Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing

Background Physical activity is associated with improved overall health in those people who survive to older ages, otherwise conceptualised as healthy ageing. Previous studies have examined the effects of mid-life physical activity on healthy ageing, but not the effects of taking up activity later in life. We examined the association between physical activity and healthy ageing over 8 years of follow-up. Methods Participants were 3454 initially disease-free men and women (aged 63.7±8.9 years at baseline) from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Self-reported physical activity was assessed at baseline (2002–2003) and through follow-up. Healthy ageing, assessed at 8 years of follow-up (2010-2011), was defined as those participants who survived without developing major chronic disease, depressive symptoms, physical or cognitive impairment. Results At follow-up, 19.3% of the sample was defined as healthy ageing. In comparison with inactive participants, moderate (OR, 2.67, 95% CI 1.95 to 3.64), or vigorous activity (3.53, 2.54 to 4.89) at least once a week was associated with healthy ageing, after adjustment for age, sex, smoking, alcohol, marital status and wealth. Becoming active (multivariate adjusted, 3.37, 1.67 to 6.78) or remaining active (7.68, 4.18 to 14.09) was associated with healthy ageing in comparison with remaining inactive over follow-up. Conclusions Sustained physical activity in older age is associated with improved overall health. Significant health benefits were even seen among participants who became physically active relatively late in life

Impact of panic attacks on bronchoconstriction and subjective distress in asthma patients with and without panic disorder

© 2017 by the American Psychosomatic Society. Objective: Panic disorder (PD) is common among asthma patients and is associated with worse asthma outcomes. This may occur because of psychophysiological factors or cognitive/affective factors. This study evaluated the impact of panic attacks (PAs) on bronchoconstriction and subjective distress in people who have asthma with and without PD. Methods: A total of 25 asthma patients (15 with PD who had a PA [PD/PA], 10 without PD who did not have a PA [no PD/no PA] ) were recruited from an outpatient clinic. They underwent a panic challenge (one vital capacity inhalation of 35% carbon dioxide [CO 2 ]) and completed the Panic Symptom Scale, the Subjective Distress Visual Analogue Scale, and the Borg Scale before and after CO 2 . Forced expiratory volume in 1 second was assessed pre-and post-CO 2 ; respiratory (i.e., CO 2 production, minute ventilation, tidal volume) was continuously recorded, and physiological measures (i.e., systolic and diastolic blood pressure [SBP/DBP]) were recorded every 2 minutes. Results: Analyses adjusting for age, sex, and provocative concentration of methacholine revealed no significant differences between groups in forced expiratory volume in 1 second change after CO 2 inhalation (F(1, 23) < 0.01, p =.961). However, patients with PD/PA reported more panic (F(1, 22) = 18.10, p < .001), anxiety (F(1, 22) = 21.93, p < .001), worry (F(1, 22) = 26.31, p < .001), and dyspnea (F(1,22) = 4.68, p =.042) and exhibited higher levels of CO 2 production (F(1, 2843) = 5.89, p =.015), minute ventilation (F(1, 2844) = 4.48, p =.034), and tidal volume (F(1, 2844) = 4.62, p =.032) after the CO 2 challenge, compared with patients with no PD/no PA. Conclusions: Results, presented as hypothesis generating, suggest that asthma patients with PD/PA exhibit increased panic-like anxiety, breathlessness, and a respiratory pattern consistent with hyperventilation that was not linked to statistically significant drops in bronchoconstriction

Relationship between antidepressant therapy and risk for cardiovascular events in patients with and without cardiovascular disease

Objective: The American Heart Association has endorsed depression as a cardiac risk factor and recommends screening as part of routine practice. This has been met with controversy due to inconsistencies in the data linking depression treatment to better cardiovascular outcomes. Our objective was to prospectively assess the association between depression treatment (defined as being prescribed antidepressant medication) and major adverse cardiovascular events (MACE) in patients referred for exercise stress tests. Methods: 2385 consecutive patients presenting for myocardial perfusion exercise stress tests underwent a sociodemographic, medical, and psychiatric interview (PRIME-MD) and completed the Beck Depression Inventory (BDI). History of CVD and antidepressant use was self-reported and verified via chart review. Participants followed over an 8.8 year follow-up, and information regarding MACE incidence (including cardiac mortality, non-fatal myocardial infarction, revascularization procedures, cerebrovascular events) was obtained from provincial administrative databases. Results: 8% (n=190) of the sample were taking antidepressants at baseline, 41% (n=916) had a history of CVD, and 38.7% (n=921) had depression according to the PRIME-MD or BDI. Antidepressant treatment was associated with a 30% reduced risk of MACE (HR=0.697; 95%CI=0.504-0.964; p=.029). A 46% reduction in risk was associated with antidepressant treatment among those without CVD (HR=0.542; 95%CI=0.299-0.981; p=.043). In depressed patients, a 33% reduction in risk of MACE associated with antidepressant use was seen (adjusted HR=0.674; 95%CI=0.440-1.033; p=.07). Conclusions: Antidepressants may be cardio-protective among patients presenting for stress testing independent of risk factors including CVD and depression. Results support treating depression with antidepressants in this population to reduce risk of MACE

Positive and negative affect is related to experiencing chest pain during exercise-induced myocardial ischemia

© 2017 by the American Psychosomatic Society. Objective: Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. Methods: A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. Results: Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95 % confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (ß = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). Conclusions: Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain

Association between depression, lung function and inflammatory markers in patients with asthma and occupational asthma

Objective: Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). Methods: 112 patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. Results: There was a statistically significant association between depressive disorder (p=.0195) and FEV1 responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression, (p < .001). Conclusions: The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms which underlie these effects

Canadian healthcare workers’ mental health and health behaviours during the COVID-19 pandemic: results from nine representative samples between April 2020 and February 2022

Objective: In the context of COVID-19, Canadian healthcare workers (HCWs) worked long hours, both to respond to the pandemic and to compensate for colleagues who were not able to work due to infection and burnout. This may have had detrimental effects on HCWs’ mental health, as well as engagement in health-promoting behaviours. This study aimed to identify changes in mental health outcomes and health behaviours experienced by Canadian HCWs throughout the COVID-19 pandemic.  Methods: Nine representative samples (N total = 1615 HCWs) completed the iCARE survey using an online polling firm between April 2020 (Time 1) and February 2022 (Time 9). Participants were asked about the psychological effects of COVID-19 (e.g., feeling anxious) and about changes in their health behaviours (e.g., alcohol use, physical activity).  Results: A majority of the HCWs identified as female (65%), were younger than 44 years old (66%), and had a university degree (55%). Female HCWs were more likely than male HCWs to report feeling anxious (OR = 2.68 [1.75, 4.12]), depressed (OR = 1.63 [1.02, 2.59]), and irritable (OR = 1.61 [1.08, 2.40]) throughout the first two years of the pandemic. Female HCWs were more likely than their male counterparts to report eating more unhealthy diets (OR = 1.54 [1.02, 2.31]). Significant differences were also revealed by age, education level, income, parental status, health status, and over time. Conclusion: Results demonstrate that the impacts of COVID-19 on HCWs’ mental health and health behaviours were significant, and varied by sociodemographic characteristics (e.g., sex, age, income).</p