Intensity-Specific Physical Activity Measured by Accelerometer, Genetic Susceptibility, and the Risk of Kidney Stone Disease: Results From the UK Biobank.

RATIONALE & OBJECTIVE: Kidney stone disease (KSD), a significant healthcare problem within both developed and developing countries, has been associated with genetic risk factors. As well, an association between physical activity and KSD risk has been hypothesized but studies have yielded inconsistent findings. This study aimed to investigate the association between the intensity of physical activity and the incidence of KSD accounting for genetic risk. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: A total of 80,473 participants from the UK Biobank Study. EXPOSURES: Physical activity levels, including total physical activity (TPA), moderate-to-vigorous intensity physical activity (MVPA), and light-intensity physical activity (LPA), were measured using accelerometers and quantified using a machine learning model. A polygenic risk score (PRS) for KSD was also constructed. OUTCOMES: Individuals with KSD were identified using the International Classification of Diseases 10th Edition, and procedure codes for KSD surgery. ANALYTICAL APPROACH: A Fine and Gray survival model was used to estimate the associations of incident KSD with TPA, MVPA, LPA, and PRS (as categorical variables). Restricted cubic splines were used to examine potential non-linear associations within the fully adjusted models. RESULTS: During an average follow-up of 6.19 years, 421 participants developed KSD. Participants in the highest quartiles of TPA, MVPA, and LPA had lower adjusted rates of KSD compared to those in the lowest quartiles: HRs (95% confidence interval) of 0.50 (0.44, 0.56), 0.57 (0.51, 0.64), and 0.66 (0.59, 0.74), respectively. TPA, MVPA, and LPA were associated with lower risk of KSD in participants with low and high genetic predisposition for KSD. LIMITATIONS: Selection bias as participants who provided accelerometry data may have been more adherent to health care. CONCLUSION: Physical activity was negatively associated with the risk of KSD, regardless of the genetic risk. Future large studies are warranted to confirm and explain the mechanisms underlying these associations.

The effect of physical activity on sleep disturbance in various populations: a scoping review of randomized clinical trials.

BACKGROUND: Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed to examine the effect of various PA intervention strategies on sleep across different populations, identify key sleep outcomes, and analyze knowledge gaps by mapping the relevant literature. METHODS: For this study, we systematically searched articles published till March 2022 from PubMed, Web of Science, Cochrane Library, and Embase databases for randomized clinical trials (RCTs) regarding the effect of physical activity on sleep. Two authors extracted key data and descriptively analyzed the data. Thematic analysis was used to categorize the results into themes by all authors. Arksey and O'Malley's scoping review framework was used to present the findings. RESULTS: Twenty-one randomized controlled trials out of 3052 studies were finally included with 3677 participants (2852 females (78%)). Five trials were conducted in healthy working-age adults with sleep disturbance but without the diagnosis of insomnia, five in healthy older adults, two in perinatal women, four in patients with cancer, three in mental illness related subjects, and another two in other disease-related areas. PA interventions were diverse, including walking, resistance training, aerobic exercise, housework, water exercise, basketball, smartphone/tablet "apps", web, online videos or wearable actigraphy, and self-determined exercise. Three major themes were identified: (1) Sleep environment may be important to address prior to instituting PA interventions, (2) All types of PA were effective for improving sleep in all populations studied, (3) Self-tolerated PA is safe for improving sleep in the elderly and in co-morbid or perinatal populations. CONCLUSIONS: PA is effective and safe for improving sleep in both healthy and co-morbid populations with sleep disturbance by increasing daily activity levels using a variety of strategies, even low intensity, such as housekeeping, sit-to-stand repetitions, along with encouraging PA through web pages, videos, and self-goal setting apps. In addition, this scoping review identifies the need for further therapeutic research and future exploration in populations with sleep initiation or sleep maintenance disturbance.

Association between vegetarian diet and gouty arthritis: A retrospective cohort study.

