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Purpose To determine age-dependent cutoff values for secondary exhaustion criteria for a general population free of exercise limiting chronic conditions; to describe the percentage of participants reaching commonly used exhaustion criteria during a cardiopulmonary exercise test (CPET); and to analyze their oxygen uptake at the respective criteria to quantify the impact of a given criterion on the respective oxygen uptake (V˙O2) values. Methods Data from the COmPLETE-Health Study were analyzed involving participants from 20 to 91 yr of age. All underwent a CPET to maximal voluntary exertion using a cycle ergometer. To determine new exhaustion criteria, based on maximal respiratory exchange ratio (RERmax) and age-predicted maximal HR (APMHR), one-sided lower tolerance intervals for the tests confirming V˙O2 plateau status were calculated using a confidence level of 95% and a coverage of 90%. Results A total of 274 men and 252 women participated in the study. Participants were nearly equally distributed across age decades from 20 to >80 yr. A V˙O2 plateau was present in 32%. There were only minor differences in secondary exhaustion criteria between participants exhibiting a V˙O2 plateau and participants not showing a V˙O2 plateau. New exhaustion criteria according to the tolerance intervals for the age group of 20 to 39 yr were: RERmax ≥ 1.13, APMHR210 - age ≥ 96%, and APMHR208 × 0.7 age ≥ 93%; for the age group of 40 to 59 yr: RERmax ≥ 1.10, APMHR210 - age ≥ 99%, and APMHR208 × 0.7 age ≥ 92%; and, for the age group of 60 to 69 yr: RERmax ≥ 1.06, APMHR210 - age ≥ 99%, and APMHR208 × 0.7 age ≥ 89%. Conclusions The proposed cutoff values for secondary criteria reduce the risk of underestimating V˙O2max. Lower values would increase false-positive results, assuming participants are exhausted although, in fact, they are not.

As ageing is a major risk factor for the development of non-communicable diseases, extending healthspan has become a medical and societal necessity. Precise lipid phenotyping that captures metabolic individuality could support healthspan extension strategies. This study applied ‘omic-scale lipid profiling to characterise sex-specific age-related differences in the serum lipidome composition of healthy humans. A subset of the COmPLETE-Health study, composed of 73 young (25.2 ± 2.6 years, 43% female) and 77 aged (73.5 ± 2.3 years, 48% female) clinically healthy individuals, was investigated, using an untargeted liquid chromatography high-resolution mass spectrometry approach. Compared to their younger counterparts, aged females and males exhibited significant higher levels in 138 and 107 lipid species representing 15 and 13 distinct subclasses, respectively. Percentage of difference ranged from 5.8% to 61.7% (females) and from 5.3% to 46.0% (males), with sphingolipid and glycerophophospholipid species displaying the greatest amplitudes. Remarkably, specific sphingolipid and glycerophospholipid species, previously described as cardiometabolically favourable, were found elevated in aged individuals. Furthermore, specific ether-glycerophospholipid and lyso-glycerophosphocholine species displayed higher levels in aged females only, revealing a more favourable lipidome evolution in females. Altogether, age determined the circulating lipidome composition, while lipid species analysis revealed additional findings that were not observed at the subclass level.

The aim was to determine the minimum maximum oxygen uptake (V˙O2max) criteria cut-offs in highly trained athletes (i.e., maximum RER [RERmax], maximum HR [HRmax], maximum RPE [RPEmax], and maximum blood lactate concentration [BLmax]) necessary to determine maximum oxygen uptake (V˙O2max) during cardiopulmonary exercise tests (CPET), by balancing type I and type II errors. A further aim was to investigate if the defined cutoffs would be robust to diurnal and to day-to-day variations.Data from two CPET studies involving young athletes were analyzed. In the first study, 70 male participants performed one CPET until exhaustion to define cutoffs. In the second study, eight males and five females performed one CPET on seven consecutive days at six different times of day (i.e., diurnal variation). The time of the CPET was identical on the sixth and seventh days (i.e., day-to-day variation). To ensure comparability both studies were carried out under the same conditions.Participants' mean V˙O2max was 63.0 ± 5.3 mL·kg·min. RERmax ≥1.10 was reached by 100%, HRmax ≥95% of age-predicted HRmax by 99%, RPEmax ≥19 by 100%, and BLmax ≥8 mmol·L by 100% of participants, respectively. Regarding the intraday variations, latter cutoffs were not reached in two cases for RERmax and in one case for HRmax and BLmax. Intraclass correlations for the day-to-day variability were r = 0.823 for RERmax, r = 0.828 for HRmax, and r = 0.380 for BLmax, respectively.The proposed high cut-off values for secondary criteria provide some assurance that V˙O2max may have been achieved in athletes without increasing type II errors. However, type I errors may still occur indicating that further methods such as V˙O2-plateau or V˙O2-validation may be required.

