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Physical Activity and Health of Middle-Aged and Older Japanese Across the COVID-19 Pandemic: Differential Outcomes Highlight a Problematic Life Stage

Michael Annear, Tetsuhiro Kidokoro, and Yasuo Shimizu

Introduction: COVID-19 caused major disruptions across the super-aged nation of Japan, yet few studies explored temporal changes among middle-aged and older cohorts from baseline to the height of community transmission. Changes in physical activity and sedentary behavior during global pandemics may alter patterns of morbidity and mortality among susceptible aging populations. Objectives: This study investigated patterns of physical activity, sitting behavior, and health among representative samples of middle-aged and older adults in Tokyo before and during the pandemic. Methods: Repeated online surveys were conducted with quota samples of 800 Tokyo residents in 2019 and 2021 using validated Japanese-language measures, including the short form-International Physical Activity Questionnaire and the Basic Ecological Health Scale-6. Statistical analyses included comparative evaluations of activity parameters by age cohort, gender, and selected covariates. Statistical tests included the Kruskal–Wallis test, Mann–Whitney U test, chi-square test for Independence and Hierarchical Regression. Results: Over 34% of respondents were inactive at each data collection point, and 72% reported negative impacts of COVID-19 on their physical activities. Older adults showed no significant changes in their activity and sitting behavior and reported better health compared with those in middle age across the pandemic. Middle-aged males reported a significant decline in total activity of 33% across the pandemic period (U = 16,958, z = −2.64, p = .008, r = .13). Middle-aged females reported the lowest levels of physical activity, and health, and showed a 29% increase in sitting behavior across the pandemic (U = 16,925, z = −2.68, p = .007, r = .13). Subjective health status was consistently associated with higher overall activity and walking before and during the pandemic. Conclusion: Differential outcomes were identified between age and gender regarding health, physical activity, walking, and sitting across the pandemic with significantly worse impacts reported among middle-aged samples. Implications: These results have implications for healthy transitions to later life and the design of postpandemic interventions to address activity opportunities in Japan.

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Personalization Characteristics and Evaluation of Gamified Exercise for Middle-Aged and Older People: A Scoping Review

Lisha Ren, Jie Yan, Zhehao Zhu, and Murui Du

Many studies have shown that personalized exergames have a positive effect on promoting regular and proper exercise. However, there is no consensus on the design characteristics and evaluation of exergames. This systematic review of published research literature aimed to explore the general characteristics, personalization characteristics, and evaluation of personalized exergames for middle-aged and older people. We screened published studies in the Web of Science, Scopus, PubMed, ACM, and IEEE Xplore databases, extracted data, and performed a thematic analysis according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Three main themes and nine subthemes were generated from 24 included papers. Moreover, a personalization model (FACTS) and evaluation system (PMSS) of exergames were developed. Personalized exergames had potential positive effects on motivating middle-aged and older people to exercise and improve their health, particularly physical, mental, and social health. However, more fine-grained studies on personalized exergames are necessary in the future.

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Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults

Letícia Martins Cândido, Núbia Carelli Pereira de Avelar, Eleonora D’Orsi, Ana Cristina Rodrigues Lacerda, Vanessa Amaral Mendonça, Gabriella Tringali, Alessandro Sartorio, and Ana Lúcia Danielewicz

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3–4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3–4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

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Association of Sitting Time With All-Cause and Cardiovascular Mortality: How Does Frailty Modify This Association?

Felipe Diaz-Toro, Carolina Nazzal Nazal, Gabriela Nazar, Ximena Diaz-Martinez, Yeny Concha-Cisternas, Carlos Celis-Morales, and Fanny Petermann-Rocha

To investigate how frailty modifies the association of sitting time with all-cause and cardiovascular mortality in Chilean adults. This prospective study included 2,604 participants aged ≥35 from the Chilean National Health Survey 2009–2010. Sitting time was self-reported, while frailty was assessed using a 36-item Frailty Index. Sitting time was categorized as low, medium, and high. Cox proportional hazard models were used to estimate the risk of mortality stratified for the sitting time categories. Over a median follow-up of 8.9 years, 311 participants died, 28% of them due to cardiovascular events. Frail people with prolonged sitting time were at higher risk of all-cause and cardiovascular mortality (hazard ratio 3.13; 95% confidence interval [2.06, 4.71] and hazard ratio 2.41; 95% confidence interval [1.50, 3.64], respectively). The observed risk was higher in women than men. Public health and individual strategies should be implemented to decrease sitting time across the population, with special attention on frail people.

