Systematic review and meta-analysis on population attributable fraction for physical inactivity to dementia.

INTRODUCTION: The number of cases of dementia attributable to physical inactivity remains unclear due to heterogeneity in physical inactivity definitions and statistical approaches used. METHODS: Studies that used population-based samples to estimate the population attributable fraction (PAF) of physical inactivity for dementia were included in this review. Weighted PAFs were adjusted for communality among the risk factors (i.e., inactive persons may also share other risk factors) analyzed. Values were reported as percentage (%) of cases of dementia attributable to physical inactivity. RESULTS: We included 22 studies. The overall impact of physical inactivity, defined by any criteria, on dementia ranged from 6.6% (95% CI: 3.6%, 9.6%; weighted) to 16.6% (95% CI: 14.4%, 18.9%; unweighted). Studies using the WHO criterion for physical inactivity estimated a higher unweighted impact (ß = 7.3%; 95% CI: 2.0%, 12.6%) than studies using other criteria. DISCUSSION: Conservatively, one in 15 cases of dementia may be attributable to physical inactivity, defined by any criteria.

The association of aerobic and muscular fitness with cognitive impairment: Findings from a nationally representative survey.

This study aimed to characterize the combined association between cardiorespiratory fitness (CRF), muscular strength, and cognitive outcomes in middle-aged and older adults from low and middle-income countries (LMICs). We analyzed cross-sectional, population-based data from adults aged 50 years or older from six LMICs. Mild cognitive impairment (MCI) was defined according to the National Institute on Aging-Alzheimer's Association criteria. Estimated CRF (eCRF) was calculated using previously validated, sex-specific equations. Handgrip strength (HS) was used as an indicator of muscular strength. We used linear and robust Poisson regression models to examine the associations between eCRF, HS, and MCI. Data from 28,339 adults (63.1 [9.5] years) were analyzed. Participants with low eCRF (PR: 1.45; 95%CI: 1.11, 1.90) and HS (PR: 1.92; 95%CI: 1.79, 2.04) were more prone to have MCI. Participants with low HS showed higher likelihood of MCI than those with preserved HS through the CRF range; however, this difference was not seen among highly fit individuals (10 METs or higher). Each 1-MET (PR: 0.77; 95%CI: 0.67, 0.86) and 5-kgf (PR: 0.63; 95%CI: 0.48, 0.79) increase was associated with a reduction in the likelihood of MCI. eCRF and HS were strongly and independently associated with MCI in middle-aged and older adults.

Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis.

BACKGROUND: During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults. METHODS: Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI). RESULTS: Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed. CONCLUSION: Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.

Physical activity during early life and the risk of all-cause mortality in midlife: findings from a birth cohort study.

BACKGROUND: The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland. METHODS: Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event. RESULTS: From age 23 to 55, 8.9% of participants (n = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60-0.98] and 16 (HR: 0.60; 95% CI: 0.46-0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48-0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women. CONCLUSIONS: Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex.

Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil.

BACKGROUND: To evaluate the short-term impact of COVID-19 pandemic on low back pain (LBP) outcomes in southern Brazil. METHODS: Data from the PAMPA Cohort were analyzed. Adults were recruited between June and July 2020 in the Rio Grande do Sul state using online-based strategies. Participants responded a self-reported, online questionnaire on LBP with two timepoints: before (retrospectively) and during COVID-19 pandemic. We assessed LBP experience, LBP-related activity limitation (no/yes), and LBP intensity (0 to 10 [strongest pain]). RESULTS: From a total sample of 2,321 respondents (mean age: 37.6 ± 13.5; 75.4% women), the prevalence of LBP did not change significantly from before (74.7% [95%CI 72.3; 76.9]) to the first months of pandemic (74.2% [95%CI 71.9; 76.3]). However, an increased pain levels (ß: 0.40; 95%CI 0.22; 0.58) and a higher likelihood for activity limitation due to LBP was observed (PR 1.14; 95%CI 1.01; 1.29). Longitudinal analyzes showed that age, gender, BMI, chronic diseases, physical activity, and anxiety and depression symptoms, were associated with LBP in the first pandemic months. CONCLUSION: Although the prevalence of LBP did not change at the first months of COVID-19 pandemic, LBP-induced impairment in daily activities and pain intensity was higher when compared to before the pandemic.

