Does Life-span Achievement of Current Physical Activity Recommendations Reduce the Likelihood of Falling? (Abstract)
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Abstract:
While some training studies have identified that
walking increases strength and reduces functional
limitations in older adults, others have identified that
aerobic physical activity is ineffective in preventing
loss of muscle strength associated with ageing
(Harridge et al., 1997: Aging, 9, 80 – 87). As muscle
weakness in the legs has been found to be predictive
of falls, this would appear to be problematic for
aerobic-based physical activity recommendations for
the prevention of falls.
The purpose of this study was to identify whether
‘‘fallers’’ and ‘‘non-fallers’’ demonstrated significantly
different levels of attainment of the current
physical activity recommendations over the life
course. Self-report lifetime physical activity was
obtained through estimation of how many days per
week an individual accumulated 30 min or more of
at least moderate-intensity physical activity during
each decade of their adult life. A fall was identified as
a loss of balance resulting in the body, or part of the
body, coming to rest on the ground. Ethical approval
was granted through institutional procedures undertaken
at departmental level.
The participants were 74 males (mean age 71.7
years, s¼7.4) and 228 females (mean age 71.0 years,
s¼7.5; range 54 – 94) with 72% indicating that they
had experienced a fall. Differences between the sexes
were apparent for the number of days active in their
thirties (females: mean 6.41 days, s¼1.98; males:
mean 5.73 days, s¼2.01 days; t308¼2.56,
P50.05). Independent samples t-tests showed that
while ‘fallers’ (mean 4.75 days, s¼2.15) were
currently less active than ‘‘non-fallers’’ (mean 5.43
days, s¼2.03; t305¼2.52, P50.05), there was no
significant difference in the number of days on which
they had performed 30 min or more of moderateintensity
physical activity in any of the decades throughout the life-span. When participants were
then classified as either active or inactive in relation
to achieving 5630 min per week, chi-square tests
revealed no differences in proportional attainment of
the recommended amounts of physical activity in
fallers and non-fallers in any decade.
Although demonstrating a progressive decline in
physical activity through the decades, the sample was
more active than the current population in each
decade, with the majority attaining recommended
amounts of physical activity into their seventies.
Attainment of current physical activity guidelines
throughout the life-span would not appear to reduce
the likelihood of falling and would suggest that
strength-based physical activity recommendations
may be needed in addition to the current general
health guidelines if the number of falls in older adults
is to be significantly reduced.Keywords:
Falling (accident)
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Societal crises and personal challenges are often followed by substantial changes in physical activity. Is there a link between such changes and psychological well-being? Seeking to answer this question, we conducted a correlational study on a representative sample in Sweden during the first year of the COVID-19 pandemic (N = 1035). About 49% of the sample had decreased their physical activity compared to their self-reported activity level prior to the pandemic, whereas 32% had increased it. The results showed a positive and robust association between changes in daily activity level and corresponding changes in psychological well-being. Specifically, individuals who had reduced their physical activity over the last year reported lower life satisfaction than before, and individuals who had increased their physical activity reported higher life satisfaction than before. The amount of complete physical inactivity (sitting) showed a similar pattern as the exercise data, meaning that individuals who reported increasing inactivity per day also reported a greater decline in life satisfaction. Additional analyses showed that the association between daily activity level and life satisfaction was somewhat stronger for men than for women, but there was no difference when comparing individual versus organized activities. The current study was based on a cross-sectional design, measuring self-reported change over time. Recent work from other research teams have used longitudinal data and experience-sampling in different settings, finding similar results. We conclude that there is good reason to recommend physical exercise as a coping strategy in difficult times.
