Risk Factors for Surgical Treatment of Lumbar Degenerative Disc Disease in Middle-aged and Older Women: A Prospective Case-Control Study of 2370 Subjects.

OBJECTIVE: Given the distinct physiological and societal traits between women and men, we propose that there are distinct risk factors for lumbar degenerative disc disease surgeries, including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS), in middle-aged and older populations. However, few studies have focused on middle-aged and older women. This study aims to identify these risk factors specifically in this population. METHODS: In this case-control study, the study group comprised 1202 women aged ≥ 45 years who underwent operative treatment of lumbar degenerative disc disease (LDH, n = 825; LSS, n = 377), and the control group comprised 1168 women without lumbar disease who visited a health examination clinic during the same period. The study factors included demographics (age, body mass index [BMI], smoking, labor intensity, and genetic history), female-specific factors (menopausal status, number of deliveries, cesarean section, and simple hysterectomy), surgical history (number of abdominal surgeries, hip joint surgery, knee joint surgery, and thyroidectomy), and systemic diseases (hypercholesterolemia, hypertriglyceridemia, hyper-low-density lipoprotein cholesterolemia, hypertension, diabetes, cardiovascular disease, and cerebrovascular disease). Multivariate binary logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of associated factors. RESULTS: The risk factors for surgical treatment of LDH in middle-aged and older women included BMI (OR = 1.603), labor intensity (OR = 1.189), genetic history (OR = 2.212), number of deliveries (OR = 1.736), simple hysterectomy (OR = 2.511), hypertriglyceridemia (OR = 1.932), and hyper-low-density lipoprotein cholesterolemia (OR = 2.662). For surgical treatment of LSS, the risk factors were age (OR = 1.889), BMI (OR = 1.671), genetic history (OR = 2.134), number of deliveries (OR = 2.962), simple hysterectomy (OR = 1.968), knee joint surgery (OR = 2.527), hypertriglyceridemia (OR = 1.476), hyper-low-density lipoprotein cholesterolemia (OR = 2.413), and diabetes (OR = 1.643). Cerebrovascular disease was a protective factor against surgery for LDH (OR = 0.267). CONCLUSIONS: BMI, genetic history, number of deliveries, simple hysterectomy, hypertriglyceridemia, and hyper-low-density lipoprotein cholesterolemia were independent risk factors for surgical treatment of both LDH and LSS in middle-aged and older women. Two disparities were found: labor intensity was a risk factor for LDH patients, and knee joint surgery and diabetes were risk factors for LSS patients.

Age at first birth is associated with the likelihood of frailty in middle-aged and older women: A population-based analysis from NHANES 1999-2018.

OBJECTIVES: This study examined whether age at first birth (AFB) is associated with the prevalence of frailty in middle-aged and older women. METHODS: The study included 10,828 women (age ≥ 45 years) from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) in the United States. AFB data were collected using a standardized reproductive health questionnaire. Frailty was measured using a 53-item frailty index and was diagnosed if the score on that index was over 0.21. Survey-weighted logistic regression models were used to assess the association between AFB and the prevalence of frailty. A survey-weighted restricted cubic spline (RCS) model was used to determine the dose-response relationship between AFB and frailty. Mediation analyses were performed to estimate the mediated effects of education levels, family poverty income ratio, and parity on the association between AFB and the likelihood of frailty. Finally, sensitivity and subgroup analyses were conducted to validate the robustness of our findings. RESULTS: Among the 10,828 women, 3828 (35.4 %) had frailty. The RCS depicted a U-shaped association between AFB and frailty. Compared with the women in the reference group (AFB: 33-35 years), women in the other groups (AFB: < 18, 18-20, 21-23, and 24-26 years) had a higher likelihood of frailty, with respective odds ratios (95 % confidence intervals) of 3.02 (1.89-4.83), 2.32 (1.54-3.50), 1.83 (1.19-2.81), and 1.64 (1.07-2.53). However, no statistically significant differences were detected for women with AFB of 27-29, 30-32, or > 35 years compared with the reference group. Education levels, family poverty income ratio, and parity significantly mediated the approximately linear negative association between AFB and frailty in the subset of women with AFB of ≤32 years and the mediation proportions were 23.4 %, 32.4 %, and 18.3 %, respectively (all p < 0.001). CONCLUSIONS: Based on our results, we conclude that early AFB is associated with a higher likelihood of frailty in middle-aged and older women.