Physical activity and the incidence of depression during the COVID-19 pandemic in Brazil: Findings from the PAMPA cohort.

We examined the longitudinal association between physical activity (PA) and the incidence of self-reported diagnosed depression in adults in southern Brazil during the COVID-19 pandemic. Data from the PAMPA (Prospective Study About Mental and Physical Health) cohort was used. Data collection for baseline was carried out on June-July 2020, with two follow-up assessments taking place six months apart. An online, self-reported questionnaire assessed depression and PA. Depression was assessed by asking participants whether they were ever diagnosed with depression. We included 441 participants (women: 75.9%; mean age [SD]: 38.0 [13.5]) in southern Brazil. Over the follow-up, 21.8% (95% confidence interval [CI]: 18.1%-25.9%) were diagnosed with depression. Insufficiently active (<150 min per week of physical activity) (Incidence rate [IR]: 61.9; 95%CI: 39.5-102.4; p = 0.047) and active (≥150 min per week of physical activity) (IR: 50.4; 95%CI: 31.9-84.0; p = 0.015) participants had reduced IR of depression per 1000 persons-year at risk compared to inactive ones (0 min per week of physical activity) (IR: 99.9; 95%CI: 79.7-126.8). In the adjusted analyses, participants in the insufficient active (hazard ratio [HR]: 0.58; 95%CI: 0.34-0.98) and active (HR: 0.53; 95%CI: 0.31-0.93) group had a lower risk of developing depression than the inactive group. PA both at and out of home reduced the risk of incident depression (HR: 0.49; 95%CI: 0.25-0.98) compared to no physical activity. Endurance (HR: 0.52; 95%CI: 0.28-0.97) and endurance plus strengthening (HR: 0.40; 95%CI: 0.17-0.95) PA reduced the risk of incident depression compared to none. Being physically active during pandemic, regardless of the amount of PA practiced, reduced the incidence of depression in adults in southern Brazil.

Physical activity trajectory in the first 10 months of the COVID-19 pandemic in Southern Brazil: a follow-up study.

BACKGROUND: A continuous tracking of the PA level during the COVID-19 pandemic is important to understand how people's behaviour has varied along time. The aim of this study was to evaluate the physical activity (PA) trajectory over the first 10 months of the COVID-19 pandemic in the south of Brazil. METHODS: Data from three timepoints of the PAMPA Cohort were used, as follows: (1) pre-COVID-19 (retrospective); (2) Jun/Jul 2020; (3) Dec 2020/Jan 2021. Self-reported PA practice, frequency, duration, as well as place where activities were performed (at or out of home) were assessed. RESULTS: A reduction in any (from 68.7 to 47.7%), sufficient (from 41.5 to 22.1%) and out of home PA (from 59.4 to 30.1%) was observed from the first (pre-COVID-19) to the second (Jun/Jul 2020) timepoint, followed by an increase in the third timepoint (Dec 2020/Jan 2021) (60.1%, 37.9%, and 54.3% for any, sufficient, and out of home PA, respectively). The PA trajectory was similar, regardless of sex, educational level or income. Only any (p = 0.0007) and sufficient (p = 0.0012) PA showed significant interaction with time by sex. Female participants were less likely to engage in any (OR 0.45 95% CI 0.26; 0.77) and sufficient PA (OR 0.40 95% CI 0.24; 0.66). CONCLUSION: During the first 10 months of COVID-19 pandemic there was a marked fluctuation on PA pattern in adults from southern Brazil. An ongoing tracking of PA behaviour during COVID-19 pandemic is important to understand how this behaviour varies. Public policies should focus on increasing PA in a higher standard than pre-COVID levels.

Reliability of a smartphone application to measure physical activity.