BACKGROUND AND AIMS: A vegetarian diet is rich in vegetables, fruits, and soy products. Although vegetarian diet is beneficial for improving the health outcomes such as body mass index, metabolic syndrome, cardiovascular disease, and mortality rate, the association between a vegetarian diet and gout incidence is not well known. METHODS AND RESULTS: We linked the MJ Health Survey Data and MJ Biodata 2000 with the National Health Insurance Research Database (NHIRD) and the National Registration of Death (2000-2018). Information on the diet was collected from the MJ Health Survey Data, and the incidence of gouty arthritis was confirmed using the NHIRD. The Kaplan-Meier survival curve and log-rank test were used to compare the differences between vegetarian and non-vegetarian participants. Cox regression models were used to estimate the risk of the incidence of gouty arthritis. Among 76,972 participants, 37,297 (48.46%) were men, 2488 (3.23%) were vegetarians and the mean age was 41.65 ± 14.13 years. The mean baseline uric acid level was 6.14 ± 1.65 mg/dL. A total of 16,897 participants developed gouty arthritis, including 16,447 (22.08%) non-vegetarians and 450 (18.9%) vegetarians over a mean follow-up of 19 years. Significant differences were observed in the Kaplan-Meier survival curves between vegetarians and non-vegetarians (log-rank p < 0.001). Vegetarians had a significantly decreased incidence of gouty arthritis compared with non-vegetarians (hazard ratio = 0.87, 95% confidence interval = 0.78-0.98, p = 0.02) after adjusting for potential confounders. CONCLUSION: People with a vegetarian diet had a significantly decreased risk of developing gouty arthritis compared with non-vegetarians in Taiwan.

Changes in physical activity and adiposity with all-cause, cardiovascular disease, and cancer mortality.

BACKGROUND: The relationship between joint changes in physical activity and adiposity with mortality is not well understood. We examined the association of changes in these two established risk factors with all-cause (ACM), cardiovascular disease (CVD), and cancer mortality. METHODS: We used longitudinal data from Taiwan's MJ Cohort, comprising 116,228 general population adults recruited from 1998-2013 with repeated measures 4.6 y (2.5) apart and followed up for mortality for 11.9 y (3.5). Physical activity, body mass index (BMI), waist circumference (WC), and body fat percentage (BF%) groups and changes were based on public health and clinical guidelines. RESULTS: Compared to stable-insufficient physical activity, increasing physical activity from any baseline level was associated with lower ACM (HR [95%CI]): 0.85 [0.74, 0.96]) and CVD mortality (0.72 [0.55, 0.93]) risk. This was approximately equal to meeting physical activity guidelines at both timepoints (eg: 0.71 [0.58, 0.88] for CVD mortality). Compared to stable-overweight/moderate adiposity, decreasing adiposity level attenuated but did not offset mortality risk for all three outcomes (eg: BMI = 0.95 [0.76, 1.16] for CVD mortality). Only maintaining a healthy adiposity level at both timepoints offset mortality risk (BMI = 0.75 [0.61, 0.89]) for CVD mortality). In the joint changes analyses, lower mortality risk was a consequence of increases in physical activity across adiposity change groups (eg: WC decrease = 0.57 [0.48, 0.67]; WC stability = 0.73 [0.66, 0.80], WC increase = 0.83 [0.72, 0.97] for ACM). Decreasing adiposity attenuated the negative associations of decreased physical activity (BF% = 1.13 [0.95, 1.35] for ACM). CONCLUSIONS: We found a lower risk for ACM, CVD, and cancer mortality from increasing physical activity and an attenuation from decreasing adiposity regardless of baseline levels. The beneficial associations of joint changes were primarily driven by physical activity, suggesting lower mortality risk may be more immediate through physical activity improvements compared to adiposity improvements alone.

Associations between daily steps and cognitive function among inpatients with schizophrenia.

