Physical activity and white matter hyperintensities: A systematic review of quantitative studies
This systematic review examined 12 quantitative studies on the association between physical activity and white matter hyperintensities (WMH). Six studies found that greater physical activity was associated with less WMH, while six found no association. Longitudinal studies and those accounting for lifetime physical activity were more likely to find an association. Greater physical activity was associated with less WMH in individuals without advanced disease.
Study on the Health Related Quality of Life of Patients with Ischemic strokeiosrjce
The work entitled, “Study on the health related quality of life of patients with ischemic stroke” was
conducted in the department of Neurology at a multispecialty hospital. After receiving the official approval, the
study was conducted for a period of eight months from December 2013 to August 2014. A total of 278 cases with
Neurological disorders were found, of which 117(42 %) patients were with ischemic stroke. Hypertension (59%)
and Diabetes (53%) were the major co-morbid conditions found. The Health related quality of life of the
patients was assessed by direct interviewing of individual patients with a stroke specific questionnaire. The
Health related quality of life of the patients was assessed by direct interviewing of individual patients with a
stroke specific questionnaire. Quality of life assessments are done by various methods like taking the floor and
ceiling effects of the scores, average score calculation etc. Assessment of the floor and ceiling effect showed the
potential for floor effects in the most difficult domain(strength) and the possibility of a ceiling effect in the
communication domain. Assessment of stroke severity is done by taking the mean and SD of the individual domains
Study on the Health Related Quality of Life of Patients with Ischemic strokeiosrjce
The work entitled, “Study on the health related quality of life of patients with ischemic stroke” was
conducted in the department of Neurology at a multispecialty hospital. After receiving the official approval, the
study was conducted for a period of eight months from December 2013 to August 2014. A total of 278 cases with
Neurological disorders were found, of which 117(42 %) patients were with ischemic stroke. Hypertension (59%)
and Diabetes (53%) were the major co-morbid conditions found. The Health related quality of life of the
patients was assessed by direct interviewing of individual patients with a stroke specific questionnaire. The
Health related quality of life of the patients was assessed by direct interviewing of individual patients with a
stroke specific questionnaire. Quality of life assessments are done by various methods like taking the floor and
ceiling effects of the scores, average score calculation etc. Assessment of the floor and ceiling effect showed the
potential for floor effects in the most difficult domain(strength) and the possibility of a ceiling effect in the
communication domain. Assessment of stroke severity is done by taking the mean and SD of the individual domains
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Comparative Studies of Diabetes in Adult Nigerians Lipid Profile and Antioxid...YogeshIJTSRD
The study sought to determine the extent to which the usage of social media in the marketing of agricultural products in South West Nigeria can enhance farmers turnover. It employed the survey research design to collect data with the help of a structured questionnaire to elicit information from respondents selected from six 6 south western states. Research data were analysed using structural equation modelling. The results showed that the use of social media WhatsApp and Facebook in marketing of agricultural products significantly enhances farmers turnover. The managerial implication is that use of Whatsapp and Facebook in the marketing of agricultural products for the enhancement of farmers’ turnover was found to have significant influence on the enhancement in farmers’ turnover from agricultural products. Policy makers in government should provide the enabling environment for the telecommunication companies to enhance their reach by installing their facilities across the length and breadth of the country so that the network coverage will be strong at all times so that the benefits of social media usage will not be constrained. Egejuru, Leonard O | Akubugwo, Emmanuel I | Ugorji, Beatrice N "Comparative Studies of Diabetes in Adult Nigerians: Lipid Profile and Antioxidants Vitamins (A and C)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45021.pdf Paper URL: https://www.ijtsrd.com/biological-science/biochemistry/45021/comparative-studies-of-diabetes-in-adult-nigerians-lipid-profile-and-antioxidants-vitamins-a-and-c/egejuru-leonard-o
ABSTRACT- Introduction: Low back pain (LBP) is an important clinical, social, economic, and public health problem
affecting the population indiscriminately. It is a disorder with many possible etiologies, occurring in many groups of the
population, and with many definitions. Nearly everyone will experience some form of back pain in his or her lifetime.
Materials ans& Methods: The current study is a cross sectional study undertaken at Lord Buddha Koshi Medical
College, Saharsa, Bihar, India from Aug 2015 to Dec 2015. The objective of this study was to see the age specific
prevalence of low back pain among 400 subjects visiting the Orthopedics OPD of the hospital. The age range of the study
participants were 25 years to 65 years. The national guidelines of LBP diagnosis is used as diagnostic criteria.
Results: Overall prevalence of LBP was found as 31.25%. The highest prevalence was seen in 55-65 years age group.
Age had positive association & important risk factors of increasing burden of LBP.
Conclusion: LBP is an important health problem & affecting all age groups and it is responsible for a great economic loss
of any country.
Key-words- Low Back Pain, Prevalence, Public Health
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
This is the large version. A very cut down version was presented at my Inaugural Lecture on 5 March 2014, Bristol, UK which is now on YouTube: make some coffee and take a peek? https://www.youtube.com/watch?v=HWnyfqOxR6E
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Comparative Studies of Diabetes in Adult Nigerians Lipid Profile and Antioxid...YogeshIJTSRD
The study sought to determine the extent to which the usage of social media in the marketing of agricultural products in South West Nigeria can enhance farmers turnover. It employed the survey research design to collect data with the help of a structured questionnaire to elicit information from respondents selected from six 6 south western states. Research data were analysed using structural equation modelling. The results showed that the use of social media WhatsApp and Facebook in marketing of agricultural products significantly enhances farmers turnover. The managerial implication is that use of Whatsapp and Facebook in the marketing of agricultural products for the enhancement of farmers’ turnover was found to have significant influence on the enhancement in farmers’ turnover from agricultural products. Policy makers in government should provide the enabling environment for the telecommunication companies to enhance their reach by installing their facilities across the length and breadth of the country so that the network coverage will be strong at all times so that the benefits of social media usage will not be constrained. Egejuru, Leonard O | Akubugwo, Emmanuel I | Ugorji, Beatrice N "Comparative Studies of Diabetes in Adult Nigerians: Lipid Profile and Antioxidants Vitamins (A and C)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45021.pdf Paper URL: https://www.ijtsrd.com/biological-science/biochemistry/45021/comparative-studies-of-diabetes-in-adult-nigerians-lipid-profile-and-antioxidants-vitamins-a-and-c/egejuru-leonard-o
ABSTRACT- Introduction: Low back pain (LBP) is an important clinical, social, economic, and public health problem
affecting the population indiscriminately. It is a disorder with many possible etiologies, occurring in many groups of the
population, and with many definitions. Nearly everyone will experience some form of back pain in his or her lifetime.
Materials ans& Methods: The current study is a cross sectional study undertaken at Lord Buddha Koshi Medical
College, Saharsa, Bihar, India from Aug 2015 to Dec 2015. The objective of this study was to see the age specific
prevalence of low back pain among 400 subjects visiting the Orthopedics OPD of the hospital. The age range of the study
participants were 25 years to 65 years. The national guidelines of LBP diagnosis is used as diagnostic criteria.
