Sex differences in physical functioning among older adults: cross-sectional results from the OUTDOOR ACTIVE study.

BACKGROUND: Maintaining good functional ability is a key component of healthy ageing and a basic requirement for carrying out activities of daily living, staying independent, and delaying admission to a nursing home. Even though women have a higher life expectancy and slower age-related muscle mass loss than men, they often show a higher prevalence of limitations in physical functioning. However, the reasons behind these sex differences are still unclear. Therefore, the aims of this study were to investigate sex differences among older adults regarding physical functioning and to study which factors are explaining these sex differences. METHODS: Cross-sectional data from participants of the OUTDOOR ACTIVE study residing in Bremen, Germany, aged 65 to 75 years, were included in the analyses. Physical functioning was assessed via a self-administered questionnaire using the SF-36 10-item Physical Functioning Scale. Social, lifestyle, and health-related factors were also assessed using the questionnaire. Physical activity was measured objectively using wrist-worn accelerometers over seven consecutive days. Descriptive analyses with absolute and relative frequencies, means and standard deviations, as well as T-tests and chi-square tests were carried out. To test for associations between sex, physical functioning, and several individual factors, linear regressions were performed. RESULTS: Data of 2 141 participants (52.1% female) were included in the study. Women and men showed statistically significant differences in physical functioning, with men perceiving fewer limitations than women. On average, women had a physical functioning score of 81.4 ± 19.3 and men 86.7 ± 17.0. Linear regression showed a statistically significant negative association between physical functioning score and sex (ß: -0.15, 95% CL: -0.19, -0.10). The association remained statistically significant when adding individual factors to the model. All factors together were only able to explain 51% of the physical functioning-sex association with health indicators and the presence of chronic diseases being the most influential factors. CONCLUSIONS: We found sex differences in physical functioning, with older women having more limitations than older men. The results showed that health-related factors and chronic diseases played the biggest roles in the different physical functioning scores of women and men. These findings contribute to future longitudinal, more in-depth research. TRIAL REGISTRATION: German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).

Exploring parental risk perception regarding childhood unintentional home injuries: A cross-sectional study.

INTRODUCTION: While previous studies on childhood injury focused mainly on the relationship between parents' preventive behavior and its determinants, knowledge about parental risk perception that can help to develop, implement, and evaluate successful interventions to prevent childhood unintentional home injuries is still limited. The aim of this study was to gain a deeper understanding of parental risk perception regarding unintentional home injuries of children under six years of age. METHOD: A convenience sample of 469 parents, residing in Germany, completed a web-based questionnaire assessing factors potentially associated with parental risk perception on the child, parental, and environmental level. Descriptive statistics, p for trend, and Spearman's Rho correlation coefficients were calculated. RESULTS: Key factors influencing parental risk perception included children's sex, age, migrant status, emotionality, and injury risk as well as parents' parenting style and external locus of control. While parental risk perception was positively associated with children's injury risk, the analyses showed no associations between parental risk perception and parents' preventive behavior. CONCLUSIONS: Our findings add to a better understanding of parental risk perception, provide practical implications for injury prevention, and indicate that the relationship between parental risk perception and parents' preventive behavior is based on a complex mechanism which is possibly moderated by parents' locus of control. PRACTICAL APPLICATIONS: The identified key factors help to assess parental risk perception more accurately. Therefore, they should be considered in the development of tailored interventions to prevent unintentional home injuries of children, for instance, by targeting specific groups of parental risk perception.

Associations between older adults' physical fitness level and their engagement in different types of physical activity: cross-sectional results from the OUTDOOR ACTIVE study.

