis was performed to identify clusters with similar profiles and investigate their characteristics and differences. Pearson’s correlation coefficient was used to test the associations between IP and other variables.Results: Statistical analyses identified two clusters of subjects with asthma based on IP. Cluster 1 presented worse IP in seven out of eight domains than Cluster 2. Cluster 1 had more negative consequences of the disease, worse understanding, and a high emotional representation of the disease than Cluster 2. Cluster 1 also had a greater extent of asthma symptoms, poor clinical control, worse HRQoL, and more symptoms of anxiety and depression. No difference between clusters was found for PADL or self-efficacy.Conclusion: Subjects with asthma who have worse IP have more negative symptoms, worse clinical control, HRQoL, and symptoms of anxiety and depression.

Comparison of motor, non-motor, and quality of life phenotype in Black and White patients with Parkinson's disease

ObjectiveTo determine phenotypic differences between Black and White patients with Parkinson's disease (PD).Design/Methods: Patients with PD in a movement disorders clinic were approached to participate. After consent, a battery of tests was completed, including MDS-UPDRS Part III and the motor domains of the NIH Toolbox, Montreal Cognitive Assessment, Single Digit Modality Test, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, Parkinson's Disease Questionnaire (PDQ39), Schwab and England, Epworth Sleepiness Scale, UPSIT smell test, and others. ResultsTwenty-four Black PD and 25 White PD patients participated. There were no differences in demographics and MDS-UPDRS Part III scores. White PD participants performed better on the 4-m walk gait speed test (p < 0.0005), standing balance test (p < 0.001), Montreal Cognitive Assessment (p < 0.0005), and Single Digit Modality Test (p < 0.005). Black PD participants had lower scores on PROMIS Satisfaction with Participation (p = 0.023), PROMIS Physical Function Mobility (p = 0.007), total PDQ39 (p = 0.008), PDQ39 mobility (p = 0.012), PDQ39 ADL (p = 0.014), PDQ39 cognition (p = 0.023), and PDQ39 body discomfort (p = 0.041) scales. ConclusionsSignificant differences were found in motor, non-motor and quality of life scales in Black and White PD participants with similar demographics. Further work will need to be done to identify the underlying reasons and ways to mitigate these disparities.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China).

This study aimed to identify multimorbidity patterns and explore the disablement process by utilizing the model raised by Verbrugge and Jette as a theoretical framework. This cross-sectional study used public Long-term Care Insurance (LTCI) claimants’ assessment data of Yiwu city in Zhejiang Province, China, for 2604 individuals aged 60 years and older, from September through December 2018. Latent Class Analysis (LCA) was conducted using 10 common chronic conditions. Structural Equation Modeling was used to examine the disablement process. The latent classes of multimorbidity patterns were the “coronary atherosclerotic heart disease” class (19.0%), the “lower limb fractures” class (26.4%), and the “other diseases” class (54.6%). The structural model results show that coronary atherosclerotic heart disease had a significant influence on incontinence, but it was not statistically significant in predicting vision impairment and mobility impairment. Lower limb fractures had significant effects on vision impairment, incontinence, and mobility impairment. Vision impairment, incontinence, and mobility impairment had significant effects on physical activities of daily living (ADLs). Our findings suggest that different impairments exist from specific patterns of multimorbidity to physical ADL disability, which may provide insights for researchers and policy makers to develop tailored care and provide support for physically disabled older people.

Relationships of Walking and non-Walking Physical Activities in Daily Life with Cognitive Function and Physical Characteristics in Male Patients with Mild Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is accompanied by dyspnea on exertion due to airflow limitation caused by bronchial stenosis, with afflicted patients being less physically active. Therefore, physical activity is important for disease management. This study aimed to examine the relationships of walking and non-walking physical activities with cognitive function or physical characteristics of patients with mild COPD in a community without respiratory rehabilitation. Cross-sectional study. We included 40 male patients (mean age, 75.7 ± 6.7 years) with stable mild COPD. A three-axis accelerometer was used to evaluate walking and non-walking physical activities in daily life. Cognition, respiratory function, skeletal muscle mass, limb muscle strength, exercise capacity, and health-related quality of life were assessed. Regarding daily exercise amount (metabolic equivalents × hours; Ex), 87.5% of the participants had walking activities of 0-2 Ex, while 67.5% had non-walking activities of 1-3 Ex. Walking activity was significantly correlated with cognitive function (P < .05), walking distance (P < .01), and health-related quality of life (P < .05), but not with muscle mass. However, non-walking activity was significantly correlated with the body mass index (P < .05), muscle mass (P < .05), and walking distance (P < .01), but not with cognitive function. Moreover, the relationship between non-walking activity and health-related quality of life was weaker than the corresponding relationship with walking activity. In patients with mild COPD, walking and non-walking physical activities showed different relationships with cognitive function and physical characteristics. The findings suggest that self-management of such patients requires maintenance of both walking and non-walking activities in a balanced manner.

