Mathieu de Greef

Gait in ageing and associated dementias; its relationship with cognition.

The focus of this review is on the close relationship between gait and cognition in ageing and associated dementias. This close relationship is supported by epidemiological studies, clinical studies of older people with and without dementia that focused on the intensity of the physical activity, clinical studies with older persons without dementia examining a relationship between gait and specific cognitive processes, and human and animal experimental studies examining a neural basis for such a relationship. Despite these findings, most studies with patients with dementia focus exclusively on the relationship between cognition and dementia, with relatively few addressing the relationship between gait and dementia. However, subtle disturbances in gait can be observed in ageing and in (preclinical) subtypes of dementia that are not known for prominent motor disturbances, i.e. Mild Cognitive Impairment, Alzheimers Disease, vascular Cognitive Impairment No Dementia, Subcortical Ischaemic Vascular Dementia, Frontotemporal Mild Cognitive Impairment, and Frontotemporal Dementia, supporting a close relationship between gait and cognition. The relationship between gait and cognition is weakened by the few available intervention studies that examine the effects of walking on cognition in patients with (preclinical) dementia. These studies report equivocal results, which will be discussed. Finally, suggestions for future research will be made.

Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program.

OBJECTIVE To investigate whether a 12-week pedometer-based exercise counseling strategy is feasible and effectively enhances daily physical activity in outclinic Chronic Obstructive Pulmonary Disease (COPD) patients who do not participate in a rehabilitation program in a controlled way. METHODS 35 outclinic COPD patients (21 males, mean age 62 years, GOLD I-III, mean FEV(1)% predicted 64.7) were randomized for a 12-week individual pedometer-based exercise counseling program promoting daily physical activities or usual care. Daily physical activity (DigiWalker SW-200), physical fitness, health-related quality of life, self-efficacy, fatigue, depression and motivation to be physically active were assessed before and after the intervention. RESULTS After the intervention, COPD patients in the exercise counseling group showed a significant increase in their mean number of steps/day (from 7087 to 7872), whereas the usual care group showed a decrease (from 7539 to 6172). Significant differences favoring the exercise counseling group were demonstrated in arm strength, leg strength, health-related quality of life and intrinsic motivation to be physically active. CONCLUSION Our study shows that a 12-week pedometer-based exercise counseling strategy is feasible and effectively enhances daily physical activity, physical fitness, health-related quality of life and intrinsic motivation in outclinic COPD patients who do not participate in a rehabilitation program. PRACTICE IMPLICATIONS The feasibility of our exercise counseling strategy is good and patients were motivated to participate.

Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life

The objective of this study was to perform a systematic review on training outcomes influencing physical fitness, activity of daily living performance, and quality-of-life in institutionalized older people. We reviewed 27 studies on older people (age, ≥70 yrs) in long-term care facilities and nursing homes. Our ultimate goal was to propose criteria for an evidence-based exercise protocol aimed at improving physical fitness, activity of daily living performance, and quality-of-life of frail institutionalized older people. The interventions, described in the reviewed studies that showed strong or very strong effect sizes were used to form an exercise prescription. The conclusion is that there is firm evidence for training effects on physical fitness, functional performance, activity of daily living performance, and quality-of-life. The training should contain a combination of progressive resistance training, balance training, and functional training. The proposed intensity is moderate to high, assessed on a 0-10 scale for muscle strengthening activities. The training frequency was three times a week, and the total duration was at least 10 wks.