BACKGROUND: Walking is the fundamental component of taking steps and is the main form of physical activity among individuals with schizophrenia; it also offers a range of health benefits. This study aimed to examine the associations between daily steps and cognitive function and further explored how many steps were related to better cognitive function among inpatients with schizophrenia. METHODS: Inpatients with schizophrenia were recruited from long-stay psychiatric wards across two hospitals (n=199 at site 1 and n=195 at site 2). Daily steps were collected with an accelerometer for 7 days. Four cognitive domains (attention, processing speed, reaction time, and motor speed) were tested at site 1, and two cognitive domains (attention and processing speed) were tested at site 2. The associations of daily steps and levels of steps/day with cognitive function were tested using multivariable linear regressions separated by site. Covariates included demographic variables, weight status, metabolic parameters, and clinical state. RESULTS: Participants took an average of 7445 (±3442) steps/day. More steps were related to better attention, processing speed, reaction time, and motor speed after multivariable adjustments. Compared with participants taking <5000 steps/day, those taking ≥5000 steps/day showed significantly better processing speed. Participants taking ≥7500 steps/day were associated with better attention, better reaction time, and better motor speed than those taking <5000 steps/day. CONCLUSION: Daily steps are associated with better cognitive function among inpatients with schizophrenia. The optimal benefit for cognitive function among this clinical population is achieving 7500 steps/day or more.

A dose response relationship between accelerometer assessed daily steps and depressive symptoms in older adults: a two-year cohort study.

OBJECTIVES: this study investigated the prospective associations of accelerometer assessed daily steps with subsequent depressive symptoms in older adults. METHODS: a 2-year prospective study was performed in the community. A total of 285 older adults ≥65 years (mean age = 74.5) attended the baseline assessment in 2012. The second wave of assessment was carried out in 2014 including 274 (96.1%) participants. Daily step counts were measured with a triaxial accelerometer (ActiGraph GT3X+), and participants were divided into three categories (<3,500, 3,500-6,999 and ≥ 7,000 steps/day). The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Negative binomial regression models with multivariable adjustment for covariates (baseline depressive symptoms, accelerometer wear time, age, gender, education, chronic disease, activities of daily living) were conducted to examine the association between daily steps and subsequent depressive symptoms. RESULTS: each 1,000-step increase in daily walking was linearly associated with a reduced rate of subsequent depressive symptoms (rate ratio [RR] = 0.95, 95% confidence interval [CI] = 0.92-0.98). Participants with daily step count in 3,500-6,999 (RR = 0.84, 95% CI = 0.70-0.99) and ≥7,000 steps (RR = 0.71, 95% CI = 0.55-0.92) per day had fewer depressive symptoms at follow-up. Sensitivity analyses assessing confounding and reverse causation provided further support for the stability of our findings. CONCLUSION: older adults engaging in more daily steps had fewer depressive symptoms after 2 years. Even as few as 3,500-6,999 steps a day was associated with a protecting effect. Accumulating ≥7,000 steps a day could provide the greatest protection against depressive symptoms.

Association of body mass index with all-cause mortality in the elderly population of Taiwan: A prospective cohort study.

BACKGROUND AND AIMS: The nutritional status of the elderly is different from that of young people. Body composition changes as people age, for example, fat mass increases, muscle mass decreases, and body fat distribution is changed. We aimed to investigate the association of body mass index (BMI) with cause-specific mortality in the elderly population. METHODS AND RESULTS: The data of annual health examination for the older citizens (≥65 years old) from 2006 to 2011 in Taipei City Hospital were used. Information on baseline demographics, lifestyle behaviors, medical, and drug usage were collected by a self-administered questionnaire. Cause-specific mortality was ascertained from the National Registration of Death. Individuals were followed up until death or December 31, 2012, whichever was earlier. Univariable and multivariable Cox proportional hazard analyses were applied to investigate the association between BMI and all-cause mortality. Among 81,221 older people included in the analysis, 42,602 (52.45%) were men. The mean age was 73.85 ± 6.32 years. Among the 81,221 participants, 3398 (4.18%) were underweight, 36,476 (44.91%) were normal weight, 25,708 (31.65%) were overweight, and 15,639 (19.25%) were obese. Those in the BMI category 27 ≤ BMI<28 kg/m2 had the lowest all-cause mortality risk. The BMI of lowest cause-specific mortality was between 27 kg/m2 and 28 kg/m2 in infection mortality, between 28 kg/m2 and 29 kg/m2 in circulation mortality, between 29 kg/m2 and 30 kg/m2 in respiratory mortality, and between 31 kg/m2 and 32 kg/m2 in cancer mortality. CONCLUSIONS: The current study found a J-shaped relation between BMI and cause-specific mortality in the elderly population of Taiwan.

Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study.

