Li-Jung Chen

Obesity, fitness and health in Taiwanese children and adolescents.

Objective:To examine the prevalence of childhood and adolescent obesity in Taiwan and investigate the association between excess weight and physical fitness and blood pressure.Design:Cross-sectional study.Subjects:A total of 13 935 children and adolescents aged 6–18 years (boys: 7031, girls: 6904) were involved in the 1999 survey and 24 586 (boys: 12 367, girls: 12 219) were available in the 2001 survey.Measurements:Weight, height, systolic and diastolic blood pressures, and health-related fitness tests (bent-leg curl-ups, sit-and-reach test and step test) were measured.Results:The overall prevalence of obesity (including overweight) in boys was 19.8% in 1999 and 26.8% in 2001. It was lower in girls with 15.2% in 1999 and 16.5% in 2001. The normal weight group performed better (P<0.05) than the overweight/obese group in all fitness tests except in the 2001 sit-and-reach test where there were no differences between the two groups. The risk of hypertension increased nearly two times for the overweight/obese-fit group and nearly three times for the overweight/obese-unfit group compared to the normal weight-fit group (adjusted odds ratio (AOR)=1.93, 95%CI=1.514–2.451 and AOR=2.93, 95%CI=2.493–3.454, respectively).Conclusion:Overall, the findings demonstrated that there is an increasing trend in overweight/obesity prevalence for Taiwanese youth even in a 2-year period. The overweight/obese youngsters tend to have poorer muscular strength and cardiovascular endurance than the normal weight group. The overweight/obese and unfit group had a greater risk of hypertension than other groups. However, this risk was significantly lower if obese/overweight children had a higher than average level of cardiovascular fitness.

Physical Activity and Depressive Symptoms in Older Adults 11-Year Follow-Up

BACKGROUND Few studies have explored the reciprocal relationships between naturally occurring changes in physical activity and depressive symptoms in later life. PURPOSE This study examined the reciprocal associations between changes in physical activity and depressive symptoms in a population-based sample of Taiwanese older adults over an 11-year period. METHODS Analyses were based on nationally representative data from the Taiwans Health and Living Status of the Elderly Survey collected in 1996, 1999, 2003, and 2007. Data from the fixed cohort of 1160 participants aged ≥67 years in 1996 with 11 years of follow-up were studied. Depressive symptoms were assessed using the ten-item Chinese version of the Center for Epidemiologic Studies-Depression Scale. Physical activity was self-reported as the number of sessions per week. Latent growth modeling was used to examine the bidirectional associations between changes in physical activity and depressive symptoms when controlling for sociodemographic variables, lifestyle behaviors, and health status. Data analyses were completed in 2011. RESULTS With multivariate adjustment, initial levels of physical activity were negatively associated with changes in depressive symptoms (β=-0.34, p<0.05). In contrast, early depressive symptoms were not related to change in physical activity (β=-0.17, p>0.05). CONCLUSIONS Physical activity engagement in later life is associated with a lower risk of subsequent depressive symptoms, but the reverse association is not supported. The finding has underlying implications for future physical activity and mental health promotion in aged populations.

Relationships of leisure-time and non-leisure-time physical activity with depressive symptoms: a population-based study of Taiwanese older adults.

BackgroundLimited research has explored the relationship between non-leisure-time physical activity (NLTPA), including domestic and work-related physical activities, with depressive symptoms. This study was designed to elucidate independent associations between leisure-time physical activity (LTPA), NLTPA, and specific parameters of physical activity (frequency, duration and intensity) with depressive symptoms in older adults.MethodsA total of 2,727 persons aged ≥ 65 years participating in the 2005 Taiwan National Health Interview Survey were studied. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale. Information regarding energy parameters for each type of LTPA and NLTPA during the past 2-week period was analyzed. After adjusting for socio-demographic variables, lifestyle behaviors and health status, multivariate logistic regression models were used to compute adjusted odds ratios (AOR) for LTPA and NLTPA for predicting depressive symptoms.ResultsLTPA but not NLTPA was significantly associated with depressive symptoms. Compared with participants expending 2000+ kcal/week through LTPA, the risk of experiencing depressive symptoms was significantly higher for those expending 1-999 kcal/week (AOR = 2.06, 95% CI: 1.25-3.39), and those who expending 0 kcal/week (AOR = 3.72, 95%CI: 2.28-6.06). Among the three parameters of LTPA (intensity, duration and frequency) examined, only intensity was independently associated with depressive symptoms.ConclusionsThese findings imply that exercise recommendations for older adults should emphasize the importance of higher intensity activity, rather than frequency or duration, for improved mental well-being. However, well-designed prospective cohort studies or intervention trials are needed to confirm these findings.