Low Physical Activity and Risk of Cardiovascular and All-Cause Mortality in Renal Transplant Recipients

BACKGROUND AND OBJECTIVES Low physical activity (PA) is a risk factor for mortality in the general population. This is largely unexplored in renal transplant recipients (RTRs). We studied whether PA is associated with cardiovascular and all-cause mortality in a prospective cohort of RTR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Between 2001 and 2003, 540 RTRs were studied (age, 51 ± 12 years; 54% male). PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). Cardiovascular and all-cause mortality were recorded until August 2007. RESULTS Independent of age, PA was inversely associated with metabolic syndrome, history of cardiovascular disease, fasting insulin, and triglyceride concentration, and positively associated with kidney function and 24-hour urinary creatinine excretion (i.e., muscle mass). During follow-up for 5.3 years (range, 4.7 to 5.7 years), 81 RTRs died, with 37 cardiovascular deaths. Cardiovascular mortality was 11.7, 7.2, and 1.7%, respectively, according to gender-stratified tertiles of PA (P=0.001). All-cause mortality was 24.4, 15.0, and 5.6% according to these tertiles (P<0.001). In Cox regression analyses, adjustment for potential confounders including history of cardiovascular disease, muscle mass, and traditional risk factors for cardiovascular disease did not materially change these associations. CONCLUSIONS Low PA is strongly associated with increased risk for cardiovascular and all-cause mortality in RTRs. Intervention studies are necessary to investigate whether PA improves long-term survival after renal transplantation.

Physical fitness related to disability in older persons

Background: In today’s aging society, preventing or reducing disability is important. Physical activity may serve this goal. Generally, physical activity aims to enhance physical fitness, which in turn may prevent disability. The relationship between physical fitness and disability has been much less explored than the relationship between physical activity and physical fitness. Objective: To investigate the relationship between separate components of physical fitness and disability. Methods: The subjects were a community-based sample of 176 men and 233 women aged 65 years or older. Physical fitness was assessed with performance-based tests. Disability and potential confounders were assessed during face-to-face interviews. Results: Independently of other fitness components, walking endurance, grip strength, manual dexterity and balance contributed significantly to the prediction of disability for both men and women. Flexibility of the hip and spine, flexibility of the shoulder and reaction time were not independent predictors of disability for men or women. Physical fitness explained a greater percentage of variance in disability for women (31–48%) than for men (14–34%). Although depressive symptoms, cognitive functioning (men), number of chronic conditions (women) and age (women) explained additional variance in disability, these variables did not confound the relationship between physical fitness and disability. Conclusion: Walking endurance, grip strength and manual dexterity are important unique predictors of disability. Physical activity programs should be directed at these fitness components.

Differences between participants and non-participants in an RCT on physical activity and psychological interventions for older persons

Background and aims: Volunteer bias in intervention studies on successful aging has been poorly explored. This paper investigated differences between participants and non-participants of the Groningen Intervention Study on Successful Aging (GISSA) over a wide range of demographic, physical, psychological and social subject characteristics. Methods: Subjects were recruited among a longitudinal cohort study (Groningen Longitudinal Aging Study) and included 558 men and 711 women, aged 65–96 years, who were invited to participate in the GISSA. Measures were obtained by questionnaires at the moment of invitation and eight years before invitation. Participants were compared with three groups of non-participants: persons who refused to participate, those who did not respond after a reminder, and those who intended to participate but withdrew before pre-test. Results: At the moment of invitation, participants were younger, better educated, and functionally and physically more active than the three groups of non-participants. They also had better scores on the physical functioning subscale of the medical outcome scale, better ADL, iADL and vigorous ADL functions and fewer depressive symptoms, and perceived less social support in everyday and problem situations. Participants reported a less strong rate of decline in physical and psychological functioning in the eight years prior to the invitation than did the other groups. Conclusion: Due to volunteer bias, results of intervention studies on successful aging may have limited generalizability.

Manipulative therapy and clinical prediction criteria in treatment of acute nonspecific low back pain.

Manipulative therapy as part of a multidimensional approach may be more effective than standard physical therapy in treating Acute Nonspecific Low Back Pain. 64 participants, 29 women and 35 men, with Acute Nonspecific Low Back Pain and a mean age of 40 yr. (SD = 9.6) were randomly assigned to two groups: an experimental group (manipulative therapy plus physical therapy) and a control group (only physical therapy). A multicentre, nonblinded, randomised clinical trial was conducted. Pain relief was the main performance criteria measured together with secondary criteria which included functional status and mobility of the lower back. Fritz, Childs, and Flynns clinical prediction rule—a duration of symptoms less than 16 days, no pain distal of the knee—was used to analyse the results. In combination with an age > 35 years, results showed a statistical significant effect for disability, but no statistically significant benefit of additional manipulative therapy over physical therapy found for pain and mobility within 4 treatments. Controlled for the applied clinical prediction rule, there were statistically significant interaction effects with low effect size for disability and sex, but no significant effects were found for pain of mobility.