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Erratum. Effects of Dancing Associated With Resistance Training on Functional Parameters and Quality of Life of Aging Women: A Randomized Controlled Trial

Journal of Aging and Physical Activity

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The Impact of Multimorbidity Patterns on Changes in Physical Activity and Physical Capacity Among Older Adults Participating in a Year-Long Exercise Intervention

Tiina Savikangas, Taija Savolainen, Anna Tirkkonen, Markku Alén, Arto J. Hautala, Jari A. Laukkanen, Timo Rantalainen, Timo Törmäkangas, and Sarianna Sipilä

This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1 year later. Participants were 314 physically inactive community-dwelling men and women aged 70–85 years, with no contraindications for exercise at baseline. Physical activity was self-reported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%–12% of baseline variance and 0%–3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training.

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Volume 31 (2023): Issue 6 (Dec 2023)

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Baseline Measures of Physical Activity and Function Do Not Predict Future Fall Incidence in Sedentary Older Adults: A Prospective Cohort Study

Justin Whitten, Rod Barrett, Christopher P. Carty, Dawn Tarabochia, David MacDonald, and David Graham

Physical activity (PA) and physical function (PF) are modifiable risk factors for falls in older adults, but their ability to predict future fall incidence is unclear. The purpose of this study was to determine the predictive ability of baseline measures of PA, PF, and lower limb strength on future falls. A total of 104 participants underwent baseline assessments of PA, PF, and lower limb strength. Falls were monitored prospectively for 12 months. Eighteen participants fell at least once during the 12-month follow-up. Participants recorded almost exclusively sedentary levels of activity. PA, PF, and lower limb strength did not differ between fallers and nonfallers. Twelve participants, who reported a minor musculoskeletal injury in the past 6 months, experienced a fall. The results of this study suggest that in a cohort of highly functioning, sedentary older adults, PA does not distinguish fallers from nonfallers and that the presence of a recent musculoskeletal injury appears to be a possible risk factor for falling.

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Impact of COVID-19 on Physical Activity, Fatigue, and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study

Veerle Knoop, Axelle Costenoble, Aziz Debain, Kristof Van der Meulen, Patricia De Vriendt, Ellen Gorus, Bert Bravenboer, Bart Jansen, Aldo Scafoglieri, Ivan Bautmans, and Gerontopole Brussels Study Group

This study aimed to describe the level of physical activity and its relation to fatigue and frailty during the COVID-19 pandemic in community-dwelling older adults aged 80 years and over. Three hundred and ninety-one older adults (aged 86.5 ± 3.00) completed a survey including physical activity, the Mobility Tiredness scale, and the FRAIL scale. Linear regression analysis was conducted to assess whether the variables age, sex, and physical activity (independent factors) were significantly related to fatigue and frailty. Respectively, 30.5% and 24.7% of the participants reported a decrease in walking and in energy-intensive activities; 25.4% reported increased sedentary behavior. A lower level of physical activity was associated with higher levels of fatigue and increased frailty risk (p < .05), independently from psychological symptoms. These results are important because participants with lower levels of physical activity and more sedentary behavior are more likely to feel fatigued and have higher risk to be frail.

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Physical Activity Changes From Before to During the First Wave of the COVID-19 Pandemic Among Community-Dwelling Older Adults in Finland

Katja Lindeman, Laura Karavirta, Johanna Eronen, Niina Kajan, Erja Portegijs, and Taina Rantanen

This study aimed to compare community-dwelling older adults’ physical activity (PA) during the COVID-19 restrictions in 2020 to their PA levels 2 years before and investigate associations between earlier physical performance and PA levels over the follow-up. Participants’ (n = 809, initial age 75–85 years) self-reported PA was assessed at baseline in 2017–2018 and May/June 2020 as total weekly minutes of walking and vigorous PA. Physical performance was assessed at baseline using the maximal handgrip strength and Short Physical Performance Battery tests. During the first wave of the COVID-19 pandemic, a median change in total weekly minutes of walking and vigorous PA among all participants was + 20.0 (interquartile range: −60.0 to 120.0, p < .001) min per week compared with 2 years earlier. Higher baseline Short Physical Performance Battery total scores were associated with higher total weekly minutes of walking and vigorous PA over the follow-up in men and women, and better handgrip strength in women.