OBJECTIVES: To describe the prevalence of different types of physical activities and to explore the association between engagement in these physical activities and performance in the physical fitness dimensions among older adults living in Bremen, Germany. DESIGN: Cross-sectional study. SETTING: Twelve subdistricts in Bremen, Germany. PARTICIPANTS: 1583 non-institutionalised adults aged 65-75 years residing in one of the 12 subdistricts in Bremen, Germany (53.1% female). PRIMARY OUTCOME MEASURES: Level of physical fitness in five dimensions: handgrip strength (hand dynamometry), lower muscle strength (30 s-chair stand test), aerobic endurance (2 min-step test), lower body flexibility (sit-and-reach test), and upper body flexibility (back scratch test); classified using normative values. RESULTS: In this study population, home-based activities (housework, gardening) and activities for transport (walking, cycling) were performed by nearly all the participants, while leisure activities were less prevalent. Logistic regression revealed a positive association between being in or over norm in handgrip strength with cycling (OR: 1.56, 95% CI: 1.13 to 2.15), hiking/running (OR: 1.50, 95% CI: 1.05 to 2.16) and other sports (OR: 3.22, 95% CI: 1.37 to 7.56). Lower muscle strength was positively related to cycling (OR: 1.91, 95% CI: 1.37 to 2.65), gym training (OR: 1.62, 95% CI: 1.16 to 2.26) and dancing (OR: 2.15, 95% CI: 1.00 to 4.61). Aerobic endurance was positively associated with cycling (OR: 1.90, 95% CI: 1.37 to 2.65), gym training (OR: 1.68, 95% CI: 1.20 to 2.36), aerobics (OR: 1.64, 95% CI: 1.19 to 2.26), dancing (OR: 2.62, 95% CI: 1.10 to 6.22) and ball sports (OR: 2.07, 95% CI: 1.30 to 3.29). Apart from housework and upper body flexibility (OR: 0.39, 95% CI: 0.19 to 0.78), flexibility dimensions did not show any significant associations. CONCLUSIONS: While muscle strength dimensions and aerobic endurance were associated with several physical activities, flexibility dimensions were associated with none of the investigated activities apart from housework. Especially cycling and leisure activities (eg, hiking/ running, gym training, aerobics, dancing) showed great potential for sustaining and increasing physical fitness in older age.

Meal Patterns of Older Adults: Results from the OUTDOOR ACTIVE Study.

Eating habits have a substantial effect on health, not only because of consumed foods and nutrients, but also because of the regularity of meals. This study investigates meal patterns in older adults. Data from 1198 adults (52.8% female) aged between 65 and 75 years, who resided in Bremen, Germany, were included in this cross-sectional study. Using a self-administered questionnaire, daily meals were assessed and categorised into three meal pattern types: 'regular eaters' (eating at least three meals a day), 'meal skippers' (skipping one meal a day), and 'irregular eaters' (skipping more than one meal a day). Descriptive analyses were carried out, stratified by sex and meal pattern types. Most women and men were regular eaters (51.5% and 51.7%, respectively), 33.8% of women and 33.3% of men were meal skippers, and 14.7% of women and 15.0% of men were irregular eaters. Differences between meal patterns were seen with regard to socioeconomic status; self-rated health; body-mass index; hypertension; consumption of self-prepared meals; and consumption of whole-grain products, green vegetables, meat, and alcohol. The results provide first insights into possible associations between meal patterns and sociodemographic and health factors, and can benefit disease prevention and health promotion in older adults.

Adherence to Lifestyle Recommendations for Bone Health in Older Adults with and without Osteoporosis: Cross-Sectional Results of the OUTDOOR ACTIVE Study.

Sustaining good bone health into older age is key for preventing osteoporosis. Bone health is associated with several lifestyle factors. This study investigates older adults' adherence to bone health-promoting lifestyle recommendations dependent on osteoporosis status. Cross-sectional data of 1610 community-dwelling older adults (65-75 years) residing in Bremen, Germany (53.4% female) were included. The Osteoporosis Self-Assessment Tool and self-reported osteoporosis diagnosis were used to classify participants by osteoporosis status (low risk, high risk, diagnosis). Adherence to bone health recommendations regarding calcium and vitamin D intake, sun exposure, alcohol consumption, resistance/weight-bearing exercise, and physical activity were assessed. Descriptive statistics were applied, stratified by sex and osteoporosis status. A total of 91 women (10.6%) and 15 men (2.0%) reported an osteoporosis diagnosis, 457 women (43.2%) and 311 men (41.4%) were classified as having a high risk, and 311 women (36.2%) and 425 men (56.6%) as having a low risk. Adherence to bone health recommendations was high for calcium intake (93.3-100.0%), vitamin D intake (77.8-93.3%), and sun exposure (86.7-97.7%). Lower adherence was observed regarding resistance/weight-bearing exercise (36.3-54.4%), physical activity (14.3-57.7%), and alcohol consumption (40.0-72.4%). In conclusion, tailored prevention strategies are needed that focus on older adults with an osteoporosis diagnosis or who are at high risk.

Associations between socioeconomic status and physical activity among older adults: cross-sectional results from the OUTDOOR ACTIVE study.

BACKGROUND: Regular physical activity (PA) is an important strategy for healthy ageing. Socioeconomic status was found to be a key determinant of PA, however, evidence on associations between socioeconomic status and PA among older adults is limited. The aim of this study was to contribute to research on the associations of socioeconomic status and PA among older adults by including self-reported and objectively measured PA data. Furthermore, we examined the self-reported PA data more closely by looking at the activities separately. METHODS: Cross-sectional data of 1507 participants (52.5% female) of the OUTDOOR ACTIVE study between 65 and 75 years, residing in Bremen, Germany, were included in the analyses. Self-reported PA was assessed via questionnaire and comprised all organised and non-organised activities. For analyses, mean hours per week of total and moderate to vigorous PA, and mean metabolic equivalents per week were used. Objectively measured PA was assessed using accelerometers over seven consecutive days. Socioeconomic status was included as an additive social class index containing education, income, and occupation. To test for associations between PA and socioeconomic status, linear regressions were carried out. RESULTS: Self-reported PA showed significant negative associations with socioeconomic status for both men and women. Objectively measured PA was positively associated with socioeconomic status, which was significant in men but not in women. When examining physical activities separately, time spent on housework, gardening, biking, and walking decreased with increasing socioeconomic status. Women in the second SES quintile and men in the third quintile reported the most, and women in the first quintile and men in the fifth quintile the least hours per week spent on exercise. CONCLUSIONS: The results of this study contributed to the existing research gap on the associations of socioeconomic status and PA among older adults. Moreover, we provided information on both self-reported and objectively measured PA, and showed the discrepancies in the two methods' results. These findings can help to develop PA promotion interventions targeting specific socioeconomic status groups and to develop accurate, valid, and reliable self-reported and objective measurements of PA for older adults.

The Role of Community-Based Men's Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review.

Men's Sheds are a community-based health promotion concept which brings men together to engage in joint activities. Prior research reported beneficial effects on health and well-being of the participants; however, evidence is limited. The main objective of this systematic review is to provide an extensive overview of current research on the effectiveness of Men's Sheds on self-rated health, social isolation, and well-being by applying a mixed-methods approach. In addition, this review aims to identify how to successfully transfer and implement the concept. Eligible for inclusion were all studies published in English, German, or French that specifically referred to the concept of Men's Sheds. Four databases were searched for eligible studies, followed by a hand search on websites and reference lists. Methodological quality of included studies was assessed using checklists developed by the Joanna Briggs Institute. Following the convergent integrated approach, quantitative data were transformed and merged with qualitative data to conduct a thematic analysis. Overall, 35 qualitative, nine quantitative, and eight mixed-methods studies were included. We found evidence regarding benefits of shed participation on self-rated health, social isolation, and well-being. We identified three key characteristics of a successful Men's Shed, including appropriate shed facilities, sufficient funding as well as a participant-driven management and organization of the shed. This mixed-methods systematic review provides a comprehensive overview of the evidence base concerning Men's Sheds and highlights the need for longitudinal studies investigating causal relationships and gathering sufficient information on how to successfully transfer and implement the concept of Men's Sheds in other countries.

Domain-specific life satisfaction among older adults with and without children: The role of intergenerational contact.

BACKGROUND: Life satisfaction is associated with many important health outcomes among older adults and is an indicator of successful ageing. The present study aims to replicate earlier findings regarding relationships between satisfaction with various life domains and life satisfaction in older adults. The study furthermore explores how parental status is associated with satisfaction with different life domains and how two types of intergenerational contact (contact with own children; post-retirement work in childcare) relate to life satisfaction. METHODS: Participants were 1978 older adults, aged 65-75 year (51.7% female), who live in Bremen and took part in the OUTDOOR ACTIVE study. 82.6% of the participants had one or more children. All participants completed a questionnaire, which among others comprised items assessing life satisfaction as well as satisfaction with six different life domains (satisfaction with living situation, financial situation, leisure time, health, family, neighbors and friends). RESULTS: LS is significantly related to all of the investigated life domains, independent of sex and age. For the participants with children, life satisfaction had the highest association with satisfaction with family (ß: 0.202; 95%CI: 0.170-0.235), followed by satisfaction with neighbors and friends (ß: 0.151; 95%CI: 0.111-0.191), and health satisfaction (ß: 0.148; 95%CI: 0.120-0.176). In comparison to that, participants without children had the highest association between life satisfaction and satisfaction with health (ß: 0.193; 95%CI: 0.135-0.252), followed by satisfaction with family (ß: 0.175; 95%CI: 0.114-0.236) and satisfaction with neighbors and friends (ß: 0.154; 95%CI: 0.077-0.232). In participants with children, there was a non-significant negative association between life satisfaction and work in childcare (ß: -0.031; 95%CI: -0.178-0.116), while life satisfaction was statistically significantly positively associated to work in childcare in participants without own children (ß: 0.681; 95%CI: 0.075-1.288). CONCLUSIONS: The results suggest that the domain-specific approach to life satisfaction can elucidate differences in the correlates of life satisfaction and well-being between older adults with and without children. They further suggest that the benefits of working with children for life satisfaction may be more pronounced in older adults without children than older adults with children.

Sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test in community-dwelling older adults aged 65-75 years in Germany: results from the OUTDOOR ACTIVE study.

BACKGROUND: Physical fitness is a key component of independent living and healthy ageing. For the measurement of physical fitness in older adults, the Senior Fitness Test is a commonly used tool. The objective of this study is to calculate sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test for older adults (65-75 years) in Germany. METHODS: Cross-sectional data of 1657 community-dwelling older adults residing in Bremen, Germany (53% female) were included in this study. Physical fitness was assessed using the following measurements of the Senior Fitness Test battery: 30s-chair stand test, 2 min-step test, sit-and-reach test, and back scratch test. In addition, handgrip strength was measured using a Saehan DHD-3 digital hand dynamometer SH1003. Sex- and age specific normative values were calculated for the 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th, and 99th percentile using the GAMLSS method. RESULTS: The normative values show differences dependent on sex and age. For handgrip strength, the 30s-chair stand test and the 2 min-step test, normative values were higher for men, while women reached higher values in the sit-and-reach test and the back scratch test. For both, men and women, normative values declined with age. CONCLUSIONS: This study provides sex- and age-specific normative values for handgrip strength and components of the Senior Fitness Test for older adults in Germany. They might be useful for future research and for the application in practice.

Promoting Physical Activity Among Older Adults Using Community-Based Participatory Research With an Adapted PRECEDE-PROCEED Model Approach: The AEQUIPA/OUTDOOR ACTIVE Project.

PURPOSE: The PRECEDE-PROCEED model (PPM) is a community-based participatory research (CBPR) framework for health promotion, yet the direct application of the PPM into practice is unclear. This paper describes how the PPM was adapted for the development and application of a pilot intervention study to promote outdoor physical activity (PA) in older adults (OUTDOOR ACTIVE). We illustrate the steps and adaptations we applied to put the PPM into practice and present the developed interventions. DESIGN: The PPM was adapted by incorporating a socio-ecological model. This ensured the design of any resultant intervention would explicitly address multi-level determinants of physical activity. The list of possible program components to select from for the design of an intervention was also extended. SETTING: Bremen, Germany. PARTICIPANTS: Participants in the intervention development were 924 noninstitutionalized older adults, aged 65-75 years (response: 25.2%), living in Bremen-Hemelingen, Germany. For implementation of the intervention and to ensure sustainability, several groups of stakeholders were involved throughout the process. METHODS: A mixed method design was employed (e.g., focus groups, quantitative survey) to identify determinants. A round table and participatory workshops were held to involve the target group and community stakeholders in the design of an intervention using the adapted PPM model. RESULTS: A conceptual model was developed illustrating the integration of a socio-ecological model into the PPM. The model received ecological validity, as it was affirmed by community stakeholders as an appropriate method for designing a community-level PA intervention. Target goals to address PA determinants were selected by target group members. An intervention to meet the goals was developed and implemented with target group input. CONCLUSION: The adapted PPM is a promising starting point for developing multi-level interventions. Steps should be taken to ensure all social groups are participating in the process and all levels of determinants are addressed.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review.

BACKGROUND: A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence. METHODS: A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided. RESULTS: Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified. CONCLUSIONS: The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

Time allocation to active domains, physical activity, and health indicators in older adults: cross-sectional results from the OUTDOOR ACTIVE study.

