Ahmed Elhakeem

Childhood socioeconomic position and adult leisure-time physical activity: a systematic review

Regular leisure-time physical activity (LTPA) benefits health and is thought to be less prevalent in lower socioeconomic groups. Evidence suggests that childhood socioeconomic circumstances can impact on adult health and behaviour however, it is unclear if this includes an influence on adult LTPA. This review tested the hypothesis that a lower childhood socioeconomic position (SEP) is associated with less frequent LTPA during adulthood. Studies were located through a systematic search of MEDLINE, Embase, PsycINFO, CINAHL and SPORTDiscus and by searching reference lists. Eligible studies were English-language publications testing the association between any indicator of childhood SEP and an LTPA outcome measured during adulthood. Forty-five papers from 36 studies, most of which were European, were included. In most samples, childhood SEP and LTPA were self-reported in midlife. Twenty-two studies found evidence to support the review’s hypothesis and thirteen studies found no association. Accounting for own adult SEP partly attenuated associations. There was more evidence of an association in British compared with Scandinavian cohorts and in women compared with men. Results did not vary by childhood SEP indicator or age at assessment of LTPA. This review found evidence of an association between less advantaged childhood SEP and less frequent LTPA during adulthood. Understanding how associations vary by gender and place could provide insights into underlying pathways.

Birth Weight, School Sports Ability, and Adulthood Leisure-time Physical Activity

Purpose This study aimed to examine the associations of birth weight with ability in school sports in adolescence and participation in leisure-time physical activity (LTPA) across adulthood and to investigate whether associations between birth weight and LTPA change with age. Methods Study participants were British singletons born in 1946 and followed up to age 68 yr (the Medical Research Council National Survey of Health and Development). Birth weights were extracted from birth records. Teacher reports of ability in school sports were collected at age 13 yr. LTPA was self-reported at ages 36, 43, 53, 60–64, and 68 yr and categorized at each age as participating in sports, exercise, and other vigorous LTPA at least once per month versus no participation. Associations were examined using standard and mixed-effects logistic regression models. Results Relevant data were available for 2739 study participants (50.1% female). When compared with the low birth weight group (⩽2.50 kg), those with heavier birth weights were more likely to be rated as above average or average at school sports (vs below average); fully adjusted odds ratio = 1.78 (95% confidence interval = 1.14–2.77). Across adulthood, those with heavier birth weights were more likely to participate in LTPA than those with low birth weight; fully adjusted odds ratio of LTPA across adulthood = 1.52 (95% confidence interval = 1.09–2.14). This association did not vary by age (P = 0.5 for birth weight by age interaction). Conclusions Low birth weight was associated with lower ability in school sports and with nonparticipation in LTPA across adulthood. Identifying the underlying developmental and social processes operating across life for low birth weight infants may inform the design of appropriate interventions to support participation in LTPA across life.

Intergenerational social mobility and leisure-time physical activity in adulthood: a systematic review

Aim To systematically review the association between intergenerational social mobility and leisure-time physical activity (LTPA) in adulthood, in order to assess all published evidence relating to the hypothesis that adults socially mobile between childhood and adulthood will have different levels of LTPA than those in the same socioeconomic group across life. Methods A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified by searching databases (MEDLINE, Embase, PsycINFO) and reference lists. Eligible studies examined associations between any indicator of social mobility, based on at least one measure of parental socioeconomic position (SEP) and one measure of own adult SEP, and LTPA in adulthood. Results 13 studies comprising a total of 44 000 participants from the UK, Finland, Sweden, Australia, USA and Brazil were included. Participants were aged 16–70 years and were from population-based surveys, occupational cohorts and primary care registries. Most studies (n=9) used occupational class measures to identify social mobility; education (n=4) and income (n=1) were also used. There was consistent evidence in nine of the 13 studies that stable high socioeconomic groups tended to report the highest levels of participation in LTPA and stable low socioeconomic groups the lowest. Upward and downwardly mobile groups participated in LTPA at levels between these stable groups. Conclusions Cumulative exposure to higher SEP in childhood and adulthood was associated with higher LTPA in adulthood. Thus, a potential outcome of policies and interventions which aim to minimise exposure to socioeconomic adversity may be increased LTPA among adults. Trial registration number CRD42016036538.

Physical Activity Producing Low, but Not Medium or Higher, Vertical Impacts Is Inversely Related to BMI in Older Adults: Findings From a Multicohort Study

