Shilpa Dogra

Correlates of extended sitting time in older adults: an exploratory cross-sectional analysis of the Canadian Community Health Survey Healthy Aging Cycle

ObjectivesSitting time has been identified as an independent predictor of health; however, little is known of the determinants of extended sitting time among older adults. The purpose of this study was to identify potential sociodemographic, physical environment, health-related and psychosocial correlates of extended sitting time among older adults living independently in the community.MethodsData from adults over the age of 65 from the Canadian Community Health Survey (Healthy Aging Cycle, 2008–2009) were used for analysis (nxa0=xa014,560). Self-reported sitting time (<4 or ≥4xa0h/day) was the main outcome.ResultsAge, retirement status, dwelling type, chronic disease, perceived health, body mass index, mood disorder and sense of belonging to community were associated with sitting for 4 or more hours/day. Very low, but not low or moderate, physical activity (OR 1.43; CI 1.19–1.72) was associated with sitting for 4 or more hours/day when compared to those classified as having high physical activity.ConclusionsSeveral specific correlates of extended sitting time were identified among older males and females; these findings have implications for public health strategies targeting older adults.

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults. Methods A trained librarian created a search strategy that was peer reviewed for completeness. Results Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose–response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults. This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

Objectively measured and self-reported sedentary time in older Canadians

Objective The aim of this study was to examine objectively measured total and self-reported leisure sedentary time among older Canadians by work status. Methods The analysis was based on 1729 older adults (60–79 years) from the 2007/09 and 2010/11 Canadian Health Measures Survey. Work status, functional limitations, smoking, and perceived health were assessed by self-report and waist circumference (WC) was measured. Total sedentary time (ST) and physical activity (PA) were objectively measured by accelerometer and leisure sedentary activities were assessed by questionnaire. Results 93.6% of individuals were sedentary for 8 or more hours per day. Measured ST did not differ by work status, while self-reported leisure ST was higher in those not working compared to those working (239 vs. 207 minutes/day, p < 0.05). Correlates of measured ST were fair/poor perceived health (β: 28.76, p < 0.01), smoking (β: 17.12, p < 0.05), high-risk WC (β: 13.14, p < 0.05), and not meeting PA guidelines (β: 35.67, p < 0.001). For self-reported leisure ST, working status (β: 33.80, p < 0.001) and functional limitations (β: 16.31, p < 0.05) were significant correlates. Conclusions Older adults accumulate substantial ST regardless of their working status and ST is correlated with indicators of health risk. Older adults are an important target population for interventions to reduce ST.

Sedentary time in older men and women: an international consensus statement and research priorities

Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose–response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies. This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

Different Types of Sedentary Activities and Their Association With Perceived Health and Wellness Among Middle-Aged and Older Adults A Cross-Sectional Analysis

Purpose: To assess the association between a variety of sedentary activities and self-reported wellness outcomes to provide a comprehensive perspective for future development of sedentary guidelines for middle-aged and older adults. Design: Cross-sectional population study. Setting: Canadian Community Health Survey (Healthy Aging Cycle, 2008–2009). Subjects: Middle-aged (45–60 years; n = 8161) and older adults (60 years and older; n = 9128) were used for analysis. Measures: Self-reported perceived health, sense of belonging to community, mood disorder, and satisfaction with life were used as outcomes. Sedentary activities were playing bingo, computer use, doing crosswords/puzzles, handicrafts, listening to radio/music, playing a musical instrument, reading, visiting others, and watching TV. Analysis: Chi-squares, t-tests and multivariable logistic regressions. Results: Among respondents not diagnosed with a mood disorder, positive associations were noted for crosswords/puzzles in older adults (odds ratio [OR]: 1.39, confidence interval [CI]: 1.01–1.91) and listening to radio/music or playing an instrument in middle-aged adults (OR: 1.43, CI: 1.16–1.75; OR: 2.14, CI: 1.17–3.81). Satisfaction with life was positively associated with computer use in middle-aged (OR: 1.53, CI: 1.07–2.20) and older adults (OR: 1.42, CI: 1.09–1.84). Sense of belonging was consistently positively associated with sedentary activities. Conclusion: Several sedentary activities were found to be positively associated with self-reported measures of psychosocial wellness in middle-aged and older adults. These findings identify potential opportunities for sedentary time interventions and dual-task physical activity promotion.

Oxygen uptake kinetics in endurance-trained and untrained postmenopausal women

The rate of adjustment for pulmonary oxygen uptake (τV̇O(2p)) is slower in untrained and in older adults. Near-infrared spectroscopy (NIRS) has shed light on potential mechanisms underlying this in young men and women and in older men; however, there is no such data available in older women. The purpose of this study was to gain a better understanding of the mechanisms of slower τV̇O(2p) in older women who were either endurance-trained or untrained. Endurance-trained (n = 10; age, 62.6 ± 1.0 years) and untrained (n = 9; age, 69.1 ± 2.2 years) older women attended 2 maximal and 2 submaximal (90% of ventilatory threshold) exercise sessions. Oxygen uptake (V̇O(2)) was measured breath by breath, using a mass spectrometer, and changes in deoxygenated hemoglobin concentration of the vastus lateralis ([HHb]) were measured using NIRS. Heart rate was measured continuously with a 3-lead electrocardiogram. τV̇O(2p) was faster in trained (35.1 ± 5.5 s) than in untrained (57.0 ± 8.1 s) women. The normalized [HHb] to V̇O(2) ratio, an indicator of muscle O(2) delivery to O(2) utilization, indicated a smaller overshoot in trained (1.09 ± 0.1) than in untrained (1.39 ± 0.1) women. Heart rate data indicated a faster adjustment of heart rate in trained (33.0 ± 13.0) than in untrained (68.7 ± 14.1) women. The pairing of V̇O(2p) data with NIRS-derived [HHb] data indicates that endurance-trained older women likely have better matching of O(2) delivery to O(2) utilization than older untrained women during moderate-intensity exercise, leading to a more rapid adjustment of V̇O(2p).

