Effect of physical activity intervention on weight change in rural older Chinese: a cluster randomized controlled trial.

BACKGROUND: Current randomized trial evidence for the effects of physical activity intervention on weight change in adults was mainly from western countries, with little reliable evidence from low- and middle-income countries, such as China, where lifestyle factors and obesity patterns differ substantially from those in western countries. We examined the effects of physical activity intervention on weight change using cluster randomized trial data among Chinese older adults. METHODS: The cluster randomized controlled trial included an 8-week physical activity intervention period and was followed up to 24 months. Eight villages were randomly assigned to the intervention group (4 villages, n = 240) or the control group (4 villages, n = 268). The intervention group received physical activity intervention based on the socio-ecological model, while the control group did not. The intervention involved three levels: individual, interpersonal, and community levels, which aimed to promote leisure-time physical activity of participants. The primary outcome of the present study was the difference in percentage weight change at 24 months from baseline. We used Tanita BC-601 analyzer scales to measure weight and recorded it to the nearest 0.1 kg. RESULTS: Among the 508 participants, the mean age was 70.93 (SD, 5.69) years, and 55.5% were female. There were significant differences in percentage weight change between the intervention group and the control group with a mean change of -1.78% (95% CI, -2.67% to -0.90%; p < 0.001) in the total sample, -1.94% (95% CI, -3.14% to -0.73%; p = 0.002) in participants with overweight/obesity, and -1.45% (95% CI, -2.73% to -0.18%; p = 0.027) among participants with underweight/healthy weight in favor of the intervention group at 24 months. CONCLUSIONS: Physical activity intervention resulted in weight loss in rural older sample at 24 months. This suggested that physical activity interventions are feasible for weight loss among older adults, especially for those with overweight/obesity or aged under 80. TRIAL REGISTRATION: The study has been registered on the Chinese Clinical Trial Registry on April 20, 2021 (ChiCTR2100045653), https://www.chictr.org.cn/showproj.html?proj=123704 .

The Relationship between Mentally Active Sedentary Behavior and Cognitive Function across Different Educational Levels.

INTRODUCTION: How education affects the relationship between sedentary behavior and cognitive function remains unclear. The aim of this study was to investigate the relationship between mentally active sedentary behavior and cognitive function in rural older Chinese across different levels of education. METHODS: Data from 517 participants aged 60 years and older in rural China at baseline, 4 weeks, 8 weeks, 6 months, 12 months, and 24 months were analyzed. Univariate analysis was carried out using descriptive statistical techniques and bivariate analysis was performed using linear mixed effects models. RESULTS: Total mentally active sedentary behavior time and playing cards/mahjong time were significantly associated with global cognition (0.25 points [95% CI, 0.15-0.35], p < 0.001; 0.27 points [95% CI, 0.16-0.37], p < 0.001, respectively), the attention dimension (0.07 points [95% CI, 0.01-0.12], p = 0.025; 0.08 points [95% CI, 0.02-0.14], p = 0.011, respectively), and the memory dimension (0.20 points [95% CI, 0.13-0.26], p < 0.001; 0.18 points [95% CI, 0.12-0.25], p < 0.001, respectively). Such associations were more pronounced in illiterate participants. CONCLUSION: Our study suggested a positive association between mentally active sedentary behavior and cognitive function, with the association being more pronounced among illiterate older adults compared to the relatively well-educated. Future cognitive interventions should focus more on mentally active behavior. In addition, education-specific intervention strategy may be considered in cognitive interventions.

Effect of physical activity intervention on cognitive function in China: A cluster randomized trial.

INTRODUCTION: Current randomized trial evidence on the effect of physical activity (PA) intervention on cognitive function is scarce and mainly found in well-educated populations, limiting its generalizability. Furthermore, the modification effect of education levels remains understudied. We conducted a cluster randomized trial to evaluate the effects of PA intervention on cognitive function in a general older population, and whether education modifies such effects. METHODS: Eight villages were randomized to the intervention (four villages, n = 240) or the control (four villages, n = 271). The intervention group received an 8-week multilevel PA intervention based on a socio-ecological model, while the control did not. The intervention has been condensed to three levels with activities occurring at the individual (telephone counseling, printed material, and training sessions), interpersonal (peer group), and community levels (group sharing and coaching). The primary outcome was changes in global cognition (overall cognitive function) measured by the Telephone Interview for Cognitive Status (TICS-10) at 12-month follow-up. Repeated measurements were modeled using the linear mixed model, which assumed that the missing values were missing at random. RESULTS: The mean age was 70.94 years (standard deviation 5.71) and 55.6% were women. Compared to the control, the orientation improved from baseline at 12-month follow-up (0.24 points [95% confidence interval (CI), 0.03 to 0.46 points; P = 0.03]). Stratified analysis showed that the global cognition and orientation improved at 12-month follow-up among illiterate participants in the intervention (for global cognition, mean difference, 0.57 points [95% CI, 0.03 to 1.10], P = 0.04; for orientation, mean difference, 0.31 points [95% CI, 0.04 to 0.58], P = 0.03). DISCUSSION: These results confirm the improvements in orientation in older adults, as well as in global cognition and orientation in the illiterate at 12-month follow-up.