Sitting
Pandemic
Association (psychology)
Psychological Well-Being
Longitudinal Study
Cross-sectional study
Experience sampling method
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More than 60 years of research have consistently shown that physical activity beneficially affects several health outcomes and reduces the risk of premature mortality. The Harvard Alumni Study, one of the first studies to suggest a dose–response association between physical activity and health, examined the association between ‘total’ physical activity (defined as strenuous sports, walking and stair climbing) and participation in strenuous sports and the risk of heart attack in about 17 000 men.1 ‘Total’ physical activity was categorised into groups based on energy expenditure in physical activity per week. The following were the important observations: (1) there was a substantial risk reduction when comparing the ‘inactive’ reference group expending <500 kcal per week in ‘total’ physical activity with the second group expending 500–999 kcal per week; (2) there was graded dose–response association, with declining risk up to about 3000 kcal per week of ‘total’ physical activity, beyond which the benefits plateaued; and (3) energy expenditure from strenuous sports appeared to have greater protective effect than ‘total’ volume of activity. However, the latter observation may partly be explained by more accurate reporting of sporting activities compared with physical activities of daily living of lower intensity (eg, stair climbing and walking). The dose–response curve from the landmark paper by Paffenbarger et al 1 was subsequently confirmed after accounting for confounding,2 and it has been replicated in women and ethnically diverse populations from low-income and middle-income countries.3–5
These previous studies assessed physical activity using different self-report instruments, which may be prone to cognitive biases (eg, recall bias) and which may result in overestimation of physical activity and underestimation of sedentary time. Due to …
Stair climbing
Metabolic equivalent
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This article reports on a study undertaken to examine age differences in the effects of stress on risky decisions, such as deciding whether to brake or accelerate as one drives up to a traffic light that has turned yellow (amber). The authors had younger adults (aged 18-33 years; N=45; 22 males) and older adults (aged 65-89 years; N=40; 21 males) play a computer-based driving game either after a stress challenge or in a control condition. The study included 15 driving game trials in which drivers accumulated points by getting their simulated vehicle stopped before the traffic light turned red. Participants randomly assigned to the stress condition submerged their non-dominant hand in ice water (2.0 to 4.2 C) for three minutes. In the control condition, participants held their hand in warm water (37.3 C to 38.8 C) for three minutes. They started the driving game 18 min after the stress challenge, during the period of peak cortisol response to acute stress. Compared with the control group, the stress group’s salivary cortisol levels increased by the time of the game for both younger and older adults, with no significant age difference in the increase. The stress condition also resulted in higher post-experiment self-ratings of stress during the water task for both younger and older adults. Being stressed reduced older adults' final scores by nearly half, but did not significantly affect younger adults' scores. Stressed older adults risked driving for a smaller proportion of the yellow light. Stress also increased older adults’ stopping rate, but did not significantly affect younger adults’ stopping rate. Overall, older adults had fewer losing trials (M = 27%) than younger adults (M = 41%), but there were no effects of stress on losing rates. Consistent effects of stress were found on driving time, stopping rate and points throughout the game. The authors conclude that their results reveal that stress can change older adults’ decision strategies. After a stress challenge, older adults not only risked significantly less driving time but also stopped and restarted more frequently than those in the control condition. The age differences in the effects of stress were robust, occurring even when each sub-phase of the game was analyzed separately and when male and female data were analyzed separately. They call for addition research using different measures of risky decision making to see if these age differences are specific to risky decisions made under time pressure (as in the current task) or also extend to other decision tasks.
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Background: The steep decline in physical activity (PA) among the oldest old is not well understood; there is little information about the patterns of change in PA and sedentary behaviour (SB) in older people. Longitudinal data on objectively measured PA data can give insights about how PA and SB change with age. Methods: Men age 70–90 yr, from a United Kingdom population-based cohort wore a GT3X accelerometer over the hip annually on up to three occasions (56%, 50%, and 51% response rates) spanning 2 yr. Multilevel models were used to estimate change in activity. Men were grouped according to achieving >=150 min·wk-1 of MVPA in bouts of >=10 min (current guidelines) at two or three time points. Results: A total of 1419 ambulatory men had >=600 min wear time on >=3 d at >=2 time points. At baseline, men took 4806 steps per day and spent 72.5% of their day in SB, 23.1% in light PA, and 4.1% in moderate-to-vigorous PA (MVPA). Mean change per year was -341 steps, +1.1% SB, -0.7% light PA, and -0.4% MVPA each day (all P < 0.001). A total of 76.3% (n = 1083) never met guidelines (“stable low”), 7.9% (n = 112) consistently met guidelines (“stable high”), 8.2% (n = 116) stopped meeting guidelines by the last occasion (“decreasers”), and 4.9% (n = 69) started meeting guidelines by the last occasion (“increasers”). “Decreasers” spent 69.3% of each day in SB at baseline, which increased by 2% per year (P < 0.005), light activity remained at 23.3% (change, -0.2% per year; P = 0.4), and total MVPA decreased from 7.1% by -1.7% per year, (P < 0.001). The number of sedentary bouts >30 min increased from 5.1 by 0.1 per year (P = 0.02). Conclusions: Among older adults, the steep decline in total PA occurred because of reductions in MVPA, while light PA is relatively spared and sedentary time and long sedentary bouts increase.