Four weeks of lower-limb static stretching reduces regional arterial stiffness in middle-aged and older women.

PURPOSE: This study aimed to clarify whether habitual lower-limb stretching intervention reduces regional arterial stiffness at the stretched site in middle-aged and older women. METHODS: In this study, the effects of 4 weeks of lower-limb static stretching (of the hip extensor and flexor, knee extensor and flexor, and plantar flexor muscles) were investigated on systemic, central, and peripheral arterial stiffness using pulse wave velocity in 14 healthy middle-aged and older women randomly assigned to either a sedentary control group (67.3 ± 5.6 years; n = 7) or a stretching intervention group (63.4 ± 6.4 years; n = 7). RESULTS: The femoral-ankle pulse wave velocity (an index of peripheral arterial stiffness) significantly decreased in the intervention group (pre, 1222.4 ± 167.5 cm/s; post, 1122.0 ± 141.1 cm/s) but did not change in the control group (pre, 1122.7 ± 107.7 cm/s; post, 1139.9 ± 77.5 cm/s). However, the brachial-ankle pulse wave velocity as an index of systemic arterial stiffness (control: pre, 1655.7 ± 296.8 cm/s, post, 1646.4 ± 232.1 cm/s; intervention: pre, 1637.6 ± 259.9 cm/s, post, 1560.8 ± 254.7 cm/s) and the carotid-femoral pulse wave velocity as an index of central arterial stiffness (control: pre, 1253.6 ± 346.4 cm/s, post, 1223.6 ± 263.4 cm/s; intervention: pre, 1125.4 ± 204.7 cm/s, post, 1024.9 ± 164.5 cm/s) did not change in either group. CONCLUSION: These findings suggest that lower-limb stretching interventions may reduce regional arterial stiffness at the stretched site.

Effects of Whole-Body Vibration Training with Different Body Positions and Amplitudes on Lower Limb Muscle Activity in Middle-Aged and Older Women.

Purpose: The present study was designed to investigate the electromyographic (EMG) response in leg muscles to whole-body vibration while using different body positions and vibration amplitudes. Methods: An experimental study with repeated measures design involved a group of community-dwelling middle-aged and older women (n = 15; mean age=60.8 ± 4.18 years). Muscle activity of the gluteus maximus (GM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and gastrocnemius (GS) was measured by surface electromyography, which participants were performing three different body positions during three WBV amplitudes. The body positions included static semi-squat, static semi-squat with elastic band loading, and dynamic semi-squat. Vibration stimuli tested were 0 mm, 2 mm, and 4 mm amplitude and 30 Hz frequencies. And the maximum accelerations produced by vibration stimuli with amplitudes of 2 mm and 4 mm are approximately 1.83 g and 3.17 g. Results: Significantly greater muscle activity was recorded in VL, BF, and GS. When WBV was applied to training, compared with the same training without WBV (P < .05). There were significant main effects of body positions on EMGrms for the GM, RF, and VM (P < .05). Compared to static semi-squat, static semi-squat with elastic band significantly increased the EMGrms of GM, and dynamic semi-squat significantly increased the EMGrms of GM, RF and VM (P < .05). And there were significant main effects of amplitudes on EMGrms for the GM, RF, and VM (P < .05). The EMGrms of the VL, BF, and GS at 4 mm were significantly higher than 0 mm, and the EMGrms of the VL and BF at 4 mm were significantly higher than 2 mm. There was no significant body interaction between body positions and amplitudes (P > .05). Conclusions: The EMG amplitudes of most leg muscles tested were significantly greater during WBV exposure than in the no-WBV condition. The dynamic semi-squat 4 mm whole-body vibration training is recommended for middle-aged and older women to improve lower limb muscle strength and function.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

DESIGN: This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES: The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS: More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS: Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE: Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Sleep and Methylation of Estrogen Receptor Genes, ESR1 and GPER, in Healthy Middle-Aged and Older Women: Findings from the Women 40+ Healthy Aging Study.