Physical Activity Level and Social-Ecological Influence Factors in Chinese Information Technology Professionals: A Cross-Sectional Study.

Objective Information technology (IT) population in China has expanded rapidly in recent decades, which has suffered severe health problems due to a lack of physical activity (PA). However, little is known about the influence and solutions of PA deficiency. The current research was designed to explore the associations between the amount of PA and potential influenced factors based on the social-ecological model (SEM) and thus to provide rationales for PA promotion. Method Six hundred and five IT professionals from five cities of China were surveyed in terms of PA in daily life as well as the potential PA influence factors based on SEM models that consisted of individual, interpersonal, environmental, and political levels in the current study. Hierarchical linear regression analyses were conducted to examine the association of the potential PA influence factors and PA amount. Result About 54.7% of the sample did not fulfill the PA recommendation of 600 MET per week, and there are significant gender differences in PA participation. Factors related to the individual (self-efficacy and value recognition), interpersonal (social support), environmental (workplace and community environment), and polity-level factors (policy advocacy) were found to be significantly associated with Chinese IT professionals' participation in PA. Conclusion Numerous correlates from individual-level to political-level factors are all important predictors of PA. Exercise value recognition and self-efficacy accounted for much of the association. Environmental variables may further influence exercise behavior. Therefore, conducting intervention efforts for individual, interpersonal, environmental, and political change of Chinese IT professionals is recommended.

Changes in physical function and ADL before and after surgery in elderly lung cancer patients

Changes in physical function and ADL before and after surgery in elderly lung cancer patients

Positive Events and Physical Activity in Daily Life for Middle-Aged and Older Adults

Previous studies reveal that positive affective well-being is positively associated with physical activity. The present study extends this work by examining the relationship between positive events and physical activity in daily life. Participants (N=1,016, ages 43-90, 56% women) from the third wave of the National Study of Daily Experiences reported their experiences of positive events and physical activity in eight daily diary interviews. Results from multilevel model analyses showed that on days when participants experienced more positive events than usual, they were more likely to engage in physical activity and reported engaging in greater physical activity than usual. Further, participants who experienced more positive events on average across the study period also reported engaging in greater daily physical activity. These results were invariant across age. Our findings highlight the importance of naturally-occurring positive experiences in daily life across middle- and later adulthood.

Walking It Off: More Stressors and Perceived Stressor Control Predict More Physical Activity in Daily Life

Research shows that, while the experience of stress relates to lower levels of physical activity (PA), people who perceive a greater sense of control engage in higher levels of PA. This study explores whether a sense of control specifically over stressful situations moderates the negative association between stressor exposure and PA in daily life. We used 8-day diary data from up to 1,236 participants (Age: Range = 43-91, M = 62.47, SD = 10.20) in the National Study of Daily Experiences. Somewhat contrary to hypotheses, people reported spending more time on light PA (but not moderate-to-vigorous PA) on days when they also experienced more stressors than usual. Perceived stressor control appears to magnify this effect, with people reporting even more light PA on days when they feel greater control. Initial findings suggest that a physically active lifestyle may help middle-aged and older adults cope with daily stressors.

In-hospital pulmonary rehabilitation after completion of primary respiratory disease treatment improves physical activity and ADL performance: A prospective intervention study.

Introduction:Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion.Methods:We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation.Results:The median age of the patients was 80 (interquartile range (IQR): 74.8–84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18–133] vs 120 m [68–203], P < .001). The Barthel Index (BI) (P < .001), the modified Medical Research Council (P < .001), and other scale scores were also improved. Among patients with acute respiratory diseases such as pneumonia, chronic obstructive pulmonary disease, and interstitial pneumonia, ISWT and other data showed improvement at the postrehabilitation timepoint. Ten patients who could perform examinations at 3 months after baseline were evaluated 3 months after taking baseline data prior to starting rehabilitation. The ISWT showed significant improvement 3 months after baseline compared to baseline (P = .024), and the ISWT distance was maintained after rehabilitation.Discussion and conclusions:Physical activity, symptoms, mental health, and ADL status in patients who had not recovered after primary treatment completion for respiratory diseases could improve through in-hospital pulmonary rehabilitation.

