Are the physical activity habits of healthcare professionals associated with their physical activity promotion and counselling?: A systematic review.

OBJECTIVE: Healthcare professionals (HCPs) play an important role in conducting brief physical activity counselling during consultations, representing one of the population's most cost-effective interventions for its promotion. Despite this, their clinical practice often falls short in addressing physical activity with the necessary depth and frequency. This study aimed to synthesise the literature concerning the association between the physical activity habits of HCPs and their attitudes toward physical activity promotion and counselling. METHODS: The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Its protocol was registered in PROSPERO under ID: CRD42023408302. In March 2023, a comprehensive search was conducted using key terms related to physical activity levels and HCPs counselling practices across the Web of Science, Scopus, PubMed, SPORTDiscus, APA PsycInfo, and CINAHL databases. Registered HCPs classified under the International Standard Classification of Occupations (ISCO) were included. The Newcastle-Ottawa Scale was used for assessing articles quality. RESULTS: The search yielded 6618 articles, with 51 meeting the inclusion criteria after filtering and cross-referencing. Predominantly cross-sectional studies were included, mainly involving HCPs responding to questionnaires regarding their physical activity habits and promotion and counselling practices. Heterogeneous results were found. CONCLUSION: High-quality studies mainly concluded that higher physical activity levels among HCPs were associated with more physical activity promotion and counselling practices. These findings are an important contribution to the relevance of the physical activity practice by HCPs and highlighting the importance of promoting its counselling in clinical practice.

The relationship of obesity predicting decline in executive functioning is attenuated with greater leisure activities in old age.

Objectives: We investigated the longitudinal relationship between obesity and subsequent decline in executive functioning over six years as measured through performance changes in the Trail Making Test (TMT). We also examined whether this longitudinal relationship differed by key markers of cognitive reserve (education, occupation, and leisure activities), taking into account age, sex, and chronic diseases as covariates.Method: We used latent change score modeling based on longitudinal data from 897 older adults tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported their weight and height (to calculate BMI), education, occupation, leisure activities, and chronic diseases.Results: There was a significant interaction of obesity in the first wave of data collection with leisure activities in the first wave on subsequent latent change. Specifically, obesity in the first wave significantly predicted a steeper subsequent decline in executive functioning over six years in individuals with a low frequency of leisure activities in the first wave. In contrast, in individuals with a high frequency of leisure activities in the first wave, this longitudinal relationship between obesity and subsequent decline in executive functioning was not significant.Conclusion: The longitudinal relationship between obesity and subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through an engaged lifestyle in old age. Implications for current cognitive reserve and gerontological research are discussed.

The Efficacy of a Multicomponent Functional Fitness Program Based on Exergaming on Cognitive Functioning of Healthy Older Adults: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Regular physical exercise can attenuate age-related cognitive decline. This study aimed to investigate the effect of a physical exercise multicomponent training based on exergames on cognitive functioning (CF) in older adults. RESEARCH DESIGN AND METHODS: This randomized controlled trial included older adults aged 61-78. Participants were randomly allocated to an intervention group (IG; n = 15) or active control group (CG; n = 16). The IG was exposed to a combined training with traditional exercise and exergaming, twice a week over a period of 12 weeks. The CG performed only traditional sessions. CF was assessed by the Cognitive Telephone Screening Instrument. The time points for assessment were at zero (pretest), 12 (posttest), and 17 weeks (follow-up). RESULTS: Active CG and IG increased from pretest to posttest in short-term memory (STM), long-term memory (LTM), and Cognitive Telephone Screening Instrument total score 1.98 > Z < 3.00, ps < .005, with moderately large positive effects (.36 > r < .54). A significant increase was seen from posttest to follow-up in STM, Z = 2.74, p = .006, and LTM, Z = 2.31, p < .021, only in IG. Across the two time periods posttest to follow-up, there were significant interaction effects between program type and time for STM (p = .022, ηp2=.17) and LTM (p = .004, ηp2=.25), demonstrating a more beneficial effect of the exergames intervention compared to the CG. Discussion and Implications: The integration of exergaming in a multicomponent functional fitness exercise might have the potential to maintain and improve CF (in particular, STM and LTM) in older adults.

Solving the Puzzle of Cognitive Reserve Effects on Cognitive Decline: The Importance of Considering Functional Impairment.

