Everyday Walking Among Older Adults and the Neighborhood Built Environment: A Comparison Between Two Cities in North America

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults\u27 walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: Results from the European Project on OSteoArthritis (EPOSA)

People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity. Methods Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders. Results The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe. Conclusions Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) is supported by the European Union (No.: 2005121) and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (project numbers FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143). The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study was supported by the Medical Research Council, UK

Framework and baseline examination of the German National Cohort (NAKO)

The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19–74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2–3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4–5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10654-022-00890-5

Large-scale assessment of physical activity in a population using high-resolution hip-worn accelerometry: the German National Cohort (NAKO)

Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process

Messung der körperlichen Fitness in der NAKO Gesundheitsstudie: Methoden, Qualitätssicherung und erste deskriptive Ergebnisse

Die körperliche Fitness ist das Maß für die individuelle Fähigkeit, körperlich aktiv zu sein. Ihre wesentlichen Komponenten sind die kardiorespiratorische Fitness (Cardiorespiratory Fitness, CRF), die Muskelkraft und die Beweglichkeit. Neben der körperlichen Aktivität ist die körperliche Fitness ein wesentlicher Prädiktor für Morbidität und Mortalität. Ziel der Arbeit sind die Beschreibung der Erhebungsmethoden körperlicher Fitness in der NAKO Gesundheitsstudie und die Darstellung erster deskriptiver Ergebnisse. In der NAKO-Basiserhebung wurden die maximale Handgreifkraft (Grip Strength, GS) und die CRF als Komponenten der körperlichen Fitness über ein Handdynamometer bzw. über einen Fahrradergometertest mit submaximaler Belastung erhoben. Daraus wurde die maximale Sauerstoffaufnahme (VO2max) zur Beurteilung der CRF abgeleitet. Die Ergebnisse von insgesamt 99.068 GS-Messungen und 3094 Messungen der CRF beruhen auf einem Datensatz zur Halbzeit der Basiserhebung der NAKO (Alter 20–73 Jahre, 47 % Männer). Männer zeigten im Vergleich zu Frauen höhere Werte der körperlichen Fitness (Männer: GS = 47,8 kg, VO2max = 36,4 ml·min−1 · kg−1; Frauen: GS = 29,9 kg, VO2max = 32,3 ml·min−1 · kg−1). Ungefähr ab dem 50. Lebensjahr konnte ein Rückgang der GS verzeichnet werden, wohingegen die CRF ab der Altersgruppe 20–29 Jahre bis zu den ≥60-Jährigen kontinuierlich abfiel. Die GS und die VO2max zeigten nach Korrektur für das Körpergewicht einen linear positiven Zusammenhang (Männer β = 0,21; Frauen β = 0,35). Die Analysen zeigten eine gute Übereinstimmung der Verteilung der körperlichen Fitness in der NAKO im Vergleich zu anderen bevölkerungsbasierten Studien. Zukünftige Auswertungen werden insbesondere die unabhängige Bedeutung der GS und CRF bei der Prädiktion von Morbidität und Mortalität beleuchten.Physical fitness is defined as an individual’s ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality. The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort. In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO2max) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20–73 years, 47% men). Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO2max = 36.4 ml·min−1 · kg−1; females: GS = 29.9 kg, VO2max = 32.3 ml · min−1 · kg−1). GS declined from the age of 50 onwards, whereas VO2max levels decreased continuously between the age groups of 20–29 and ≥60 years. GS and VO2max showed a linear positive association after adjustment for body weight (males β = 0.21; females β = 0.35). These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality

A physically active lifestyle in old age: the role of the physical and social environment