The impact of lifestyle on forearm fractures in children: A retrospective cohort analysis

Forearm fractures are frequent in children. It is important to identify predisposing factors for increased fracture risk. This retrospective analysis aimed to investigate the correlation between forearm fractures in children and co-factors such as age, TV consumption, consumption of soft drinks, the kind of soft drinks consumed as well as physical activity in daily life and BMI. This retrospective cohort analysis compared 355 participants at the age of 4 to 12 between 2017 and 2018 with and without forearm fractures in children. It was based on a questionnaire to assess the above-mentioned cofactors regarding behavior and lifestyles choices and aimed to identify whether or not these lead to an increased risk of forearm fractures. For statistical analysis logistic regression was used. Logistic regression showed a significant effect on forearm fractures in children for the variables age (Odds ratio 3.3 [95% confidence interval 1.5-7.3], P=.003), TV consumption (Odds ratio 5.4 [95% confidence interval 2.5-22.6], P<.001), consumption of soft drinks (Odds ratio 2.6 [95% confidence interval 1.2-5.6], P=.013), and the kind of soft drinks consumed (Odds ratio 3.1 [95% confidence interval 1.5-6.3], P=.003), [Nagelkerkes-R2=0.458; Chi2=85.037; df=6]) with a strong effect according to Cohen (f2=0.84). The study showed a significant correlation between TV and soft drink consumption and increased risk for forearm fractures in children. TV consumption and consumption of soft drinks should be reduced in children to prevent forearm fractures.

중국 도시노인의 일상생활 수행능력 현황 및 영향요인 분석: 강서성 구강시를 중심으로

본 연구는 중국 강서성 구강시에 거주하는 60세 이상 노인들의 일상생활 수행능력(ADL: Activities Daily Living)에 관한 현황 및 영향요인에 관한 연구로써 본 연구는 신체활동, 세대 간 지지를 주요 요인으로 노인연령층의 ADL 손상률 및 상실률에 관한 지표를 개선하는데 목적이 있다. 연구를 위해 설문지법을 사용하였으며, 총 1,076개의 설문지를 회수하였다. 본 연구는 Lawton and Baody (1969)가 사용했던 신체적 일상생활 수행능력(PADL: Physical Activities of Daily Living)과 도구적 일상생활 수행능력(IADL: Instrumental Activities of Daily Living)을 중심으로 노인의 일상생활 활동능력을 측정하였으며, SPSS통계적 도구를 이용하여 분석을 진행하였다.BR 연구 결과는 다음과 같다. 첫째, 구강시 거주 노인들의 ADL은 Ｍ=15.18, ADL 손상율은 15.52%, ADL 상실률은 5.48%였으며, IADL 손상율은 19.42%, IADL 상실률은 .56%, PADL 손상율은 12.17%, PADL 상실률은 .28%인 것으로 나타났다. 둘째, 노인의 ADL, PADL, IADL의 상실률과 손상율 기능 지수는 성별과 세대 간 지지의 대부분 지표에서 통계적으로 유의미한 차이가 나타나지 않았으나 연령, 학력, 경제적 조건, 신체활동 참여, 만성질환 보유수가 노인의 ADL, PADL, IADL의 상실률과 손상율에 직접적인 영향을 미쳤다. 특히 학력과 만성질환의 보유수는 노인의 ADL, PADL, IADL등의 상실률 및 손상율과 음(-)의 상관관계를 이루었다. 이러한 결과는 노인들에 대한 의료 서비스 지원은 물론 부양의 의무가 보장되어야 한다는 점과 사회적 지원, 정신건강 상태 및 심리적 차원에서 노인에 대한 주변의 관심과 배려가 필요한 것으로 해석할 수 있다. 그 밖에 노인들의 일상생활 수행능력을 향상시키기 위한 적극적인 신체활동이 수반되어야 한다는 점에서 노인 건강을 위한 다양한 생활체육프로그램이 개발 및 활용되어야 한다.

Maximal exercise outcomes with a face mask: the effects of gender and age differences on cardiorespiratory responses.

