Longitudinal patterns of physical activity from midlife to old age: predictors and consequences for cardiovascular disease morbidity and mortality risks

BACKGROUND/AIMS: Physical activity is important for almost all aspects of healthy ageing, including cardiovascular disease (CVD) prevention. While an age-related decline in physical activity is clear from cross-sectional studies, there are few prospective cohort studies with sufficient follow up to identify the long-term patterns of physical activity across adulthood and into old age. Subsequently, the predictors and health consequences of long-term patterns of physical activity are unclear. The primary aim of this thesis is to identify the patterns of long-term physical activity from midlife to old age and examine the predictors of such patterns and consequences in relation to cardiovascular morbidity and mortality. METHODS: This thesis uses data from the British Regional Heart Study, a prospective cohort study of men recruited in 1978-80 when they were aged 40 to 59 years. Initially, this thesis uses data from baseline up to the 20-year follow up, when men were aged 60-79 years, to examine change and trajectories of total and specific types of physical activity. Subsequent analyses explore associations between trajectories of physical activity and CVD risk factors, major stroke and coronary heart disease events, CVD mortality and all-cause mortality up until June 2016. RESULTS: One of the key findings was that total physical activity levels in old age were largely predicted by midlife physical activity. Trajectories of physical activity varied according to type; walking and recreational activity were more variable over time than total physical activity and sport/exercise. Smoking, being overweight or obese and suffering from breathlessness were associated with increased odds of following unfavourable trajectories for total and specific types of physical activity. Sociodemographic, health and behavioural factors were also associated but the direction and magnitude of associations were specific to physical activity type. Compared to a low, decreasing trajectory, light stable and moderate, increasing trajectories were associated with more favourable levels of CVD risk factors and a lower risk of all-cause mortality, CVD mortality and major coronary heart disease. There was also a dose-response relationship, suggesting that higher levels of physical activity across adulthood were more favourable. CONCLUSIONS: Physical activity levels in midlife largely determine activity levels throughout adulthood and into old age. Sport and exercise appears to be the most stable physical activity type and the strongest predictor of subsequent activity levels, whereas walking and recreational activity are more variable. A range of sociodemographic, health and behavioural factors were associated with long-term patterns of physical activity and could be used to inform intervention strategies. Although sustaining/increasing moderate levels of physical activity from midlife to old age are optimal for minimising risks of CVD and mortality, maintaining a light level of physical activity across the adult life course can also provide significant survival benefits and could be achievable for the least active

Context-Specific Associations of Physical Activity and Sedentary Behavior With Cognition in Children

In the present study, we investigated how overall and specific domains of physical activity and sedentary behavior at the age of 7 years were associated with cognition at the age of 11 years in 8,462 children from the Millennium Cohort Study. Data were collected from 2001 to 2013. Participation in domains of physical activity and sedentary behavior at 7 years of age were reported. Activity levels were also measured objectively. Cognition was assessed using the British Ability Scales. General linear models were used to assess longitudinal associations of physical activity and sedentary behavior, measured both objectively and via self-report, with cognition. Analyses were adjusted for prespecified covariates. Sports/physical activity club attendance (B = 0.6, 95% confidence interval (CI): 0.2, 1.1), doing homework (B = 0.5, 95% CI: 0.0, 0.9), and objectively measured sedentary time (B = 0.8, 95% CI: 0.1, 1.4) at age 7 years were positively associated with cognition at age 11 years in final the models. Television viewing was negatively associated with cognition (B = −1.7, 95% CI: −2.4, −1.0), although the association was attenuated to the null after adjustments for baseline cognition. Objectively measured light physical activity was inversely associated with cognition (B = −0.7, 95% CI: −1.3, −0.1). Moderate-to-vigorous physical activity was also inversely associated with cognition in girls only (B = −1.1, 95% CI: −2.0, −0.3). Associations of physical activity and sedentary behavior with cognition appear to be context-specific in young people

Fundus Autofluorescence and Spectral Domain OCT in Central Serous Chorioretinopathy

Background. To describe the standard autofluorescence (FAF), the near infrared autofluorescence (NIA) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy, correlating them with fluorescein angiography. Methods. Cross-sectional observational study, in which patients with at least seven months of CSC underwent ophthalmologic examination, fundus photography, FAF, NIA, fluorescein angiography (FA), and spectral-domain OCT. Results. Seventeen eyes of thirteen patients were included. the presentation features were a mottled hyperFAF in the detached area and areas with pigment mottling. NIA images showed areas of hyperNIA similar to FAF and localized areas of hypoNIA, which correlated with the points of leakage in the FA. OCT showed pigment epithelium detachment at the location of these hypoNIA spots. Discussion. FAF showed increased presence of fluorophores in the area of retinal detachment, which is believed to appear secondary to lipofuscin accumulation in the RPE or the presence of debris in the subretinal fluid. NIA has been related to the choroidal melanin content and there were areas of both increased and decreased NIA, which could be explained by damage ahead the retina, basically RPE and choroid. These findings, along with the PEDs found in the areas of hypoNIA, support the notion of a primary choroidal disease in CSC.Universidade Federal de São Paulo, Dept Ophthalmol, Paulista Sch Med, BR-04025011 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, Paulista Sch Med, BR-04025011 São Paulo, BrazilWeb of Scienc

