Relationship between socioeconomic status and quality of life in older adults: a path analysis.

PURPOSE: The main objective of this study was to determine the relationship between quality of life, social functioning, depressive symptoms, self-efficacy, physical function, and socioeconomic status (SES) in community-dwelling older adults. METHODS: A cross-sectional design was used to examine the relationships. A sample of 193 community-dwelling older adults completed the measurements. Structural equation modeling with full information maximum likelihood in LISREL was used to evaluate the relationships between the latent variables (SES, social functioning, depressive symptoms, self-efficacy, physical function, and quality of life). RESULTS: The path analysis exhibited significant effects of SES on physical function, social functioning, depressive symptoms, and self-efficacy (γ = 0.42-0.73), and significant effects in regard to social functioning, depressive symptoms, and self-efficacy on quality of life (γ = 0.27-0.61). There was no direct effect of SES on the quality of life. The model fit indices demonstrated a reasonable fit (χ (2) = 98.3, df = 48, p < 0.001), matching the relative Chi-square criterion and the RMSEA criterion. The model explained 55.5 % of the variance of quality of life. CONCLUSIONS: The path analysis indicated an indirect effect of SES on the quality of life by social functioning, depressive symptoms, and self-efficacy in community-dwelling older adults. Physical function did not have a direct effect on the quality of life. To improve the quality of life in older adults, additional focus is required on the socioeconomic psychosocial differences in the community-dwelling older population.

Longitudinal measurement of physical activity following kidney transplantation.

The purpose of this longitudinal observational study was to (i) examine the change of daily physical activity in 28 adult kidney transplant recipients over the first 12 months following transplantation; and (ii) to examine the change in metabolic characteristics and renal function. Accelerometer-based daily physical activity and metabolic- and clinical characteristics were measured at six wk (T1), three months (T2), six months (T3) and 12 months (T4) following transplantation. Linear mixed effect analyses showed an increase in steps/d (T1 = 6326 ± 2906; T4 = 7562 ± 3785; F = 3.52; p = 0.02), but one yr after transplantation only 25% achieved the recommended 10 000 steps/d. There was no significant increase in minutes per day spent on moderate-to-vigorous intensity physical activity (T1 = 80.4 ± 63.6; T4 = 93.2 ± 55.1; F = 1.71; p = 0.17). Body mass index increased over time (T1 = 25.4 ± 3.2; T4 = 27.2 ± 3.8; F = 12.62; p < 0.001), mainly due to an increase in fat percentage (T1 = 30.3 ± 8.0; T4 = 34.0 ± 7.9; F = 14.63; p < 0.001). There was no significant change in renal function (F = 0.17; p = 0.92). Although the recipients increased physical activity, the majority did not meet the recommended levels of physical activity after one yr. In addition to the weight gain, this may result in negative health consequences. Therefore, it is important to develop strategies to support kidney transplant recipients to comply with healthy lifestyle recommendations, including regular physical activity.

Quantifying daily physical activity and determinants in sedentary patients with Parkinson's disease.

BACKGROUND: Although physical activity is beneficial for Parkinson's disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical activity in self-identified sedentary PD patients; (2) compare this with criteria of a daily physical activity guideline; and (3) identify determinants of daily physical activity. METHODS: Daily physical activity of 586 self-identified sedentary PD patients was measured with a tri-axial accelerometer for seven consecutive days. Physical fitness and demographic, disease-specific, and psychological characteristics were assessed. Daily physical activity was compared with the 30-min activity guideline. A linear mixed-effects model was estimated to identify determinants of daily physical activity. RESULTS: Accelerometer data of 467 patients who fulfilled all criteria revealed that >98% of their day was spent on sedentary to light-intensity activities. Eighty-two percent of the participants were 'physically inactive' (0 days/week of 30-min activity); 17% were 'semi-active' (1-4 days/week of 30-min activity). Age, gender, physical fitness, and scores on the Unified Parkinson's Disease Rating Scale explained 69% of the variability in daily physical activity. CONCLUSIONS: Performance-based measurements confirmed that most self-identified sedentary PD patients are 'physically inactive'. However, the variance in daily physical activity across subjects was considerable. Higher age, being female, and lower physical capacity were the most important determinants of reduced daily physical activity. Future therapeutic interventions should aim to improve daily physical activity in these high-risk patients, focusing specifically on modifiable risk factors.