BACKGROUND: Physical activity (PA) is one of the key determinants of healthy ageing. Research showed that time allocation plays an important role in PA. Therefore, an understanding of the time use of older adults is crucial for developing PA programs. The aim of this study was to examine the associations of time allocation and objectively measured PA, and several health indicators in older adults. METHODS: In this cross-sectional study all 915 participants of the OUTDOOR ACTIVE study were included. The participants were 65 to 75 years old and resided in a subdistrict of Bremen, Germany (50.9% female). The active domains were derived from the SLOTH model (leisure activities, occupation, active transport, home-based activities). PA was objectively measured with accelerometers over seven consecutive days. Binary logistic regressions were used to test the associations of total PA and time spent in the domains with several health indicators (self-rated health, overweight, obesity, activities of daily living (ADL)). RESULTS: Participants over the age of 70 years were significantly less physically active than those under 70 years and women were significantly more physically active than men. Regardless of age and sex, most time was spent on home-based activities (women: 118.5 ± 87.8 min/day; men: 80.2 ± 69.4 min/day). Both PA and time spent on leisure activities were associated with a lower risk of bad self-rated health (0.36; 95%-CL: 0.20, 0.65 for PA; 0.93; 95%-CL: 0.87, 0.99 for leisure activities) and less limitations in ADL. PA and active transport seemed to lower the risk of overweight (0.39; 95%-CL: 0.25, 0.62 for PA; 0.80; 95%-CL: 0.69, 0.93 for active transport) and obesity (0.36; 95%-CL: 0.21, 0.60 for PA; 0.77; 95%-CL: 0.64, 0.92 for active transport). Having an occupation was associated with a lower risk of bad self-rated health (0.60; 95%-CL: 0.40, 0.92). CONCLUSIONS: The results of this study provide insights in the time allocation to active domains and total PA of older adults, as well as the associations with health indicators. These findings have important implications for the development of PA programs and guidelines. Future research should examine the associations further in longitudinal studies.

Accelerometer-assessed outdoor physical activity is associated with meteorological conditions among older adults: Cross-sectional results from the OUTDOOR ACTIVE study.

BACKGROUND: Meteorological conditions are potential determinants of physical activity (PA). A profound understanding of the determinants of PA behaviour is required for PA promotion. This study examined the association between accelerometer-assessed PA and meteorological conditions among older adults. METHODS: This cross-sectional study included data of 577 adults aged 65-75 years living in Bremen, Germany (52% female; 3278 days). PA was measured with accelerometers for seven consecutive days (10/15-08/16). A threshold of 240 lx was used to differentiate between outdoor physical activity (OPA) and indoor physical activity (IPA). Linear mixed models estimated the association between PA (daily accelerometer counts per minute (CPM)) and meteorological factors (temperature, cloud cover, wind, and no precipitation) derived by principal component analysis. RESULTS: The analyses showed associations between PA in CPM and the meteorological factors temperature (93.7; 95%-CL: 64.9, 122.5) and no precipitation (48.4; 95%-CL: 19.8, 77.0) in women and wind (-40.3; 95%-CL: -59.7, -20.8) and no precipitation (30.1; 95%-CL: 5.6, 54.6) in men. After distinguishing in OPA and IPA for a subsample of 128 participants (473 days), the sex differences were no longer present. OPA in CPM was associated with temperature (women: 174.5; 95%-CL: 81.3, 267.6; men: 183.3; 95%-CL: 81.2, 285.4), cloud cover (women: -153.0; 95%-CL: -200.3, -105.7; men: -123.2; 95%-CL: -174.7, -71.7), and wind (women: -118.6; 95%-CL: -189.6; -47.7; men: -96.9; 95%-CL: -177.0, -16.7). No association between OPA and no precipitation was found (women: 2.9; 95%-CL: -89.0, 94.8; men: -17.1; 95%-CL: -116.7, 82.4). CONCLUSIONS: The results of this study emphasize the importance of meteorological conditions as environmental determinants of PA among older adults. Meteorological conditions should be accounted for in the unbiased assessment of habitual PA and the development of PA promotion programs. Future research should focus on the associations of OPA and IPA with meteorological conditions in different climatic regions.

Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65-75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial.

BACKGROUND: Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany. Physical activity promotion programs for older adults are often not successful, one reason is insufficient relevance of intervention measures for the study population. Community-based participatory research (CBPR) is a possible key strategy for tailoring more meaningful intervention programs to a specific community. However, evidence for the effectiveness of CBPR in the general population is scarce. This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults. METHODS/DESIGN: The OUTDOOR ACTIVE intervention trial is a cluster-randomised intervention study carried out in a random sample of eight subdistricts in the city of Bremen, Germany. The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and land use mix of the subdistrict. Within the pairs, the subdistricts are assigned randomly to the two study arms: participatory development and implementation of a community-based program to promote outdoor physical activity (intervention) versus no intervention (controls). For evaluation, a survey is carried out before (baseline) and after (follow-up) the intervention period. The measurements include 7-day accelerometer measurement, physical fitness test, blood pressure, basic anthropometry, and self-administered questionnaire. DISCUSSION: The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting. Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group, and it will inform policy makers and other stakeholders how to benefit from the results. TRIAL REGISTRATION: German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).