OBJECTIVE: Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan. METHODS: The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status. RESULTS: There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio [HR] = 1.16; 95% confidence interval [CI] = 1.06-1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82-1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07-1.27). CONCLUSIONS: Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.

Association of exercise with all-cause mortality in older Taipei residents.

BACKGROUND: Human life expectancy has increased rapidly in recent decades. Regular exercise can promote health, but the effect of exercise on mortality is not yet well understood. OBJECTIVE: To investigate the association of exercise with mortality in the older people. METHODS: We used data from annual health check-ups of the older citizens of Taipei in 2006. Participants were interviewed by trained nurses using a structured questionnaire to collect data on demographics and lifestyle behaviours. Overnight fasting blood was collected for measuring blood glucose, liver and renal function and lipid profiles. Exercise frequency was categorised into no exercise, 1-2 times in a week and more than 3-5 times in a week. All-cause mortality was ascertained from the National Registration of Death. All participants were followed up until death or December 312012, whichever came first. Kaplan-Meier curves and Cox proportional hazard analysis were used to investigate the association between exercise and all-cause mortality. RESULTS: In total, 42,047 older people were analysed; 22,838 (54.32%) were male and with a mean (SD) age of 74.58 (6.32) years. Kaplan-Meier curves of all-cause mortality stratified by exercise frequency demonstrated significant findings (Log-rank P < 0.01). Multivariate Cox regression analysis showed that older people with higher exercise levels had a significantly decreased risk of mortality (moderate exercise HR = 0.74, 95% CI: 0.68-0.81, high exercise HR = 0.65, 95% CI: 0.59-0.70) after adjusting for potential confounders, with a significant trend (P for trend<0.01). CONCLUSIONS: Older people with increased exercise levels had a significantly decreased risk of all-cause mortality.

Device-measured light-intensity physical activity and mortality: A meta-analysis.

INTRODUCTION: The association of light-intensity physical activity (LPA) with mortality is poorly understood. This meta-analysis of cohort studies aimed to examine the dose-response relationships between daily device-measured LPA and mortality in adults aged 18 or older and to explore whether the associations were independent of moderate-to-vigorous physical activity (MVPA). METHODS: Searches for prospective cohort studies providing effect estimates of daily LPA (exposure) on all-cause mortality (outcome) were systematically undertaken in electronic databases up to April 30, 2019. Subgroup analyses and meta-regression analyses with random-effects models were performed to quantify the dose-response relationships between daily LPA and mortality. Sensitivity analyses were also conducted to assess the stability of the results. RESULTS: A total of 11 studies were included in the meta-analysis. Analyses contained 49 239 individuals (mean age 60.7, SD = 13.6) who were followed up for a mean 6.2 years (2.3-14.2 years), during which 3669 (7.5%) died. In comparison with the reference group (<3 h/d), the pooled HRs (and 95% CIs) of mortality were 0.71 (0.62-0.82), 0.68 (0.59-0.79), 0.56 (0.44-0.71) for groups 3 to <5 h/d, 5 to <7 h/d, and more than 7 hours a day LPA, respectively. Meta-regression models indicated that there was a log-cubic dose-response relationship between daily LPA and mortality in adults and older people, independent of MVPA. CONCLUSIONS: Time spent in daily LPA was associated with reduced risks of mortality in adults and older people. These data support the inclusion of LPA in the future physical activity guidelines.

The Associations between Near Visual Activity and Incident Myopia in Children: A Nationwide 4-Year Follow-up Study.