AIMS: We investigated whether the longitudinal relation between cognitive reserve accumulated across the lifespan and rate of cognitive decline over 6 years differed by the individual's degree of functional impairment. METHODS: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in 2 waves 6 years apart. RESULTS: There was a significant interaction of functional impairment with cognitive reserve on latent change in cognitive functioning. Specifically, with no functional impairment in the first wave of assessment, greater cognitive reserve accumulated across the lifespan significantly predicted a reduced cognitive decline over 6 years (i.e., smaller increase in TMT completion time). In contrast, with certain functional impairment (in at least some activities) in the first wave, greater cognitive reserve build-up predicted a steeper cognitive decline (i.e., larger increase in TMT completion time). CONCLUSION: Individuals with greater cognitive reserve accumulated across the lifespan show a reduced cognitive decline if they still have relatively little functional impairment, while they will show a steeper decline (compared to individuals with less cognitive reserve) as soon as functional impairment becomes substantial.

Muscle Mass and Muscle Strength Relationships to Balance: The Role of Age and Physical Activity.

OBJECTIVE: To investigate the relations of balance to muscle mass (MM) and muscle strength (MS), depending on age and physical activity, which is of particular importance to functional independence in older people. METHODS: This cross-sectional study included 802 volunteers (69.82 ± 5.60 years). The Fullerton Advanced Balance scale was used to assess balance and a composite score, including arm curl and chair stand tests for assessing MS. MM was estimated by dual-energy X-ray absorptiometry and physical activity by questionnaire. RESULTS: Greater MM (r = .26, p < .001) and MS (r = .53, p < .001) were positively correlated to balance. The old-old adults and less active individuals attained lower balance. Notably, moderation and subsequent simple slope analyses revealed that the relations of balance, MM, and MS were larger in less active and the old-old adults. CONCLUSIONS: The old-old and less active adults were more prone to muscle weakness and balance impairments. Tailored interventions should particularly consider these vulnerable groups.

Cognitive Reserve Attenuates the Relation between Gastrointestinal Diseases and Subsequent Decline in Executive Functioning.

AIMS: We investigated whether the longitudinal relationship between gastrointestinal diseases and subsequent decline in executive functioning over 6 years differed by cognitive reserve. METHODS: We analyzed longitudinal data from 897 older adults (mean age 74.33 years) tested on TMT parts A and B in two waves 6 years apart. Participants reported information on education, occupation, leisure activity engagement, and gastrointestinal diseases. RESULTS: There was a significant interaction of gastrointestinal diseases with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with low (but not those with high) leisure activity engagement, gastrointestinal diseases significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). CONCLUSION: Cognitive reserve may attenuate the detrimental influences of gastrointestinal diseases on subsequent decline in executive functioning.

Cognitive Reserve Attenuates 6-Year Decline in Executive Functioning after Stroke.

AIMS: We investigated whether the longitudinal relationship between history of stroke and subsequent decline in executive functioning over 6 years differed by cognitive reserve. METHODS: We analyzed longitudinal data from 897 older adults (mean age, 74.33 years) tested on the Trail Making Test (TMT) in two waves 6 years apart. Participants reported information on key frequently used proxies of lifelong cognitive reserve accumulation (i.e., education, occupation, and leisure activity engagement), and history of stroke. RESULTS: There was a significant interaction of stroke with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with low (but not those with high) leisure activity engagement, history of stroke significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). CONCLUSION: The detrimental aftereffects of stroke on subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through leisure activity engagement across their life.

Cognitive Reserve Mediates the Relation between Openness to Experience and Smaller Decline in Executive Functioning.

AIMS: We investigated the mediating role of leisure activity engagement in the longitudinal relation between openness to experience and subsequent change in executive functioning over 6 years as measured through performance changes in the Trail Making Test (TMT). METHODS: We analyzed longitudinal data from 897 older adults (mean = 74.33 years in the first wave) tested on TMT parts A and B in two waves 6 years apart. Participants reported information on leisure activity engagement and openness to experience. RESULTS: Latent change score modeling revealed that 37.2% of the longitudinal relation between higher openness to experience in the first wave of data collection and a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning) was mediated via a higher frequency of leisure activities in the first wave. CONCLUSION: Individuals with higher openness to experience show greater activity engagement in old age. By enhancing their cognitive reserve, this activity engagement may finally result in smaller subsequent decline in executive functioning.

