Dynamic associations between frailty and cognition over 4 years: A population-based study on adults aged ≥50 from 12 European countries.

PURPOSE: This study aimed (1) to investigate autoregressive and cross-lagged associations between frailty and cognition over 4 years in a large sample of European citizens aged ≥50 years, (2) to examine the 4-year temporal associations' differences between sex and between active and inactive physical behaviour, and (3) to explore in the years 2011, 2013, and 2015 associations between cognitive performance and the pre-frailty and frailty conditions. MATERIALS AND METHODS: This longitudinal analysis was conducted with 20,857 individuals (11,540 women) from 12 countries aged ≥50 years who responded to waves 4, 5, and 6 of the SHARE project. The variables analysed were frailty (SHARE-FI) and a general cognition index (Cogindex) calculated for each wave from verbal fluency, immediate recall, and delayed recall. RESULTS: A greater propensity for cognitive impairment was found in women, as well as in pre-frail and frail individuals. There were no significant differences between the sexes for the autoregressive effect of frailty and Cogindex over 4 years. On the other hand, sedentary and active individuals differed in frailty between Time 1-2. Cross-lagged analyses indicated a significant difference for the sexes between frailty and Cogindex Time 1-3 and between Cogindex and frailty of Time 2-3. Sedentary and active differed significantly in the path of frailty on Cogindex between Time 2-3. CONCLUSION: Health policies should increase surveillance of frailty, cognition, and level of physical activity in the older European population, with a special focus on women.

Grip strength buffers the harmful association between multimorbidity and depression among middle-aged and older adults.

BACKGROUND: Grip strength (GS) is associated to both multimorbidity and depression, however its possible moderating effect is unknown. This study aimed to investigate GS moderating effect on the association between multimorbidity and depression. METHODS: Data from SHARE wave 8 was used. Participant were 41457 middle-aged and older adults (17954 men) from 18 European countries. A regression analysis was conducted for the moderating effect of sex- and age-specific GS quartiles (W) on the association between number of chronic diseases (X1) or multimorbidity (X2) and depression symptoms (Y). RESULTS: More chronic diseases were associated with greater depressive symptomatology (men: B = 0.39, 95 % CI: 0.35, 0.42; women: B = 0.42, 95 % CI: 0.39, 0.45). On the other hand, being in a higher GS quartile was associated with fewer depression symptoms, and this association was stronger the higher the quartile was. Having a higher GS represented a decrease in depression symptoms associated with multimorbidity for men (quartile 1: B = 0.85, 95 % CI = 0.74, 0.95 vs. quartile 4: B = 0.49, 95 % CI = 0.38, 0.61) and women (quartile 1: B = 1.08, 95 %CI = 0.97, 1.19 vs. quartile 4: B = 0.59, 95 %CI: 0.47, 0.70). CONCLUSIONS: Strategies aiming to reduce the impact of multimorbidity on mental health should promote muscle-strengthening physical activity among middle-aged and older adults.

Estimated Energy Expenditure in Youth While Playing Active Video Games: A Systematic Review.

Sedentary behavior and inadequate energy expenditure are serious global public health concerns among youngsters. The exponential growth in technology emerges as a valuable opportunity to foster physical activity, particularly through active video games. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, Cochrane, and Scopus to provide a comprehensive view of the literature on energy expenditure levels among adolescents while playing active video games. Among the 574 manuscripts identified at the first screening stage, 23 were retained for analysis. Ten studies were characterized by longitudinal and thirteen by cross-sectional designs. The results showed that short-term active video games elicited energy expenditure values comparable to moderate-intensity physical activity (3-6 METs). However, in intervention programs (with at least six weeks) the results indicate no significant effects of active video games on youngsters' energy expenditure levels and physical activity profiles between baseline and follow-up assessments. Overall, active video games based on sports and dance were the most used, and boys tended to achieve higher energy expenditure than girls. The diversity of methods implemented limits comparing results and drawing generalized conclusions. However, considering its attractiveness to youth, active video games might emerge as a complementary tool to traditional physical activities promoted in schools and local communities. Details regarding gender differences and contradictory results of longitudinal approaches should be considered in future research based on standardized methods.

Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation.

BACKGROUND: We examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality. METHODS: Prospective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation. RESULTS: 27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up. LIMITATIONS: The data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias. CONCLUSIONS: Reverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.

Comics as a Physical Education Tool for Health Promotion in Brazilian Primary Education, Based on Paulo Freire's Principles of Empowerment.

Incorrect postural habits developed already at an early age are predictors of low back pain and functional limitations in adult life. Postural education programs (PEPs) are activities developed in Physical Education classes with the aim of promoting healthy habits. One tool used by PEPs is comics. The objective of this study was to develop comics and apply them as a teaching tool in PEPs for students aged seven to ten years. The procedures were based on individual empowerment principles, including creation activities, reading, painting, crosswords, and discussion of comics. The activities strengthened the students' interactions, gaining new knowledge that required cognitive and expressive resources to interpret, associate, and conceptualize themes of correct body posture. During six weeks of intervention, knowledge about body posture, anatomy, and health promotion exercises increased significantly in relation to the beginning of activities. The comic book proved to be an effective, attractive, and low-cost didactic resource.

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.

Weekly External Load Performance Effects on Sports Injuries of Male Professional Football Players.

One of the most challenging issues professional football players face throughout their careers is injuries. Those injuries often result from suboptimal training programs that were not designed according to the players' individual needs. This prospective study aimed to examine in detail the effects of sports injuries on professional football players' weekly external load performances. Thirty-three male professional football players were monitored using 10-Hz Global Positioning System (GPS) units (Apex pro series, StatSports) during an entire season. The variables considered in the analysis were total distance (TD), high-speed running (HSR), accelerations (ACC), and decelerations (DEC). The comparisons were made between the four-week block before injury (-4T), four-week block after return (+4T), and players' season averages (S). Players displayed significantly higher values of TD, HSR, ACC, and DEC in the -4T, compared to the other two moments (+4T and S). Furthermore, the comparison between the +4T and S showed no significant variations in the GPS metrics. It was shown that a significant increase in players' weekly external load performance over a four-week period may have a negative effect on the occurrence of injuries from a professional football standpoint. Future research should consider the effects of injury severity on players' external load variations.

Impacts of Social Isolation on the Physical and Mental Health of Older Adults During Quarantine: A Systematic Review.

OBJECTIVES: To systematically review articles that reported the impacts of social isolation on the physical and mental health of healthy older adults during the coronavirus disease 2019 (Covid-19) quarantine. METHODS: Electronic search was performed in PubMed, EMBASE, Web of Science, Scopus, and BIREME databases. It included cohort and cross-sectional studies published between January 2020 and January 2022 which evaluated the impacts of social isolation on the physical and mental health of older adults during quarantine. The study was registered in PROSPERO (CRD42021269720). RESULTS: Out of 8,505 studies identified, 17 met the inclusion criteria, with moderate to excellent quality. The majority of the older population perceived changes in their physical and mental health. Impacts differed in cohorts according to sex, age group, income, social participation, exercising before and during confinement, and living alone or with other people. CONCLUSIONS: The long period of social isolation dictated by the COVID-19 pandemic caused changes in most older adults`, reducing levels of physical activity and/or generating depression, anxiety, fear, and mood problems. Follow-up studies are necessary to observe the evolution of these impacts. CLINICAL IMPLICATIONS: Public policies must be developed to promote the emotional and physical health of the older adult population in the post-pandemic period.

Prevalence of Frailty and Its Association with Depressive Symptoms among European Older Adults from 17 Countries: A 5-Year Longitudinal Study.