Respiratory muscle activity and dyspnea during exercise in chronic obstructive pulmonary disease.

We aimed to determine by non-invasive EMG, whether during exercise: (1) COPD patients increase scalene and intercostal EMG activity, (2) increased EMG activity is associated with increased dyspnea, and (3) the ratio between EMG activity and volume displacement is increased in COPD compared to healthy subjects (HS). During a maximal incremental cycle test, scalene and intercostal EMG was derived transcutaneously in 17 COPD patients and 10 HS. Dyspnea was quantified using a Borg scale, ranging from zero to 10 (maximal dyspnea). For analyses the ratio between inspiratory muscle activity during exercise and activity during quiet breathing was used (logEMGAR). In COPD patients, scalene and intercostal activity increased at greater rate early in exercise compared to that of the HS. With a doubling of the logEMGAR, in COPD, dyspnea increased with 2.8/3.8 points, while in the HS, dyspnea increased less with 1.1/1.4 points. In COPD, there was a larger increase in EMG activity relatively to tidal volume increases.

[Pedometers for monitoring and improvement of the level of physical activity]. / Stappentellers voor het monitoren en bevorderen van het lichamelijke activiteitenniveau.

Pedometers are cheap and easy to handle devices that have proven their accuracy to measure the number of steps taken during a time period (day or week). However, at lower walking speeds and if used by obese persons the accuracy of several pedometers decreases significantly. Pedometers are not able to record the intensity of daily physical activity. In addition, the number of steps depends on age, gender, body weight and season. Nevertheless, monitoring of daily physical activity with a pedometer may be an effective method to enhance the daily physical activity of selected subgroups. For instance, subjects with an increased risk of obesity or hypertension, sedentary patients with diabetes mellitus type 2, patients with coronary heart disease and cancer patients can more easily be stimulated to become physically active and meet healthy living standards. Pedometers combined with existing effective counseling methods may be an effective strategy for many health care providers for adoption and enhancement of healthy lifestyles by sedentary patients.

Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass.

UNLABELLED: Low bone mineral density is frequently seen in COPD patients. Advanced COPD, low BMI and muscle depletion are risk factors for developing low bone mineral density (BMD). Low bone mineral density is seen in 75% of the GOLD stage IV patients. INTRODUCTION: We set out to investigate the prevalence of low bone mineral density (BMD) in chronic obstructive pulmonary disease (COPD) as well as the predictors of abnormal bone mineral density. METHODS: A cross-sectional design was used to evaluate 115 subjects with COPD (GOLD stages II-IV). Bone mineral density (BMD) was measured using an ultrasound densitometer. The forced expiratory volume in 1 s (FEV(1)) was assessed and fat-free mass was measured using bioelectrical impedance analysis. Chi-square tests and logistic regression were used for analysis. RESULTS: The prevalence of a T-score < -1.0 SD and > -2.5 SD was 28.6% in GOLD stage II, 40.3% in GOLD stage III and 57.1% in GOLD stage IV. The prevalence of a T-score

Successful treatment of respiratory dysfunction in cystinosis by nocturnal non-invasive positive pressure ventilation.

Cystinosis is a rare metabolic disorder characterized by lysosomal cystine accumulation leading to multi-organ damage, with kidneys being clinically first affected. Longer survival of cystinosis patients due to successful renal replacement therapy, revealed previously unknown extra-renal symptoms of cystinosis, generally appearing after the first decade. Respiratory insufficiency caused by overall respiratory muscle myopathy is a severely invalidating and sometimes a life-threatening complication of cystinosis. We report a successful treatment of hypoventilation, due to diaphragm myopathy in a cystinosis patient, by nocturnal non-invasive positive pressure ventilation (NIPPV). After initiation of NIPPV the clinical condition of the patient improved and blood-gasses normalized, indicating that this treatment modality should be considered in cystinosis patients with severe respiratory insufficiency.

