Can step count be used to identify older adults with high sedentary time and low moderate-to-vigorous physical activity?

INTRODUCTION: Combined high sedentary time (ST) and low moderate-to-vigorous physical activity (MVPA) has been associated with adverse cardiovascular events. However, accurately assessing ST and MVPA in older adults is challenging in clinical practice. PURPOSE: To investigate whether step count can identify older adults with unhealthier movement behavior (high ST/low MVPA) and poorer cardiometabolic profile. METHODS: Cross-sectional study (n = 258; 66 ± 5 years). Step count, ST, and MVPA were assessed by hip accelerometry during 7 days. The cardiometabolic profile was assessed using a continuous metabolic syndrome score (cMetS), including blood pressure, HDL-cholesterol, triglycerides, fasting glucose, and waist circumference. Receiving operating curve analysis was used to test the performance of step count in identifying older adults with unhealthier movement behavior (highest tertile of ST/lowest tertile of MVPA). Healthier movement behavior was defined as lowest tertile of ST/highest tertile of MVPA, with neutral representing the remaining combinations of ST/MVPA. RESULTS: A total of 40 participants (15.5%) were identified with unhealthier movement behavior (ST ≥ 11.4 h/day and MVPA ≤ 10 min/day). They spent ~73% and 0.4% of waking hours in ST and MVPA, respectively. Step count identified those with unhealthier movement behavior (area under the curve 0.892, 0.850-0.934; cutoff: ≤5263 steps/day; sensitivity/specificity: 83%/81%). This group showed a higher cMetS compared with neutral (ß = .25, p = .028) and healthier movement behavior groups (ß = .41, p = .008). CONCLUSION: Daily step count appears to be a practical, simple metric for identifying community-dwelling older adults with concomitant high ST and low MVPA, indicative of unhealthier movement behavior, who have a poorer cardiometabolic profile.

Association of 'Tortoise' and 'Hare' movement behavior patterns with cardiometabolic health, body composition, and functional fitness in older adults.

We investigated the association of movement behavior patterns with cardiometabolic health, body composition, and functional fitness in older adults. A total of 242 older adults participated of this cross-sectional study. Sedentary time, light physical activity (LPA) and moderate-vigorous physical activity (MVPA), steps/day, and step cadence were assessed by accelerometry. The movement behavior patterns were derived by principal component analysis. Cardiometabolic health was defined by a metabolic syndrome score (cMetS). Body composition was determined by appendicular lean mass/body mass index (ALM/BMI). Functional fitness was assessed by a composite z-score from the Senior Fitness Test battery. Two patterns were identified: 'Tortoise' (low sedentary time, high LPA and steps/day) and 'Hare' (high MVPA, steps/day, and step cadence). 'Tortoise' and 'Hare' were associated with better cMetS. 'Hare' was positively associated with ALM/BMI and Functional Fitness. While 'Tortoise' and 'Hare' were associated with better cMetS, only 'Hare' was associated with better ALM/BMI and functional fitness.

Independent and joint associations of cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults.

The aim of this study was to investigate the independent and joint associations of low cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults. A total of 360 community-dwelling older adults aged 60-80 years participated in this cross-sectional study. Cardiometabolic risk was based on the diagnosis of Metabolic Syndrome and poor Ideal Cardiovascular Health according to the American Heart Association guidelines. Cardiorespiratory fitness and lower-limb muscle strength were estimated using the six-minute walk and the 30-second chair stand tests, respectively. Participants in the 20th percentile were defined as having low cardiorespiratory fitness and lower-limb muscle strength. Poisson's regression was used to determine the prevalence ratio (PR) and 95% confidence intervals (CI) of Metabolic Syndrome and poor Ideal Cardiovascular Health. Participants with low cardiorespiratory fitness alone and combined with low lower-limb muscle strength were similarly associated with a higher risk for Metabolic Syndrome (PR 1.27, 95% CI 1.09-1.48, and PR 1.32, 95% CI 1.10-1.58, respectively), and poor Ideal Cardiovascular Health (PR 1.76, 95% CI 1.25-2.47, and PR 1.65, 95% CI 1.19-2.28, respectively). Low lower-limb muscle strength alone was not associated with a higher risk for either Metabolic Syndrome or poor Ideal Cardiovascular Health (PR 1.23, 95% CI 0.81-1.87, and PR 1.11, 95% CI 0.89-1.37, respectively). Low cardiorespiratory fitness alone or combined with low lower-limb muscle strength, but not low lower-limb muscle strength alone, was associated with a higher cardiometabolic risk in older adults. The assessment of physical fitness may be a "window of opportunity" to identify youngest-old adults with a high cardiovascular disease risk.