BACKGROUND: This study aimed to examine the association between frailty and depressive symptoms. METHODS: Cross-sectional and five-year longitudinal study. Data were from the population-based Survey of Health, Aging, and Retirement in Europe (SHARE) waves six (2015) and eight (2020). Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported, and grip strength was measured using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depressive symptoms. RESULTS: The sample comprised 25,771 older adults (56.2% female) with a mean age of 66.5 (95% CI 66.4, 66.6) years. The prevalence of frailty was 4.2% (95% CI 3.9, 4.4) in 2015 and 6.7% (95% CI 13.5, 14.3) in 2020. Among frail participants, 72.5% and 69.6% had depression in 2015 and 2020, respectively. Frailty was associated with depression over the 5 years. Those with pre-frailty and those with frailty in 2015 had 1.86 (95% CI 1.71, 2.01) and 2.46 (95% CI 2.14, 2.83) greater odds of having depressive symptoms in 2020. CONCLUSIONS: Frailty is a predictor of depression in older adults, and frail participants had greater odds of presenting depressive symptoms.

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.

Predictive Modeling of Injury Risk Based on Body Composition and Selected Physical Fitness Tests for Elite Football Players.

Injuries are one of the most significant issues for elite football players. Consequently, elite football clubs have been consistently interested in having practical, interpretable, and usable models as decision-making support for technical staff. This study aimed to analyze predictive modeling of injury risk based on body composition variables and selected physical fitness tests for elite football players through a sports season. The sample comprised 36 male elite football players who competed in the First Portuguese Soccer League in the 2020/2021 season. The models were calculated based on 22 independent variables that included players' information, body composition, physical fitness, and one dependent variable, the number of injuries per season. In the net elastic analysis, the variables that best predicted injury risk were sectorial positions (defensive and forward), body height, sit-and-reach performance, 1 min number of push-ups, handgrip strength, and 35 m linear speed. This study considered multiple-input single-output regression-type models. The analysis showed that the most accurate model presented in this work generates an error of RMSE = 0.591. Our approach opens a novel perspective for injury prevention and training monitorization. Nevertheless, more studies are needed to identify risk factors associated with injury prediction in elite soccer players, as this is a rising topic that requires several analyses performed in different contexts.

Avaliação sensorial do equilíbrio e estimativa do risco de queda de idosas praticantes do Pilates mate

Introdução: Déficits dos sistemas visual, vestibular e somatossensonrial de idosos afetam o controle postural, elevando o risco de queda. Objetivos: Avaliar a diferença do equilíbrio entre idosas caidoras e não, praticantes do método Pilates Mat nas diferentes situações de entradas sensoriais, verificar a correlação . Método: Estudo transversal quantitativo e analítico realizado na cidade de Petrolina-PE, entre os anos de 2017 e 2018, com 94 mulheres (67,90 ± 5,19 anos), divididas em caidoras (n=29) e sem histórico de quedas (n=65), cálculo definido "a posteriori". Dados sociodemográficos, medicamentos e frequência de quedas foram coletados por meio de um questionário. O equilíbrio foi avaliado utilizando teste clinical test of sensory interaction and balance (CTSIB) e o teste de equilíbrio corporal (TEC). Resultados: A taxa de queda observada foi de 29% e o tempo médio de prática do Pilates de 27 meses. A análise de regressão logística indicou resultados negativos, revelando como fator protetor de quedas o bom desempenho no teste EDRI, CTSIB 1 e CTSIB 5, com diminuição da chance de queda de 64, 78 e 75%, respectivamente. Associação positiva com queda foi mostrada pelo CTSIB 2 (OR=0,286; 95% CI [-0,119 ­ 0,063]), indicando aumento da chance de cair em até 71%. Conclusão: Embora, o grupo de mulheres idosas fossem praticante regular de exercícios físicos, verificou-se que o risco de cair independe do histórico de quedas anteriores e o déficit da regulação sensorial do equilíbrio estático e dinâmico é comum ao avanço da idade.

Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial : Variable- and fixed-priority dual-task for older adults.

BACKGROUND: Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. METHODS: This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. DISCUSSION: This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.

Fatores preditores de quedas em mulheres praticantes de exercício físico / Predictive factors of falls in women practicing physical exercise / Factores predictores de caídas en mujeres que practican actividad física

Objetivo: Identificar fatores preditores de quedas em idosas praticantes de exercício físico. Métodos: Estudo transversal, observacional, com amostra não probabilística e intencional, realizado entre abril e julho de 2016, em Petrolina, Pernambuco, com 109 mulheres (60-84 anos) praticantes do método Pilates, hidroginástica e natação, com e sem histórico de queda. Utilizou-se como instrumento de coleta um questionário para dados sociodemográficos, comorbidades, número de medicações, índice de massa corporal (IMC), desempenho da marcha pelo teste Time up and Go (TUG) e equilíbrio pela escala do equilíbrio de Berg (EEB). Para a análise dos dados, utilizou-se o teste de Kruskal Wallis, correlação de Spearman e regressão linear. Resultados: Observou-se déficit do desempenho da marcha com o avanço da idade (p<0,05). Na avaliação do equilíbrio corporal, octogenárias apontaram risco para queda (p<0,05). A análise de regressão logística indicou que o risco de queda foi potencializado em 22% pelo déficit de atenção, e em 21% pelo uso diário superior a três tipos de medicamentos (p<0,05). Conclusão: O déficit da capacidade cognitiva e o número de tipos de medicações se apresentam como preditores de queda em idosas praticantes de exercícios físicos.

Objective: To identify factors associated with the risk of falls in older women engaged in regular physical exercise. Methods: Observational cross-sectional study with a non-probability and intentional sample conducted between April and July 2016 in Petrolina, Pernambuco, with 109 women (60-84 years old) doing Pilates, water aerobics and swimming, with and without history of falls. A questionnaire addressing sociodemographic data, comorbidities and number of medications used was used as the instrument of data collection in addition to Body Mass Index (BMI), gait performance by the Time Up and Go (TUG) test and balance by the Berg Balance Scale (BBS). Data were analyzed using Kruskal Wallis test, Spearman's correlation and linear regression. Results: A gait performance deficit was observed with advancing age (p<0.05). In the assessment of body balance, octogenarians showed a risk for falling (p<0.05). Logistic regression analysis indicated that the risk of falls was increased by 22% due to attention deficit and by 21% due to daily use of more than three types of medication (p<0.05). Conclusion: Cognitive deficit and the number of medications used were predictors of falls in older women doing regular physical exercise.

Objetivo: Identificar los factores predictores de caídas en mujeres mayores practicantes de actividad física. Métodos: Estudio transversal y observacional con muestra no probabilística e intencional realizado entre abril y julio de 2016, en Petrolina, Pernambuco, con 109 mujeres (60-84 años) practicantes del método Pilates, hidroginástica y natación con y sin histórico de caídas. Se utilizó como instrumento de recogida de datos un cuestionario para los datos sociodemográficos, las comorbidades, el número de medicaciones, el índice de masa corporal (IMC), el desempeño de la marcha por la prueba Time up and Go (TUG) y el equilibrio con la escala de equilibrio de Berg (EEB). Se utilizó la prueba de Kruskal Wallis, la correlación de Spearman y la regresión linear para el análisis de los datos. Resultados: Se observó un déficit para el desempeño de la marcha al avanzo de la edad (p<0,05). En la evaluación del equilibrio corporal, las octogenarias presentaron riesgo para caída (p<0,05). El análisis de regresión logística ha indicado que el riesgo de caída ha sido potencializado en el 22% por el déficit de atención y el 21% por el uso a diario de más de tres tipos de medicamentos (p<0,05). Conclusión: El déficit de la capacidad cognitiva y el número de tipo de medicamentos se han presentado como predictores de caída en mujeres mayores que practican actividad física.