Will We Do If We Can? Habitual Qualitative and Quantitative Physical Activity in Multi-Morbid, Older Persons with Cognitive Impairment

This study aimed to identify determinants of quantitative dimensions of physical activity (PA; duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristics while walking straight and while walking turns were documented by a validated, sensor-based activity monitor. Univariate and multiple linear regression analyses were performed to delineate associations of quantitative PA dimensions with qualitative characteristics of gait performance and further potential influencing factors (motor capacity measures, demographic, and health-related parameters). In 94 multi-morbid, older adults (82.3 ± 5.9 years) with CI (Mini-Mental State Examination score: 23.3 ± 2.4), analyses of quantitative and qualitative PA documented highly inactive behavior (89.6% inactivity) and a high incidence of gait deficits, respectively. The multiple regression models (adjusted R2 = 0.395–0.679, all p < 0.001) identified specific qualitative gait characteristics as independent determinants for all quantitative PA dimensions, whereas motor capacity was an independent determinant only for the PA dimension duration. Demographic and health-related parameters were not identified as independent determinants. High associations between innovative, qualitative, and established, quantitative PA performances may suggest gait quality as a potential target to increase quantity of PA in multi-morbid, older persons.

[1]  R. Kirkwood,et al.  The geriatric depression scale and the timed up and go test predict fear of falling in community-dwelling elderly women with type 2 diabetes mellitus: a cross-sectional study , 2016, BMC Geriatrics.

[2]  Kevin T. Hansen,et al.  Journal of Neuroengineering and Rehabilitation Open Access Quantitative Gait Analysis under Dual-task in Older People with Mild Cognitive Impairment: a Reliability Study , 2022 .

[3]  L. Yardley,et al.  Validity and Sensitivity to Change of the Falls Efficacy Scales International to Assess Fear of Falling in Older Adults with and without Cognitive Impairment , 2010, Gerontology.

[4]  J. Kaprio,et al.  Chronic diseases and objectively monitored physical activity profile among aged individuals – a cross-sectional twin cohort study , 2019, Annals of medicine.

[5]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[6]  Greta C Bernatz,et al.  Video task analysis of turning during activities of daily living. , 2007, Gait & posture.

[7]  S. Lord,et al.  Older People with Dementia Have Reduced Daily-Life Activity and Impaired Daily-Life Gait When Compared to Age-Sex Matched Controls. , 2019, Journal of Alzheimer's disease : JAD.

[8]  Klaus Hauer,et al.  Validity, reliability, and feasibility of the uSense activity monitor to register physical activity and gait performance in habitual settings of geriatric patients , 2019, Physiological measurement.

[9]  Lorenzo Chiari,et al.  Natural turn measures predict recurrent falls in community-dwelling older adults: a longitudinal cohort study , 2018, Scientific Reports.

[10]  P. Donnan,et al.  Social, Environmental and Psychological Factors Associated with Objective Physical Activity Levels in the Over 65s , 2012, PloS one.

[11]  Jeffrey M. Hausdorff,et al.  Association Between Quantitative Gait and Balance Measures and Total Daily Physical Activity in Community-Dwelling Older Adults , 2018, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  Mahmoud El-Gohary,et al.  Continuous monitoring of turning in Parkinson's disease: Rehabilitation potential. , 2015, NeuroRehabilitation.

[13]  Mark A Hollands,et al.  Differences in axial segment reorientation during standing turns predict multiple falls in older adults. , 2012, Gait & posture.

[14]  A. Swank.  Physical Dimensions of Aging , 1996 .

[15]  Wiebren Zijlstra,et al.  Mobility in Old Age: Capacity Is Not Performance , 2016, BioMed research international.

[16]  D. Bennett,et al.  Total daily activity is associated with cognition in older persons. , 2008, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[17]  K. Hauer,et al.  Development of a home-based training program for post-ward geriatric rehabilitation patients with cognitive impairment: study protocol of a randomized-controlled trail , 2017, BMC Geriatrics.

[18]  Jeffrey M. Hausdorff,et al.  A wearable sensor identifies alterations in community ambulation in multiple sclerosis: contributors to real-world gait quality and physical activity , 2020, Journal of Neurology.

[19]  S. Seino,et al.  Association between habitual light‐intensity physical activity and lower‐extremity performance: A cross‐sectional study of community‐dwelling older Japanese adults , 2015, Geriatrics & gerontology international.

[20]  Michael Schwenk,et al.  The Impact of Mild Cognitive Impairment on Gait and Balance: A Systematic Review and Meta-Analysis of Studies Using Instrumented Assessment , 2016, Gerontology.

[21]  The association between motor capacity and mobility performance: frailty as a moderator , 2019, European Review of Aging and Physical Activity.

[22]  H. Yack,et al.  Dynamic stability in the elderly: identifying a possible measure. , 1993, Journal of gerontology.