[Is the Activities-specific Balance Confidence Scale suitable for Dutch older persons living in the community?]. / Is de Activities-specific Balance Confidence Scale geschikt voor het meten van valangst bij Nederlandse niet-geïnstitutionaliseerde ouderen?

BACKGROUND: In ageing populations fear of falling is an important issue. International studies and collaborations require scales suitable to more cultures. Scales developed in one culture require adaptation and additional investigation of psychometric properties for use in other countries. OBJECTIVE: To investigate the psychometric properties of a Dutch version of the Activities-specific Balance Confidence scale (ABC-NL) and whether adding questions about complex/dual tasks improves the discriminatory power. METHOD: Subjects were 106 men and 140 women aged 65-92 years. Measures were the 16-item ABC-NL and seven additional more complex items, fall history, general and physical self-efficacy, a functional reach test and a balance platform test. RESULTS: The ABC-NL had a weak ceiling effect. Internal consistency (Cronbachs alpha) was high. The relationship between ABC-NL and physical self-efficacy was significantly stronger than between the ABC-NL and general self-efficacy. Relationships with performance-based measures of balance were moderate. Differences between fallers and non-fallers and between activity avoiders and non-avoiders were significant. Adding questions about complex tasks hardly improved discriminatory power, reliability and validity. CONCLUSION: Psychometric properties of the ABC-NL were satisfactory. Further research is needed for use in high-functioning older persons.

Is de Activities-specific Balance Confidence Scale geschikt voor het meten van valangst bij Nederlandse niet-geïnstitutionaliseerde ouderen?

Is the Activities-specific Balance Confidence Scale suitable for Dutch older persons living in the community? Background: In ageing populations fear of falling is an important issue. International studies and collaborations require scales suitable to more cultures. Scales developed in one culture require adaptation and additional investigation of psychometric properties for use in other countries.Objective: To investigate the psychometric properties of a Dutch version of the Activities-specific Balance Confidence scale (ABC-NL) and whether adding questions about complex/dual tasks improves the discriminatory power.Method: Subjects were 106 men and 140 women aged 65-92 years. Measures were the 16-item ABC-NL and seven additional more complex items, fall history, general and physical self-efficacy, a functional reach test and a balance platform test.Results: The ABC-NL had a weak ceiling effect. Internal consistency (Cronbachs alpha) was high. The relationship between ABC-NL and physical self-efficacy was significantly stronger than between the ABC-NL and general self-efficacy. Relationships with performance-based measures of balance were moderate. Differences between fallers and non-fallers and between activity avoiders and non-avoiders were significant. Adding questions about complex tasks hardly improved discriminatory power, reliability and validity.Conclusion: Psychometric properties of the ABC-NL were satisfactory. Further research is needed for use in high-functioning older persons.

The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis.

The aim of the present study was to compare the effect of a new prefabricated Thämert forearm/hand splint with the effect of a simple elbow band as a treatment for lateral epicondylitis. Forty-three (43) patients that met the inclusion criteria were randomly assigned to the elbow band group and the splint group. They wore the orthotic devices for 6 weeks. Outcome measures were obtained at baseline and directly after the intervention. These outcome measures were maximal grip strength on the involved side with a pain scale from 1 to 10 to determine the extent of pain during gripping, and the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ). Analysis of variances with repeated measures, a Mann Whitney test and multiple linear regression analysis were used to compare the two groups. Main effect for time was significant for maximal grip strength and sum scores on the PRFEQ, but no differences between groups were found, even when a distinction between acute and chronic symptoms was made. Change in pain score during gripping did not differ significantly between the groups. A multiple linear regression analysis showed that the use of the splint did not significantly contribute to the prediction of change in maximal grip strength and in overall PRFEQ. The conclusion is that the forearm/hand splint is not more effective than the elbow band as a treatment for lateral epicondylitis.

Groningen active living model (GALM): stimulating physical activity in sedentary older adults; first results.