High-Density Lipoprotein Cholesterol Level Relates to Working Memory, Immediate and Delayed Cued Recall in Brazilian Older Adults: The Role of Cognitive Reserve.

AIMS: The present study set out to investigate the relation of the high-density lipoprotein cholesterol (HDL-C) level to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults. METHODS: We assessed tests of working memory, immediate and delayed cued recall in 701 older adults from Amazonas, Brazil. The HDL-C level was derived from fasting blood samples. In addition, we interviewed individuals on their education, past occupation, and cognitive leisure activity. RESULTS: A critically low HDL-C level (<40 mg/dL) was significantly related to lower performance in working memory, immediate and delayed cued recall. Moderation analyses suggested that the relations of the HDL-C level to working memory and delayed cued recall were negligible in individuals with longer education, a higher cognitive level of the job, and greater engagement in cognitive leisure activity. CONCLUSION: Cognitive reserve accumulated during the life course may reduce the detrimental influences of a critically low HDL-C level on cognitive functioning in old age.

Correlates of health-related quality of life in young-old and old-old community-dwelling older adults.

PURPOSE: This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old-old). METHODS: This cross-sectional study included 802 older adults aged 60-79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires. RESULTS: A multiple regression analysis showed that BMI (ß = -0.15, p = 0.001), body strength (ß = 0.21, p < 0.001), aerobic endurance (ß = 0.29, p < 0.001), physical activity (ß = 0.11, p = 0.007), depressive symptoms (ß = -0.19, p < 0.001), falls (ß = -0.19, p < 0.001), and living alone (ß = -0.16, p < 0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old-old compared to young-old adults. CONCLUSION: This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.

The Role of Leisure Activities in Mediating the Relationship between Physical Health and Well-Being: Differential Patterns in Old and Very Old Age.

BACKGROUND: Recently, Paggi et al. [Gerontology 2016;62:450-458] for the very first time showed in a cross-sectional sample of 259 adults aged 18-81 years that the relation of physical health to psychological well-being was mediated via frequency of leisure activity participation. OBJECTIVE: To extend this framework, we followed theories on successful aging and vulnerability to propose to add a differential perspective predicting that certain individuals may be more vulnerable than others and therefore may show differences in the mediation pattern. Specifically, we examined whether mediation patterns were differential in certain populations, such as in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. METHODS: We analyzed data from 3,080 individuals on physical health (number of chronic diseases, subjective health status, and subjective evaluation of change in health over the last 10 years), frequency of participation in 18 leisure activities, and physical and psychological well-being using moderated mediation models with a path model approach that allowed the simultaneous estimation of all model paths, including their significance. RESULTS: We found that the relation of physical health to physical and psychological well-being was mediated via frequency of activity participation. For physical (but not for psychological) well-being, this mediation was more pronounced in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. These moderated mediations were attributable to differential relations of physical health to frequency of activity participation and to differential relations of frequency of activity participation to physical well-being between the investigated moderator levels. CONCLUSION: Present data suggest that participation in leisure activities may play a key role in mediating the relationship between physical health and well-being, particularly in very old age. Findings are discussed with respect to theories of successful aging and differences between physical and psychological well-being.

The relation of education, occupation, and cognitive activity to cognitive status in old age: the role of physical frailty.

BACKGROUND: It remains unclear so far whether the role of cognitive reserve may differ between physically frail compared to less frail individuals. Therefore, the present study set out to investigate the relation of key markers of cognitive reserve to cognitive status in old age and its interplay with physical frailty in a large sample of older adults. METHODS: We assessed Mini-Mental State Examination (MMSE) in 701 older adults. We measured grip strength as indicator of physical frailty and interviewed individuals on their education, past occupation, and cognitive leisure activity. RESULTS: Greater grip strength, longer education, higher cognitive level of job, and greater engaging in cognitive leisure activity were significantly related to higher MMSE scores. Moderation analyses showed that the relations of education, cognitive level of job, and cognitive leisure activity to MMSE scores were significantly larger in individuals with lower, compared to those with greater grip strength. CONCLUSIONS: Cognitive status in old age may more strongly depend on cognitive reserve accumulated during the life course in physically frail (compared to less frail) older adults. These findings may be explained by cross-domain compensation effects in vulnerable individuals.