[23]  Robert Briggs,et al.  Do Differences in Spatiotemporal Gait Parameters Predict the Risk of Developing Depression in Later Life? , 2019, Journal of the American Geriatrics Society.

[24]  Kade Paterson,et al.  Stride dynamics, gait variability and prospective falls risk in active community dwelling older women. , 2011, Gait & posture.

[25]  T. Hortobágyi,et al.  Old adults perform activities of daily living near their maximal capabilities. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[26]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[27]  K. Hauer,et al.  Transition from inpatient rehabilitation to the home environment in cognitively impaired older persons after hip fracture. , 2020, Journal of Rehabilitation Medicine.

[28]  T. Hortobágyi,et al.  Barriers, motivators, and facilitators of physical activity in dementia patients: A systematic review. , 2016, Archives of gerontology and geriatrics.

[29]  K. Niu,et al.  Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China , 2017, Clinical interventions in aging.

[30]  A comparison of turn and straight walking phases as predictors of incident falls. , 2020, Gait & posture.

[31]  Jochen Klenk,et al.  Validation of an accelerometer for measurement of activity in frail older people. , 2018, Gait & posture.

[32]  Andreas Daffertshofer,et al.  Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study , 2016, PloS one.

[33]  D. Thijssen,et al.  DEMENTIA PATIENTS ARE MORE SEDENTARY AND LESS PHYSICALLY ACTIVE THAN AGE- AND SEX-MATCHED COGNITIVELY HEALTHY OLDER ADULTS , 2018, Alzheimer's & Dementia.

[34]  Rosaria Rucco,et al.  Step length predicts executive dysfunction in Parkinson’s disease: a 3-year prospective study , 2018, Journal of Neurology.

[35]  K. Paterson,et al.  The Association Between Gait Characteristics and Ambulatory Physical Activity in Older People: A Cross-Sectional and Longitudinal Observational Study Using Generation 100 Data. , 2017, Journal of aging and physical activity.

[36]  I. Norman,et al.  Physical activity in older people: a systematic review , 2013, BMC Public Health.

[37]  Todd M Manini,et al.  Metabolic Cost of Daily Activities and Effect of Mobility Impairment in Older Adults , 2011, Journal of the American Geriatrics Society.

[38]  A. F. Ernst,et al.  Regression assumptions in clinical psychology research practice—a systematic review of common misconceptions , 2017, PeerJ.

[39]  S. Flynn,et al.  Turning difficulty characteristics of adults aged 65 years or older. , 2000, Physical therapy.

[40]  R. Lipton,et al.  Quantitative gait markers and incident fall risk in older adults. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  Suzanne G. Leveille,et al.  Gait coordination impairment is associated with mobility in older adults , 2016, Experimental Gerontology.

[42]  T. Hadjistavropoulos,et al.  Evaluation of age-related differences in the stride-to-stride fluctuations, regularity and symmetry of gait using a waist-mounted tri-axial accelerometer. , 2014, Gait & posture.

[43]  Rose Anne Kenny,et al.  Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults. , 2013, Gait & posture.

[44]  Jeffrey M. Hausdorff,et al.  Is every-day walking in older adults more analogous to dual-task walking or to usual walking? Elucidating the gaps between gait performance in the lab and during 24/7 monitoring , 2019, European Review of Aging and Physical Activity.

[45]  F. Horak,et al.  Continuous Monitoring of Turning Mobility and Its Association to Falls and Cognitive Function: A Pilot Study. , 2016, The journals of gerontology. Series A, Biological sciences and medical sciences.

[46]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[47]  S. Greenberg,et al.  How To try this: The Geriatric Depression Scale Short Form , 2007, The American journal of nursing.

[48]  J. Eriksson,et al.  Objectively measured physical activity and physical performance in old age , 2016, Age and ageing.

[49]  Sean Pearson,et al.  Continuous Monitoring of Turning in Patients with Movement Disability , 2013, Sensors.

[50]  Jeffrey M. Hausdorff,et al.  Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study , 2011, Journal of NeuroEngineering and Rehabilitation.

[51]  Jeffrey M. Hausdorff,et al.  Coordination Impairments Are Associated With Falling Among Older Adults , 2017, Experimental aging research.

[52]  Jeffrey M. Hausdorff,et al.  A new measure for quantifying the bilateral coordination of human gait: effects of aging and Parkinson’s disease , 2007, Experimental Brain Research.

[53]  K. Hauer,et al.  Acute and chronic pain in geriatrics: clinical characteristics of pain and the influence of cognition. , 2004, Pain medicine.

[54]  C. Durand.  Development of a Scale to Assess Avoidance Behavior Due to a Fear of Falling: The Fear of Falling Avoidance Behavior Questionnaire , 2011, Physical Therapy.