Early life cognitive function and health behaviours in late childhood: testing the neuro-selection hypothesis

Background: Higher cognitive function in childhood is associated with healthier behaviours and a reduced risk of chronic disease in adulthood, but it is unclear whether this selection of healthier behaviours occurs in childhood or later in life. The present study investigated how cognitive function at age 3-7 years was associated with health behaviours at age 11. Methods: Verbal, non-verbal and spatial abilities were assessed using the British Ability Scales at ages 3-7. At age 11, children reported how often they engaged in sport/physical activity, sedentary behaviours (e.g. reading and games console usage), cigarette smoking and alcohol consumption. Logistic regression was used to estimate odds of engaging in health behaviours at age 11 according to early life cognition. Results: A one standard deviation increase in early childhood verbal ability was associated with reduced odds of attempting smoking by age 11 in boys and girls (OR 0.69 [95% CI 0.57, 0.84]) and reduced odds of computer gaming in girls (OR 0.79 [95% CI 0.72, 0.86]). Verbal ability was also associated with reduced odds of regular participation at age 11 in sport/active games and increased odds of reading for enjoyment. Non-verbal ability was associated with reduced odds of alcohol consumption in boys and girls (OR 0.92 [95% CI 0.85, 0.99]) and reduced odds of online messaging (OR 0.89 [95% CI 0.81, 0.98]). Spatial ability was associated with reduced odds of participating in sport/active games in boys. Conclusion: Neuroselection may occur during early life resulting in some, but not all, healthier behaviours

Tracking of sport and exercise types from midlife to old age: a 20-year cohort study of British men.

Background: Previous physical activity (PA) tracking studies have examined the stability of overall PA and/or PA types, but few have investigated how specific types of sport/exercise track over the life course. The aim of this study was to determine how specific sports/exercises in midlife track and predict future sport/exercise and PA in men transitioning to old age. Methods: Seven thousand seven hundred thirty-five men (aged 40-59 years) recruited in 1978-80 were followed up after 12, 16 and 20 years. At each wave men self-reported participation in sport/exercise. Frequent sport/exercise participants (> 1/month) reported the types of sport/exercise they engaged in. Men also reported total PA, health status, lifestyle behaviours and socio-demographic characteristics. Stability of each sport/exercise was assessed using kappa statistics and intraclass correlation coefficients. Logistic regression estimated the odds of participating in sport/exercise and being active at 20-year follow up according to specific types of sport/exercise in midlife. Results: Three thousand three hundred eighty-four men with complete data at all waves were included in analyses. Tracking of specific sports/exercises ranged from fair to substantial, with golf being the most common and most stable. Bowls was the most frequently adopted. Odds of participating in sport/exercise and being active in old age varied according to sport/exercise types in midlife. Golf and bowls in midlife were the strongest predictors of sport/exercise participation in old age. Golf, cricket and running/jogging in midlife were among the strongest predictors of being active in old age. Compared to participating in just one sport/exercise in midlife, sampling multiple sports/exercises was more strongly associated with sport/exercise participation and being active in old age. Conclusion: The stability of sport/exercise participation from midlife to old age varies by type. Specific sports/exercises in midlife may be more likely to predict future PA than others. However, participating in a range of sports/exercises may be optimal for preserving PA into old age

Effects of reallocating time in different activity intensities on health and fitness: a cross sectional study

BACKGROUND: The effects of replacing time in specific activity categories for other categories (e.g. replacing sedentary time with light activity) on health and fitness are not well known. This study used isotemporal substitution to investigate the effects of substituting activity categories in an equal time exchange fashion on health and fitness in young people. METHODS: Participants were drawn from schools in Camden, London (n = 353, mean age 9.3 ± 2.3 years). Time sedentary, in light and in moderate-to-vigorous activity (MVPA) was measured via accelerometry. The effects of substituting time in activity categories (sedentary, light and MVPA) with equivalent time in another category on health and fitness were examined using isotemporal substitution. RESULTS: In single and partition models, MVPA was favourably associated with body fat %, horizontal jump distance and flexibility. Time sedentary and in light activity were not associated with health and fitness outcomes in these models. In substitution models, replacing one hour of sedentary time with MVPA was favourably associated with body fat % (B = -4.187; 95% confidence interval (CI), -7.233, -1.142), horizontal jump distance (B = 16.093; 95% CI, 7.476, 24.710) and flexibility (B = 4.783; 95% CI, 1.910, 7.656). Replacing time in light activity with MVPA induced similar benefits but there were null effects for replacing sedentary with light intensity. CONCLUSION: Substituting time sedentary and in light activity with MVPA was associated with favourable health and fitness. Time in sedentary behaviour may only be detrimental to health and fitness when it replaces time in MVPA in young people

Mothers' perceived proximity to green space is associated with TV viewing time in children: the Growing Up in Scotland study

Objective. The aim of this study is to investigate whether mothers' perception of distance from home to green/ open spaces is associated with their child's screen time. Method. We used mother-reported data from sweep six (2010–2011) of the Growing Up in Scotland study (n = 3586 children aged 5.9 yrs) to examine associations between walking distance from home to green/open space and screen time (TV viewing time/computer use). Analyses were adjusted for age, sex and other prespecified covariates, including sport/exercise participation, mental and general health, birth weight, parental socio-economic group (SEG) and smoking status. Results. Children living the furthest distance from green/open spaces (N20 minutes' walking distance) displayed over 2 h (95% CI, 0.65 to 3.51) more weekly TV time than the reference category (b5 minutes' walking distance). Compared to children in the reference category, those in the N20 minute category had worse mental health (mean SDQ [Strengths and Difficulties Questionnaire] score ± SD, 7.0 ± 4.6 vs. 8.7 ± 6.2) and general health (% fair–poor, 4.6 vs. 8.6), and were more likely to come from lower SEG households. Conclusion. Mothers' perceived distance from home to green/open spaces was associated with child's TV time at age 5.9 years

Aggio et al. Respond to "Lessons for Research on Cognitive Aging"

Aggio et al. Respond to "Lessons for Research on Cognitive Aging

'On Your Feet to Earn Your Seat': update to randomised controlled trial protocol

Background: This update describes changes to procedures for our randomised controlled trial of 'On Your Feet to Earn Your Seat', a habit-based intervention to reduce sedentary behaviour in older adults. Some of the amendments have arisen from the addition of new sites, each offering different possibilities and constraints for study procedures. Others have been made in response to problems encountered in administering intended recruitment procedures at the London sites described in our original protocol. All changes have received ethics and governance clearance, and were made before or during data collection and prior to analyses.Methods/design: Five non-London UK NHS-based sites (three general practices, one hospital, one NHS Foundation Trust) have been added to the study, each employing locally-tailored variations of recruitment and data collection procedures followed at the London sites. In contrast to the London sites, accelerometry data are not being collected nor are shopping vouchers being given to participants at the new sites. Data collection was delayed at the London sites because of technical difficulties in contacting participants. Subsequently, a below-target sample size was achieved at the London sites (n = 23), and recruitment rates cannot be estimated. Additionally, the physical inactivity inclusion criterion (i.e., <30 consecutive minutes of leisure time activity) has been removed from all sites, because we found that participants at the London sites meeting this criterion at consent subsequently reported activity above this threshold at the baseline assessment.Conclusion: This is primarily a feasibility trial. The addition of new sites, each employing different study procedures, offers the opportunity to assess the feasibility of alternative recruitment and data collection methods, so enriching the informational value of our analyses of primary outcomes. Recruitment has finished, and the coincidence of a small sample at the London sites with addition of new sites has ensured a final sample size similar to our original target

On Your Feet to Earn Your Seat::pilot RCT of a theory-based sedentary behaviour reduction intervention for older adults

BackgroundOf all age groups, older adults spend most of the time sitting and are least physically active. This sequential, mixed-methods feasibility study used a randomised controlled trial design to assess methods for trialling a habit-based intervention to displace older adults’ sedentary behaviour with light activity and explore impact on behavioural outcomes.MethodsEligibility criteria were age 60–74 years, retired, and ≥6 h/day leisure sitting. Data were collected across four sites in England. The intervention comprised a booklet outlining 15 ‘tips’ for disrupting sedentary habits and integrating activity habits into normally inactive settings, and eight weekly self-monitoring sheets. The control was a non-habit-based factsheet promoting activity and sedentary reduction. A computer-generated 1:1 block-randomisation schedule was used, with participants blinded to allocation. Participants self-reported sedentary behaviour (two indices), sedentary habit, physical activity (walking, moderate, vigorous activity) and activity habit, at pre-treatment baseline, 8- and 12-week follow-ups and were interviewed at 12 weeks. Primary feasibility outcomes were attrition, adverse events and intervention adherence. The secondary outcome was behavioural change.ResultsOf 104 participants consented, 103 were randomised (intervention N = 52, control N = 51). Of 98 receiving allocated treatment, 91 (93%; intervention N = 45; control N = 46) completed the trial. One related adverse event was reported in the intervention group. Mean per-tip adherence across 7 weeks was ≥50% for 9/15 tips. Qualitative data suggested acceptability of procedures, and, particularly among intervention recipients, the allocated treatment. Both groups appeared to reduce sedentary behaviour and increase their physical activity, but there were no apparent differences between groups in the extent of change.ConclusionsTrial methods were acceptable and feasible, but the intervention conferred no apparent advantage over control, though it was not trialled among the most sedentary and inactive population for whom it was developed. Further development of the intervention may be necessary prior to a large-scale definitive trial. One possible refinement would combine elements of the intervention with an informational approach to enhance effectiveness