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      Leisure-time physical activity and risk of disability incidence: A 12-year prospective cohort study among young elderly of the same age at baseline

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          Abstract

          Background

          To clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly.

          Methods

          In the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64–65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1–2 or care levels 1–5); 2) care levels 2–5; 3) support or care levels with dementia; and 4) care levels 2–5 or death. In addition, we also assessed 5) all-cause mortality.

          Results

          After controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25–0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability.

          Conclusion

          We identified an inverse dose–response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.

          Highlights

          • We examined associations between physical activity and disability incidence.

          • We quantified amount of leisure-time physical activity.

          • A dose–response relationship was found for the risk of disability with dementia.

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          Most cited references44

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          Geriatric Depression Scale.

          J Yesavage (1988)
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            Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines

            Background The purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence. Methods Prospective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed. Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices. Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.
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              Predicting nursing home admission in the U.S: a meta-analysis

              Background While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled empirical associations for sociodemographic, functional, cognitive, service use, and informal support indicators that predict nursing home admission among older adults in the U.S. Methods Studies published in English were retrieved by searching the MEDLINE, PSYCINFO, CINAHL, and Digital Dissertations databases using the keywords: "nursing home placement," "nursing home entry," "nursing home admission," and "predictors/institutionalization." Any reports including these key words were retrieved. Bibliographies of retrieved articles were also searched. Selected studies included sampling frames that were nationally- or regionally-representative of the U.S. older population. Results Of 736 relevant reports identified, 77 reports across 12 data sources were included that used longitudinal designs and community-based samples. Information on number of nursing home admissions, length of follow-up, sample characteristics, analysis type, statistical adjustment, and potential risk factors were extracted with standardized protocols. Random effects models were used to separately pool the logistic and Cox regression model results from the individual data sources. Among the strongest predictors of nursing home admission were 3 or more activities of daily living dependencies (summary odds ratio [OR] = 3.25; 95% confidence interval [CI], 2.56–4.09), cognitive impairment (OR = 2.54; CI, 1.44–4.51), and prior nursing home use (OR = 3.47; CI, 1.89–6.37). Conclusion The pooled associations provided detailed empirical information as to which variables emerged as the strongest predictors of NH admission (e.g., 3 or more ADL dependencies, cognitive impairment, prior NH use). These results could be utilized as weights in the construction and validation of prognostic tools to estimate risk for NH entry over a multi-year period.
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                Author and article information

                Contributors
                Journal
                J Epidemiol
                J Epidemiol
                Journal of Epidemiology
                Elsevier
                0917-5040
                1349-9092
                09 June 2017
                November 2017
                09 June 2017
                : 27
                : 11
                : 538-545
                Affiliations
                [a ]Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
                [b ]Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
                [c ]Kyoto University Health Service, Kyoto, Japan
                [d ]Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
                Author notes
                []Corresponding author. Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.Department of Preventive MedicineNagoya University Graduate School of Medicine65 Tsurumai-choShowa-kuNagoya466-8550Japan matsunaga.takashi@ 123456d.mbox.nagoya-u.ac.jp
                Article
                S0917-5040(17)30120-X
                10.1016/j.je.2016.11.004
                5608599
                28606710
                2cdfb111-4312-43a7-a5a5-a0a7df392a65
                © 2017 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 July 2016
                : 16 November 2016
                Categories
                Original Article

                leisure-time physical activity,disability,elderly
                leisure-time physical activity, disability, elderly

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