OBJECTIVE: This nationwide population-based study aimed to examine the prospective association between near visual activities and incident myopia in Taiwanese children 7 to 12 years old over a 4-year follow-up period. DESIGN: Prospective cohort design. PARTICIPANTS: There were 1958 children aged 7 to 12 years from the Taiwan 2009 National Health Interview Survey who were linked to the 2009 through 2013 claims data from the National Health Insurance system. METHODS: Multivariable Cox proportional hazard models were used to estimate the associations between 3 types of near visual activities in sedentary posture, namely reading (< 0.5, 0.5-0.9, ≥1.0 hours per day [h/d]), use of computer, Internet, and games (<0.5, 0.5-0.9, ≥1.0 h/d), and "cram school" attendance (<0.5, 0.5-1.9, ≥2.0 h/d), and incident myopia. MAIN OUTCOME MEASURES: Prevalent myopia was defined as those who had ≥2 ambulatory care claims (International Classification of Diseases code 367.1) in 2008-2009. Incident myopia was defined by those who had at least 2 ambulatory care claims (International Classification of Diseases code 367.1) during the 4-year follow-up period (2010-2013) after excluding prevalent cases. RESULTS: Overall, 26.8% of children had myopia at baseline, and 27.7% of those without myopia at baseline developed incident myopia between 2010 and 2013. On average, they spent 0.68±0.86 h/d on computer/Internet use, 0.63±0.67 h/d on reading, and 2.78±3.53 h/d on cram school. The results showed that children attending cram schools ≥2 h/d (hazard ratio, 1.31; 95% confidence interval, 1.03-1.68) had a higher risk of incident myopia. The effects of these activities remained similar in sensitivity analyses. CONCLUSIONS: Cram school attendance for ≥2 h/d may increase the risk of children's incident myopia. This effect may be due to increased near visual activity or reduced time outdoors.

A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants.

BACKGROUND: The appropriate limit to the amount of daily sedentary time (ST) required to minimize mortality is uncertain. This meta-analysis aimed to quantify the dose-response association between daily ST and all-cause mortality and to explore the cut-off point above which health is impaired in adults aged 18-64 years old. We also examined whether there are differences between studies using self-report ST and those with device-based ST. METHODS: Prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were identified via MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar databases until January 2018. Dose-response relationships between daily ST and all-cause mortality were examined using random-effects meta-regression models. RESULTS: Based on the pooled data for more than 1 million participants from 19 studies, the results showed a log-linear dose-response association between daily ST and all-cause mortality. Overall, more time spent in sedentary behaviors is associated with increased mortality risks. However, the method of measuring ST moderated the association between daily ST and mortality risk (p < 0.05). The cut-off of daily ST in studies with self-report ST was 7 h/day in comparison with 9 h/day for those with device-based ST. CONCLUSIONS: Higher amounts of daily ST are log-linearly associated with increased risk of all-cause mortality in adults. On the basis of a limited number of studies using device-based measures, the findings suggest that it may be appropriate to encourage adults to engage in less sedentary behaviors, with fewer than 9 h a day being relevant for all-cause mortality.

Prospective relationship between objectively measured light physical activity and depressive symptoms in later life.

BACKGROUND: The use of self-report measures of physical activity is a serious methodological weakness in many studies of physical activity and depressive symptoms. It is still equivocal whether light physical activity protects older adults from depressive symptoms. OBJECTIVE: This study aimed to explore whether objectively measured light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in older adults. METHODS: This was a 2-year prospective cohort study. A total of 285 community-dwelling older adults aged 65 years or older were interviewed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in physical activity at different intensities was assessed using triaxial accelerometers. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Negative binomial regression models with adjustment for baseline depressive symptoms, accelerometer wear time, socio-demographic variables, lifestyle behaviors, and chronic disease conditions were conducted. RESULTS: Time spent in moderate-to-vigorous and light physical activities were both inversely related to depressive symptoms at follow-up. Sedentary time was associated with an increased risk of subsequent depressive symptoms. When sedentary or moderate-to-vigorous activity were included in the multivariable-adjusted regression models with light physical activity simultaneously, only light physical activity remained significant. Sensitivity analyses for assessing confounding and reverse causation provided further support for the stability of these findings. CONCLUSION: Light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in later life. Copyright © 2017 John Wiley & Sons, Ltd.

Prospective associations of social isolation and loneliness with poor sleep quality in older adults.

PURPOSE: There is evidence for negative associations between social isolation and loneliness and sleep quality in older adults. However, it is unclear to what extent these two factors independently affect sleep quality. This study examined the simultaneous associations of social isolation and loneliness with sleep quality in a longitudinal study of older adults. METHODS: Data were analyzed from the Social Environment and Biomarkers of Aging Study in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66.14, SD 7.26). Poisson regression models were conducted to examine the association of social isolation and/or loneliness with sleep quality at follow-up after adjusting for multiple confounding variables. RESULTS: Univariate analysis showed that sleep quality was inversely associated with both social isolation and loneliness. After demographic, health, cognitive factors, and depressive symptoms were controlled in multivariable analysis, social isolation at the baseline still predicted poor sleep quality 6 years later (incident rate ratio, IRR 1.14; 95% CI 1.04-1.24; p < 0.01), while the association between loneliness and sleep quality was no longer significant (IRR 1.08; 95% CI 0.94-1.23; p = 0.27). The results were unchanged when participants who had poor sleep quality at the baseline were excluded from the analysis. CONCLUSIONS: These findings confirm an adverse effect of social isolation on the sleep quality of older adults, but indicate that this effect is independent of loneliness. Social isolation and loneliness seem to have distinct pathways in affecting the sleep quality of older adults.

Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study.

BACKGROUND: Obesity has been associated with increased physical limitations among older adults, although few studies have adjusted for important covariates. There is limited information about the relationship between apolipoprotein E (APOE) polymorphisms and physical limitations, and the findings have been inconsistent. PURPOSE: This study examined the longitudinal associations of obesity and APOE ε4 with difficulties in activities of daily living (ADLs) over a 6-year follow-up period controlling for multiple covariates. METHODS: Data were analyzed from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66). Body mass index (BMI) was used to define obesity at a baseline, and the APOE genotype was classified into an APOE ε4 carrier and non-carrier status. The combination of basic and instrumental activities of daily living (ADLs and IADLs) was used to define impaired ADLs. RESULTS: APOE ε4 carriers had greater difficulties in combined ADLs (incident rate ratio; IRR = 1.87, 95 % CI = 1.40-2.51) than non-carriers. Obese but not overweight adults had greater difficulties in activities of daily living (IRR = 1.59, 95 % CI = 1.20-2.10) compared with the normal/underweight group. Obese older adults without APOE ε4 had greater subsequent difficulties in ADLs than non-obese non-carriers. Among APOE ε4 carriers, obesity was not a significant risk factor for the development of impaired ADLs in older adults, indicating an interaction between genotype and obesity. CONCLUSIONS: The interaction between genotype and obesity phenotype adds new information about the determinants of physical impairment.

A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan.

BACKGROUND: Intervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan. METHODS: A nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes. RESULTS: A total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan-Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33-1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22-0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02). CONCLUSIONS: An exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.

Prospective association between late-life physical activity and hospital care utilisation: a 7-year nationwide follow-up study.

Background: it is still equivocal whether there is a potential role of late-life physical activity in ameliorating the challenges of increasing healthcare expenditure due to the consequence of global population ageing. Objective: this study aimed to examine the prospective association between physical activity and subsequent hospital care utilisation in older adults and to explore the optimal dose of physical activity required to reduce hospital care utilisation. Design: this was a prospective cohort study based on the data from the Taiwan 2005 National Health Interview Survey, which were linked to the 2005-12 claims data from the National Health Insurance system. Participants: 1,760 older adults aged 65 or more. Methods: the frequency, duration and intensity for physical activity were assessed, and total physical activity energy expenditure was estimated. The average annualised hospital care utilisation for the period 2006 through 2012, including number of hospitalisations, number of days in hospital and the costs of hospitalisation, were calculated. Results: older adults engaging in at least moderate volume of physical activity (≥1,000 kcal/week) experienced fewer subsequent hospital admissions and fewer days in hospital than did sedentary individuals, after adjusting for covariates. Trends for reduced hospitalisation costs were also found. These associations persisted in sensitivity analyses, including tests of reverse causation. Conclusion: this study has provided evidence that older adults who are at least moderately active may minimise utilisation of hospital care services. The findings highlight the importance of maintaining a physically active lifestyle in later life.

Prospective associations of exercise and depressive symptoms in older adults: the role of apolipoprotein E4.