The aim of this study was to evaluate how accurate is a smartphone app to measure a physical activity parameter (steps). Physical Education undergraduate students (n = 46), both male and female, were recruited. A tally counter, a validated device (Xiaomi Mi Band 2®) and My Active Life app were used to perform the steps count. Each participant took three low-intensity treadmill walks (5 km h-1), with a number of target steps (500-, 1000- and 1500-steps walk). Visual agreement analyses was performed through Bland-Altman plots. There was no significant interaction between steps walks and device during treadmill walking test (F(2,84) = 3.854; p = 0.07). Differences in steps measured by Mi Band were not different from 0 in 500-steps walk (p = 0.243) and 1000-steps walk (p = 0.350), and in My Active Life in 500-steps walk (p = 0.177) and 1500-steps walk (p = 0.221). Bland-Altman analyses indicated an acceptable agreement between My active Life app and Mi Band devices for 1000-steps walk (-359.01; 310.43) and 1500-steps walk (-572.97; 377.11). In conclusion, My Active Life app showed accuracy in measuring total steps, in longer walking activities (e.g. higher than 1000 steps), and can be used on a daily basis and in research setting.

Are gender differences in physical inactivity associated with the burden of dementia in low- and lower-middle income countries?

We explore the association between gender differences in physical inactivity and dementia in low and lower-middle-income countries (LLMIC). Data were extracted from the Repository of the Global Health Observatory and the United Nations Development Program with 2016 as reference year. Sample was composed using countries with a Human Development Index lower than 0.700. We calculated the population attributable fraction for physical inactivity in dementia. Absolute and relative gender differences in physical inactivity were calculated by subtracting and dividing the prevalence of physical inactivity among men from women's prevalence, respectively. Physical inactivity accounts for 12.25% cases of dementia in LLMIC. Women account for 58% of deaths and 56% of DALY's due to dementia in LLMIC. Adjusted prevalence of dementia was associated with prevalence and absolute gender difference in physical inactivity. DALYs and deaths due to dementia were associated with absolute and relative gender differences in physical inactivity. A reduction of 10% in physical inactivity only among women might reproduce a similar decline in the burden of dementia compared to the same 10% decrease in physical inactivity in the whole LLMIC population. Decreasing gender gap in physical inactivity may be an alternative approach to reduce the burden of dementia in LLMIC.

How has COVID-19 social distancing impacted physical activity patterns? Data from the PAMPA cohort, Brazil.

OBJECTIVE: This study aimed to evaluate how social distancing measures affected physical activity (PA) patterns in adults from Rio Grande do Sul, Brazil. METHODS: Participants were recruited from social and local media campaigns, contacts with private and public universities, as well as research personal contacts across the state. PA was assessed before (retrospectively) and during social distancing. Frequency (days per week) and time (minutes per day) were asked to those participants who practiced PA. Two PA variables were built to each time-frame (before and during social distancing): 1) any PA (yes/no question), and 2) sufficient PA (based on the 150 min/week cut-off point). RESULTS: Overall, 2321 participants answered the questionnaire. Any and sufficient PA decreased from before to during social distancing (22.3% and 17.0%, respectively). A linear increase of activity during social distancing was observed in participants who practiced up to 400 min or less of PA per week before social distancing. Regarding associated factors, female, overweight/obese and diagnosed chronic disease participants were less likely to practice any or sufficient PA during social distancing when compared to the period before. CONCLUSION: PA practice (both any and sufficient) decreased in Southern Brazil in the first months of social distancing. Women, overweight/obese and chronic diseased participants showed a higher decrease in PA compared to other groups. Finally, those participants who practiced PA before social distancing were more likely to continue practicing during COVID-19 pandemic.

Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study.

From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.

Multimorbidity and leisure-time physical activity over the life course: a population-based birth cohort study.