Regular physical activity is of utmost importance for the health and quality of life of older adults (F. Sun, Norman, & While, 2013). However, whether and to what extent older adults are physically active is not only the result of individual habits and attitudes, but also shaped by the structural context. The aim of this thesis is to investigate the role of both the physical and the social context for physical activity. Moreover, this thesis was interested in comparing these context effects between adults with osteoarthritis (OA) and older adults without this condition. These insights could be the basis on which effective physical activity promotion activities could be developed, particularly in older adults with OA. Older adults with OA might have a lower ability to respond to environmental demands because they are restricted in everyday activities (van der Pas et al., 2016). OA is a leading cause of functional limitations among older adults (Dillon, Hirsch, Rasch, & Gu, 2006) and the second greatest cause of disability worldwide (Vos et al., 2012). However, many older adults with OA do not engage in regular physical activity, even though it helps them to overcome symptoms. Moreover, physical activity is recommended as a self-management strategy by the American Colleague of Rheumatology (Hochberg et al., 2012). Besides a focus on OA, this thesis discusses the influence of social isolation on low physical activity levels. Social isolation has consistently been found to be an important predictor of low physical activity among older adults (Chang, Wray, & Lin, 2014). However, there is little knowledge about the interrelation of physical activity levels in persons with restricted social networks and the location in which physical activity might occur. In summation, this thesis looks in more detail at the relationship between (low) physical activity levels in older adults and (1) country variations among older adults with OA, (2) physical environmental conditions (e.g., weather conditions) and (3) social environment (e.g., social isolation). This publication-based dissertation is comprised of three articles, which present results of two different studies. All are part of the ActiFE study (Activity and Function in the Elderly in Ulm) (Denkinger et al., 2010). The first article of this thesis presents a multi-centric cross-sectional analysis of physical activity data on older adults from six European countries (n=2,942). The study examined whether the same health condition (knee OA) had different effects on physical activity in different European countries. Depending on the country of residence, older adults with knee OA were either equally or much less physically active compared to individuals without the condition. Knee OA had a greater effect on physical activity in southern European countries than northern European countries, which indicated the relevance of environmental factors. The second article used the same data source with a focus on weather conditions that were retrieved from local weather stations. Similarly, to the first article, this study compared people with OA and older adults without the condition. High temperature and low humidity were associated with more outdoor physical activity. The relationship was stronger in older adults without OA in comparison with individuals with the condition. Older adults without OA might be better able to adapt their behavior to physical environmental circumstances. Finally, the third article examined the importance of social isolation on physical activity in German participants, without a focus on OA. This study combined objective accelerometer-based physical activity data with data from an outdoor physical activity diary. Social isolation from friends turned out to be strongly associated with lower levels of physical activity. Furthermore, outdoor physical activity was highly correlated with physical activity. Outdoor physical activity was more likely associated with social isolation from friends and neighbors than indoor physical activity. In conclusion, the results showed that lower physical activity levels were associated with the physical and social environment. These findings document the critical role of the environment in promoting or inhibiting physical activity in older adults.Regelmäßige körperliche Aktivität wirkt sich positiv auf die Gesundheit und die Lebensqualität im Alter aus (F. Sun et al., 2013). Ob und inwieweit ältere Personen körperlich aktiv sind, ist nicht nur von persönlichen Gewohnheiten und Einstellungen eines jeden Einzelnen abhängig, sondern wird auch durch die Lebensumwelt geprägt. Die vorliegende Arbeit untersuchte nun, inwiefern das physischen und das sozialen Umfeld körperliche Aktivität beeinflusst. Darüber hinaus ging diese Arbeit der Frage nach, ob kontextuelle Einflüsse besonders stark bei Personen mit Osteoarthrose (OA) auf körperliche Aktivität wirken. Der Vergleich von Personen mit OA mit Personen ohne die Erkrankung ermöglichte es, Erkenntnisse zu gewinnen, die als Grundlage für effektive körperliche Aktivitätsförderung herangezogen werden könnten. Ältere Personen mit OA haben eine geringere Fähigkeiten auf Umweltanforderungen zu reagieren, da OA mit körperlichen Einschränkungen im alltäglichen Leben einhergeht (van der Pas et al., 2016). OA gilt als eine Hauptursache für funktionelle Einschränkungen bei älteren Personen (Dillon et al., 2006) und als zweitgrößte Ursache für körperliche Einschränkungen im Alter weltweit (Vos et al., 2012). Obwohl körperliche Aktivität dabei hilft, die Symptome von OA abzumildern und vom „American College of Rheumatology“ empfohlen wird (Hochberg et al., 2012), sind die meisten ältere Personen mit OA unzureichend körperlich aktiv. Neben dem Schwerpunkt auf OA, beleuchtet die Arbeit den Zusammenhang zwischen sozialer Isolation und geringer körperlicher Aktivität. Soziale Isolation gilt als ein wichtiger Prädiktor für geringe körperliche Aktivität bei älteren Personen (Chang et al., 2014). Allerdings gibt es wenige Erkenntnisse über das Zusammenwirken von körperlicher Aktivität, eingeschränkten sozialen Netzwerken und dem Ort, an dem ältere Personen besonders aktiv sind. Zusammenfassend untersucht diese Arbeit das Verhältnis zwischen (niedriger) körperlichr Aktivität bei älteren Personen und (1) länderspezifischen körperlichen Aktivitätsmustern bei Personen mit OA (2) unter Einbeziehung des physischen Umfeldes (z. B. meteorologische Bedingungen) und (3) des sozialen Umfeldes (z.B. soziale Isolation). Diese publikations-basierte Dissertation umfasst drei Manuskripte, die Ergebnisse aus zwei miteinander zusammenhängenden Studien aufgreift. Alle Studienteilnehmer haben an der ActiFE-Studie (Aktivität und Funktion bei älteren Menschen in Ulm) teilgenommen (Denkinger et al., 2010). Das erste Manuskript der Dissertation präsentiert eine multizentrische Querschnittsanalyse zu körperlicher Aktivität bei älteren Personen aus sechs europäischen Ländern (n=2,942). Die Studie untersucht, ob die gleiche Erkrankung (Knie OA) unterschiedliche Auswirkungen auf die körperliche Aktivität in den einzelnen europäischen Ländern hat. Je nach untersuchtem Land waren die Personen mit OA im Knie entweder gleich oder weniger aktiv als Personen ohne die Erkrankung. Dabei hatte OA im Knie eine größere Wirkung auf die körperliche Aktivität in den südeuropäischen Ländern im Vergleich zu nordeuropäischen Ländern. Dies weist auf die Relevanz von Umweltfaktoren hin. Das zweite Manuskript nutzt die gleiche Datengrundlage mit dem Fokus auf meteorologische Bedingungen. Diese Information wurde von Wetterstationen vor Ort abgerufen. Analog zum ersten Manuskript verglich diese Studie Personen mit OA mit älteren Erwachsenen ohne die Erkrankung. Hohe Temperaturen und niedrige Luftfeuchtigkeit hingen mit höherer körperlicher Aktivität im Freien zusammen. Der Zusammenhang war stärker bei älteren Personen ohne OA im Vergleich zu Personen mit der Erkrankung. Eine mögliche Erklärung war, dass ältere Personen ohne OA ihr Verhalten besser an Umgebungsbedingungen anpassen konnten.   Schließlich untersuchte das dritte Manuskript den Zusammenhang zwischen sozialer Isolation und körperliche Aktivität (ohne einen Schwerpunkt auf OA zu legen). Dieses Manuskript kombiniert objektive akzelerometer-basierte Aktivitätsdaten mit einem Tagebuch, in dem außerhäusliche Aktivitäten dokumentiert wurden. Kein oder wenig Kontakt zu Freunden erwies sich als die wichtigste Einflussgröße auf körperliche Aktivität. Darüber hinaus wurde festgestellt, dass außerhäusliche körperliche Aktivität von besonderer Bedeutung war. Sozialer Isolation war eher mit außerhäusliche körperliche Aktivität assoziiert, als mit körperlicher Aktivität, die im oder um das Haus stattfand. Die Ergebnisse dieser Dissertation deuten darauf hin, dass geringe körperliche Aktivität mit dem physischen und sozialen Umfeld zusammenhängt. Dies dokumentiert die bedeutende Rolle der Umwelt für körperliche Aktivität bei älteren Personen