Consequences of physical inactivity in chronic obstructive pulmonary disease

The many health benefits of regular physical activity underline the importance of this topic, especially in this period of time when the prevalence of a sedentary lifestyle in the population is increasing. Physical activity levels are especially low in patients with chronic obstructive pulmonary disease (COPD). Regular physical activity and an active lifestyle has shown to be positively associated with outcomes such as exercise capacity and health-related quality of life, and therefore could be beneficial for the individual COPD patient. An adequate level of physical activity needs to be integrated into daily life, and stimulation of physical activity when absent is important. This article aims to discuss in more detail the possible role of regular physical activity for a number of well-known outcome parameters in COPD.

Self-efficacy for physical activity and insight into its benefits are modifiable factors associated with physical activity in people with COPD: a mixed-methods study

QUESTIONS What are the perceived reasons for people with chronic obstructive pulmonary disease (COPD) to be physically active or sedentary? Are those reasons related to the actual measured level of physical activity? DESIGN A mixed-methods study combining qualitative and quantitative approaches. PARTICIPANTS People with mild to very severe COPD. OUTCOME MEASURES Participants underwent a semi-structured interview and physical activity was measured by a triaxial accelerometer worn for one week. RESULTS Of 118 enrolled, 115 participants (68% male, mean age 65 years, mean FEV1 57% predicted, mean modified Medical Research Council dyspnoea score 1.4) completed the study. The most frequently reported reason to be physically active was health benefits, followed by enjoyment, continuation of an active lifestyle from the past, and functional reasons. The most frequently reported reason to be sedentary was the weather, followed by health problems, and lack of intrinsic motivation. Mean steps per day ranged between 236 and 18 433 steps. A high physical activity level was related to enjoyment and self-efficacy for physical activity. A low physical activity level was related to the weather influencing health, financial constraints, health and shame. CONCLUSION We identified important facilitators to being physically active and barriers that could be amenable to change. Furthermore, we distinguished three important potential strategies for increasing physical activity in sedentary people with COPD, namely reducing barriers and increasing insight into health benefits, tailoring type of activity, and improvement of self-efficacy.

Psychological and Physical Activity Training for Older Persons: Who Does Not Attend?

Background: Interventions to promote successful aging include psychological and physical activity programs. Identification of determinants of attendance of older persons may be useful to develop strategies to improve attendance. For physical activity programs determinants of attendance have been investigated extensively. For psychological programs hardly any knowledge is available. Determinants of attendance at psychological and physical activity programs have never been investigated simultaneously. Objective: To identify demographic, physical and psychological determinants of attendance of older subjects following multifaceted psychological training – aimed at promoting active social participation – and physical activity training and to compare the variation of these determinants between the two training programs. Method: 118 subjects aged 65–92 years were randomized over psychological and physical activity training. Determinants of attendance were obtained at pretest with questionnaires and performance-based tests. Results: Mean attendance was 62%. Attendance was not related to type of program. Having chronic diseases facilitated attendance in the psychological training group and limited attendance in the physical activity training group. Low and high levels of Activities of Daily Living performance (ADLs) and walking endurance were related to a high attendance in the psychological training group. A low level of activities of daily living (ADL) and a low walking endurance were related to a low attendance in the physical activity training group. For both training groups, persons living with a partner had higher attendance rates than persons living alone, and persons with a low level of anxiety had higher attendance rates than persons with a moderate or a high level of anxiety. Conclusion: Psychological training may be more suitable for frail older persons with chronic diseases, low ADL levels and low walking endurance than physical activity training, and may help to prepare such persons for physical activity.