Fitness Change and Subsequent Academic Performance in Adolescents

BACKGROUND This study examined the association between fitness change and subsequent academic performance in Taiwanese schoolchildren from 7th grade to 9th grade. METHODS The 7th graders from 1 junior high school district participated in this study (N = 669). Academic performance was extracted from school records at the end of each grade. Cardiovascular (CV) fitness, sit-and-reach flexibility, bent-leg curl-ups, and height and weight for calculating body mass index (BMI) were assessed at the start of each grade. RESULTS The results showed that improvement in CV fitness, but not muscular endurance or flexibility, is significantly related to greater academic performance. A weak and nonsignificant academic-BMI relationship was seen. CONCLUSION CV fitness exhibits stronger longitudinal associations with academic performance than other forms of fitness or BMI for adolescents.

Prospective associations between leisure-time physical activity and cognitive performance among older adults across an 11-year period.

Background Few studies have explored the relations between naturally occurring changes in physical activity and cognitive performance in later life. This study examined prospective associations between changes in physical activity and cognitive performance in a population-based sample of Taiwanese older adults during an 11-year period. Methods Analyses were based on nationally representative data from the Taiwan Health and Living Status of the Elderly Survey collected in 1996, 1999, 2003, and 2007. Data from a fixed cohort of 1160 participants who were aged 67 years or older in 1996 and followed for 11 years were included. Cognitive performance (outcome) was assessed using 5 questions from the Short Portable Mental Status Questionnaire. Physical activity (exposure) was self-reported as number of sessions per week. The latent growth model was used to examine associations between changes in physical activity and cognitive performance after controlling for sociodemographic variables, lifestyle behaviors, and health status. Results With multivariate adjustment, higher initial levels of physical activity were significantly associated with better initial cognitive performance (standardized coefficient β = 0.17). A higher level of physical activity at baseline (1996) was significantly related to slower decline in cognitive performance, as compared with a lower level of activity (β = 0.22). The association between changes in physical activity and changes in cognitive performance was stronger (β = 0.36) than the previous 2 associations. The effect remained after excluding participants with cognitive decline before baseline. Conclusions Physical activity in later life is associated with slower age-related cognitive decline.

Prospective Associations Between Household-, Work-, and Leisure-Based Physical Activity and All-Cause Mortality Among Older Taiwanese Adults

Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

Accelerometer-assessed light physical activity is protective of future cognitive ability: A longitudinal study among community dwelling older adults

Objective: Physical activity (PA), especially moderate‐to‐vigorous intensity, could protect older adults from cognitive impairment. However, most literature is based on self‐reported PA which is limited by recall bias. Light PA is popular among older adults, but a paucity of objective longitudinal data has considered the relationship between light PA and cognitive ability. We examined if a higher level of objectively measured light PA, independent of moderate‐to‐vigorous physical activity (MVPA), was prospectively associated with better cognitive ability in older adults. Methods: A longitudinal study over 22.12 (± 1.46) months including 274 community‐dwelling older adults across 14 regions in Taiwan was undertaken. Cognitive ability was obtained using a Chinese version of the Ascertain Dementia 8‐item Questionnaire (AD8) and light PA and MVPA captured by 7 days accelerometer positioned on waist. Multivariable negative binomial regression adjusted for confounders were undertaken. Results: 274 participants (74.52 years, 45.6% male) attended the follow‐up (96.1%). Higher light PA, independent from MVPA, was associated with a reduced rate of decline in cognitive ability (rate ratio 0.75 [0.60–0.92]). MVPA, was also associated with a reduced decline in cognitive ability (rate ratio 0.85 [0.75–0.95]). Light PA was protective of cognitive ability in sensitivity analyses removing participants with activities of daily living difficulties, depressive symptoms and cognitive impairment at baseline. Conclusion: Our data suggest that light PA may offer a protective influence of future cognitive ability in community dwelling older adults. The promotion of light PA may be a valuable means to maintain cognitive ability in older age. HighlightA paucity of studies have considered objective longitudinal PA and future cognitive ability decline in older adults.Our data suggests that higher LPA, independent of MVPA, is associated with a reduced risk of future cognitive decline.This is the first longitudinal paper to investigate light intensity PA and cognitive decline in older adults.This extends the existing evidence for the benefits of PA for preventing cognitive deterioration in later life.