[55]  Ulf Ekelund,et al.  Guide to the assessment of physical activity: Clinical and research applications: a scientific statement from the American Heart Association. , 2013, Circulation.

[56]  Jaap H. van Dieën,et al.  Physical Performance and Physical Activity in Older Adults: Associated but Separate Domains of Physical Function in Old Age , 2015, PloS one.

[57]  S. Hutchins,et al.  The effect of aging on gait parameters in able-bodied older subjects: a literature review , 2016, Aging Clinical and Experimental Research.

[58]  Jeffrey M. Hausdorff,et al.  Everyday Stepping Quantity and Quality Among Older Adult Fallers With and Without Mild Cognitive Impairment: Initial Evidence for New Motor Markers of Cognitive Deficits? , 2018, The journals of gerontology. Series A, Biological sciences and medical sciences.

[59]  Jaap H van Dieën,et al.  Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. , 2015, The journals of gerontology. Series A, Biological sciences and medical sciences.

[60]  O. Beauchet,et al.  Gait variability while dual-tasking: fall predictor in older inpatients? , 2008, Aging clinical and experimental research.

[61]  Caroline Paquette,et al.  Medio-lateral stability during walking turns in older adults , 2018, PloS one.

[62]  Y. Netz,et al.  Aging and inactivity—capitalizing on the protective effect of planned physical activity in old age , 2009, European Review of Aging and Physical Activity.

[63]  J. VanSwearingen,et al.  Harmonic ratios: a quantification of step to step symmetry. , 2013, Journal of biomechanics.

[64]  Mark G. Davis,et al.  Associations of objectively measured physical activity with lower limb function in older men and women: findings from the Older People and Active Living (OPAL) study. , 2014, Journal of Aging and Physical Activity.

[65]  Tibor Hortobágyi,et al.  Older Adults with Dementia Are Sedentary for Most of the Day , 2016, PloS one.

[66]  Jeffrey M. Hausdorff,et al.  Gait and Cognition: A Complementary Approach to Understanding Brain Function and the Risk of Falling , 2012, Journal of the American Geriatrics Society.

[67]  K. Hinrichs,et al.  Long-term Care Insurance in Germany , 2011 .

[68]  R. Fitzpatrick,et al.  Age-related differences in walking stability. , 2003, Age and ageing.

[69]  Wiebren Zijlstra,et al.  Sensor-based assessment of mobility-related behavior in dementia: feasibility and relevance in a hospital context , 2016, International Psychogeriatrics.

[70]  C. Sforza,et al.  Study of the association between gait variability and physical activity , 2017, European Review of Aging and Physical Activity.

[71]  Giampaolo Ferraioli,et al.  Type and Location of Wearable Sensors for Monitoring Falls during Static and Dynamic Tasks in Healthy Elderly: A Review , 2018, Sensors.

[72]  Yukai Wang,et al.  Wearable Sensor-Based Daily Life Walking Assessment of Gait for Distinguishing Individuals With Amnestic Mild Cognitive Impairment , 2019, Front. Aging Neurosci..

[73]  D. Shin,et al.  Timed up-and-go test is a useful predictor of fracture incidence. , 2019, Bone.

[74]  Massimiliano Pau,et al.  Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor , 2020, Sensors.

[75]  Wiebren Zijlstra,et al.  Detection of gait and postures using a miniaturised triaxial accelerometer-based system: accuracy in community-dwelling older adults. , 2010, Age and ageing.

[76]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[77]  C. Cooper,et al.  Correlates of high-impact physical activity measured objectively in older British adults , 2017, Journal of public health.

[78]  Jeffrey M. Hausdorff,et al.  Does the Evaluation of Gait Quality During Daily Life Provide Insight Into Fall Risk? A Novel Approach Using 3-Day Accelerometer Recordings , 2013, Neurorehabilitation and neural repair.

[79]  Hassan A. Aziz,et al.  Comparison between Field Research and Controlled Laboratory Research , 2017 .

[80]  R. Cumming,et al.  Fall Frequency and Characteristics and the Risk of Hip Fractures , 1994, Journal of the American Geriatrics Society.

[81]  Jeffrey M. Hausdorff,et al.  Gait variability and fall risk in community-living older adults: a 1-year prospective study. , 2001, Archives of physical medicine and rehabilitation.

[82]  M. Mcmurdo,et al.  Validation of the AX3 triaxial accelerometer in older functionally impaired people , 2016, Aging Clinical and Experimental Research.

[83]  M. Montero‐Odasso,et al.  Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention , 2018, Journal of the American Geriatrics Society.

[84]  Jorunn L Helbostad,et al.  Estimation of gait cycle characteristics by trunk accelerometry. , 2004, Journal of biomechanics.

[85]  H. Shimada,et al.  Objectively measured physical activity and cognitive function in urban‐dwelling older adults , 2018, Geriatrics & gerontology international.