Results: Overall prevalence of LBP was found as 31.25%. The highest prevalence was seen in 55-65 years age group.
Age had positive association & important risk factors of increasing burden of LBP.
Conclusion: LBP is an important health problem & affecting all age groups and it is responsible for a great economic loss
of any country.
Key-words- Low Back Pain, Prevalence, Public Health
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
National reports point towards disparities in the utilization of preventive care services but sparse literature exists regarding predicting utilization pattern of preventive care services.
METHODS: The 2007 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the ambulatory civilian US population, was analyzed to determine demographic patterns of utilization. Recommendations by JNC-VII and NCEP were used to determine guideline adherence to blood pressure and cholesterol checkup respectively. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable while age, gender, race, ethnicity, insurance status, perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, chi-square analysis was used to determine the group differences for the categorical variables. Multivariate logistic regression model was built to predict odds of utilizing appropriate preventive se!
rvices. All analysis was carried out using SAS v9.1.
RESULTS: Total number of adult respondents was 20,434 of which data was available for blood pressure checkup for 20,187 respondents and 15,784 respondents for cholesterol checkup. Overall, respondents were found to adhere to guideline recommendations for getting the blood pressure (n=17,959, 89.0%) and cholesterol (n=14,956, 94.7%) check-up done. A univariate chi-square analysis showed statistically significant differences across all independent variables between people who utilized the preventive care service and those who didn t for blood pressure checkup (p<0><0>65) had much higher odds of using the blood pressure (OR=2.815, CI=2.317-3.420 ) and cholesterol (OR=3.190, CI=2.396-4.!
249 ) preventive services. Males had much lower odds of getting blood pressure (OR=0.350, CI=0.318-0.384) and cholesterol (OR=0.597, CI=0.516-0.692) checks done compared to females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR=0.282, CI=0.253-0.315) and cholesterol (OR=0.314, CI=0.262-0.376) use compared to privately insured people.
CONCLUSIONS: Overall MEPS respondents adhered to blood pressure and cholesterol check up guidelines. The study was however successful in identifying existing age, race, income, insurance status related disparities in US population.
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
This is the large version. A very cut down version was presented at my Inaugural Lecture on 5 March 2014, Bristol, UK which is now on YouTube: make some coffee and take a peek? https://www.youtube.com/watch?v=HWnyfqOxR6E
Informed 2010 - Las TICs en la Continuidad Asistencial - Proyecto Osarean Osa...Alfredo Alday
Informed 2010 - Las TICs en la Continuidad Asistencial - Proyecto Osarean Osakidetza en red. Un Proyecto de Integración de las Actividades no Presenciales en el Sistema Sanitario Utilizando las TIC
"Qualitative Research in Conversion Optimization" Every Conversion Optimization process has to start with appropriate conversion research. Andra will take you on a trip through qualitative research and show you: • How to apply qualitative research in your optimization plans • How to use behavioral surveys to investigate your audience and create a personalized on-site journey using this data.
Running Head FREE RADICAL THEORY OF AGING 1 .docxjeanettehully
Running Head: FREE RADICAL THEORY OF AGING 1
Research Article Summary:
Free Radical Theory of Aging
University of Maryland Baltimore County
FREE RADICAL THEORY OF AGING 2
Theories of aging are important aspects of understanding the aging process. The
theories give society different methods to understand how and why aging occurs, even
though not all of the theories are accurate. Most theories of aging have some sort of
research that back them, unlike personal experiences or educated guesses. Theories of
aging change our perception of adults and aging by giving us an understanding of the
process of aging. If we are able to better understand how aging occurs and why it occurs,
society is more likely to accept the process and accept elders. Theories of aging are
relevant to those who work with older adults because theories can help workers focus on
specific aspects of aging to increase care. An example is our knowledge of the
immunological theory. As we age our immune system deteriorates leaving elders more
susceptible to disease; workers can attempt to improve sanitation of elder care to decrease
risk of diseases. The quality of programs and services of older adults can be improved by
the theories because they allow for a better understanding of the development of older
adults, which allows caretakers to improve their approaches to care.
The biological theory of free radicals contributes to the physical aspect of aging.
Free radicals are waste products produced by cells, specifically, molecules of ionized
oxygen that have an extra electron (Moody & Sasser, 2014, p. 21). The free radicals
cause damage because they bond with proteins and other structures in the body, which
can inactivate them and make them unable to function. The amount of free radicals in the
body increase as people age. This causes mutations, damage to organs, and ultimately the
symptoms we see as aging. The body does create antioxidants, which are protection
against free radicals; they find and destroy the free radicals, preventing damage of cells
FREE RADICAL THEORY OF AGING 3
(Moody & Sasser, 2014, p. 62). Although it is thought that consuming antioxidants will
slow aging, studies have only shown minimal effects (Moody & Sasser, 2014, p. 62).
Schöttker et al. (2015) studied if free radicals were associated with mortality,
more specifically the association of derivatives of reactive oxygen metabolites (d-ROMs)
and total thiol levels (TTL) with mortality from all causes, cardiovascular disease, and
cancer. The study was conducted on two groups. The first group was Health, Alcohol and
Psychosocial Factors in Eastern Europe (HAPIEE) from Poland, Czech Republic, and
Lithuania. The second group was an eight year follow up from Epidemiologische Studie
zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer
Erkrankungen in d ...
Writing Assignment Answer SheetWhen answering these questions,.docxambersalomon88660
Writing Assignment Answer Sheet
When answering these questions, please use your own words. Do not copy and paste and do not cite verbatim from the article.
Part 1: Article summary
· Make sure to answer only in the space provided. If you go beyond it only part of your text will be visible and this will be the only part we will grade. DO NOT change he font size to fit more into the allotted space. DO NOT change the size of the text box to increase the allotted space. EACH SUCH ATTEMPT WILL BE CONSIDERED A BREACH OF ETHICAL GUIDELINES AND WILL RESULT IN A GRADE OF 0 (ZERO) IN THE ASSIGNMENT and additional steps as I see fit.
· If the answer is similar across studies, just say so rather than elaborate (for example, X was measured like in Study 1; the source of data was the one in Study 1…)
1. (a) What are the major factual reasons and theoretical arguments for this research? (b) What gap in the literature/knowledge do these researchers attempt to fill? (c) What are the three overall research questions the researchers try to answer?
2. Define the two types of bias discussed and how can they contribute to health disparities?
3. What are the specific research questions the researchers examined in each study?
Study 2:
Study 1:
4. (a) What are the data sources in each study? (b) How many participants were included in the final analyses? (you do not need to discuss the various ways to calculate and weight the various types of data).
Study 1:
Study 2:
5. What were the major variables examined in each study? How were they measured? (you do not need to discuss the Correlates).
Study 1 (4 major variables):
Study 2 (4 major variables):
6. What were the major results in each study? (you do not need to discuss the analyses. Refer only to the major variables and research questions as indicated below).