PURPOSE: Sleep problems in middle-aged and older women are very common and have been associated with menopause-related changes in estrogen levels. However, not all women experience sleep problems as they enter perimenopause, and epigenetic mechanisms might contribute to the differences in sleep quality within this population. In this study, we hypothesized that increased methylation of two estrogen receptor (ER) genes (ESR1 and GPER) would be associated with increased sleep problems in healthy pre-, peri-, and postmenopausal women, either directly or indirectly through the experience of vasomotor symptoms (VMS). MATERIALS AND METHODS: In 130 healthy women aged 40-73 years, we assessed DNA methylation from dried blood spots (DBS). Women rated their sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and VMS using the Menopause Rating Scale (MRS). RESULTS: Higher percentage methylation of ESR1 was associated with increased sleep problems, mediated by VMS, even after controlling for age, menopausal status, body mass index, estradiol levels, depressive symptoms, and caffeine consumption. There was no significant association between GPER methylation and either sleep problems or VMS. CONCLUSION: The study findings support an association between increased ESR1 methylation and sleep problems through increased VMS among healthy women aged 40-73 years.

Target intensity and interval walking training in water to enhance physical fitness in middle-aged and older women: a randomised controlled study.

PURPOSE: To determine the target intensity for fast walking during interval walking training (IWT) in water for middle-aged and older people to enhance physical fitness. METHODS: Thirty-one women [59 ± 5 (SD) years old] were randomly divided into two groups: IWT on land (LG, N = 15) and in water (WG, N = 16). All subjects were instructed to perform ≥ 6 sets of fast and slow walking for 3 min each in a day, ≥ 4 days week(-1), for 8 weeks, at an intensity 35% higher than the oxygen consumption rate at the gas exchange threshold (VO2GET), with a subjective feeling of 16-18 points of the Borg scale during fast walking in each condition. Before and after IWT, we measured VO2GET, peak aerobic capacity (VO2peak) by graded walking and cycling tests on land and isometric knee extension (F EXT) and flexion (F FLX) forces. RESULTS: Before IWT, the VO2GET for walking in water was 14% higher and the heart rate (HR) at a given VO2 was ~10 beats min(-1) lower (P=0.001) than on land. During IWT, subjects in both groups performed IWT for ~4 days week(-1)(P > 0.9) with a 14% higher fast walking intensity in WG than in LG (P < 0.05). After IWT, the VO2peak and VO2GET for cycling, F EXT and F FLX increased more in WG than in LG (all, P < 0.05). CONCLUSION: Walking in water elevated VO2GET and decreased HR at a given exercise intensity in middle-aged and older women, which enabled them to perform exercise at a higher metabolic rate than on land due to improved subjective feelings, which, for these subjects, resulted in greater gains in physical fitness.

Do Modifiable Cardiovascular Risk Factors Differ By Rural Classification in Women Who Enroll in a Weight Loss Intervention?

PURPOSE: If clinicians and researchers are aware of specific cardiovascular risks associated with women's rural status, whether it be large or small/isolated rural areas, it may help in developing more relevant rural resources. The purpose of this study was to examine whether there were differences in modifiable cardiovascular risk factors of overweight and obese rural women living in large or small/isolated rural areas. SAMPLE: This secondary analysis examined baseline cross-sectional data from the "Web-based Weight Loss and Weight Maintenance Intervention for Older Rural Women" clinical trial. Analysis included data from 299 rural Midwestern women, ages 40-69 years with a baseline body mass index of 28-45 kg/m2, who provided rural classification data and were randomized into groups. METHODS: Demographic and biomarker baseline data were used. Chi-square and independent t-tests were used for data analyses. FINDINGS: There are no significant differences found in overweight and obese women with cardiovascular risk factors when compared to rural classification, with one exception. Total cholesterol was associated with rural classification (p=0.047), where women living in large rural areas were more likely to have elevated total cholesterol levels (≥240 mg/dL) compared to women living in small/isolated areas (18.5% vs. 10.0%, respectively). Demographic characteristics such as age and education demonstrated no significant differences by rural classification; however, the majority of women in this study were of high socioeconomic status. CONCLUSIONS: Although this secondary analysis found that rural women have similar cardiovascular risk factors and demographic characteristics, this study highlights the need for clinicians to carefully consider the rural community characteristics for primary prevention.

Moderate physical activity level as a protective factor against metabolic syndrome in middle-aged and older women.

AIMS AND OBJECTIVES: To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women. BACKGROUND: Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors. DESIGN: Cross-sectional design. METHODS: A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire. RESULTS: The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower (OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose (OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure (OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides (OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein (OR = 0·28; OR = 0·27, p = 0·004) and central obesity (OR = 0·31; OR = 0·22, p = 0·027). CONCLUSIONS: After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women. RELEVANCE TO CLINICAL PRACTICE: Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome.