Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study

There is increased recognition that determinants of health should be investigated in a life-course perspective. Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population. The authors examined the effect of retirement on changes in physical activity in the GLOBE Study, a prospective cohort study known by the Dutch acronym for "Health and Living Conditions of the Population of Eindhoven and surroundings," 1991-2004. They followed respondents (n = 971) by postal questionnaire who were employed and aged 40-65 years in 1991 for 13 years, after which they were still employed (n = 287) or had retired (n = 684). Physical activity included 1) work-related transportation, 2) sports participation, and 3) nonsports leisure-time physical activity. Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation (odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.97, 4.65), adjusted for sex, age, marital status, chronic diseases, and education, compared with remaining employed. Retirement was not associated with an increase in sports participation (OR = 1.12, 95% CI: 0.71, 1.75) or nonsports leisure-time physical activity (OR = 0.80, 95% CI: 0.54, 1.19). In conclusion, retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity.     

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults

BACKGROUND: Better understanding the impact of changes in physical activity behavior on short-term health care charges may inform resource allocation decisions to increase population levels of physical activity. This study examines the prospective relationship of changes in physical activity status on short-term changes in health care charges for older adults. METHODS: A prospective cohort study was done on a stratified random sample of 2,393 adults aged 50 and older enrolled in a Minnesota health plan, predicting changes in resource use between two periods (September 1994 to August 1995 and September 1996 to August 1997) based on billed health care charges. RESULTS: After adjustment for age, gender, comorbidity, smoking status, and body mass index, all physical activity states had declining health care charges, relative to those who were consistently inactive. Subjects who increased their physical activity from 0-1 to 3+ days/week had significant declines in their mean annualized total charges (-2,202 dollars, P < 0.01) relative to those who remained inactive. CONCLUSIONS: Increased physical activity among older adults is associated with lower health care charges within 2 years, relative to charges for those who were persistently inactive. These cost savings may justify investments in effective interventions to increase physical activity in older adults.     

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

Objective

To describe associations of muscle strength, physical activity and self-rated health.

Method

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30 s repeated chair stand test (30 s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007–2008.

Results

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR = 6.84, 95% CI: 4.85–9.65 and OR = 7.34, 95% CI: 5.42–9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30 s-CS test (6.06, 95% CI: 4.32–8.50 and 13.38, 95% CI: 9.59–18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30 s-CS).

Conclusion

The combined score for physical activity level with either HGS or 30 s-CS was strongly positively associated with self-related health.     

Leisure-time physical activity and psychotropic medication: A prospective cohort study

Background

Physical inactivity is a major public health problem associated with an increased risk of mental health problems. The aim of this study was to examine the associations of leisure-time physical activity with subsequent psychotropic medication among middle-aged people employed at baseline.

Methods

Questionnaire survey data collected in 2000–02 among 40–60-year-old employees of the City of Helsinki (N = 8960) were linked with register data on prescribed psychotropic medication (74% gave permission to linkage). The mean follow-up time was 4.2 years. The analysis included 5961 respondents (78% women). The participants were classified into four groups according to physical activity recommendations. Cox regression analysis was used to calculate hazard ratios (HR) for the first psychotropic medication purchase.

Results

Leisure-time physical activity was associated with decreased risk of any psychotropic medication. After adjusting for prior psychotropic medication conditioning exercisers (HR = 0.65, 95% CI, 0.53–0.80), the vigorously active (HR = 0.83, 95% CI, 0.71–0.98) and the moderately active (HR = 0.85, 95% CI, 0.74–0.97) all showed a reduced risk of medication compared with the inactive. The associations were similar for the two main groups of psychotropic medication: antidepressants as well as sedatives and sleep medication.

Conclusions

Leisure-time physical activity is potentially important for preventing mental health problems among the middle-aged.     

Cancer incidence among Danish seafarers: a population based cohort study

Aims: Seafarers aboard oil and chemical tankers may be exposed to many chemicals, including substances like benzene that are known to be carcinogenic. Other seafarers are exposed to engine exhaust, different oil products, and chemicals used aboard and some years ago asbestos was also used extensively in ships. The aim of this study was to study cancer morbidity among Danish seafarers in relation to type of ship and job title. Methods: A cohort of all Danish seafarers during 1986–1999 (33 340 men; 11 291 women) registered by the Danish Maritime Authority with an employment history was linked with the nationwide Danish Cancer Registry and followed up for cancer until the end of 2002. The number of person years at risk was 517 518. Standardised incidence ratios (SIR) were estimated by use of the corresponding national rates. Results: The SIR of all cancers combined was higher than expected: 1.26 (95% CI 1.19 to 1.32) for men and 1.07 (95% CI 0.95 to 1.20) for women. This was mainly due to an excess of cancer of the larynx, lung, tongue, mouth, pharynx, oesophagus, pancreas, kidney, urinary bladder, colon, and bone as well as skin melanomas among men (the three latter borderline significantly increased), and an excess of cancer of the lung, rectum, and cervix uteri among women. The differences in risk pattern for lung cancer between the different job categories among men ranged in terms of SIR from 1.2 (95% CI 0.9 to 1.7) (engine officers) to 2.3 (1.6 to 3.3) (engine room crew), and 4.1 (2.1 to 7.4) among maintenance crew. Non-officers had a 1.5 times higher lung cancer risk than officers. No increased occurrence of all lymphatic and haematopoietic malignancies combined was found for employees on tankers, but the number of cases was limited to a total of 7. Conclusions: Danish seafarers, especially men, face an increased overall cancer risk, in particular a risk for lung cancer and other tobacco associated cancers.     