Association of daily step volume and intensity with cardiometabolic risk in older adults.

BACKGROUND: To investigate the association of daily step volume and intensity with cardiometabolic risk in older adults. METHODS: This cross-sectional study included 248 community-dwelling older adults (66.0 ± 4.6 years; 78 % females). The daily step volume and intensity were assessed using accelerometry. Cardiometabolic risk was defined using a continuous metabolic syndrome score (cMetS). The participants were categorized according to their daily step volume (inactive <5000; low active 5000-7499; active 7500-9999; highly active 10,000+ steps/day), and intensity (peak 30-min cadence; lowest, < 40; low, 40-59; average, 60-79; high, 80-99; highest, 100+ steps/min). Generalized linear models were used for data analyses. RESULTS: The active (ß = -0.29, p = 0.040) and the highly active (ß = -0.40, p = 0.026) groups had lower cMetS compared to the inactive group. No significant difference was found between the low active and inactive groups (ß = -0.21, p = 0.098). Every increment of 1000 steps/day was associated with a decrease of 0.06 in cMetS (p < 0.001). The average (ß = -0.37, p = 0.028), high (ß = -0.42, p = 0.015), and highest (ß = -0.81, p = 0.001) groups had lower cMetS than the lowest group. No significant difference was observed between the low and lowest groups (ß = -0.22, p = 0.192). Every increment of 10 steps/min in the peak 30-min cadence was associated with a decrease of 0.07 in cMetS (p = 0.003). CONCLUSIONS: Daily step volume and intensity were inversely associated with cardiometabolic risk in community-dwelling older adults in a dose-response manner.

COVID-19 pandemic and explicit processes towards physical activity in Brazilian older adults with hypertension.

This study investigated the initial three-month impact of the COVID-19 pandemic on the explicit processes towards physical activity (PA). In addition, we explored whether potential changes in explicit processes are associated with changes in PA and sedentary behavior (SB). Seventeen older adults (aged 65.7 ± 3.8 years; 76.5% women) with hypertension were included in this longitudinal study performed in Natal, Brazil. Explicit processes (explicit attitude [perceived benefits and cons perceived], social norms, social modeling, self-efficacy, intention and motivation) were evaluated through self-reported questionnaire before (January to March 2020) and during (June 2020) the COVID-19 pandemic. In addition, PA and SB were measured by accelerometry during seven days. Generalized linear and mixed models were used for data analysis. There was a decrease in the explicit attitudes (ß = - 4.8, p = 0.001) and moderate-vigorous PA (ß = - 4.8, p = 0.035) during the COVID-19. Changes in the explicit attitudes were associated with the changes in the moderate-vigorous PA (ß = - 1.6, 95% CI - 2.9, - 0.3, p = 0.034). No significant changes were found in the additional explicit process measures, time spent doing light PA and SB, and step count. Our findings may suggest that the COVID-19 pandemic has negatively impacted the explicit attitudes related to PA and contributed to decrease the time spent in the moderate-vigorous PA in older adults with hypertension.

Life-Space Mobility and Objectively Measured Movement Behavior in Older Adults with Hypertension after Receiving COVID-19 Vaccination.

This study examined the changes in life-space (LS) mobility and objectively measured movement behavior in older adults with hypertension after receiving the COVID-19 vaccine and their associations with housing type. A total of 32 participants were included in this exploratory longitudinal study with a 1-year follow-up. LS mobility and accelerometer-based physical activity (PA) and sedentary behavior (SB) were assessed before and ~2 months after receiving COVID-19 vaccination. Participants residing in apartment/row housing showed an increase in LS mobility composite score (ß = 14, p < 0.05). In addition, they showed an increase in light PA on weekdays and the weekend (ß = 3.5%; ß = 6.5%; p < 0.05) and a decrease in SB on weekdays and the weekend (ß = -3.7%; ß = -6.6%; p < 0.05). Furthermore, changes in SB pattern were found (less time spent in bouts of ≥10 and 30 min, more breaks/day and breaks/hour). Significant associations were found between changes in LS mobility composite score and PA (positive association) and SB (negative association) in older adults residing in apartment/row housing (p < 0.05). Older adults with hypertension, particularly those who resided in houses with limited outdoor space (apartment/row housing), showed positive changes in LS mobility and objectively measured movement behavior in a period after receiving the COVID-19 vaccine and characterized by social distancing policies without mobility restrictions when compared with the period of social distancing policies with high mobility restrictions and without vaccine.