Abstract Background High impact physical activity (PA) is thought to improve skeletal health, but its relation to other health outcomes are unclear. We investigated associations between PA impact magnitude and body mass index (BMI) in older adults. Methods Data were taken from the Cohort for Skeletal Health in Bristol and Avon (COSHIBA), Hertfordshire Cohort Study, and MRC National Survey of Health and Development. Vertical acceleration peaks from 7-day hip-worn accelerometer recordings were used to classify PA as low (0.5 < g < 1.0g), medium (1 < g < 1.5g), or higher (≥1.5g) impact. Cohort-specific associations of low, medium, and higher impact PA with BMI were examined using linear regressions and estimates combined using random-effects meta-analysis. Results A total of 1182 participants (mean age = 72.7 years, 68% female) were included. Low, medium, and higher impact PA were inversely related to BMI in initial models. After adjustment for confounders and other impacts, low, but not medium or higher, impacts were inversely related to BMI (−0.31, p < .001: overall combined standard deviation change in BMI per doubling in the number of low impacts). In adjusted analyses of body composition measured by dual-energy X-ray absorptiometry in COSHIBA, low, but not medium or higher, impacts were inversely related to total body fat mass (−0.19, p < .001) and android:gynoid fat mass ratio (−0.16, p = .01), whereas high impact PA was weakly and positively associated with lean mass (0.05, p = .06). Conclusions Greater exposure to PA producing low magnitude vertical impacts was associated with lower BMI and fat mass at older age. Low impact PA may help reduce obesity risk in older adults.

Prevention of cervical cancer in HIV-seropositive women from developing countries: a systematic review protocol.

BackgroundOver 85% of cervical cancer cases and deaths occur in developing countries. HIV-seropositive women are more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women. However, the literature on cervical cancer prevention in seropositive women in developing countries has not been reviewed. The aim of this study is to systematically review cervical cancer prevention modalities available for HIV-seropositive women in developing countries.Methods/designThis protocol was developed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and the systematic review will be reported in accordance with the PRISMA guidelines. Embase, MEDLINE, PubMed, CINAHL and Cochrane Library will be searched from inception up to date of final search, and additional studies will be located through citation and reference list tracking. Eligible studies will be randomised controlled trials, prospective and retrospective cohort studies, case-control and cross-sectional studies carried out in developing countries. Studies will be included if they are published in English and examine cervical cancer prevention modalities in HIV-seropositive women. Results will be summarised in tables and, where appropriate, combined using meta-analysis.DiscussionThis review will address the gap in evidence by systematically reviewing the published literature on the different prevention modalities being used to prevent cervical cancer in HIV-seropositive women in developing countries. The findings may be used to inform evidence-based guidelines for prevention of cervical cancer in seropositive women as well as future research.Systematic review registrationPROSPERO CRD42017054678.

Leisure-time physical activity across adulthood and biomarkers of cardiovascular disease at age 60-64: a prospective cohort study

Background and aims This study examined associations between leisure-time physical activity (LTPA) across adulthood (from age 36) and cardiovascular disease (CVD) biomarkers at age 60–64. Methods LTPA was reported by study participants from the MRC National Survey of Health and Development at ages 36, 43, 53 and 60–64 (n = 1754) and categorised as inactive, moderately active (1–4/month) or most active (5+/month) at each age. Linear regression was used to examine associations between a cumulative adulthood LTPA score (range = 0–8), and change in LTPA between ages 36 and 60–64 (i.e. always inactive, became inactive, became active, always active) and inflammatory [C-reactive protein (CRP), interleukin-6 (IL-6)], endothelial [tissue-Plasminogen Activator (t-PA), E-selectin] and adipokine [leptin, adiponectin] measures extracted from overnight fasting blood samples at age 60–64. Results The more active a participant was over adulthood, the better their biomarker profile, e.g. fully-adjusted difference in t-PA (both sexes) and adiponectin (women) per unit increase in the LTPA score (95% confidence interval) = −2.2% (−3.6; −0.8) and 2.0% (0.2; 3.8). Those that became active at age 60–64 showed slightly healthier biomarker profiles than those that became inactive [e.g. fully-adjusted difference in IL-6 = −9.9% (−23.9; 4.1) vs. −3.8% (−12.4; 4.8)], although the best profiles were seen for those always active [IL-6: −15.0% (−24.2; −5.7)], when compared with the always inactive group. Conclusions Greater accumulation of LTPA across adulthood was associated with a more favourable CVD biomarker profile in early old age. Earlier uptake and long-term maintenance of LTPA may provide the greatest benefits for CVD prevention.

Childhood socioeconomic position and adult leisure-time physical activity: a systematic review protocol

BackgroundParticipation in leisure-time physical activity benefits health and is thought to be more prevalent in higher socioeconomic groups. Evidence indicates that childhood socioeconomic circumstances may have long-term influences on adult health and behaviour; however, it is unclear if this extends to an influence on adult physical activity. The aim of this review is to examine whether a lower childhood socioeconomic position is associated with lower levels of leisure-time physical activity during adulthood.Methods/designKeywords will be used to systematically search five online databases and additional studies will be located through a search of reference lists. At least two researchers working independently will screen search results assess the quality of included studies and extract all relevant data. Studies will be included if they are English language publications that test the association between at least one indicator of childhood socioeconomic position and a leisure-time physical activity outcome measured during adulthood. Any disagreements and discrepancies arising during the conduct of the study will be resolved through discussion.DiscussionThis study will address the gap in evidence by systematically reviewing the published literature to establish whether childhood socioeconomic position is related to adult participation in leisure-time physical activity. The findings may be used to inform future research and policy.Systematic review registrationPROSPERO CRD42014007063.

