Objectively assessed physical activity and subsequent health service use of UK adults aged 70 and over: a four to five year follow up study.

OBJECTIVES: To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. STUDY DESIGN: A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided by Project OPAL (Older People and Active Living). OPAL-PLUS provided data on numbers of primary care consultations, prescriptions, unplanned hospital admissions, and secondary care referrals, extracted from medical records for up to five years following the baseline OPAL data collection. PARTICIPANTS AND DATA COLLECTION: OPAL participants were a diverse sample of 240 older adults with a mean age of 78 years. They were recruited from 12 General Practitioner surgeries from low, middle, and high areas of deprivation in a city in the West of England. Primary care consultations, secondary care referrals, unplanned hospital admissions, number of prescriptions and new disease diagnoses were assessed for 213 (104 females) of the original 240 OPAL participants who had either consented to participate in OPAL-PLUS or already died during the follow-up period. RESULTS: In regression modelling, adjusted for socio-economic variables, existing disease, weight status, minutes of moderate-to-vigorous physical activity (MVPA) per day predicted subsequent numbers of prescriptions. Steps taken per day and MVPA also predicted unplanned hospital admissions, although the strength of the effect was reduced when further adjustment was made for lower limb function. CONCLUSIONS: Community-based programs are needed which are successful in engaging older adults in their late 70s and 80s in more walking, MVPA and activity that helps them avoid loss of physical function. There is a potential for cost savings to health services through reduced reliance on prescriptions and fewer unplanned hospital admissions.

Objectively measured sedentary time and its association with physical function in older adults.

The relationship of objectively measured sedentary time (ST), frequency of breaks in ST, and lower extremity function (LEF) was investigated in a diverse sample aged ≥ 70 years (n = 217). Physical activity (PA) was assessed by accelerometry deriving moderate-vigorous PA (MVPA) minutes per registered hour (MVPA min · hr(-1)), registered ST (ST min · hr(-1)), and breaks in ST min · hr(-1) (breaks · hr(-1)). LEF was assessed by the Short Physical Performance Battery. Univariate associations with overall LEF were MVPA (r = .523), ST (r = -.499), and breaks (r = .389). Adjusted linear regression including MVPA min · hr(-1), ST min · hr(-1), and breaks · hr(-1) explained 41.5% of LEF variance. Each additional break · hr(-1) was associated with 0.58 point increase in LEF. Breaks and MVPA had strongest independent associations with LEF. Promoting regular breaks might be useful in maintaining or increasing LEF and later life independence. This novel finding is important for the design of effective lifestyle interventions targeting older adults.

Associations of objectively measured physical activity with lower limb function in older men and women: findings from the Older People and Active Living (OPAL) study.

Associations of objectively measured physical activity (PA) with objectively measured lower limb function in adults age 70 and older were studied. Lower limb function was assessed using the Short Physical Performance Battery (SPPB) and PA by an accelerometer providing mean daily counts per minute (CPM), mean daily steps and minutes of moderate or vigorous PA (MVPA) per day. A minority (32 [13%]) scored low (≤6 out of a maximum of 12) on the SPPB, but only 3 (1%) achieved recommended PA levels. Adjusting for confounders, the odds ratio of low SPPB (≤6) comparing those in the lowest one third to highest two thirds of mean CPM was 55 (95%CI: 6, 520); for mean steps per day it was 23 (95%CI: 4, 137) and for minutes of MVPA per day 56 (95%CI: 6, 530). Low levels of PA are common and are associated with poor levels of lower limb function in older adults.

Bridging the gap in health inequalities with the help of health trainers: a realistic task in hostile environments? A short report for debate.

BACKGROUND: From a public health theoretical perspective, there is acknowledgement that synchronized policies, which address both individual and area level risks to health, are important to reduce inequalities and improve health. Despite this, much research focuses on just one of these two approaches (often pitting them against each other) and much practice tends to focus on individual level interventions. Efforts to address health inequalities between rich and poor in the UK continue to focus on individual-based interventions, with the most recent initiative being health trainers. METHODS: In this debate piece, we will use health trainers as a specific example, and focusing primarily on levels of physical activity, we will argue that neither individual level interventions nor environmental change alone are likely to improve levels of activity or reduce health inequalities. CONCLUSIONS: We argue that synchronized policies that tackle both individual and neighbourhood environmental barriers to improving health behaviours are essential.

Improving health through neighbourhood environmental change: are we speaking the same language? A qualitative study of views of different stakeholders.

OBJECTIVE: To explore the perspectives of four groups of stakeholders to proposed improvements to the built environment-a neighbourhood renewal consisting of a home zone development and an extension of the National Cycle Network (NCN). Design Qualitative focus group study. Setting A deprived neighbourhood. Sample Four focus groups were conducted with 10 residents from the neighbourhood undergoing change, nine pupils from a local primary school, 10 students and tutors from a local further education college and three local authority planners overseeing the developments. RESULTS: We identified four main themes relating to the impact of environmental change. These were safety, space, antisocial behaviour and physical activity and health, the latter being the least important to all groups. A mismatch regarding environmental change emerged in perspectives between different stakeholders. The residents were most concerned about home and car (parking) safety and in particular felt that the new cycle/walk way would reduce their safety, whereas the planners felt that the environmental change would provide a safer and healthier environment for the residents. CONCLUSION: The assumption that planned provision of supportive environments will improve levels of physical activity, health and lifestyle may not be true if the developments do not take account of community concerns regarding personal safety.