BACKGROUND: We aimed to test which life course model best described the association between leisure-time physical activity (LTPA) and multimorbidity at age 55. We analyzed data from birth to age 55 using the database from the 1958 National Child Development Survey. METHODS: Multimorbidity was considered as the presence of more than one chronic condition. LTPA was measured through questionnaires from 1965 (age 7) to 2013 (age 55), which were applied in eight different occasions. We compared the fit of a series of nested adjusted logistic regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. Data were reported as odds ratio (OR) and 95% confidence interval (CI). RESULTS: From an eligible sample of 15,613 cohort members, 9137 were interviewed in the latest sweep (58.5%). Men were more physically active than women at ages 11, 16, and 23 (p < 0.001). LTPA every day in the week was more frequent in women than men in ages 33, 42, and 50 (p < 0.001). The prevalence of multimorbidity at age 55 was 33.0% (n = 2778). The sensitive analysis revealed that LTPA during adolescence (OR: 0.83; 95% CI: 0.70, 0.98) and mid adult life (age 50 and 55; OR: 0.82; 95%CI: 0.69, 0.98) have a stronger effect on the risk for multimorbidity at age 55 considering all other life stages in the model. Also, adolescence showed a critical independent effect on the risk for multimorbidity (OR: 0.82; 95%CI: 0.70, 0.97). No difference was found between those models. CONCLUSIONS: These data support the notion of a protective physical activity "legacy" at early ages of childhood against multimorbidity at older ages. We highlight the need for LTPA promotion through intervention tailored especially on schooling and older ages in order to reduce the burden of multimorbidity.

Association between physical activity and subjective memory decline triggered by the COVID-19 pandemic: Findings from the PAMPA cohort.

Implementation of social distancing reduced the incidence of coronavirus disease (COVID-19) cases. Nevertheless, this strategy has other undesirable effects such as physical inactivity and psychological distress, which are associated with cognitive impairment. We aimed to examine whether physical activity during social distancing restrictions could reduce the risk of subjective memory decline in adults. Participants (n=2321) completed the baseline assessment of PAMPA cohort (Prospective Study About Mental and Physical Health), a ambispective cohort study conducted in southern Brazil. An online-based, self-administered questionnaire assessed physical activity and self-rated memory in two different periods: before and during social distancing. Data collection was executed from June 22nd to July 23rd 2020. Adjusted Poisson regression models were performed and values reported in prevalence ratio (PR) with 95% confidence interval (CI). Participants presented with a mean age of 38.2 (95%CI: 37.5, 38.9) years. Most were women (76.6%), had at least a university degree (66.7%), and were overweight or obese (53.3%). Subjective memory decline was reported by 30.0% (95%CI: 27.7%, 32.4%) of respondents. Most individuals with subjective memory decline reported being physically inactive during the pandemic of COVID-19. Participants were less likely to experience subjective memory decline if they either became (PR: 0.56; 95%CI: 0.36, 0.89) or remained (PR: 0.68; 95%CI: 0.49, 0.93) physically active compared to inactive respondents. Physical activity participation during social distancing reduced the likelihood of subjective memory decline in adults. Physical activity should be highlighted as a potential alternative to reduce the burden of the COVID-19 pandemic on cognitive function and mental health.

Physical activity in later life and risk of dementia: Findings from a population-based cohort study.

BACKGROUND: Dementia is the second leading cause of death in the United Kingdom, affecting 7.1% of older adults. One in five dementia cases in Europe can be attributable to physical inactivity. We examined the association between physical activity at age 50 or older and risk of dementia over 15 years. METHODS: The English Longitudinal Study of Ageing (ELSA) comprises a national population-based cohort that began in 2002-03 (baseline) with 9275 individuals aged ≥50 years. Dementia diagnosis was followed over 15 years. Physical activity in daily life and at work was measured at baseline and at two yearly intervals and participants were categorized as inactive, low, or moderate-to-high active. Cumulative incidence of dementia during follow-up was calculated; hazard ratios and 95% confidence intervals (CI) were estimated using survival analysis. RESULTS: At baseline, 69% of the sample were categorized as moderate-to-high active. The inactive, low, and moderate-to-high active groups had a cumulative incidence of dementia of 4.8% (95%CI: 4.4 to 5.4), 0.9% (95%CI:0.8 to 1.1), and 0.2% (95%CI: 0.1 to 0.5), respectively. In adjusted analyses, participants in the low and moderate-to-high active groups had, respectively, 60% and 78% lower risk of developing dementia than the inactive group. Survival analyses showed large between-group differences in the cumulative incidence of dementia over 15 years based on the physical activity categories. CONCLUSION: In people aged 50 or more, there is an inverse dose-response association between physical activity and incidence of dementia over 15 years. Even low levels of physical activity have beneficial effects.