Sedentary Behavior
Longitudinal Study
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The dose–response relationship between physical activity and health is of great interest to policy makers, clinicians and individuals. Several recent analyses of large-scale population data have advanced our understanding, particularly in teasing apart minimal and optimal physical activity dosage. For example, if we focus on ‘minimal’ dose, 15 min a day of moderate-intensity exercise lowered mortality in a sample of more than 400 000 adults from Taiwan.1 A recent meta-analysis of nine cohort studies revealed that undertaking some moderate to vigorous physical activity (MVPA) but less than the guidelines was associated with 22% reduction in mortality risk in older adults.2 For those fortunate to be able to be performing the ‘optimal’ levels of physical activity, an analysis of more than 600 000 adults of all ages from the USA and Europe showed that a nearly optimal threshold for longevity occurred at three to five times the physical activity recommendation (39% reduction in all-cause mortality). Note that the additional benefit over and above doses corresponding to one to two multiples of the physical activity guideline (31% reduction in all-cause mortality) was rather modest in general.3
In a new study4 using a …
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Two new studies offer some good news and some bad news about exercise, especially for people who are just starting. Shorter bouts of exercise can be just as effective at protecting the heart as longer workouts, but getting the heart rate up is a key factor because light activity offers no cardiac benefit.
Physical activity has long been associated with a decreased risk of coronary heart disease. It has been unclear, however, whether the duration of exercise episodes was important and whether accumulated shorter sessions were as predictive of decreased risk as longer sessions, provided that the same amount of energy was expended in each instance.
In 2 new studies, the researchers found that even with relatively small amounts of physical activity, with an energy expenditure of only 1,000 kcal (4.2 MJ) a week, the risk of coronary heart disease decreased by 20% compared with that in people who did not partake in that amount of activity. Whether the exercise occurred in a few long sessions or more frequent shorter sessions did not matter—there was a positive correlation between lowered risk and vigorous activity.
The same group of investigators conducted both studies, exploring the effects of the intensity and duration of exercise on coronary heart disease. Data for the 2 studies were taken from the Harvard alumni health study, during which Harvard alumni who entered the university from 1916 to 1950 were observed (Circulation 2000;102:975-980, 981-987).
In the first study, led by Dr Howard Sesso from the Department of Epidemiology at the Harvard School of Public Health in Boston, the researchers observed 12,516 men aged 39 to 88 years from 1977 to 1993. They found that those who expended more than 1,000 kcal a week in total physical activity reduced their risk of coronary heart disease by about 20%.
Overall, a lower but nonsignificant reduction in risk of 10% was seen for those expending 500 to 999 kcal a week, slightly less than the current exercise recommendations of the US Surgeon General.
In addition, the researchers found that vigorous activity was also predictive of a reduction in risk. “Moderate and light activities, which may be less precisely measured, showed nonsignificant inverse association,” the article said. The subject's heart rate needed to be raised more than 75% above baseline, so if a person's heart rate was 60, he or she needed to raise it above 105.
In a second study, led by Dr I-Min Lee from the Department of Medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, the researchers again found that physical activity was associated with about a 20% decrease in the risk of coronary heart disease.
This study observed 7,307 men with an average age of 66 years from 1988 to 1993. The researchers found that shorter sessions of physical activity were just as beneficial in decreasing the risk of coronary heart disease as 1 longer, continuous session of exercise, as long as the total caloric expenditure was equivalent.
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Objective To investigate, using accelerometers, the levels of physical activity being undertaken by individuals with intellectual disabilities with and without Down's syndrome. Methods One hundred and fifty two individuals with intellectual disabilities aged 12–70 years from East and South-East England. Physical activity levels in counts per minute (counts/min), steps per day (steps/day), and minutes of sedentary, light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) measured with a uni-axial accelerometer (Actigraph GT1M) for seven days. Results No individuals with intellectual disabilities met current physical activity recommendations. Males were more active than females. There was a trend for physical activity to decline and sedentary behaviour to increase with age, and for those with more severe levels of intellectual disability to be more sedentary and less physically active, however any relationship was not significant when adjusted for confounding variables. Participants with Down's syndrome engaged in significantly less physical activity than those with intellectual disabilities without Down's syndrome and levels of activity declined significantly with age. Conclusions Individuals with intellectual disabilities, especially those with Down's syndrome may be at risk of developing diseases associated with physical inactivity. There is a need for well-designed, accessible, preventive health promotion strategies and interventions designed to raise the levels of physical activity for individuals with intellectual disabilities. We propose that there are physiological reasons why individuals with Down's syndrome have particularly low levels of physical activity that also decline markedly with age.