PURPOSE: Exercise is associated with reduced risk of depressive symptoms at older ages, while recent work suggests that the apolipoprotein E type 4 allele (APOE-e4) may increase risk. There are no studies of whether APOE-e4 moderates the relationship between exercise and later life depressive symptoms. This study aimed to explore whether the prospective associations between exercise and subsequent depressive symptoms were distinct between APOE-e4 carriers and non-carriers using nationwide data. METHODS: Data from 639 participants (mean age = 66.14, SD = 7.26) in 2000 with 6 years of follow-up were studied. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale. Exercise and the APOE genotype were also assessed at baseline. Negative binomial regression models were conducted to examine the combined effects of exercise and APOE-e4 status on subsequent depressive symptoms when controlling for baseline depressive symptoms and other covariates. Sensitivity analyses to test for confounding, reverse causality, and attrition were conducted. RESULTS: Among APOE-e4 carriers, there was no significant difference in depressive symptoms between high active and low active groups. In contrast, high active APOE-e4 non-carriers had fewer depressive symptoms than low active APOE-e4 non-carriers. The beneficial effect of exercise on depressive symptoms is restricted to APOE-e4 non-carriers. Sensitivity analyses provided further support for the robustness of these findings. CONCLUSIONS: This is the first prospective study investigating whether APOE-e4 moderates the association between exercise and depressive symptoms. It proposes that genetic variation in APOE may influence the effect of exercise on depressive symptoms.

Physical activity ameliorates the association between sedentary behavior and cardiometabolic risk among inpatients with schizophrenia: A comparison versus controls using accelerometry.

OBJECTIVE: A lack of clarity exists regarding the relationship between objectively measured physical activity (PA) and sedentary behavior (SB) and cardiometabolic outcomes in people with schizophrenia. We conducted a large study investigating the independent relationships of PA and SB among inpatients with schizophrenia versus healthy controls (HCs). METHODS: A cross sectional study including 199 inpatients with schizophrenia (mean age 44.0years, mean illness duration 23.8years) versus 60 age/sex/body mass index matched HCs. Participants wore accelerometers for 7days to capture SB and daily steps. Cardiometabolic outcomes included blood pressure, fasting blood glucose (FBG), triglycerides, high-density lipoprotein cholesterol (HDL-C) and waist circumference (WC). Multivariate regression analyses adjusting for multiple confounders were undertaken. RESULTS: Compared to HCs, patients engaged in more sedentary behavior and less daily steps versus HCs (p<0.001). Patients with higher levels of SB (n=89) had increased fasting glucose compared to patients with low levels of SB (105.2 vs. 96.3mg/dl, p<0.05). In the multivariate analysis, sedentary behavior was associated with higher FBG (ß = .146, p=.041) but this was ameliorated when daily steps were inserted in to the model (ß = .141, p=.059). In the final model, higher daily steps were associated with more favorable HDL-C (ß=-.226, p=.004), independent of SB and other confounders. CONCLUSIONS: Our data suggest that higher than while sedentary behavior is related to worse fasting glucose, this relationship is attenuated when PA is taken into account. Physical activity is also associated with favorable HDL-C. Interventions targeting replacing sedentary behavior with PA may improve metabolic risk.

Late-Life Exercise and Difficulty with Activities of Daily Living: an 8-Year Nationwide Follow-up Study in Taiwan.

BACKGROUND: Many studies have shown that low levels of exercise in later life are associated with the progression of difficulties with activities of daily living. However, few have assessed the independent effect of exercise components on difficulty in performing activities of daily living and explored whether the relationship between exercise and activities of daily living is reciprocal. PURPOSES: This study aimed to examine, in a nationally representative sample of older Taiwanese, the independent effect of the frequency, duration, and intensity of exercise on difficulty with activities of daily living. A secondary objective was to explore the degree to which the relationship of late-life exercise with activities of daily living is bi-directional. METHODS: Data from a fixed cohort (n = 1268, aged 70+) in 1999 with 8 years of follow-up were analyzed. Generalized estimating equation models with multivariate adjustment were performed. RESULTS: Participants engaging in higher levels of exercise had less difficulty with subsequent activities of daily living. Among the components of exercise, only duration, especially 30 min or more per session, was associated with fewer difficulties with activities of daily living. The relationship between exercise and activities of daily living was reciprocal, although the influence of activities of daily living on subsequent exercise levels was weaker. CONCLUSIONS: Exercise in later life may be able to minimize the difficulties in activities of daily living and help maintain the mobility and independence of older adults.