BackgroundSurgical masks have become an important accessory of physical activity in daily life due to the COVID-19 pandemic.AimsTo determine the effects of the surgical mask on respiratory gas exchange parameters, dyspnoea, and hemodynamic responses during maximal exercise in different age groups and gender.MethodsTwenty-six healthy participants between 18 and 65 years (mean 37.35 ± 15.99) performed a maximal exercise test twice randomly, with and without a mask. To determine the respiratory gas exchange parameters (peak oxygen consumption (VO2peak), minute ventilation (VE), energy expenditure (EE), respiratory rate), and hemodynamic responses, each participant underwent a maximal exercise test with Bruce protocol on the treadmill. The modified Borg scale (MBS) was used to determine the dyspnoea before and after exercise test.ResultsTest duration (min), metabolic equivalents (MET), VO2peak ml/kg/min, respiratory rate, and peak heart rate (HRpeak) of young participants after exercise test with and without a mask were higher than in middle-aged participants (p < 0.01). There was no significant difference between males and females in test duration, VO2peak ml/kg/min, VO2peak ml/min, MET, VE l/min, respiratory rate, MBS, and EE in masked tests (p > 0.05).ConclusionThe surgical mask use affected the maximal exercise capacity of middle-aged participants more than young participants. Although males performed better than females in tests without masks, the decrease in exercise capacity with mask use was greater than in females. Advanced age and male gender may be factors that need more attention during exercise with mask use.Trial registration number and dateNCT04498546—02/17/2021.

The impact of muscle mass loss and deteriorating physical function on prognosis in patients receiving hemodialysis

Muscle mass loss and worsening physical function are crucial issues in patients receiving hemodialysis (HD). However, few studies have investigated the association between temporal changes in muscle mass and physical function in a large number of HD patients. We examined 286 patients receiving HD (males, 58%; age, 66.8 ± 13.0 years) at a single center, and calculated the percent changes in psoas muscle mass index (%PMI) using computed tomography over two screenings, once per year (July 2011–June 2013). Physical function was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) (range 0–4). The observation period was from July 2012 to June 2021. The median %PMI was -9.5%, and those with the lowest quartile of %PMI (< −20.5%) showed a significantly poor prognosis compared with other patients (p < 0.001). Multivariable logistic regression analysis revealed that these patients tended to have decreased physical function (ECOG-PS 2–4) [odds ratio (OR): 2.46, p < 0.001] and albumin levels (OR: 0.22, p = 0.007). Multiple-factor-adjusted Cox regression analyses showed that %PMI (hazard ratio: 0.99, p = 0.004) and each ECOG-PS stage (1–4 vs. 0) (p < 0.01) were associated with mortality. Augmenting physical activities in daily life and serum albumin levels should be considered to maintain muscle mass and improve the prognosis of patients receiving HD.

Modified Medical Research Council and COPD Assessment Test Cutoff Points.

The modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) are assessment instruments associated with level of physical activity of daily living (PADL) in patients with COPD. This study aimed to identify mMRC and CAT cutoff points to discriminate sedentary behavior and PADL level of subjects with COPD and verify whether these cutoff points differentiate pulmonary function, health-related quality of life (HRQOL), functional status, and mortality index in subjects with COPD. Subjects (N = 131, FEV1: 36.7 ± 16.1% predicted) were assessed for lung function, mMRC, CAT, HRQOL, functional status, and mortality index. PADL was monitored using a triaxial accelerometer, and subjects were classified as sedentary/nonsedentary (cutoff point of 8.5 h/d in PADL < 1.5 metabolic equivalent of task [MET]), physically active/inactive (cutoff point of 80 min/d in PADL ≥ 3 METs), and with/without severe physical inactivity (cutoff point of 4,580 steps/d), according to variables provided by accelerometer. ROC curve indicated mMRC cutoff point of ≥ 2 (P < .05) for physical inactivity (sensitivity = 66%, specificity = 56%, AUC = 0.62), severe physical inactivity (sensitivity = 81%, specificity = 66%, AUC = 0.76), and sedentary behavior (sensitivity = 61%, specificity = 70%, AUC = 0.65). The identified CAT cutoff points were ≥ 16 and ≥ 20, considering severe physical inactivity (sensitivity = 76%, specificity = 54%, AUC = 0.69, P < .001) and sedentary behavior (sensitivity = 51%, specificity = 90%, AUC = 0.71, P = .001), respectively. Subjects who had mMRC ≥ 2 and CAT ≥ 16 or ≥ 20 presented worse pulmonary function, HRQOL, functional status, and mortality index compared with those who scored mMRC < 2 and CAT <16 or < 20. mMRC cutoff point of ≥ 2 is recommended to discriminate PADL level and sedentary behavior, whereas CAT cutoff points of ≥ 16 and ≥ 20 discriminated severe physical inactivity and sedentary behavior, respectively. These cutoff points differentiated subjects with COPD regarding all the outcomes assessed in this study.