Association of Physical Activity With Cognitive Function Among Older Adults in Rural Sichuan, China.

The purpose of this study was to explore the relationship between total physical activity and different dimensions of cognitive function (orientation, attention, and memory) among older adults in rural Sichuan, China. This cross-sectional study involved 715 older adults (average age of 72 years). Total PA was measured by the Physical Activity Scale for the Elderly, and cognitive function was assessed by the Telephone Interview for Cognitive Status (TICS) questionnaire. The multivariate linear regression analysis indicated that total PA and household PA were significantly associated with the overall Telephone Interview for Cognitive Status score (ß = 0.143, p < .001; ß = 0.115, p = .002, respectively), the orientation dimension (ß = 0.142, p < .001; ß = 0.131, p = .001, respectively), and the memory dimension (ß = 0.179, p < .001; ß = 0.134, p = .001, respectively). The study showed a positive association between total PA, household PA, and cognitive function in older adults, especially in the orientation dimension and the memory dimension of cognitive function.

Association between socio-ecological factors and leisure time physical activity (LTPA) among older adults in Sichuan, China: a structural equation modeling analysis.

BACKGROUND: Few studies examined socio-ecological factors and leisure time physical activities (LTPA) and rarely focused on self-regulation and social capital, which might play a significant role in impacting people's physical activity behavior. This study aimed to examine the direct and indirect effects of individual level (perceived benefits, perceived barriers, and self-efficacy), interpersonal level (self-regulation), social level (social capital), and environmental level factors (perceived physical environment) on LTPA among older adults. METHODS: A cross-sectional study was conducted in 737 older adults from Sichuan, China. Structural equation modeling (SEM) analysis was used to examine the associations of individual, interpersonal, social, and environmental level factors with LTPA. RESULTS: The mean age of all participants was 71.22 (range, 60-97), and 56.1% of them were women. The SEM results showed that individual level variables (ß = 0.32, ρ < 0.001), self-regulation (ß = 0.18, ρ < 0.001) and social capital (ß = 0.14, ρ < 0.001) could all directly affect LTPA while there was no significant association of perceived physical environment with LTPA. Self-regulation served as a bridge linking social capital and LTPA. Individual level variables contributed the largest total effect (0.32) on LTPA. Self-regulation and social capital had the same total effect (0.18) on LTPA. CONCLUSIONS: Factors on three levels were all significantly associated with LTPA. Interventions that incorporate individual, interpersonal, social factors may be considered to promote LTPA in older adults. Self-regulation should receive more attention in future interventions.

Longer-term Effect of Physical Activity Intervention on Sleep Quality: A Secondary Analysis of Cluster Randomized Controlled Trial.

STUDY OBJECTIVES: To examine the longer-term effect of physical activity (PA) intervention on sleep quality and whether the effect was heterogeneous between daytime nappers and non-nappers. METHODS: This study was a secondary analysis of a cluster randomized controlled trial in China. Eight villages were randomized 1:1 to intervention or control group. The intervention group received an 8-week PA intervention, while the control group did not. The primary outcome of this study was the change in the Pittsburgh Sleep Quality Index (PSQI) global score at 24 months. RESULTS: The 511 participants had a mean age of 70.94 years (SD 5.73) and 55.6% were female. The intervention showed improvements in the PSQI global score at 8 weeks (adjusted mean difference -1.05; P=0.002), and the effect diminished at 24 months (-0.64; P=0.06). There were statistically significant improvements in the PSQI global score for daytime nappers, but not for non-nappers at 8 weeks (adjusted mean difference -0.98; P=0.01 vs -1.27; P=0.05), 12 months (-0.86; P=0.03 vs -0.84; P=0.21), and 24 months (-0.80; P=0.04 vs -0.14; P=0.84), although these improvements were below the minimum detectible level of the PSQI which is 1 point. CONCLUSION: The 8-week PA intervention was effective in improving sleep quality, while the effect was diminished and below the minimum detectible level of the PSQI which is 1 point after 24 months. The effect of PA intervention on sleep quality was more pronounced in daytime nappers. Additional interventions (e.g., focusing on multiple behavioral interventions such as PA and healthy diet) are needed to maintain the beneficial effect of PA on sleep quality in the general older populations. Further research is required to confirm the mechanisms of the effect of napping and develop tailored interventions.