Study 1:
a. Access to healthcare as related to race AND the different types of bias:
b. Circulatory disease diagnosis as related to race AND the different types of bias:
Study 2:
a. Death rate due to circulatory diseases as related to race AND the different types of bias:
7. What was the research design used in these studies (descriptive, correlational, or experimental?) explain your answer: (a) why do you think this is the particular design? (b) why didn’t you chose the other two designs? (c) can you make causal inferences based on these studies? Why? (make sure to refer to Chapter 2 when answering this question).
In the next page, you will answer Part 2: Critical evaluation and conclusions. Remember it should not be longer than a page. Use 12-point Times New Roman font and 1” margins on all sides. When answering these questions, use the materials you have learned in the course that might be relevant to this type of research topic. See more details about this answer in the separate instructions sheet.
Part 2 – A critical review of the paper
Psychological Science
2016, Vol. 27(10) .
Final PaperThis Final Paper involves the critical review and ana.docxssuser454af01
Final Paper
This Final Paper involves the critical review and analysis of a published epidemiological research study, using the epidemiological concepts covered in Modules 1–6. You do not choose your own study; your Instructor will provide the research study to review and analyze. The audience for this 5–8 page scholarly paper is other epidemiological researchers.
The Final Paper must include, but is not limited to, the following:
Part I. Study Summary (2–3 pages)
(Note: this summary must be in your own words)
· The study objective/research question
· Primary exposure(s) and outcome(s) of interest
· Identification of study design
· Description of study population and the sampling/selection process
· Description of the statistical analysis used and the primary measures of association reported
· Identification of potential confounders (if any) and the technique used to minimize them or analyze their effects
· Identification of potential effect modifiers (if any) and the technique used to analyze their effects
· Summary of major study results
Part II. Critical Analysis (3–5 pages)
· Discussion of random error and how it might have affected the results
· Explanation of possible selection bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Explanation of possible misclassification (information) bias and how it might have affected the results, including a discussion of the size and direction of any possible bias
· Evaluation of the other limitations of the study
· Critique of the discussion section of the paper and whether it adequately addresses the strengths and limitations of the study
· Description of the potential generalizability of the study results
· Critique of the authors’ conclusions and whether or not they are appropriate given the study findings
· Descriptions of future studies that would be appropriate given the study findings
Original Contribution
Physical Activity, Sedentary Behavior, and Cause-Specific Mortality in Black and
White Adults in the Southern Community Cohort Study
Charles E. Matthews*, Sarah S. Cohen, Jay H. Fowke, Xijing Han, Qian Xiao, Maciej S. Buchowski,
Margaret K. Hargreaves, Lisa B. Signorello, and William J. Blot
* Correspondence to Dr. Charles E. Matthews, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, 9609 Medical Center Drive, Room 6E340, MSC 9704, Bethesda, MD 20892-9704 (e-mail: [email protected]).
Initially submitted November 15, 2013; accepted for publication May 6, 2014.
There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms
associated with sedentary behavior in black adults, so we examined the relationships between these health behav-
iors and cause-specific mortality in a prospective study that had a large proportion of black adults. Participants
(40–79 years of age) enrolled in the Southern Community ...
Evolution of the biopsychosocial model: prospects and challenges for health p...ellen1066
Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: prospects and challenges for health psychology. Health Psychology, 23(2),119-125. *
Running head: PHYSICAL ACTIVITY AND SELF-EFFICACY 1
PHYSICAL ACTIVITY AND SELF-EFFICACY 2
The Relationship between Physical Activity and Self-Efficacy in Schools
Abstract
Few studies have examined the relationship between physical activities and health outcomes among adolescents. The majority of the adult population knows much about health-risk behaviours of adolescents, and knows less about their health-promoting behaviours. The purpose of the study was to determine the relationship between physical activity levels and self-efficacy among adolescents.
Introduction
According to Start Active, regular physical activity associates with benefits for physical and mental health (as cited in Roberts et al, 2015). Studies have indicated that health life traits and styles have an impact on lifelong health and life quality. Childhood poor diet and physical inactivity have been risk factors for a multitude of chronic health condition in adulthood (Matthews et al, 2015). According to the Centers for Disease Control and Prevention for children, only 42% of children and 8% of adolescents achieve current recommended physical activity.
Most students studying in Hoca Ahment Yesevi University were hound to have health issues emanating from lack of physical exercise and personal fitness programs (Ozkan, 2015). Up to 70 per cent of university students are reported as not participating in regular free-time physical activity or exercise (Haase et al, 2004, as cited in Roberts et al, 2014). Simon et al (2015) mentioned that majority of the adult population fails to achieve recommended daily exercise, 30-minutes moderate intensity exercise. When physical activity is conducted regularly as the researchers found out, it is likely to improve the physical fitness of the students and generally of people and therefore contributing heavily to better healthy life styles. Achieving daily exercise was shown to promote better sleep quality and higher psychological functioning in adolescents (Kalak et al, 2012, as cited in Rew et al, 2015).
Styles and activities that promote the health of humans increase their chances of wellbeing and therefore promote healthy living. In achieving well-being in health, there must be a mentioned engagement in activities which are likely to enhance the same such as proper exercises and fitness methods. Health promotion takes quite a multidimensional structure, that is, intellectual, mental, physical and social and therefore a number of behaviours which are meant at promoting behaviours are identified by health professionals and other researchers. These behaviours include life appreciation, stress management, health responsibility, social support, exercise and better nutrition. Therefore a general conclusion is arrived at that physical activity and exercise have an impact on the quality of human life and can actually aid its improveme.
Scanned by CamScannerScanned by CamScannerRE.docxanhlodge
Scanned by CamScanner
Scanned by CamScanner
RESEARCH ARTICLE
Association between Physical Fitness and
Successful Aging in Taiwanese Older Adults
Pay-Shin Lin1,2☯‡*, Chih-Chin Hsieh1☯‡, Huey-Shinn Cheng3, Tsai-Jou Tseng1, Shin-
Chang Su1
1 Department of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine,
Chang Gung University, Taoyuan, Taiwan, 2 Health Aging Research Center, Chang Gung University &
Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3 Internal & Geriatric Medicine, Chang Gung Memorial
Hospital, LinKou Branch, Taoyuan, Taiwan
☯ These authors contributed equally to this work.
‡ PSL and CCH are co-first authors on this work.
* [email protected]
Abstract
Population aging is escalating in numerous countries worldwide; among them is Taiwan,
which will soon become an aged society. Thus, aging successfully is an increasing concern.
One of the factors for achieving successful aging (SA) is maintaining high physical function.
The purpose of this study was to determine the physical fitness factors associated with SA
in Taiwanese older adults (OAs), because these factors are intervenable. Community-
dwelling OAs aged more than 65 years and residing in Northern Taiwan were recruited in
this study. They received a comprehensive geriatric assessment, which includes sociode-
mographic data, health conditions and behaviors, activities of daily living (ADL) and instru-
mental ADL (IADL) function, cognitive and depressive status, and quality of life. Physical
fitness tests included the grip strength (GS), 30-second sit-to-stand (30s STS), timed up-
and-go (TUG), functional reach (FR), one-leg standing, chair sit-and-reach, and reaction
time (drop ruler) tests as well as the 6-minute walk test (6MWT). SA status was defined as
follows: complete independence in performing ADL and IADL, satisfactory cognitive status
(Mini-Mental State Examination� 24), no depression (Geriatric Depression Scale < 5), and
favorable social function (SF subscale� 80 in SF-36). Adjusted multiple logistic regression
analyses were performed. Among the total recruited OAs (n = 378), 100 (26.5%) met the
aforementioned SA criteria. After adjustment for sociodemographic characteristics and
health condition and behaviors, some physical fitness tests, namely GS, 30s STS, 6MWT,
TUG, and FR tests, were significantly associated with SA individually, but not in the multi-
variate model. Among the physical fitness variables tested, cardiopulmonary endurance,
mobility, muscle strength, and balance were significantly associated with SA in Taiwanese
OAs. Early detection of deterioration in the identified functions and corresponding interven-
tion is essential to ensuring SA.
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10, 2016 1 / 12
OPEN ACCESS
Citation: Lin P-S, Hsieh C-C, Cheng H-S, Tseng T-J,
Su S-C (2016) Association between Physical Fitness
and Successful Aging in Taiwanese Older Adults.
PLoS ONE 11(3): e0150389. .
Here is a copy of the presentation that I gave to MRC CBU at Cambridge University on the 5th July 2017, essentially a summary of a book chapter of mine to be published later this year. The focus of my presentation was on connections between #self, #other and our #connections with the environment.
This paper investigates the non-pecuniary benets of education using several individuals' health outcomes, health-damaging and health-improving behaviors, and preventive care. We exploit a reform which raised compulsory schooling by three years in Italy to identify the causal effect of lower secondary education and, unlike most previous papers in the literature, we analyze a wide range of health indicators. Our analysis shows that the rise in schooling induced by the reform reduced BMI and the incidence of obesity across Italian women, and raised men's likelihood of
doing regular physical activity and cholesterol and glycemia checks. No effect is found instead on preventive care and health-improving behavior for women, and on smoking prevalence and intensity for both genders. Some potential reasons for the gender differences in the results are discussed.
This draft: December 16, 2016
Preliminary and Incomplete. Please do not cite.
IMPACT OF SLEEP DISORDER ON OVERALL HEALTH1IMPACT OF SLEEP DISO.docxsheronlewthwaite
IMPACT OF SLEEP DISORDER ON OVERALL HEALTH 1
IMPACT OF SLEEP DISORDER ON OVERALL HEALTH 5
Formatting style: Vancouver (Alhola & Polo-Kantola, 2007)
Impact of sleep disorder on overall health
Instructor:
BIO-317V
11/29/19
Abstract
Sleep disorders have several impacts on overall health. With the increase in sleep disorders over the last few years, there is a need to identify some of the most common causes of sleep disorders and if factors such as age, gender, ethnicity and social status may be considered as risk factors. Different studies have been done to determine the impacts of sleep disorders on an individual’s overall health. The central focus of this research is to review some of these studies, and come up with a conclusion that tends to bring out these health impacts that are associated with sleep disorders, particularly, sleep deprivation.
Introduction
Sleep is considered as a biological process and it has regularly been essential for good life and optimal health (Wells & Vaughn, 2012). Sleep has been essential in controlling brain functioning, and even in other biological and systematic processes such as metabolism, regulation of appetite, and improving one’s immunity against a number of diseases, especially in children. Normally, a good sleep is associated by the duration of the sleep, the quality, and regularity among other factors. Although a number of studies, and even media, have covered the health benefits of sleep, more than 70 million individuals in the US are still suffering from sleep-related disorders, and moreover, in Europe, approximately 45 million people are also victims of these disorders. For instance, a study conferred that of all the car accidents that occur in the US, 20% are as a result of lack of enough sleep, or other disorders associated wit either too much sleep or lack of enough sleep (Palma et al., 2013).
There are a number of consequences that may arise as a result of sleep loss and other sleep-related disorders. As conveyed by Ming et al. (2011), the most common consequences that may be related to sleep include judgment errors, which may lead to disastrous events. On the other pedestal, some of the less visible consequences of sleep disorder include increased mortality and morbidity rate, car accidents and injuries, QoL, the well-being of the family, and utilization of healthcare services among the affected persons. Some of these consequences may arise a few minutes after having less hours of sleep, or too much sleep. However, there are some long-term impacts of sleep, for instance, obesity and hypertension. Sleeping for a longer duration enhances the body’s inactivity and this is greatly associated with obesity, which may also give chance to the development of hypertension and other cardiovascular complications. According to Ming et al. (2011), there are approximately 90-100 sleep disorders which may result from factors such as environmental factors, psychosocial issues, and ot ...
Similar to Physical Activity and White Matter Hyperintensities, A Systematic Review of Quantitative Studies (20)
3. Inclusion criteria comprised cross-sectional, longitudinal and experi-
mental studies of human subjects, and any measurement of physical
activity or WMH. Since the focus of this study was on health promotion,
exclusion criteria comprised studies focused solely on individuals
with advance diseases associated with WMH, specifically depression,
cognitive decline, dementia and stroke. Table 1 describes the keyword
searches in each of the databases. Leukoaraiosis was included as
a search term as it is a synonym for WMH. Leukoencephalopathy/
leukoencephalopathies were included as search terms as they are
broad term that applies to all brain white matter diseases. Two re-
viewers performed an independent screening of each study. Abstracts
were reviewed, and full-text articles were inspected. We also examined
the reference lists from full-text articles to seek additional sources.
Results
The process of inclusion of studies identified for review and analysis
is shown in Fig. 1 (Liberati et al., 2009). Of the 256 non-duplicate articles
found, we excluded 245 during a secondary screen. The most common
reason for exclusion was that the study measured physical activity or
WMH, but not both. We excluded other studies due to methodological
issues, such as measuring white matter, but not WMH. Some studies
measured mobility, gait, or cognitive exercises, but not physical activity.
Since the purpose of this review was to determine the effects of physical
activity on WMH, WMH had to be the dependent variable. Finally, we
excluded studies in which the association between physical activity
and WMH was undeterminable.
Studies included in the review (Fig. 1) represent data collected in six
countries: the United States, the United Kingdom, Iceland, Finland,
Austria, and Australia. Per Table 2, seven of the studies were cross-
sectional (Ho et al., 2011; Rosano et al., 2010; Saczynski et al., 2008;
Sen et al., 2012; Smith et al., 2009; Tseng et al., 2013; Zheng et al.,
2012). Per Table 3, the five longitudinal studies (Carmelli et al., 1999;
Gow et al., 2012; Podewils et al., 2007; Rovio et al., 2010; Willey et al.,
2011) measured physical activity at baseline and WMH from three
(Gow et al., 2012) to 25 years (Carmelli et al., 1999) later. All except
one of the studies were community- or population-based (Tseng et al.,
2013). The non-community/population-based study was the only one
designed to examine the association between physical activity and
WMH (Tseng et al., 2013). All studies focused on older adults, excluded
individuals with contraindications to MRI, and excluded those missing
data on variables of interest. Five studies reported no other exclusion
criteria (Carmelli et al., 1999; Gow et al., 2012; Podewils et al., 2007;
Rovio et al., 2010; Saczynski et al., 2008). Four studies excluded adults
with cognitive impairment or dementia (Ho et al., 2011; Sen et al.,
2012; Tseng et al., 2013; Zheng et al., 2012), while another study
accounted for adults with cognitive impairment or dementia in the
analysis (Podewils et al., 2007). Three studies excluded adults with a
history of neurological disorders (Tseng et al., 2013), such as stroke
(Sen et al., 2012; Willey et al., 2011). The study originally designed to
examine the association between physical activity and WMH excluded
a number of potential confounders—that is smoking, recreational drug
use, cardiovascular or cerebrovascular diseases, dementia, and major
psychiatric and neurologic disorders (Tseng et al., 2013).
Six of the twelve articles showed a statistically significant association
between physical activity and WMH, with more physical activity associ-
ated with less WMH (Gow et al., 2012; Podewils et al., 2007; Rovio et al.,
2010; Saczynski et al., 2008; Sen et al., 2012; Tseng et al., 2013). One
article found a statistically significant association in crude analyses,
Table 1
Keyword searches of articles published in English through March 18, 2014.
Databases Search terms
PubMed (“Leukoencephalopathies”[Mesh] OR “Leukoaraiosis”[Mesh] OR
(white matter hyperintensities[All Fields] OR white matter
hyperintensity[All Fields]) OR “white matter lesion*”[All Fields])
AND
(“Motor Activity”[Mesh] OR “Exercise”[Mesh] OR “physical
activity”[All Fields] OR (“exercise”[MeSH Terms] OR
“exercise”[All Fields]))
Web of Science TOPIC: (white matter hyperintensities OR white matter
hyperintensity OR white matter lesions OR white matter lesion
OR leukoaraiosis)
AND
TOPIC: (physical activity OR exercise)
Cochrane
Library
(“white matter hyperintensities” or “white matter
hyperintensity” or “white matter lesions” or “white matter
lesion” or “leukoaraiosis”)
AND
(“physical activity” or “exercise”)
EBSCOhost:
CINAHL Plus
PsycInfo
PsycARTICLES
SocIndex
Social
Sciences
(MH “Physical Activity”) OR “physical activity” OR (MH
“Exercise”) OR (MH “Physical Fitness”) OR (MH “Physical
Performance”) OR (MH “Physical Endurance”) OR (MH “Exercise
Test”) OR (MH “Activity and Exercise Enhancement (Iowa NIC)
(Non-Cinahl)”) OR (MH “Physical Activity (Omaha)”) OR (MH
“Physical Education, Adapted”) OR (MH “Activity Therapy
(Iowa NIC)”)
AND
DE “White Matter” OR DE “Leukoaraiosis” OR DE
“Leukoencephalopathy” OR white matter hyperintensit* OR
“white matter lesion*”
Fig. 1. Flow diagram of articles published in English through March 18, 2014.
320 E.R. Torres et al. / Preventive Medicine Reports 2 (2015) 319–325
4. Table 2
Summary of cross-sectional studies on physical activity and white matter hyperintensities published in English through March 18, 2014.
Citation Sample Physical activity White matter hyperintensities
(WMH)
Statistical analysis Results
Ho et al.
(2011)
Pittsburgh, PA, U.S., n = 226,
42% male, mean age 77.9
(SD = 3.6). Exclusion criteria:
mild cognitive impairment or
Alzheimer's disease.
Modified Minnesota
Leisure-Time Activities
Questionnaire covered two
weeks prior to when MRI was
obtained, estimated in
kcal/week which was divided
into quintiles.
Expert visual grading on a scale
of 0 to 9, with no white matter
findings classified as grade 0
and the most severe WMH
classified as grades 8 and 9.
Kruskal–Wallis one-way
ANOVA (WMH not normally
distributed)
No association
Rosano
et al.
(2010)
Pittsburgh, PA, U.S., n = 27, 3%
male, mean age 81 (SD = 3.4),
20 remained active and 10
remained sedentary 2 years
after a pilot intervention; 18 of
the active group had WMH
measurements. Inclusion
criteria: age of 70–89 years,
sedentary lifestyle
(b20 min/week spent in
structured physical activity
during the past month), being
able to walk 400 m within
15 min without sitting and
without use of any assistive
device, having a Short Physical
Performance Battery score 9
(on a scale of 0–12), having
completed behavioral tests
related to logging health
behavior, and not planning to
move for at least 9 months.
The physically active group
was asked if they completely
stopped their regular physical
activity after the pilot
intervention ended, and were
included if they responded
“No.” The sedentary group was
asked if they spent at least
20 min a week getting regular
exercise after the pilot
intervention ended and were
included if they responded
“No.”
WMH was measured with a
fully deformable automatic
algorithm.
t-Test No association
Saczynski Reykjavik, Iceland,
population-based sample of
older adults, n = 1787, 38.9%
male, mean age = 75.9
(SD = 5.4).
Questionnaire, current
moderate/vigorous physical
activity was assessed as never
(reference), rarely, 1 h/week,
1–3 h/week, 4–7 h/week, or
N7 h/week and dichotomized
into the upper quartile (high
leisure activity) compared
with the bottom three
quartiles (low leisure activity).
WMH measured with a rating
scale. Individuals in the upper
quartile of WMH load for either
subcortical or periventricular
WMH were compared with the
reference group comprising
those in the lower three
quartiles (reference group).
Age-adjusted analysis of
variance
Compared to the low
WMH/high activity group,
the high WMH/low activity
(F = 53.9) and high
WMH/high activity
(F = 41.0) were more likely
to be physically inactive
(p b .0.05).
Sen et al.
(2012)
Austria, community-based
cohort, n = 715, 46% male,
mean age 65, range 44–83.
Exclusion criteria: dementia,
previous strokes.
VO2 max on cycle ergometer. Two experienced investigators
marked and outlined each
WMH, which was positively
skewed and log-transformed.
Linear regression; adjusted for
age, sex, hypertension, body
mass index, cholesterol,
smoking status, diabetes,
treatment with β-blockers or
calcium channel blockers.
Significant association in men
(β = −0.10, p = 0.02), not
women.
Smith Midwest U.S.,
community-based white
adults, n = 777, 41% male,
mean age 60 (SD = 10).
Inclusion criteria: essential
hypertension diagnosed before
age 60 years.
Self-report average # of
hours/day engaged in
sedentary, moderate and heavy
activity.
Global WMH was obtained
with a fully automated
algorithm. Brain scans with
cortical infarctions were
excluded due to distortions in
the automated segmentation
algorithm. The natural
logarithm (cm3
) of WMH was
obtained after adjustment for
age, sex, and total brain
volume.
Least squares linear regression;
tested for association between
each of the predictor variables
(1649 single nucleotide
polymorphisms and
quantitative covariates):
hypertension, BMI, pulse
pressure, smoking history,
coronary heart disease, serum
triglycerides, creatinine, total
cholesterol, high-density
lipoprotein, low-density
lipoprotein, & five novel
vascular risk factors including
C-reactive protein,
homocysteine, fibrinogen,
Lp(a), and LDL particle size.
No association
Tseng
et al.
(2013)
U.S., n = 20, 75% male, mean
age 73 ± 5 years, free of major
medical problems based on a
detailed medical history and
physical exams including
12-lead electrocardiogram and
echocardiogram. Exclusion
criteria: smoking, used
recreational drugs, had clinical
evidence of cardiovascular
(e.g., hypertension, diabetes
10 master athletes: history of
endurance training N15 years,
who were still engaged in
endurance exercise at the time
of this study. 10 sedentary
older adults: not engaging in
moderate or high intensity
aerobic exercise for more than
30 min, 3 times/week over the
past two years. Aerobic fitness
was measured with maximal
Total, periventricular, and deep
WMH were obtained with a
semiautomatic method.
Mann–Whitney Rank Sum
Test was conducted to detect
differences in WMH volume
and cardiopulmonary fitness
between groups.
No differences in total or
periventricular WMH
between groups. Masters
athletes showed 83%
reduction in deep WMH
volume when compared with
the sedentary elderly.
(continued on next page)
321E.R. Torres et al. / Preventive Medicine Reports 2 (2015) 319–325
5. but not when controlled for socio-demographic and vascular factors
(Rovio et al., 2010). One article found a statistically significant associa-
tion in men, not women (Sen et al., 2012), and four articles found that
a higher frequency of physical activity was associated with less WMH
(Gow et al., 2012; Podewils et al., 2007; Saczynski et al., 2008; Tseng
et al., 2013). Five of the six articles were population- or community-
based (Gow et al., 2012; Podewils et al., 2007; Rovio et al., 2010;
Saczynski et al., 2008; Sen et al., 2012).
Physical activity was typically measured with a questionnaire
(Carmelli et al., 1999; Gow et al., 2012; Ho et al., 2011; Podewils et al.,
2007; Rovio et al., 2010; Saczynski et al., 2008; Smith et al., 2009;
Willey et al., 2011; Zheng et al., 2012). Physical activity was measured
at ages 50–92, with a mean age of 71.4. Physical activity was rarely
measured objectively (i.e., VO2 max) (Sen et al., 2012; Tseng et al.,
2013). Although physical activity was often measured over two weeks
prior to the interview (Ho et al., 2011; Podewils et al., 2007; Willey
et al., 2011), most studies did not specify a time frame (Carmelli et al.,
1999; Gow et al., 2012; Rovio et al., 2010; Saczynski et al., 2008; Smith
et al., 2009). Leisure physical activity was the most common setting
measured (Ho et al., 2011; Podewils et al., 2007; Rosano et al., 2010;
Rovio et al., 2010; Tseng et al., 2013; Willey et al., 2011; Zheng et al.,
2012), although often a setting was not specified (Carmelli et al.,
1999; Saczynski et al., 2008; Smith et al., 2009). Most studies measured
duration (Ho et al., 2011; Podewils et al., 2007; Rosano et al., 2010;
Rovio et al., 2010; Saczynski et al., 2008; Smith et al., 2009; Tseng
et al., 2013; Willey et al., 2011; Zheng et al., 2012), frequency (Gow
et al., 2012; Ho et al., 2011; Podewils et al., 2007; Rovio et al., 2010;
Tseng et al., 2013; Willey et al., 2011; Zheng et al., 2012), and/or inten-
sity (Gow et al., 2012; Ho et al., 2011; Podewils et al., 2007; Rovio et al.,
2010; Saczynski et al., 2008; Smith et al., 2009; Tseng et al., 2013; Willey
et al., 2011).
WMH were measured semi-automatically (Carmelli et al., 1999;
Gow et al., 2012; Tseng et al., 2013; Willey et al., 2011) and automati-
cally (Rosano et al., 2010; Smith et al., 2009; Zheng et al., 2012). Many
studies used a variety of visual rating scales (Gow et al., 2012; Ho
et al., 2011; Podewils et al., 2007; Rovio et al., 2010; Saczynski et al.,
2008). For example, one study used a Fazekas scale (Gow et al., 2012);
another used a scale of 0 to 9 with no white matter findings classified
as grade 0 and the most severe WMH classified as grades 8 and 9 (Ho
et al., 2011). One study divided WMH by quartiles (Saczynski et al.,
2008) and another by quintiles (Rovio et al., 2010). WMH were often
measured continuously (Carmelli et al., 1999; Gow et al., 2012; Ho
et al., 2011; Podewils et al., 2007; Rosano et al., 2010; Saczynski et al.,
2008; Sen et al., 2012; Smith et al., 2009; Tseng et al., 2013; Willey
et al., 2011) and occasionally log-transformed (Sen et al., 2012; Smith
et al., 2009; Willey et al., 2011). Total or global WMH were most
commonly measured (Carmelli et al., 1999; Gow et al., 2012; Ho et al.,
2011; Podewils et al., 2007; Rovio et al., 2010; Sen et al., 2012; Smith
et al., 2009; Tseng et al., 2013; Willey et al., 2011), followed by subcor-
tical measures (Saczynski et al., 2008), specifically periventricular
(Podewils et al., 2007; Saczynski et al., 2008; Tseng et al., 2013; Zheng
et al., 2012) and deep (Podewils et al., 2007; Tseng et al., 2013; Zheng
et al., 2012).
Discussion
Half of the studies found more physical activity associated with less
WMH. Studies were more likely to find an association between physical
activity and WMH if they were conducted outside the U.S. (4 studies
outside the U.S. found an association vs. 1 study outside the U.S. that
did not), were more likely to be longitudinal or take into consideration
physical activity across the lifespan, had a slightly younger sample
(mean age 68.5 vs. 72.8), measured different types of physical activity
beyond leisure or objectively measured fitness via VO2 max, measured
WMH manually or semi-automatically, and performed multivariate
analyses or controlled for risk factors associated with WMH (all 6
studies that found an association between physical activity and WMH
vs. 2 studies that did not). There were no differences between the arti-
cles that found that more physical activity was associated with less
WMH and those that did not in terms of sample size, sex, exclusion
criteria, and whether WMH was transformed or measured continuously
vs. dichotomously. Notably, only one study was originally designed to
examine the association between physical activity and WMH.
Most of the studies measured physical activity differently, which
may account for the conflicting results. Half of the studies used a stan-
dardized physical activity measurement. Three used an objective mea-
surement of cardiorespiratory fitness, such as VO2 max. Three used
established questionnaires—the Modified Minnesota Leisure-Time Ac-
tivities Questionnaire and the Incidental and Planned Exercise Ques-
tionnaire. When physical activity was measured with a questionnaire,
a variety of outcomes were measured: metabolic equivalent (MET)
score, kcal/week, and number of hours per day or per week. Only one
study measured the setting of physical activity beyond leisure, namely
household, but combined both into one variable (Tseng et al., 2013). Fu-
ture studies should use a standardized measurement of physical activity
with standardized outcomes, such as a MET score, that take into consid-
eration frequency, intensity, and duration and that measure more than
one setting of physical activity, such as occupation, transportation,
household, and leisure.
Table 2 (continued)
Citation Sample Physical activity White matter hyperintensities
(WMH)
Statistical analysis Results
mellitus, hyperlipidemia) or
cerebrovascular diseases
(e.g., history of stroke,
transient ischemic attack or the
presence of cortical infarction
on MRI scans), dementia,
major psychiatric and
neurologic disorders.
oxygen uptake (VO2 max)
testing.
Zheng Eastern Sydney, Australia, pro-
spective community-dwelling
cohort, n = 287, aged 70–90,
46.3% male, mean 77.8 ± 4.5
years. Exclusion criteria:
Diagnosis of dementia and
inability to walk 20 m without
a walking aid due to a
neurological, cardiovascular, or
major musculoskeletal
impairment.
Incidental and Planned
Exercise Questionnaire
(last week — 3 months
preceding interview),
hour/week.
A validated automatic
procedure was carried out to
calculate WMH volume.
Regional WMH comprised
deep (frontal, parietal,
temporal and occipital) and
periventricular regions
(anterior cap, posterior cap and
periventricular body).
t-Test examined differences in
baseline physical activity
between participants with
high and low volumes of
WMH (cut off at the median).
No association
322 E.R. Torres et al. / Preventive Medicine Reports 2 (2015) 319–325
6. WMH were typically measured semi-automatically with a variety of
visual rating scales, which may also explain the conflicting results. Un-
like physical activity, there appears to be no standardized method for
measuring WMH. One method to decrease the variability between
studies may be to use a validated automatic segmentation technique
allowing for a more precise measurement of WMH, thereby facilitating
the detection of small but significant differences that may go unnoticed
when relying solely on visual rating scales (Herrmann et al., 2008).
Table 3
Summary of longitudinal studies on physical activity and white matter hyperintensities published in English through March 18, 2014.
Citation Design Sample Physical activity White matter
hyperintensities (WMH)
Statistical analysis Results
Carmelli
et al.
(1999)
Longitudinal U.S. World War II veterans,
monozygotic white male
twins, n = 74, age 68–79 at
baseline.
Interviewer-administered
questionnaire at baseline.
Measured over 25 years
after physical activity on
scanners at four study sites.
Image evaluation based on a
semi-automated
segmentation analysis
involving operator-guided
removal of non-brain
elements.
Univariate correlation No association
Gow
et al.
(2012)
Longitudinal Lothian, U.K., n = 691,
53% male, mean age 70
(SD = 0.8) at baseline.
Self-report questionnaire
measured at baseline.
Physical activity rated on a
6-point scale, from “moving
only in connection with
necessary (household)
chores” to “keep-fit/heavy
exercise or competitive
sport several times per
week.”
Measured 3 years after
physical activity. WMH
calculated
semi-automatically fusing 2
previously aligned structural
MRI sequences. Stroke
lesions were extracted from
total WMH, which were
normalized by intracranial
volume. WMH were also
rated using FLAIR &
T2-weighted sequences and
the Fazekas scale coded for
periventricular and deep
WMH separately in right and
left hemispheres, and
subsequently combined into
total WMH ranging from 0
to 6 with ↑ score = ↑WMH.
Linear regression, adjusted
for age, sex, social class, IQ,
dementia risk & disease
history (hypertension,
cardiovascular disease and
stroke).
A higher level of physical
activity predicted lower
WMH (standardized
β = 0.09,
non-standardized
β = 0.09, p = 0.029),
when WMH was measured
semi-automatically.
Podewils
et al.
(2007)
Longitudinal U.S., population-based,
n = 179; 38% male, mean
age 77 (SD = 6), 59 had
Alzheimer's disease, 60 had
mild cognitive impairment,
and 60 cognitively stable,
3 group frequency matched
by 5-year age category and
sex.
Modified Minnesota Leisure
Time Questionnaire, covered
2 weeks prior to baseline
interview. Total energy
expenditure in
kilocalories/week was
categorized as 271–759,
760–1874 and N1875.
Measured 6–7 years after
physical activity.
Periventricular and deep
WMH measured with
standardized
semi-quantitative rating
scale by a single reader
blinded to physical activity
and covariates.
Multiple linear regression
adjusting for age, sex,
ethnicity, years of
education, APOE &
corresponding
region-specific baseline
WMH score.
Physical activity
N1875 kcal/week was
significantly associated
with less periventricular
(β = 0.85, CI = 0.32, 1.4)
and deep (β = 0.69,
CI = 0.01, 1.4) WMH in the
cognitively stable group
only.
Rovio
et al.
(2010)
Longitudinal North Karelia & Kuopio,
eastern provinces of
Finland, random
population-based sample,
n = 75, 32 active,
43 sedentary; 21 with
dementia, 23 with mild
cognitive impairment & 31
normal controls; 29.7%
male, mean age at midlife
was 50.6 (SD = 6.0) years,
and 71.6 (SD = 4.1) at
re-examination.
Self-administered
questionnaire at midlife:
“How often do you
participate in leisure time
physical activity that lasts at
least 20–30 min and causes
breathlessness and
sweating?” Active persons
participated in leisure time
physical activity ≥2×/week;
sedentary persons
participated in leisure time
physical activity ≤1×/week.
Measured with a mean
duration follow-up of 20.9
(SD = 4.9) years. A
semi-quantitative visual
rating scale was used by a
single trained rater blinded
to clinical data. The total
score was used to address
the participants belonging to
the upper quintile of the
distribution to one group
(severe WMH) and persons
belonging to all other
quintiles to another group
(no or mild WMH).
Logistic regression
unadjusted (crude model)
and after that adjusted for
age, sex, diagnosis of
dementia or mild cognitive
impairment, years of
education and follow-up
time, systolic blood
pressure, total serum
cholesterol, BMI, APOE 4
allele carrier status, and
smoking. Furthermore, all
analyses were additionally
adjusted for white matter
volume.
Crude analysis significant
(OR = 4.65, p = 0.03). No
longer significant when
control for
socio-demographic and
vascular factors
(OR = 4.20, p = 0.32).
Willey
et al.
(2011)
Longitudinal Northeast U.S.,
community-based cohort,
n = 1238, 40% male, 65%
Hispanic, mean age 70 ± 9
SD at baseline
Exclusion criteria: history of
stroke.
Self-report duration and
frequency of various leisure
time/recreational activities
for the 2 weeks prior to
interview categorized by
quartiles of the metabolic
equivalent (MET) score;
VO2 max.
Measured a mean of 6 ± 3
years after physical activity
assessment. WMH was
measured semi-automatic,
corrected for total cranial
volume, and
log-transformed. Analyses
were performed blind to
participant identifying
information.
Linear regression
unadjusted and adjusted
models with demographics
(age, sex, race–ethnicity,
and education) and
vascular risk factors
(systolic blood pressure,
diastolic blood pressure,
glomerular filtration rate,
diabetes mellitus,
high-density lipoprotein
cholesterol, low-density
lipoprotein cholesterol,
moderate alcohol use, and
smoking) were
constructed.
