Economic evaluation of a community based exercise programme to prevent falls

OBJECTIVE: To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women. DESIGN: An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117). SETTING: 17 general practices in Dunedin, New Zealand. PARTICIPANTS: Women aged 80 years and older living in the community and invited by their general practitioner to take part. MAIN OUTCOME MEASURES: Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented. MAIN RESULTS: 27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and$265 (1995 New Zealand dollars) per fall prevented, and $457 and$426 per fall resulting in a moderate or serious injury prevented. CONCLUSIONS: The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies

Objective measurement of physical activity and sedentary behavior among US adults aged 60 years or older

Introduction: Estimates of objectively measured physical activity among older adults differ depending on the cut points used to define intensity. Our objective was to assess 1) moderate to vigorous physical activity (MVPA), exploring differences in prevalence depending on the cut point used, and 2) sedentary behavior, among US adults aged 60 years or older. Methods: We used the most recently available accelerometer data (2003-2004 and 2005-2006) from the National Health and Nutrition Examination Survey. The sample included 2,630 adults aged 60 or older who wore an ActiGraph accelerometer for 1 week. We defined MVPA using 4 cut points (≥500, ≥1,000, ≥1,500, and ≥2,000 counts/min) and sedentary behavior as fewer than 100 counts per minute. All estimates were weighted to reflect the US population. Results: The overall average counts per minute was 216. Mean MVPA ranged from 10.8 minutes per day (based on 2,000 counts/min) to 106.8 minutes per day (based on 500 counts/min). Regardless of the cut point used, MVPA was lower with each successive age group (60-69, 70-79, and ≥80) and higher among men than women. At any cut point, MVPA was highest for Hispanics and "other" racial/ethnic groups, followed by non-Hispanic whites and non-Hispanic blacks. The average time spent in sedentary behavior was 8.5 hours per day. The amount of sedentary time was greater among participants who were aged 80 or older compared to younger groups and among men compared to women. Conclusion: MVPA estimates vary among adults aged 60 or older, depending on the cut point chosen, and most of their time is spent in sedentary behaviors. These considerations and the data presented suggest more research is necessary to identify the appropriate method of setting accelerometer cut points for MVPA in older adults

Hot Deck Multiple Imputation for Handling Missing Accelerometer Data

Missing data due to non-wear are common in accelerometer studies measuring physical activity and sedentary behavior. Accelerometer outputs are high-dimensional time-series data that are episodic and often highly skewed, presenting unique challenges for handling missing data. Common methods for missing accelerometry either are ad-hoc, require restrictive parametric assumptions, or do not appropriately impute bouts. This study developed a flexible hot-deck multiple imputation (MI; i.e., “replacing” missing data with observed values) procedure to handle missing accelerometry. For each missing segment of accelerometry, “donor pools” contained observed segments from either the same or different participants, and ten imputed segments were randomly drawn from the donor pool according to selection weights, where the donor pool and selection weight depended on variables associated with non-wear and/or accelerometer-based measures. A simulation study of 2550 women compared hot deck MI to two standard methods in the field: available case (AC) analysis (i.e., analyzing all observed accelerometry with no restriction on wear time or number of days) and complete case (CC) analysis (i.e., analyzing only participants that wore the accelerometer for ≥ 10 h for 4–7 days). This was repeated using accelerometry from the entire 24-h day and daytime (10am–8pm) only, and data were missing at random. For the entire 24-h day, MI produced less bias and better 95% confidence interval (CI) coverage than AC and CC. For the daytime only, MI produced less bias and better 95% CI coverage than AC; CC produced similar bias and 95% CI coverage, but longer 95% CIs than MI

Systematic Cu-63 NQR studies of the stripe phase in La(1.6-x)Nd(0.4)Sr(x)CuO(4) for 0.07 <= x <= 0.25

We demonstrate that the integrated intensity of Cu-63 nuclear quadrupole resonance (NQR) in La(1.6-x)Nd(0.4)Sr(x)CuO(4) decreases dramatically below the charge-stripe ordering temperature T(charge). Comparison with neutron and X-ray scattering indicates that the wipeout fraction F(T) (i.e. the missing fraction of the integrated intensity of the NQR signal) represents the charge-stripe order parameter. The systematic study reveals bulk charge-stripe order throughout the superconducting region 0.07 <= x <= 0.25. As a function of the reduced temperature t = T/T(charge), the temperature dependence of F(t) is sharpest for the hole concentration x=1/8, indicating that x=1/8 is the optimum concentration for stripe formation.Comment: 10 pages of text and captions, 11 figures in postscript. Final version, with new data in Fig.