Predictors of opioid misuse in patients with chronic pain: a prospective cohort study

Background  

Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice.     

Predictors of work-related repetitive strain injuries in a population cohort

OBJECTIVES: We assessed predictors of work-related repetitive strain injuries using data from 4 waves of the Canadian National Population Health Survey. METHODS: Participants were 2806 working adults who completed an abbreviated version of the Job Content Questionnaire in 1994-1995 and did not experience repetitive strain injuries prior to 2000-2001. Potential previous wave predictors of work-related repetitive strain injuries were modeled via multivariate logistic regression. RESULTS: Female gender (odds ratio [OR] = 1.98; 95% confidence interval [CI]=1.24, 3.18), some college or university education (OR=1.98; 95% CI=1.06, 3.70), job insecurity (OR=1.76; 95% CI=1.07, 2.91), high physical exertion levels (OR = 2.00; 95% CI = 1.29, 3.12), and high levels of psychological demands (OR = 1.61; 95% CI = 1.02, 2.52) were all positively associated with work-related repetitive strain injuries, whereas working less than 30 hours per week exhibited a negative association with such injuries (OR=0.2; 95% CI=0.1, 0.7). CONCLUSIONS: Modifiable job characteristics are important predictors of work-related repetitive strain injuries.     

Recreational physical activity and the risk of preeclampsia: a prospective cohort of Norwegian women

Previous case-control studies suggest that recreational physical activity protects against preeclampsia. Using a prospective design, the authors estimated the risk of preeclampsia for pregnant women according to level of physical activity, taking other variables that influence risk into consideration. The data set comprised 59,573 pregnancies from the Norwegian Mother and Child Cohort Study (1999-2006). Information on physical activity and other exposures was extracted from questionnaire responses given in pregnancy weeks 14-22, whereas diagnosis of preeclampsia was retrieved from the Medical Birth Registry of Norway. Estimation and confounder control was performed with multiple logistic regression. About 24% of pregnant women reported no physical activity, and 7% reported more than 25 such activities per month. The adjusted odds ratio was 0.79 (95% confidence interval: 0.65, 0.96) for preeclampsia when comparing women who exercised 25 times or more per month with inactive women. The association appeared strongest among women whose body mass index was less than 25 kg/m(2) and was absent among women whose body mass index was higher than 30 kg/m(2). These results suggest that the preventive effect of recreational physical activity during pregnancy may be more limited than has been shown in case-control studies and may apply to nonobese women only.     

Characterizing longitudinal patterns of physical activity in mid-adulthood using latent class analysis: results from a prospective cohort study

The authors aimed to describe how longitudinal patterns of physical activity during mid-adulthood (ages 31-53 years) can be characterized using latent class analysis in a population-based birth cohort study, the Medical Research Council's 1946 National Survey of Health and Development. Three different types of physical activity-walking, cycling, and leisure-time physical activity-were analyzed separately using self-reported data collected from questionnaires between 1977 and 1999; 3,847 study members were included in the analysis for one or more types of activity. Patterns of activity differed by sex, so stratified analyses were conducted. Two walking latent classes were identified representing low (52.8% of males in the cohort, 33.5% of females) and high (47.2%, 66.5%) levels of activity. Similar low (91.4%, 82.1%) and high (8.6%, 17.9%) classes were found for cycling, while 3 classes were identified for leisure-time physical activity: "low activity" (46.2%, 48.2%), "sports and leisure activity" (31.0%, 35.3%), and "gardening and do-it-yourself activities" (22.8%, 16.5%). The classes were reasonably or very well separated, with the exception of walking in females. Latent class analysis was found to be a useful tool for characterizing longitudinal patterns of physical activity, even when the measurement instrument differs slightly across ages, which added value in comparison with observed activity at a single age.     

Cognitive performance in childhood and early adult illness: a prospective cohort study

STUDY OBJECTIVE: To evaluate whether cognitive performance in childhood is an early determinant of adult illness. DESIGN: Prospective cohort study covering over 30 years. SETTING: Providence, Rhode Island, USA. PARTICIPANTS: 633 people ages 30-39 followed up since birth as part of the Providence cohort of the national collaborative perinatal project. MAIN RESULTS: Higher cognitive performance at age 7 was related to a significantly reduced risk of serious illness in adulthood, OR = 0.65 (95%CI: 0.47 to 0.89) for a one standard deviation (15 point) increase in IQ score. This association was independent of both parental socioeconomic status and participant's attained level of education. CONCLUSIONS: General cognitive performance may be an important and informative early determinant of adult health. Further evaluation of this association and mechanisms linking cognitive performance and health may provide new and innovative strategies to improve disease management and reduce morbidity.     

Infancy and childhood growth and physical activity in adolescence: prospective birth cohort study from Brazil

Background

A poor understanding of the specific lifestyle behaviors that result in weight loss has hindered the development of effective interventions. The aim of this paper was to identify potential behavioral mediators of weight loss in the Healthy Dads, Healthy Kids (HDHK) intervention for overweight fathers.

Findings

The three-month intervention was evaluated in a randomized controlled trial and conducted in Newcastle, New South Wales, Australia. Baseline, three month (immediate post-intervention) and six month assessments were conducted. Recruitment and follow-up occurred between October 2008 and May 2009. The study sample included 53 overweight/obese men [mean ( SD) age=40.6( 97.1) years; body mass index (BMI)=33.2 (3.9) kgm^-2] and their primary school-aged children [n=71, 54% boys; age=8.2 (2.0) years] who were randomized to HDHK program or a wait-list control group. Physical activity (PA) was assessed using pedometers and dietary behaviors were measured using a validated food frequency questionnaire. The intervention resulted in significant weight loss (5.131.27kg, P<0.0001) and increased PA among fathers (2769750 steps/day, P<0.001) and their children (1486521 steps/day, P<0.01). Fathers PA mediated weight loss in the intervention (AB=2.31, 95% CI=4.63 to 0.67) and was responsible for 47% of the intervention effect. Changes in dietary behaviors were not statistically significant.

Conclusions

PA was an important mediator of weight loss in the HDHK intervention. Encouraging overweight fathers to be more active with their children appears to be a promising strategy for obesity treatment in men.     

Predictors of smokeless tobacco initiation in a young adult military cohort

OBJECTIVE: To identify predictors of smokeless tobacco (ST) initiation among young adults. METHODS: A military cohort (N=28,229) was analyzed to identify variables associated with ST initiation. RESULTS: Baseline current cigarette smoking at baseline was a strong predictor for any ST use (OR 3.88; 95% CI: 3.33-4.52) and daily ST use (OR 3.01, 2.34-3.88) as was experimental ST use for any (OR 2.39, 2.09-2.73) and daily ST use (OR 2.41, 1.93-3.01). CONCLUSIONS: Smoking and previous ST use are strong predictors for ST use in adults. Research is needed to characterize ST initiation and changes in smoking behavior over time.     

Predictors of adipose tissue concentrations of organochlorine pesticides in a general Danish population

Organochlorine pesticides are ubiquitously present in the environment and suspected of carcinogenic, neurological and immunological effects. Our objective was to identify determinants of adipose tissue levels of organochlorine pesticides experienced by a general Danish population. Adipose tissue was collected upon enrolment of 245 randomly selected persons from a prospective cohort of 57,053 persons enrolled between 1993 and 1997. We examined geography, gender, age, lactation, body mass index (BMI) and intake of nine dietary groups and tap water drinks, as potential determinants of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene, hexachlorocyclohexane, dieldrin, hexachlorobenzene, cis-nonachlor, trans-nonachlor and oxychlordane. Living in Copenhagen city and age at enrolment showed positive associations with all compounds. BMI was positively associated with all compounds except cis-nonachlor. Fatty-fish consumption showed positive associations with cis-nonachlor, trans-nonachlor, DDT and dieldrin and fruit and vegetables were inversely associated with dieldrin. Determinant estimates of trans-nonachlor were similar to estimates of total chlordanes while cis-nonachlor and oxychlordane seemed to differ. This is one of the first studies of organochlorine pesticides predictors in adipose tissue and contributes to the ongoing debate about exposure sources of these compounds. Single determinants varied among the individual compounds, even within related chlordane residues, suggesting that organochlorine pesticides should not be treated as a homogenous group.     

Smoking and colorectal cancer in a non-Western population: a prospective cohort study in Japan

BACKGROUND: The risk of colorectal cancer in relation to smoking habits has been examined mostly in Caucasians, and evidence for other ethnic groups is still scarce. METHODS: Our data came from the Japan Collaborative Cohort (JACC) Study. From 1988 through 1990, 25,260 men and 34,619 women aged 40-79 years completed a questionnaire on cigarette smoking and other lifestyle factors. Hazard ratios (HR) were estimated by fitting proportional hazards models. RESULTS: During the mean follow-up of 7.6 years through December 1997, we documented 408 incident colon cancers and 204 rectal cancers. We found a non-significant increase in colon cancer risk in male current smokers compared with never smokers. The multivariate-adjusted hazard ratios were 1.07 (95% confidence interval [CI]: 0.72-1.59) for ex-smokers and 1.23 (95% CI: 0.85-1.78) for current smokers. We however failed to observe a clear dose-response relationship between smoking intensity or duration and colon cancer risk. The adjusted hazard ratio was 1.07 (95% CI: 0.71-1.61) even for 40+ years of smoking. Almost no increase in colon cancer risk was detected for female smokers, and male smokers were not at an enhanced risk of rectal cancer. CONCLUSIONS: Cigarette smoking was not a strong risk factor for colorectal cancer even after a long-term exposure, although a weak association remains open to discussion.     

Changes in leisure-time physical activity and subsequent sickness absence: A prospective cohort study among middle-aged employees

ObjectiveThe aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence.MethodsHelsinki Health Study cohort baseline questionnaire survey data were collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (> 3 days) sickness absence spells were examined, using Poisson regression analysis.ResultsInactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR = 0.80, 95% CI 0.65–0.97) and medically certified (RR = 0.63, 95% CI 0.49–0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found.ConclusionsFor reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.     

Bidirectional association between mental health and physical activity in older adults: Whitehall II prospective cohort study

ObjectiveTo investigate longitudinal and bidirectional associations between mental health and physical activity from midlife into old age.MethodsAnalysis was based on data from 6909 participants (aged 45 to 69 in 1997/99) from the Whitehall II cohort in the UK. Latent growth curve analysis examined possible bidirectional associations between the SF-36 Mental Component Summary and weekly physical activity measured at three time-points over ten years.ResultsMental health and physical activity were associated at baseline (β = 0.17, 95% CI 0.13, 0.21) and associations persisted into old age. In the latent growth curve model, both mental health and physical activity increased and their rates of change ‘moved together’ over time (β = 0.24, 95% CI 0.11, 0.37). Relatively high baseline levels of either variable were associated with slightly slower increases in the other outcome (β = − 0.02, 95% CI − 0.03, − 0.01; β = − 0.07, 95% CI − 0.11, − 0.13), which are thought to reflect regression to the mean. However, those who started high on either variable remained the most advantaged at end of follow-up.ConclusionsFrom midlife to old age, greater physical activity is associated with better mental health and vice versa. These findings suggest persistent longitudinal and bidirectional associations between physical activity and mental health.     

Back pain and restricted daily physical activity in the Spanish adult population

Background. Low back pain is a widespread health problem that affects a great part of the Spanish adult population; it also places a constraint on developing activities of daily living. The aim of this paper is to estimate the association between daily physical activity and chronic back pain in Spain. Material and methods. This paper analyses data from the European Health Survey in Spain 2009; it presents a cross sectional epidemiological study designed to assess the health of the Spanish population, in which 22,188 people participated (10,876 men and 11,312 women over 16 years ), representative of the total Spanish population. The variables studied are: back pain indicators obtained from the European Health Status Module and the European Health Care Module included in this survey, and the daily physical activity pattern obtained from the European Module of Health Determinants. Results. The total volume of daily physical activity is similar in healthy people and those who have back pain, but a pattern of low or moderate intensity in people with chronic back pain in the last twelve months (p <0.01) was observed with greater frequency. Conclusions. People with chronic back pain do not show a lower volume of physical activity, but their physical activity pattern is often low or moderate. Developing a vigorous pattern of physical activity should be considered not only as a strategy to prevent this disease, but also as a therapeutic target in these patients.     

Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study

OBJECTIVES: We examined the association between physical activity and cognitive functioning in middle age. METHODS: Data were derived from a prospective occupational cohort study of 10308 civil servants aged 35-55 years at baseline (phase 1; 1985-1988). Physical activity level, categorized as low, medium, or high, was assessed at phases 1, 3 (1991-1994), and 5 (1997-1999). Cognitive functioning was tested at phase 5, when respondents were 46-68 years old. RESULTS: In both prospective (odds ratio [OR] = 1.65; 95% confidence interval [CI]=1.30, 2.10) and cross-sectional (OR=1.79; 95% CI=1.38, 2.32) analyses, low levels of physical activity were a risk factor for poor performance on a measure of fluid intelligence. Analyses aimed at assessing cumulative effects (summary of physical activity levels at the 3 time points) showed a graded linear relationship with fluid intelligence, with persistently low levels of physical activity being particularly harmful (OR=2.21; 95% CI=1.37, 3.57). CONCLUSIONS: Low levels of physical activity are a risk factor for cognitive functioning in middle age, fluid intelligence in particular.