The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVEnThe purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder.nnnMETHODSnWe conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias.nnnRESULTSnWe screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections.nnnCONCLUSIONSnThe current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.

Perceptions of Sedentary Behavior Among Socially Engaged Older Adults

PurposenTo better understand the perceptions of sedentary behavior, its pros and cons, and the barriers associated with reducing sedentary time as it pertains to older adults.nnnDesign and MethodsnFour focus group sessions were conducted with older adults (n = 26). Each focus group lasted approximately 45min, was led by an experienced qualitative researcher, and utilized probing questions on the definition of sedentary behavior, pros and cons of sedentary behavior, and programming needs for sedentary time reduction. Sessions were recorded and transcribed verbatim. Two researchers independently extracted data from the transcripts and identified major themes and subthemes. Data on sociodemographics and current activity levels were collected via questionnaires.nnnResultsnParticipants were 74±8.5 years old and were primarily women (77%). They self-reported sitting for 5.6±1.7h per day and engaging in physical activity for 172±115min/day. Four themes were identified. The first theme indicated that older adults have varied definitions of the term sedentary behavior and that they have a negative perception of this term. The second theme indicated that participants perceived social, cognitive, and physical benefits to the sedentary activities in which they engaged, and that these activities were meaningful. The third theme indicated that physical health was the only perceived disadvantage of engaging in sedentary activities. Finally, the fourth theme indicated that there were several perceived barriers to sedentary time reduction, both person and environment related.nnnImplicationsnThese findings have implications for use of terminology in policy and public health strategies targeting sedentary time reduction in older adults.

The acute response to interval and continuous exercise in adults with confirmed airway hyper-responsiveness

OBJECTIVESnTo determine changes in lung function following an acute bout of high intensity interval exercise (HIIE), moderate intensity interval exercise (MIIE), and moderate intensity continuous exercise (MICE) in adults with airway hyper-responsiveness (AHR).nnnDESIGNnA randomized cross-over design was used.nnnMETHODSnParticipants completed five laboratory sessions: (1) eucapnic voluntary hyperpnea challenge (2) maximal exercise test to determine peak power output (PPO) and, (3-5) HIIE (90% PPO for 1min followed by 10% PPO for 1min, repeated 10 times), MIIE (65% PPO for 1min followed by 10% PPO for 1min, repeated 10 times) and MICE (65% PPO for 20min). Lung function was assessed pre and post-exercise.nnnRESULTSnThirteen participants (age: 21.1±2.7years) with mild/moderate asthma completed all protocols. Lung function was significantly lower following the MICE (-14.8%±12.2) protocol compared to the HIIE (-7.1%±8.3) and MIIE (-4.5%±3.3).nnnCONCLUSIONSnIt appears that MICE is associated with the greatest decline in post-exercise FEV1 among those with AHR. Interval exercise may be better tolerated than continuous exercise among those with AHR.

Physical activity and sedentary time are related to clinically relevant health outcomes among adults with obstructive lung disease

BackgroundThe purpose of the current study was to determine the association between sedentary time and physical activity with clinically relevant health outcomes among adults with impaired spirometry and those with or without self-reported obstructive lung disease (asthma or COPD).MethodsData from participants of the Canadian Longitudinal Study on Aging were used for analysis (nu2009=u20094156). Lung function was assessed using spirometry. Adults were said to have impaired spirometry if their Forced Expiratory Volume in 1xa0s was <5th percentile lower limit of normal (LLN). A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Healthcare use and quality of life outcomes were assessed using self report.ResultsAmong those with asthma, participating in strengthening activities was associated with lower odds of reporting poor perceived health (ORu2009=u20090.65, CI: 0.53, 0.79), poor perceived mental-health (ORu2009=u20090.73, CI: 0.60, 0.88), unhealthy aging (ORu2009=u20090.68, CI: 0.56, 0.83), and reporting an emergency department visit in the past 12xa0months (ORu2009=u20090.76, CI: 0.60, 0.95). Among those with COPD, those who reported highest weekly sedentary time had higher odds of reporting poor perceived health (ORu2009=u20092.70, CI: 1.72, 4.24), poor perceived mental-health (ORu2009=u20091.99, CI: 1.29, 3.06), and unhealthy aging (ORu2009=u20093.04, CI: 1.96, 4.72). Among those below the LLN, sitting time (ORu2009=u20092.57, CI: 1.40, 4.72) and moderate intensity physical activity (ORu2009=u20090.23, CI: 0.09, 0.63) were associated with overnight hospital stays.ConclusionsHigher physical activity levels and lower sedentary time may be associated with lower healthcare use and better quality of life. This research may have implications related to the use of physical activity for improving health outcomes and quality of life among adults with obstructive lung disease or impaired spirometry.