Calibrating physical activity intensity for hip-worn accelerometry in women age 60 to 91 years: The Women's Health Initiative OPACH Calibration Study

Objective: We conducted a laboratory-based calibration study to determine relevant cutpoints for a hip-worn accelerometer among women ≥. 60. years, considering both type and filtering of counts. Methods: Two hundred women wore an ActiGraph GT3X. + accelerometer on their hip while performing eight laboratory-based activities. Oxygen uptake was measured using an Oxycon portable calorimeter. Accelerometer data were analyzed in 15-second epochs for both normal and low frequency extension (LFE) filters. Receiver operating characteristic (ROC) curve analyses were used to calculate cutpoints for sedentary, light (low and high), and moderate to vigorous physical activity (MVPA) using the vertical axis and vector magnitude (VM) counts. Results: Mean age was 75.5. years (standard deviation 7.7). The Spearman correlation between oxygen uptake and accelerometry ranged from 0.77 to 0.85 for the normal and LFE filters and for both the vertical axis and VM. The area under the ROC curve was generally higher for VM compared to the vertical axis, and higher for cutpoints distinguishing MVPA compared to sedentary and light low activities. The VM better discriminated sedentary from light low activities compared to the vertical axis. The area under the ROC curves were better for the LFE filter compared to the normal filter for the vertical axis counts, but no meaningful differences were found by filter type for VM counts. Conclusion: The cutpoints derived for this study among women ≥. 60. years can be applied to ongoing epidemiologic studies to define a range of physical activity intensities

Accelerometer-Measured Sedentary Patterns are Associated with Incident Falls in Older Women

Background/Objective: Falls cause significant problems for older adults. Sedentary time is associated with lower physical function and could increase the risk for falls. Design: Prospective study. Setting: Sites across the United States. Participants: Older women (N = 5,545, mean age 79 years) from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study. Measurements: Accelerometers worn at the hip for up to 1 week collected measures of daily sedentary time and the mean sedentary bout duration, a commonly used metric for sedentary accumulation patterns. For up to 13 months after accelerometer wear, women reported daily whether they had fallen on monthly calendars. Results: In fully adjusted models, the incident rate ratios (95% confidence interval) for quartiles 1 (lowest), 2, 3, and 4 of sedentary time respectively were 1.0 (ref.), 1.07 (0.93–1.24), 1.07 (0.91–1.25), and 1.14 (0.96–1.35; P-trend =.65) and for mean sedentary bout duration was 1.0 (ref.), 1.05 (0.92–1.21), 1.02 (0.88–1.17), and 1.17 (1.01–1.37; P-trend =.01), respectively. Women with a history of two or more falls had stronger associations between sedentary time and falls incidence compared with women with a history of no or one fall (P for interaction =.046). Conclusions: Older women in the highest quartile of mean sedentary bout duration had a significantly increased risk of falling. Women with a history of frequent falling may be at higher risk for falling if they have high sedentary time. Interventions testing whether shortening total sedentary time and/or sedentary bouts lowers fall risk are needed to confirm these observational findings

Sedentary Behavior and Cardiovascular Disease in Older Women: The OPACH Study

Background: Evidence that higher sedentary time is associated with higher risk for cardiovascular disease (CVD) is based mainly on self-reported measures. Few studies have examined whether patterns of sedentary time are associated with higher risk for CVD. Methods: Women from the OPACH Study (Objective Physical Activity and Cardiovascular Health; n=5638, aged 63-97 years, mean age 79±7 years) with no history of myocardial infarction or stroke wore accelerometers for 4 to 7 days and were followed up for up to 4.9 years for CVD events. Average daily sedentary time and mean sedentary bout duration were the exposures of interest. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs for CVD using models adjusted for covariates and subsequently adjusted for potential mediators (body mass index, diabetes mellitus, hypertension, and CVD risk biomarkers [fasting glucose, high-density lipoprotein, triglycerides, and systolic blood pressure]). Restricted cubic spline regression characterized dose-response relationships. Results: There were 545 CVD events during 19 350 person-years. With adjustment for covariates, women in the highest (≈11 h/d or more) versus the lowest (≈9 h/d or less) quartile of sedentary time had higher risk for CVD (HR, 1.62; 95% CI, 1.21-2.17; P trend 0.05, each). Women jointly classified as having both high sedentary time and long bout durations had significantly higher risk for CVD (HR, 1.34; 95% CI, 1.08-1.65) than women with low sedentary time and short bout duration. All analyses were repeated for incident coronary heart disease (myocardial infarction or CVD death), and associations were similar, with notably stronger HRs. Conclusions: Both high sedentary time and long mean bout durations were associated in a dose-response manner with increased CVD risk in older women, which suggests that efforts to reduce CVD burden might benefit from addressing either or both components of sedentary behavior