Motor performance in early life and participation in leisure-time physical activity up to age 68 years

Abstract Background This study examined associations between motor performance in early life and leisure‐time physical activity (LTPA) participation across adulthood, and whether these changed with age. Methods Data were from 2526 participants from the Medical Research Council National Survey of Health and Development. Motor indicators were mother‐reported ages at first standing and walking, teacher‐rated games ability at age 13, and finger‐ and foot‐tapping speed at age 15. LTPA was reported at ages 36, 43, 53, 60‐64, and 68 years and classed at each age as none, moderate (1‐4/mo), or regular (≥5/mo). Associations were examined using mixed‐effects Poisson regression models with robust error variance. Results Better ability at games and faster tapping speed were associated with more frequent participation in LTPA across adulthood, for example, fully adjusted relative risk of regular LTPA across adulthood (vs none) for above‐average ability (vs below average or average) = 1.46 (95% CI 1.32, 1.61); and per 10‐unit higher number of finger‐taps/15 seconds = 1.04 (95% CI 1.02, 1.07). These associations did not vary by age (P ≥ .33 for interactions with age at LTPA). Ages at reaching motor milestones were not associated with LTPA (eg, fully adjusted relative risk of regular LTPA across adulthood for walking ≤10 and ≥18 months (vs 11‐17 months) were 1.01 (95% CI 0.86, 1.20) and 0.89 (95% CI 0.75, 1.06) respectively. Conclusions Better ability at games and faster tapping speed in adolescence were associated with greater participation in LTPA throughout adult life; from age 36 up to age 68. Childhood motor skill interventions may therefore have the potential to promote lifelong LTPA.

Physical activity across adulthood and bone health in later life: the 1946 British birth cohort

Leisure‐time physical activity (LTPA) is widely recommended for the prevention of osteoporosis and fractures in older populations. However, whether the beneficial effects of LTPA on bone accumulate across life and are maintained even after reduction or cessation of regular PA in later life is unknown. We examined whether LTPA across adulthood was cumulatively associated with volumetric and areal bone mineral density (vBMD, aBMD) at ages 60 to 64 and whether associations were mediated by lean mass. Up to 1498 participants from the Medical Research Council National Survey of Health and Development were included in analyses. LTPA was self‐reported at ages 36, 43, 53, and 60 to 64, and responses summed to generate a cumulative score (range 0 = inactive at all four ages to 8 = most active at all four ages). Total and trabecular vBMD were measured at the distal radius using pQCT and aBMD at the total hip and lumbar spine (L1 to L4) using DXA. Linear regression was used to test associations of the cumulative LTPA score with each bone outcome. After adjustment for height and weight, a 1‐unit increase in LTPA score (95% CI) in men was associated with differences of 1.55% (0.78% to 2.31%) in radial trabecular vBMD, 0.83% (0.41% to 1.25%) in total hip aBMD, and 0.97% (0.44% to 1.49%) in spine aBMD. Among women, positive associations were seen for radial trabecular vBMD and total hip aBMD, but only among those of greater weight (LTPA × weight interaction p ≤ 0.01). In men, there was evidence to suggest that lean mass index may partly mediate these associations. These findings suggest that there are cumulative benefits of LTPA across adulthood on BMD in early old age, especially among men. The finding of weaker associations among women suggests that promotion of specifıc types of LTPA may be needed to benefit bone health in women.

Associations of lifetime walking and weight bearing exercise with accelerometer-measured high impact physical activity in later life

High impact physical activity (PA) is thought to benefit bone. We examined associations of lifetime walking and weight bearing exercise with accelerometer-measured high impact and overall PA in later life. Data were from 848 participants (66.2% female, mean age = 72.4 years) from the Cohort for Skeletal Health in Bristol and Avon, Hertfordshire Cohort Study and MRC National Survey of Health and Development. Acceleration peaks from seven-day hip-worn accelerometer recordings were used to derive counts of high impact and overall PA. Walking and weight bearing exercise up to age 18, between 18–29, 30–49 and since age 50 were recalled using questionnaires. Responses in each age category were dichotomised and cumulative scores derived. Linear regression was used for analysis. Greater lifetime walking was related to higher overall, but not high impact PA, whereas greater lifetime weight bearing exercise was related to higher overall and high impact PA. For example, fully-adjusted differences in log-overall and log-high impact PA respectively for highest versus lowest lifetime scores were: walking [0.224 (0.087, 0.362) and 0.239 (− 0.058, 0.536)], and weight bearing exercise [0.754 (0.432, 1.076) and 0.587 (0.270, 0.904)]. For both walking and weight bearing exercise, associations were strongest in the ‘since age 50’ category. Those reporting the most walking and weight bearing exercise since age 50 had highest overall and high impact PA, e.g. fully-adjusted difference in log-high impact PA versus least walking and weight bearing exercise = 0.588 (0.226, 0.951). Promoting walking and weight bearing exercise from midlife may help increase potentially osteogenic PA levels in later life.