Skeletal Muscle and Physical Activity in Portuguese Community-Dwelling Older Adults.

The aims of this study were to describe age- and sex-related differences in total body skeletal muscle (TB-SM) mass and to determine the variance explained by physical activity (PA). This cross-sectional study included 401 males and 402 females, aged 60-79 years. TB-SM was determined by dual-energy x-ray absorptiometry (DXA) and PA by Baecke questionnaire. Statistical analysis included t test, ANOVAs, Pearson correlations, and multiple regression analysis. TB-SM mass was higher in the youngest age group when compared with the oldest in males and females. Males had greater TB-SM values than females. PA made a significant and positive contribution to the variation in TB-SM, ß = 0.071; p = .016. Sex, height, fat mass, and PA explained 77% of the variance in TB-SM. The oldest cohorts and females had lower TB-SM than the younger cohorts and males. This study suggests that PA exerts a significant role in the explanation of TB-SM.

Differential Patterns in Motivations for Practicing Sport and Their Effects on Physical Activity Engagement across the Lifespan.

This study aims to report what motivates individuals to be physically active, to determine whether motivating factors influence physical activity (PA) levels, and whether this differs across the lifespan. This is a cross-sectional study with 498 individuals: 117 adolescents, 306 adults, and 75 older adults. PA was assessed using Baecke's questionnaire, and motivating factors for practicing sports were investigated using a scale with twelve questions. The factor analysis identified three motivating factors for sports practice: psychosocial, bodily, and well-being. The scale's overall reliability and internal consistency indicated a Cronbach's alpha of 0.885. The analysis of covariance (ANCOVA) adjusted for sex indicated the three factors as having a significant effect on PA (p < 0.050); however, only the well-being factor showed a significant interaction with age groups (p = 0.023, ηp2 = 0.030). Subsequently, the effect of the well-being factor on PA scores in each age group was explored through regression analyses. Only older adults showed a significant association in the unadjusted [OR = 0.378, p = 0.001, R2 = 0.243] and the sex-adjusted analysis [OR = 0.377, p = 0.001, R2 = 0.288]. These results help us to better understand the underlying motivational reasons in different age groups for engaging in sports.

Sex Differences in Falls: The Mediating Role of Gait Stability Ratio and Body Balance in Vulnerable Older Adults.

This study, conducted on a large sample of older adults at elevated fall risk (1), aimed to verify statistical differences in gait stability ratio (GSR) and body balance (BB) according to sex, (2) to examine and compare GSR and BB performance between older adult fallers and non-fallers, (3) to determine an association between GSR and BB according to the history of falls, and (4) to explore whether GSR and BB mediate the association between sex and falls. We included 619 individuals (69.8 ± 5.6 years) living in the Autonomous Region of Madeira, Portugal. The frequency of falls was obtained by self-report. BB was determined by the Fullerton Advanced Balance scale, while GSR was established by dividing cadence by gait speed and data collected during the 50-foot walk test. Males indicated a lower prevalence of falls in the last 12 months (23.6%), while females had a higher score (48.7%), as well as a lower balance performance (p < 0.001) and higher GSR scores (p < 0.001). Lower BB control (p < 0.001), as well as higher GSR, were more expressive for fallers (p < 0.001). We found a large, negative and significant correlation between GSR and BB for historical falls (r = −0.560; p < 0.001), and between male and female cohorts (r = −0.507; p < 0.001). The total effect of sex on falls mediated by GSR and BB was 16.4%. Consequently, GSR and BB mediated this association by approximately 74.0% and 22.5%, respectively.

Muscle Strength and Balance as Mediators in the Association between Physical Activity and Health-Related Quality of Life in Community-Dwelling Older Adults.

Lower extremity muscle strength (LEMS) and body balance (BB) are essential for older adults to maintain an upright posture and autonomously perform their basic activities of daily living. This study aimed to examine whether LEMS and BB mediate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in a large sample of community-dwelling older adults. This is a cross-sectional study carried out with 802 individuals, 401 males and 401 females (69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. PA and HRQoL were assessed by the Baecke Questionnaire and e SF-36, respectively. LEMS was assessed by the Senior Fitness Test and BB by the Fullerton Advance Balance (FAB). The serial mediation pathway model pointed out that LEMS and BB partially mediated the association between PA and HRQoL in approximately 39.6% and 47%, respectively. The total variance in HRQoL explained by the entire model was 98%. Our findings may indicate the role that LEMS and BB play in the relationship between PA and HRQoL in the older population.

