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

A graphical perspective of marginal structural models : an application for the estimation of the effect of physical activity on blood pressure

Estimating causal effects requires important prior subject-matter knowledge and, sometimes, sophisticated statistical tools. The latter is especially true when targeting the causal effect of a time-varying exposure in a longitudinal study. Marginal structural models (MSMs) are a relatively new class of causal models which effectively deal with the estimation of the effects of time-varying exposures. MSMs have traditionally been embedded in the counterfactual framework to causal inference. In this paper, we use the causal graph framework to enhance the implementation of MSMs. We illustrate our approach using data from a prospective cohort study, the Honolulu Heart Program. These data consist of 8006 men at baseline. To illustrate our approach, we focused on the estimation of the causal effect of physical activity on blood pressure, which were measured at three time-points. First, a causal graph is built to encompass prior knowledge. This graph is then validated and improved utilizing structural equation models. We estimated the aforementioned causal effect using MSMs for repeated measures and guided the implementation of the models with the causal graph. Employing the causal graph framework, we also show the validity of fitting conditional MSMs for repeated measures in the context implied by our data

Training physicians in behavioural change counseling: A systematic review

Background: Poor health behaviours (e.g., smoking, physical inactivity) represent major underlying causes of non-communicable chronic diseases (NCDs). Prescriptive behaviour change interventions employed by physicians show limited effectiveness. Physician training in evidence-based behaviour change counselling (BCC) may improve behavioural risk factor management, but the efficacy and feasibility of current programs remains unclear. Objective: (1) To systematically review the efficacy of BCC training programs for physicians, and (2) to describe program content, dose and structure, informing better design and dissemination. Methods: Using PRISMA guidelines, a database search up to January 2018, yielded 1889 unique articles, screened by 2 authors; 9 studies met inclusion criteria and were retained for analysis. Results: 100% of studies reported significant improvements in BCC skills among physicians, most programs targeting provider-patient collaboration, supporting patient autonomy, and use of open questions to elicit “change-talk”. Limitation included: poor reporting quality, high program heterogeneity, small sample sizes, 78% of studies having no comparison group, and less than 30% of skills taught being formally assessed. Conclusion: Training programs were efficacious, but methodological weaknesses limit the ability to determine content and delivery. Caution is necessary when interpreting the results

A cautionary note concerning the use of stabilized weights in marginal structural models

Marginal structural models (MSMs) are commonly used to estimate the causal effect of a time-varying treatment in presence of time-dependent confounding. When fitting a MSM to data, the analyst must specify both the structural model for the outcome and the treatment models for the inverse-probability-of-treatment weights. The use of stabilized weights is recommended since they are generally less variable than the standard weights. In this paper, we are concerned with the use of the common stabilized weights when the structural model is specified to only consider partial treatment history, such as the current or most recent treatments. We present various examples of settings where these stabilized weights yield biased inferences while the standard weights do not. These issues are first investigated on the basis of simulated data and subsequently exemplified using data from the Honolulu Heart Program. Unlike common stabilized weights, we find that basic stabilized weights offer some protection against bias in structural models designed to estimate current or most recent treatment effects. Copyright © 2010 John Wiley & Sons, Ltd

The Relationship between Multiple Health Behaviours and Brachial Artery Reactivity

Background. The effects of smoking, alcohol consumption, obesity, and a sedentary lifestyle on endothelial function (EF) have only been examined separately. The relative contributions of these behaviours on EF have therefore not been compared. Purpose. To compare the relative associations between these four risk factors and brachial artery reactivity in the same sample. Methods. 328 patients referred for single-photon emission computed tomography (SPECT) exercise stress tests completed a nuclear-medicine-based forearm hyperaemic reactivity test. Self-reported exercise behaviour, smoking habits, and alcohol consumption were collected and waist circumference was measured. Results. Adjusting for relevant covariates, logistic regression analyses revealed that waist circumference, abstinence from alcohol, and past smoking significantly predicted poor brachial artery reactivity while physical activity did not. Only waist circumference predicted continuous variations in EF. Conclusions. Central adiposity, alcohol consumption, and smoking habits but not physical activity are each independent predictors of poor brachial artery reactivity in patients with or at high risk for cardiovascular disease

Public perceptions and behavioural responses to the first COVID-19 pandemic wave in Italy: Results from the iCARE study

Background: Italy was the first European country to be affected by COVID-19. Considering that many countries are currently battling the 2nd wave of the pandemic, understanding people's perceptions and responses to government policies remains critical for informing on-going mitigation strategies. We assessed attitudes towards COVID-19 policies, levels of adherence to preventive behaviours, and the association between COVID-19 related concerns and adherence levels. Methods: We recruited a convenience sample of Italian individuals from an international cross-sectional survey (www.icarestudy.com) from March 27th to May 5th 2020. Multivariate regression models were used to test the association between concerns and the adoption of preventive measures. Results: The survey included 1,332 participants (female (68%), younger than 25 (57%)) that reported high awareness (over 96%) and perceived importance (88%) of policies. We observed varied levels of adherence to: hand washing (96%), avoiding social gatherings (96%), self-isolation if suspected or COVID-19 positive (77%). Significantly lower adherence to self-isolation was reported by individuals with current employment. High levels of concerns regarding health of other individuals and country economy were reported. Only health concerns for others were significantly associated with higher adherence to hand washing behaviour. Conclusions: In order to inform current/future government strategies, we provide insights about population's responses to the initial pandemic phase in Italy. Communication approaches should consider addressing people's concerns regarding the health of other individuals to motivate adherence to prevention measures. Provision of social and economic support is warranted to avoid unequal impacts of governmental policies and allow effective adherence to self-isolating measures. Keywords: COVID-19; cross-sectional study; population concerns; preventive behviours

Sex-specific response to physical activity changes using e-health behaviour change interventions: a systematic review and Meta Analysis

Background: Non-communicable diseases (NCDs) account for 70% of deaths globally every year. Cancer, diabetes, cardiovascular diseases, and chronic pulmonary diseases are four commonly caused NCDs. These NCDs usually occur due to modifiable risk factors such as poor diet, alcohol intake, and physical inactivity. Physical activity (PA) has benefits on reducing NCDs and the overall wellbeing of adults. E-health behaviour change interventions with PA outcomes, even though aimed at helping adults increase their PA, may differ in responses between men and women. Objective: The aim of this systematic review was to synthesise the current evidence on sex-differences in PA changes after an e-health behaviour change intervention. Methods: Electronic databases PubMed, Web of Science, PsycInfo, and Cochrane were searched to retrieve papers published in peer-reviewed journals. Articles were included, that provided descriptions of interventions that employed e-health delivery modes such as Internet, email, and short messaging services (SMS), included PA as one of their outcomes and focused on healthy adult populations. Results: In total 18 studies were included in the current systematic review. Of the 18 studies, 14 studies were analysed in both meta-analysis and qualitative synthesis. These 14 studies measured PA subjectively and had usable outcome data. In all, the group comparison showed no significant sex-effect (p=0.685) on changes in PA, post-intervention, whereas comparisons of pooled effects iv of men and women at follow-up showed a significant effect (p=0.008) indicating greater increases in PA among women over the long-term (mean follow-up = 23.5, SD = 12.7 weeks). Conclusions: E-health behaviour change interventions lead to significant increases in PA, at both post-intervention and follow-up among men and women, with greater increases at follow-up among women compared to men. Clinically, it means that both men and women maybe able to maintain sustained increase in PA using e-health behaviour change interventions