Associations of steps per day and peak cadence with arterial stiffness in older adults.

BACKGROUND: There is evidence showing an inverse association between steps/day and arterial stiffness in adults. However, the relationship of steps/day and peak cadence with arterial stiffness is poorly understood in older adults. This study aimed to investigate the association between steps/day and peak cadence with arterial stiffness in older adults. METHODS: This cross-sectional study included 222 community-dwelling older adults (66 ± 5 years; 81.5% females; 70.3% with hypertension). Arterial stiffness was measured by aortic pulse wave velocity (aPWV). Steps/day and peak cadence were assessed by accelerometry. The participants were categorized according to the number of steps/day: sedentary <5000; low active 5000-7499; active 7500-9999; highly active 10,000+. Peak cadence was defined as the average of steps/day of the highest 30 min (not necessarily consecutive) for all valid days. Generalized linear models were used for data analyses. RESULTS: The active (ß = -0.34 m/s, 95% CI -0.60, -0.08) and highly active (ß = -0.51 m/s, 95% CI -0.83, -0.20) groups had lower aPWV compared to the sedentary group. No significant difference was found between the low active group and the sedentary group (ß = -0.21 m/s, 95% CI -0.46, 0.05). Every increment of 1000 steps/day was associated with a decrease of 0.05 m/s in the aPWV (95% CI -0.08, -0.02). Every increment of 10 steps/min in peak 30-min cadence was associated with a decrease of 0.05 m/s in aPWV (95% CI -0.09, -0.01). CONCLUSIONS: Our findings show that easy-to-use proxies of the volume (steps/day) and intensity (peak cadence) of ambulatory behavior are inversely associated with arterial stiffness in older adults. The inverse association of steps/day and peak cadence with arterial stiffness is dose-response.

Associations of objectively measured movement behavior and cardiorespiratory fitness with mental health and quality of life in older adults with hypertension: an exploratory analysis during the COVID-19 pandemic.

Objectives: Herein, we explored the associations of pre-pandemic COVID-19 physical activity (PA), sedentary behavior (SB) and cardiorespiratory fitness (CRF) with mental health and quality of life in older adults with hypertension.Method: Objectively measured PA and SB, perceived stress, depression symptoms, and quality of life were assessed before and during the pandemic in seventeen older adults with hypertension. CRF was assessed before the pandemic by cardiopulmonary exercise testing. Longitudinal and cross-sectional associations were analyzed using the mixed linear model.Results: Pre-pandemic light PA (positive association) and SB (negative association) were associated with quality of life during the pandemic. Higher pre-pandemic CRF was associated with less negative changes in perceived stress, depression symptoms, and quality of life during the pandemic.Conclusion: Our preliminary findings suggest that a healthier pre-pandemic movement behavior (more PA, less SB) and better CRF can mitigate the negative impact of the COVID-19 pandemic on mental health and quality of life in older adults with hypertension.

Initial impact of the COVID-19 pandemic on physical activity and sedentary behavior in hypertensive older adults: An accelerometer-based analysis.

BACKGROUND: This study reports the accelerometer-based physical activity (PA) and sedentary behavior (SB) before and during the COVID-19 pandemic in hypertensive older adults. METHODS: Thirty-five hypertensive older adults were included in this observational study. Accelerometer-based PA and SB measures were assessed before (January to March 2020) and during (June 2020) the COVID-19 pandemic. Linear mixed models were used to assess within-group changes in PA and SB measures, adjusted by accelerometer wear time. RESULTS: Before COVID-19 pandemic participants presented: 5809 steps/day (SE = 366), 303.1 min/day (SE = 11.9) of light PA, 15.5 min/day (SE = 2.2) of moderate-vigorous PA, and 653.0 min/day (SE = 12.6) of SB. During COVID-19 pandemic there was a decrease in steps/day (ß = -886 steps/day, SE = 361, p = 0.018), in moderate-vigorous PA (ß = -2.8 min/day, SE = 2.4, p = 0.018), and a trend in light PA (ß = -26.6 min/day, SE = 13.4, p = 0.053). In addition, SB increased during the COVID-19 pandemic (ß = 29.6 min/day, SE = 13.4, p = 0.032). The magnitude of changes was greater on the weekend, mainly for steps/day (ß = -1739 steps/day, SE = 424, p < 0.001) and the SB pattern (more time spent in bouts of ≥10 and 30 min, less breaks/day and breaks/h). CONCLUSIONS: The COVID-19 pandemic may elicit unhealthy changes in movement behavior in hypertensive older adults. Lower PA, higher and more prolonged SB on the weekend are the main features of the behavioral changes.