Sedentary lifestyle
Promotion (chess)
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Establishing and maintaining healthy physical activity (PA) levels is important throughout life. The purpose of this study was to determine the extent of PA tracking between ages 3 and 7 y. Objective measures of PA (RT3, triaxial accelerometer) were collected every 4 mo from ages 3–7; data from 234 children with PA measures available during each year of age were analyzed. Mean PA (total, moderate/vigorous (MV), and inactivity [IA]) was calculated for each year of age and adjusted for wear time. Correlations with age 3 PA were moderate at age 4 ( r = .42−.45) but declined by age 7 ( r = .19−.25). After classification into sex-specific tertiles of PA at age 3, boys in the high age 3 MVPA tertile maintained significantly higher PA at all subsequent ages, while girls in the high age 3 MVPA tertile were not significantly higher at age 6 and 7. Boys and girls in the high age 3 IA tertile had significantly higher IA at multiple subsequent years of age ( p < .05 at ages 5 and 6). In conclusion, boys who were relatively more active at age 3 remained more active for several subsequent years. These findings highlight early-childhood differences in physical activity patterns between boys and girls.
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Both cross-sectional and longitudinal data suggest that the age-associated decline in VO 2max is greater in men when expressed in absolute terms such as L or mL· min —1 . When expressed in relative terms (ie, percentage decline per decade), the apparent gender difference disappears. Cross-sectional studies report a slower rate of decline than longitudinal studies, probably due to selection bias. The impact of physical activity on the rate of decline in aerobic power with age is not entirely clear. Meta-analyses of cross-sectional studies did not find increased levels of physical activity to be associated with lower rates of decline in VO 2max . Longitudinal studies suggest that regular vigorous exercise can slow the rate of decline in VO 2max by as much as 50%, but the reduction or cessation of training with advancing age may result in a misleading acceleration in that decline. The most consistent finding in cross-sectional and longitudinal studies is a strong association between the age-associated declines in maximal heart rate and VO 2max , but physical activity has little, if any, impact on maximal heart rate. Aerobic exercise training of sufficient intensity can increase aerobic power in both men and women, but the mechanisms may be different, with men demonstrating a greater improvement in factors related to stroke volume and cardiac output, whereas the adaptations in women appear to be more dependent on increased oxygen extraction by skeletal muscle.
Aerobic Exercise
Cross-sectional study
Exercise physiology
Metabolic equivalent
Aerobic capacity
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While most physicians readily accept the concept of vitalism, a vital force not necessarily chemical or mechanical is responsible for life itself, there have been no formal studies directly investigating energy and age. Daly (1984) noted an indirett relationship between life change and energy but did not study effects of age per se. Energy level, defined as the inherent potential for actively performing one's life work, was selfassessed by 54 middle-aged (M = 51.7 yr.) and 40 older (M = 73.5 yr.) adults from a convenience sample in a middle-sized Canad~an city. Respondents were predominantly in good health (85 % middle-aged and 65 % older adults reporting good health) and of middle level income (71% middle and 65% older). Middle-aged persons felt their 'peak' energy output had occurred at a mean age of 39.4 yr. ( S D 8.87), while older adults perceived their peak age at a mean of 47.5 yr. ( S D 4.71). Ac age 40, older adults felt they had retained 95.1% of their capacity (middle-aged 96.6%). At age 50, older adults felt they had retained 88.8% (middleaged 8 5 % ) . At age 60, older adults perceived their energy lwel at 78.2% (middleaged 82 2 % ) . At age 70, 80, and 90 yr. the older adults felt theic energy level at 74%, 78.8% and 72% capacity, respectively. Is it possible to collect normative data on energy level? Are these data reliable, accurate, and replicable? There are unfortunately clear methodological limitations in this study with regard to sampling, i.e., the older adults were obtained from an active square-dancing group) as well as to estimating energy level without distortion. Researchers could better assess energy level by employing cohort-longitudinal designs that include multiple measures of energy, e.g., neuromuscular testing at various ages. There are at hand some present findings which merit further study by researchers in gerontology: ( 1 ) middle-aged and older adults' perceptions of energy peaks and nadirs began to parallel one another and ( 2 ) , while 27% of the subjects studied felt that time or nonspecific living had led to a decline in energy, the remaining 73% all named specific stressful life events (Dohrenwend & Dohrenwend, 1978) chat appeared to change their energy level throughout the lifespan. Several respondents noted a return to premorbid levels after the stressors passed. The reason some older persons recovered was uncertain but may have to do with maintaining meaningful activity. As one spry 90-yr.-old aptly illustrated by the comment how interested in what I'm doing tells me my energy level!
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