Physical Activity Intervention for Leisure-Time Activity Levels Among Older Adults: A Cluster Randomized Trial.

Importance: Current randomized trial evidence of the effects of physical activity interventions in older adults is mainly from developed countries, with little reliable evidence from low- and middle-income countries, such as China, where race, culture, and lifestyles differ substantially from those in Western populations. Objective: To evaluate the effects of a multilevel intervention for increasing leisure-time activity levels in Chinese older adults. Design, Setting, and Participants: This cluster randomized trial was conducted from May 2021 to May 2023, including an 8-week intervention period and a follow-up period of 24 months. Eight villages in China were randomly assigned to the intervention (4 villages) or the control (4 villages) group. Potentially eligible participants were 60 years or older. A total of 511 older adults from the selected 8 villages were enrolled. Interventions: The intervention group received an 8-week socioecological model-based intervention, comprising individual, interpersonal, and community-level components, whereas the control group did not. Main Outcome and Measure: The primary outcome was the change in leisure-time activity at 8 weeks, measured by the Physical Activity Scale for the Elderly (PASE). Possible PASE scores for leisure-time activity range from 0 to 502, with higher scores indicating higher activity levels. Results: A total of 511 older adults from 8 villages were recruited and randomly allocated to the intervention (240 participants, 4 villages) or control (271 participants, 4 villages) groups. The mean (SD) age was 70.95 (5.72) years, and 284 (55.6%) were female participants. Seven serious adverse events (unrelated deaths) were reported. Participants in the intervention group increased leisure-time activity more than those in the control group, with a mean difference in PASE scores of 13.74 points (95% CI, 8.58-18.91 points) between the groups at 8 weeks (P < .001). Significant differences in leisure-time activity were also found over 24 months (mean difference in scores at 4 weeks, 11.66 points; 95% CI, 6.41-16.90 points; P < .001; at 6 months, 12.35 points; 95% CI, 7.19-17.50 points; P < .001; at 12 months, 11.55 points; 95% CI, 6.32-16.78 points; P < .001; and at 24 months, 14.51 points; 95% CI, 9.28-19.75 points; P < .001). Conclusions and Relevance: In this cluster randomized trial, the multilevel intervention was effective in promoting leisure-time activity over 24 months of follow-up in older adults from China. This finding suggests that implementation of such interventions could be an important step in addressing physical inactivity in older adults in low- and middle-income countries. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100045653.

A Multilevel Physical Activity Intervention Among Chinese Rural Older Adults (Stay Active While Aging): A Study Protocol for a Clustered Randomized Controlled Trial.

Background: Although a large number of studies have confirmed the benefits of physical activity (PA) in preventing age-related diseases and disabilities, a growing number of older people spent more time in sedentary behavior as opposed to PA. To reverse the alarming trend, numerous studies have corroborated the effectiveness of PA interventions in improving PA among older adults. However, such research is scarce in rural China, where a majority of older adults do not meet the PA recommendation. The Stay Active While Aging (SAWA) aimed to conduct an intervention to improve the PA level among older adults in rural China. Methods: The SAWA is designed as a single-blind, clustered randomized controlled trial carried out in rural Sichuan, China with an 8-week intervention and a 24-month follow-up. The intervention group will receive a multilevel intervention (individual, interpersonal, and community levels), while the control group will not. The primary outcome is the PA level. Secondary outcome measures include sedentary behavior level, self-efficacy, self-regulation, cognitive function, night-time sleep quality, and anthropometry. The difference-in-differences (DID) will be performed to investigate the between-group differences, adjusted for baseline data and covariates. Discussion: The SAWA trial will provide a multilevel intervention based on the socio-ecologic model among older adults in rural China. We target the PA level and health status changes while also focus on the maintenance of such intervention during 24 months. If the SAWA produces positive results, it will be possible to recommend similar strategies to be implemented in other Chinese older adults and beyond. Trial registration: ChiCTR2100045653 (https://www.chictr.org.cn/index.aspx).