Exploring the Role of Physical Activity in Mediating the Association between Educational Level and Health-Related Quality of Life in an Adult Lifespan Sample from Madeira Island.

Background: People more socioeconomically vulnerable tend to have a poorer health-related quality of life (HRQoL). Studies are trying to analyse the factors that may condition this relationship, including physical activity (PA), which may influence the relationship between socioeconomic status (SES) and HRQoL. This study aimed to analyse the relationship between SES and HRQoL through specific domains of PA. Methods: A total of 381 adults (≥18 years) from the Autonomous Region of Madeira completed the measurements. Mediation analyses using bootstrapping methods adjusted for confounding variables were performed to relate SES and HRQoL; the latter was evaluated using the physical component score (PCS) of the SF-12, the mental component score (MCS) of the SF-12, and the total score in the SF-12 questionnaire (SF-12 score), through physical activity. Results: Educational level was positively related to PCS and SF-12 score. Leisure-time PA (not including sports PA) and PA at work, as single mediating variables, did not mediate the relationship between SES and HRQoL. The total PA suppressed the socioeconomic gradient of HRQoL by 8-10%, 39-46%, and 15-16%, respectively, for the PCS, MCS, and the SF-12 score; sports PA mediated the relationship by 13-16%, 50%, and 15-21%, respectively. Conclusions: The results suggest that sports PA contributes to reducing the socioeconomic gradient of HRQoL.

The Role of Physical Function in the Association between Physical Activity and Gait Speed in Older Adults: A Mediation Analysis.

Adequate levels of physical function (PF) are essential for vulnerable older adults to perform their daily tasks safely and remain autonomous. Our objective was to explore the mediating role of PF in the relationship between physical activity (PA) and gait speed (GS) in a large sample of older adults from the north of Brazil. This is a cross-sectional study that analyzed 697 older adults (mean age 70.35 ± 6.86 years) who participated in the project "Health, Lifestyle, and Physical Fitness in Older Adults in Amazonas" (SEVAAI). PA was assessed using the Baecke Questionnaire, PF using the Senior Fitness Test, and GS using the 50-foot Walk Test. Mediation pathways were analyzed to test the possible mediating role of PF between specific PA domains (PA-total score, PA-housework, PA-sport, PA-leisure) and GS. Regarding PA-total, the analysis showed that high-performance GS was partially mediated in approximately 19% by better PF performance. Moreover, the PF could partially mediate the association between PA-sport and PA-leisure with GS, at levels of approximately 9% and 46%, respectively. An inverse relationship was observed between PA-housework (sedentary lifestyle) and GS. This association was partially mediated to an extent of approximately 9% by better PF performance. We conclude that PF plays a crucial role in mediating the association between PA and GS among vulnerable older adults.

The Mediating Role of Physical Activity and Physical Function in the Association between Body Mass Index and Health-Related Quality of Life: A Population-Based Study with Older Adults.

This study aimed (1) to investigate the association between body mass index (BMI), physical activity (PA), and physical function (PF) with health-related quality of life (HRQoL), and (2) to examine in-depth whether PA and PF mediate the relationship between BMI and HRQoL in older adults. We investigated 802 individuals (mean age 69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. Harmol and PA were assessed using the SF-36 and Baecke questionnaires, respectively, and PF by the Senior Fitness Test. The prevalence of overweight was 71.3%, 26.5% for normal weight, and 2.1% for underweight. We verified a small correlation between age and sex with BMI, PA, PF, and medium borderline with HRQoL. After adjusting for covariates (i.e., sex, age, comorbidities), the multivariate regression analysis indicated a 93.1% chance of improvement in HRQoL for low BMI, while PA and PF revealed a chance of increasing HRQoL by 91.8% and 60.0%, respectively. According to the serial mediation pathway, PA and PF partially mediated the association between BMI and HRQoL by 32.3% and 81.5%, respectively. The total variance of the model was 90%. It was concluded that BMI can negatively affect HRQoL. On the other hand, PA and PF are able to increase HRQoL levels during the aging process.

Associations of Gait Speed, Cadence, Gait Stability Ratio, and Body Balance with Falls in Older Adults.

To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.