BACKGROUND: A significant proportion of older adults in The Netherlands does not regularly participate in leisure-time physical activity. The Groningen Active Living Model (GALM) was developed to change this situation for the better. In this article the first results with respect to the validation of the model are presented. METHODS: We obtained cross-sectional data from a sample of 392 potential participants. Scores on the potentially causal variables (self-efficacy, social support, perceived fitness, and enjoyment) and the stages of change give a first indication of the potential validity of the GALM behavioral change model. RESULTS: Seventeen percent of the subjects could be categorized as in the precontemplation stage, 42% in the contemplation/preparation stage, and 39% in the action/maintenance stage. Data with respect to stages of change were missing for 2% of the subjects. Scores on all potentially causal variables rose significantly from the precontemplation to the action/maintenance stage. Discriminant analysis resulted in a canonical correlation of 0.58 between the precontemplation and the contemplation/preparation stages and 0.59 between the contemplation/preparation and action/maintenance stages; respectively, 82.6 and 78.3% of the subjects had been classified correctly. CONCLUSIONS: The results found in this study support our hypothesis, as described in the conceptual theory of the GALM behavioral change model. For a more comprehensive validation of the model's action theory and conceptual theory, follow-up measurements are required.

Physical fitness related to disability in older persons.

BACKGROUND: In today's aging society, preventing or reducing disability is important. Physical activity may serve this goal. Generally, physical activity aims to enhance physical fitness, which in turn may prevent disability. The relationship between physical fitness and disability has been much less explored than the relationship between physical activity and physical fitness. OBJECTIVE: To investigate the relationship between separate components of physical fitness and disability. METHODS: The subjects were a community-based sample of 176 men and 233 women aged 65 years or older. Physical fitness was assessed with performance-based tests. Disability and potential confounders were assessed during face-to-face interviews. RESULTS: Independently of other fitness components, walking endurance, grip strength, manual dexterity and balance contributed significantly to the prediction of disability for both men and women. Flexibility of the hip and spine, flexibility of the shoulder and reaction time were not independent predictors of disability for men or women. Physical fitness explained a greater percentage of variance in disability for women (31-48%) than for men (14-34%). Although depressive symptoms, cognitive functioning (men), number of chronic conditions (women) and age (women) explained additional variance in disability, these variables did not confound the relationship between physical fitness and disability. CONCLUSION: Walking endurance, grip strength and manual dexterity are important unique predictors of disability. Physical activity programs should be directed at these fitness components.

A Dutch version of the Social Support for Exercise Behaviors Scale.

We studied the reliability of a Dutch version of the Social Support for Exercise Behaviors Scale, originally developed by Sallis, Grossman, Pinski, Patterson, and Nader, using a sample of 461 older adults between 55 and 65 years of age. Cronbach alpha for the three subscales was calculated, respectively, as .69, .71, and .26, which are lower than the alphas reported in the original study. This may be due to the cultural differences between The Netherlands and the United States and differences between the samples of the two studies.

The Groningen Enjoyment Questionnaire: a measure of enjoyment in leisure-time physical activity.

The purpose of this study was to develop a short and easily used questionnaire to measure enjoyment in leisure-time physical activity. The first part of the study involved the questionnaire's composition. A set of 30 positively formulated potential items was generated and subsequently completed by 59 subjects. We used these results to trim the questionnaire to 10 items. In the second part of the study, the questionnaire was administered to 82 subjects and research was done into reliability and validity. The results indicate that the Groningen Enjoyment Questionnaire can be considered reliable and valid.

Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults.

BACKGROUND: A significant number of Dutch older adults can be considered sedentary when it comes to regular participation in leisure-time physical activity. Sedentariness is considered a potential public health burden-all the more reason to develop a strategy for stimulating older adults toward becoming more involved in leisure-time physical activity. The Groningen Active Living Model (GALM) is a behavioral change strategy for stimulating participation in leisure-time physical activity. METHODS: The GALM strategy is based on a process model of behavioral change in which behavioral change is seen as a multidimensional and dynamic process. The strategy has three phases: recruitment, introduction, and follow-up, and lasts 18 months. RESULTS: Preliminary results indicate that, up until the summer of 1998, about 4000 older adults were participating in 76 local GALM projects. Further research will be done to assess the validity of the model and its effects on the leisure-time physical activity pattern, ADL performance, and health in newly active older adults. CONCLUSIONS: The GALM strategy is a feasible strategy for stimulating leisure-time physical activity participation on a large-scale basis. The strategy is being implemented in The Netherlands on a nationwide basis.