Relationship Between Objectively Measured Sedentary Behavior and Cognitive Performance in Patients With Schizophrenia Vs Controls.

Objective Sedentary behavior (SB) is associated with poor cognitive performance in the general population. Although people with schizophrenia are highly sedentary and experience marked cognitive impairments, no study has investigated the relationship between SB and cognition in people with schizophrenia. Methods A total of 199 inpatients with schizophrenia (mean [SD] age 44.0 [9.9] years, 61.3% male, mean [SD] illness duration 23.8 [6.5]) and 60 age and sex matched controls were recruited. Sedentary behavior and physical activity (PA) were captured for 7 consecutive days with an accelerometer. Cognitive performance was assessed using the Vienna Test System, and the Grooved Pegboard Test. Multivariate regression analyses adjusting for important confounders including positive and negative symptoms, illness duration, medication, and PA were conducted. Results The 199 patients with schizophrenia engaged in significantly more SB vs controls (581.1 (SD 127.6) vs 336.4 (SD 107.9) min per day, P < .001) and performed worse in all cognitive performance measures (all P < .001). Compared to patients with high levels of SB (n = 89), patients with lower levels of SB (n = 110) had significantly (P < .05) better motor reaction time and cognitive processing. In the fully adjusted multivariate analysis, SB was independently associated with slower motor reaction time (β = .162, P < .05) but not other cognitive outcomes. Lower levels of PA were independently associated with worse attention and processing speed (P < .05). Conclusion Our data suggest that higher levels of sedentary behavior and physical inactivity are independently associated with worse performance across several cognitive domains. Interventions targeting reductions in SB and increased PA should be explored.

A Longitudinal Study of Childhood Obesity, Weight Status Change, and Subsequent Academic Performance in Taiwanese Children.

BACKGROUND This study examined the association among childhood obesity, weight status change, and subsequent academic performance at 6-year follow-up. METHODS First-grade students from one elementary school district in Taichung City, Taiwan were followed for 6 years (N = 409). Academic performance was extracted from the school records at the end of each grade. Weight and height were measured at the beginning of each grade. A weight change variable was created based on each childs weight status difference at grades 1 and 6. A multivariate linear regression model for predicting academic performance at grade 6 was developed with adjustment for individual characteristics and family factors. A latent growth curve (LGC) showed the association between changes in body mass index (BMI) and in academic performance across a 6-year period. RESULTS BMI in children increased significantly across 6 years. The rate of increase in BMI over 6 years was higher for children with higher baseline BMIs than it was for children with lower baseline BMIs. However, BMI changes were not significantly associated with changes of academic performance. CONCLUSION There was no significant relationship between initial obesity or change in weight status and subsequent academic performance. It appears that either being or becoming overweight/obese did not impact academic achievement for these Taiwanese children.

Physical activity ameliorates the association between sedentary behavior and cardiometabolic risk among inpatients with schizophrenia: A comparison versus controls using accelerometry

OBJECTIVE A lack of clarity exists regarding the relationship between objectively measured physical activity (PA) and sedentary behavior (SB) and cardiometabolic outcomes in people with schizophrenia. We conducted a large study investigating the independent relationships of PA and SB among inpatients with schizophrenia versus healthy controls (HCs). METHODS A cross sectional study including 199 inpatients with schizophrenia (mean age 44.0years, mean illness duration 23.8years) versus 60 age/sex/body mass index matched HCs. Participants wore accelerometers for 7days to capture SB and daily steps. Cardiometabolic outcomes included blood pressure, fasting blood glucose (FBG), triglycerides, high-density lipoprotein cholesterol (HDL-C) and waist circumference (WC). Multivariate regression analyses adjusting for multiple confounders were undertaken. RESULTS Compared to HCs, patients engaged in more sedentary behavior and less daily steps versus HCs (p<0.001). Patients with higher levels of SB (n=89) had increased fasting glucose compared to patients with low levels of SB (105.2 vs. 96.3mg/dl, p<0.05). In the multivariate analysis, sedentary behavior was associated with higher FBG (β = .146, p=.041) but this was ameliorated when daily steps were inserted in to the model (β = .141, p=.059). In the final model, higher daily steps were associated with more favorable HDL-C (β=-.226, p=.004), independent of SB and other confounders. CONCLUSIONS Our data suggest that higher than while sedentary behavior is related to worse fasting glucose, this relationship is attenuated when PA is taken into account. Physical activity is also associated with favorable HDL-C. Interventions targeting replacing sedentary behavior with PA may improve metabolic risk.