Association of Light Physical Activity Measured by Accelerometry and Incidence of Coronary Heart Disease and Cardiovascular Disease in Older Women

Importance: To our knowledge, no studies have examined light physical activity (PA) measured by accelerometry and heart disease in older women. Objective: To investigate whether higher levels of light PA were associated with reduced risks of coronary heart disease (CHD) or cardiovascular disease (CVD) in older women. Design, Setting, and Participants: Prospective cohort study of older women from baseline (March 2012 to April 2014) through February 28, 2017, for up to 4.91 years. The setting was community-dwelling participants from the Women's Health Initiative. Participants were ambulatory women with no history of myocardial infarction or stroke. Exposures: Data from accelerometers worn for a requested 7 days were used to measure light PA. Main Outcomes and Measures: Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% CIs for physician-adjudicated CHD and CVD events across light PA quartiles adjusting for possible confounders. Light PA was also analyzed as a continuous variable with and without adjustment for moderate to vigorous PA (MVPA). Results: Among 5861 women (mean [SD] age, 78.5 [6.7] years), 143 CHD events and 570 CVD events were observed. The HRs for CHD in the highest vs lowest quartiles of light PA were 0.42 (95% CI, 0.25-0.70; P for trend <.001) adjusted for age and race/ethnicity and 0.58 (95% CI, 0.34-0.99; P for trend = .004) after additional adjustment for education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health. Corresponding HRs for CVD in the highest vs lowest quartiles of light PA were 0.63 (95% CI, 0.49-0.81; P for trend <.001) and 0.78 (95% CI, 0.60-1.00; P for trend = .004). The HRs for a 1-hour/day increment in light PA after additional adjustment for MVPA were 0.86 (95% CI, 0.73-1.00; P for trend = .05) for CHD and 0.92 (95% CI, 0.85-0.99; P for trend = .03) for CVD. Conclusions and Relevance: The present findings support the conclusion that all movement counts for the prevention of CHD and CVD in older women. Large, pragmatic randomized trials are needed to test whether increasing light PA among older women reduces cardiovascular risk

Accelerometer-Measured Moderate to Vigorous Physical Activity and Incidence Rates of Falls in Older Women

Objectives: To examine whether moderate to vigorous physical activity (MVPA) measured using accelerometry is associated with incident falls and whether associations differ according to physical function or history of falls. Design: Prospective study with baseline data collection from 2012 to 2014 and 1 year of follow-up. Setting: Women's Health Initiative participants living in the United States. Participants: Ambulatory women aged 63 to 99 (N = 5,545). Measurements: Minutes of MVPA per day measured using an accelerometer, functional status measured using the Short Physical Performance Battery (SPPB), fall risk factors assessed using a questionnaire, fall injuries assessed in a telephone interview, incident falls ascertained from fall calendars. Results: Incident rate ratios (IRRs) revealed greater fall risk in women in the lowest quartile of MVPA compared to those in the highest (IRR = 1.18, 95% confidence interval = 1.01–1.38), adjusted for age, race and ethnicity, and fall risk factors. Fall rates were not significantly associated with MVPA in women with high SPPB scores (9–12) or one or fewer falls in the previous year, but in women with low SPPB scores (≤ 8) or a history of frequent falls, fall rates were higher in women with lower MVPA levels than in those with higher levels (interaction P <.03 and <.001, respectively). Falls in women with MVPA above the median were less likely to involve injuries requiring medical treatment (9.9%) than falls in women with lower MVPA levels (13.0%) (P <.001). Conclusion: These findings indicate that falls are not more common or injurious in older women who engage in higher levels of MVPA. These findings support encouraging women to engage in the amounts and types of MVPA that they prefer. Older women with low physical function or frequent falls with low levels of MVPA are a high-risk group for whom vigilance about falls prevention is warranted

Towards a definition of sarcopenia--results from epidemiologic studies

The age-related loss of muscle mass, also called sarcopenia, is receiving increasing attention in aging research. While the concept is frequently being used in research settings and introduced to clinical settings, thus far no consensus on its definition has been established. This article provides an overview of the history of sarcopenia definitions proposed in the literature thus far. It will describe the methodology used to develop the cutpoints for low muscle mass (or strength) in large epidemiological studies, how sarcopenia based on these cutpoints relates to functional outcomes, and the advantages and disadvantages of the different definitions. This overview will contribute to the current need to develop a consensus definition of sarcopenia which can be used in all relevant settings. The Journal of Nutrition, Health & Aging©