Migrationshintergrund: Fluch oder Segen bei der Ratswahl?

Der Beitrag beschäftigt sich mit dem relativen Wahlerfolg von Kandidatinnen und Kandidaten mit Migrationshintergrund in vier süddeutschen Großstädten. Auf der Grundlage von Aggregatdatenanalysen für den Zeitraum 2006 bis 2009 zeigt sich, dass solche Kandidaten vor allem in Wahlbezirken mit hohen Migrantenanteilen gut abschneiden. Insgesamt betrachtet erhöht der Migrationshintergrund die Wahlchancen allerdings nicht, denn in Wahlbezirken mit niedrigen Migrantenanteilen büßten die Kandidatinnen Stimmen ein. Der Beitrag ist ein Indiz dafür, dass Kandidaten mit Migrationshintergrund vor allem von Wählern mit Migrationshintergrund unterstützt werden, und dies auch über Parteigrenzen hinweg

Additional file 1: of Cognitive function and the agreement between self-reported and accelerometer-accessed physical activity

Figure S1. Figure that illustrates the distribution of cognitive function in both sexes. Ttif (TIFF 3086 kb

Minimal clinically important decline in physical function over one year: EPOSA study

Background: The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods. Methods: The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12–18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study’s anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis. Results: Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function. Conclusions: The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.This work was supported by a non-commercial private funder. The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) was supported by the European Union [2005121] and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain [FIS PI 05/1898; FIS RETICEF RD06/0013/ 1013 and FIS PS09/02143]. The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study is funded by the Medical Research Council of Great Britain, Arthritis Research UK, the British Heart Foundation and the International Osteoporosis Foundation

Neighborhood Resources Associated With Active Travel in Older Adults : A Cohort Study in Six European Countries

Objectives: To study associations between perceived neighborhood resources and time spent by older adults in active travel. Methods: Respondents in six European countries, aged 65–85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options “a lot,” “some,” and “not at all.” Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12–18 months later (n = 2,189). Results: Reporting a lot of any of the separate resources (range B’s = 0.19–0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources. Discussion: Perceiving multiple neighborhood resources may support older adults’ active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.peerReviewe