No association
323E.R. Torres et al. / Preventive Medicine Reports 2 (2015) 319–325
7. While the majority of studies measured total WMH, future studies
should also measure regional WMH. For example, in the only study
designed to examine the association between physical activity and
WMH, no association was found with total or periventricular WMH;
however, an association was found between physical activity and deep
WMH.
Only two studies used advanced imaging techniques such as diffu-
sion tensor imaging (DTI) (Gow et al., 2012; Tseng et al., 2013), which
is superior at assessing white matter integrity and detecting locations
where WMH may directly predispose to the development of neuropsy-
chiatric disorders, including depression (Herrmann et al., 2008), cogni-
tive decline, dementia, and stroke (Debette et al., 2010). DTI is used to
map and characterize the three-dimensional diffusion of water as a
function of spatial location and is therefore a sensitive marker of neuro-
pathology (Alexander, Lee, Lazar, and Field, 2007). Fractional anisotropy
(FA) reflects the directional coherence of water molecule diffusion
(Alexander et al., 2007). Given that hundreds of research studies have
observed reduced FA in a broad spectrum of diseases, while increases
are rarely reported (Alexander et al., 2007), it is significant that more
physical activity is associated with higher FA (Gow et al., 2012; Tseng
et al., 2013). FA is highly sensitive to microstructural changes, but not
specific to the type of changes (Alexander et al., 2007). Mean diffusivity
(MD) is a measure of the rotationally invariant magnitude of diffusion,
or how tissue is changing (Alexander et al., 2007). MD increases with
the increased tissue water engendered by inflammation and edema,
resulting in a decrease in FA (Alexander et al., 2007), while more phys-
ical activity is associated with lower MD (Tseng et al., 2013). Vigorous
PA has been shown to reduce vessel tortuosity and increase the number
of small vessels (Bullitt et al., 2009), helping to improve vascular risk
factors (Nelson et al., 2007) and decreasing brain ischemia (Kim,
MacFall, and Payne, 2008), which may help to preserve the integrity
of white matter microstructure and forestall age-related white matter
degeneration (Colcombe et al., 2006).
Finally, physical activity and WMH were each measured at one time
point, even in longitudinal studies. Since physical activity typically de-
creases and WMH increase throughout much of the life span, the infor-
mation provided by one or two time point may be incomplete and lead
to erroneous conclusions about patterns of age-related change in central
nervous system parameters (Coleman et al., 2004), such as WMH. Phys-
ical activity and WMH should both be measured repeatedly. In addition,
physical activity should be measured at multiple time points, such as
childhood, adolescence, adulthood, middle age and old age. Although
recommendations have been made for measuring physical activity
over relatively short reporting intervals (no longer than three months),
in advanced age, long-term memory may be better preserved than re-
cent recollections (Shephard, 2003).
There are limitations to this systematic literature review. There are
likely other factors, such as nutrition, that may stop or slow the progres-
sion of WMH beyond physical activity. Although several studies mea-
sured the consequence of nutrition such as glucose levels (Carmelli
et al., 1999; Willey et al., 2011), cholesterol (Carmelli et al., 1999;
Rovio et al., 2010; Sen et al., 2012; Smith et al., 2009) and lipid concen-
trations (Carmelli et al., 1999; Smith et al., 2009; Willey et al., 2011),
none of the studies measured nutrition. Another limitation surrounds
theses, proceedings, and textbooks that were not reviewed, nor were
researchers and sponsoring organizations contacted for unpublished re-
sults. Thus, this systematic review is at risk of publication bias leading to
overestimation of the association of physical activity with WMH. How-
ever, the results of this review found that only half of the eligible studies
resulted in a significant inverse association between physical activity
and WMH. Whereas the discussion on publication bias focuses almost
exclusively on randomized controlled trials (Dwan, Gamble,
Williamson, Kirkham, and Group, 2013), the current systematic review
comprises observational studies, whereby examining the association
between physical activity and WMH was not part of the original design
for 11 of the 12 studies. This may explain the lack of evidence for
publication bias in our review. Little empirical evidence exists to recom-
mend blinding reviews of the identities of study authors, institutions,
sponsorship, publication year, and journal or study results; therefore,
blind peer-reviews were not used. Data combination for meta-analysis
was inappropriate (Stroup et al., 2000) due to differences in how phys-
ical activity and WMH were measured, as well as variation in use of sta-
tistical measures (i.e., Mann–Whitney Rank Sum Test, t-tests, one-way
analysis of variance, correlation, and linear and logistic regression).
Due to these same reasons, the magnitude of the association varied
greatly by study, is difficult to compare between studies, and makes it
difficult to make physical activity recommendations to the public. For
instance, one study found that physical activity in excess of 1875 kcal/
week in the previous two weeks prior to the baseline interview was as-
sociated with less periventricular and deep WMH five years later
(Podewils et al., 2007), while another study found those who had en-
gaged in endurance training for 15 years had an 83% reduction in deep
WMH compared to their sedentary counterparts (Tseng et al., 2013). Fi-
nally, factors relating to imaging protocol—field strength of magnet,
number, thickness, contiguity, and orientation of slices—add to the het-
erogeneity of results.
Strengths of this review include a priori development of a focused
clinical question, clear and concise selection criteria, and assessment of
quality (Stroup et al., 2000). The quality of the studies was assessed by
focusing on methodological aspects including design, generalizability,
various measurements of physical activity and WMH, and potential con-
founders such as neuropsychiatric disorders and vascular risk factors.
Conclusion
The progression of WMH can be slowed by controlling vascular risk
factors in patients who have had a stroke or have Alzheimer's disease. It
is not known if it is possible to stop or slow the progression of WMH in
individuals without advanced disease, thereby delaying or preventing
disorders associated with WMH. This systematic literature review
found that physical activity is associated with less WMH in individuals
without advanced disease when studies are longitudinal or take into
consideration physical activity across the lifespan, have a younger sam-
ple of older adults, measure different types of physical activity beyond
leisure or objectively measure fitness via VO2 max, measure WMH
manually or semi-automatically, and perform multivariate analyses or
control for risk factors associated with WMH. Future studies should
account for neuropsychiatric disorders and vascular risk factors; include
the use of a standardized measurement of physical activity that ac-
counts for different settings, frequency, intensity, and duration over
longer time periods; measure physical activity and WMH repeatedly;
standardize WMH measurements (e.g., using a validated automatic
procedure); and measure total and regional WMH.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
The authors wish to thank Laura Hogan, Kathleen Freimuth and
Michael A. Holly for their editorial assistance, and Roger Brown for his
statistical consult. The project described was supported by the Clinical
and Translational Science Award (CTSA) program, through the NIH
National Center for Advancing Translational Sciences (NCATS), grant
UL1TR000427. The funding source has no role in the study design,
collection, analysis, interpretation of data, writing of the report, or the
decision to submit for publication. The content is solely the responsibil-
ity of the authors and does not necessarily represent the official views
of the NIH.
324 E.R. Torres et al. / Preventive Medicine Reports 2 (2015) 319–325
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