OBJECTIVES Brachial arterial low flow-mediated constriction (L-FMC) and flow-mediated dilation (FMD) are ultrasound-based biomarkers that emerge into scientific and clinical practice indicating cardiovascular effects of medical and lifestyle-based treatment beyond classical risk factors. This study is the first to provide reference values and to assess the predictive value of L-FMC, FMD and their composite endpoint vasoactive range (VAR) in healthy adults. METHODS L-FMC, FMD and VAR were measured in 457 nonsmoking adults of 20-91 years without chronic diseases, medication, with normal heart function and very low cardiovascular risk. Sex-specific percentiles were calculated and predictive ability for elevated cardiovascular risk was assessed using receiver-operating characteristic (ROC) curves. RESULTS From 20 to 91 years of age, L-FMC increased 86.1 and 105.3%, FMD decreased 63.6 and 47.1% and VAR decreased 58.3 and 55.2% in women and men, respectively. Area under the ROC curves was 0.54 (95% CI = 0.49-0.54) for L-FMC, 0.67 (95% CI = 0.62-0.67) for FMD and 0.72 (95% CI = 0.67-0.72) for VAR (P

Objectives Physical activity and cardiorespiratory fitness (CRF) are relevant modifiers of cardiovascular risk. Their independent effects on arterial stiffness have not been assessed in people with obesity. This study aimed to assess the independent effects of light (LPA) and moderate-to-vigorous (MVPA) physical activity and CRF on Pulse wave velocity (PWV). Methods Brachial-ankle PWV (baPWV) was measured cross-sectionally in 55 subjects (43.0 ± 13.8 years; 66% women) with moderate cardiovascular risk. Body composition was assessed with bioelectrical impedance-analysis. Daily minutes of LPA and MVPA were measured by accelerometry and CRF (peak oxygen uptake [VO2 peak]) with spiroergometry. Independent effects of LPA, MVPA, and VO2 peak on baPWV were analyzed in an age-, sex-, body fat mass-, and blood pressure-adjusted ANOVA. Results Every 10 minutes increase of daily MVPA was associated with a 2.8% (0.32m/s [-0.64 to 0.001 m/s], P = .05) reduction of baPWV, whereas LPA and VO2 peak had only a little or no relevant effects on baPWV. Conclusions Higher MVPA is associated with lower composite arterial stiffness independent of CRF and the number of metabolic risk factors in patients with obesity and further metabolic risk factors. Thus, lifestyle interventions should aim for an increase in MVPA. BaPWV may improve the monitoring of favorable effects of MVPA, even if an improvement of VO2 peak cannot be obtained.

Background: Preventing falls and fractures from falls in residents of aged care facilities are an eminent public health goal. Evidence on the effectiveness of non-pharmaceutical methods to prevent falls and fall-related fractures in residential aged care facilities (RACFs) is unclear. This review aims to assess and rank the effectiveness of the most common fall- and fracture prevention strategies of non-pharmaceutical nature in RACFs. Method: This systematic review with network-meta-analysis follows the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P). We will conduct the systematic literature search across the medical databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL). We will conduct pairwise meta-analyses with a random effects model. When appropriate, we will construct a network graph and conduct network meta-analyses within a Bayesian framework for all outcomes and interventions. Bayesian network meta-analysis (random effects models) will be used to compare the relative effectiveness of the different interventions under investigation. Conclusion: Our review should provide a broader picture of the evidence of benefits and harms of exercise and other non-pharmaceutical interventions in fall- and fracture prevention in residents of residential aged care facilities (RACFs). Findings will benefit public and individual health by contributing in the beneficence of multidisciplinary care of institutionalized seniors through optimization of fall- and fracture prevention programs. Registration: Protocol registration: PROSPERO 2018 CRD42018116446; Registration on 28 November 2018.

OBJECTIVE Cardiopulmonary exercise testing is clinically used to estimate cardiorespiratory fitness (CRF). The relation to total body mass (TBM) leads to an underestimation of CRF in people with obesity and to inappropriate prognostic and therapeutic decisions. This study aimed to determine body composition-derived bias in the estimation of CRF in people with obesity. METHODS Two hundred eleven participants (58.8% women; mean BMI 35.7 kg/m2 [± 6.94; 20.7-58.6]) were clinically examined, and body composition (InBody720; InBody Co., Ltd., Seoul, South Korea) and spiroergometrical peak oxygen consumption (VO2 peak) were assessed. The impacts of TBM, lean body mass (LBM), and skeletal muscle mass (SMM) on CRF estimates were analyzed by the application of respective weight models. Linear regression and plotting of residuals against BMI were performed on the whole study population and two subgroups (BMI

Population-based, cross-sectional. To determine pain prevalence and identify factors associated with chronic pain in individuals with spinal cord injury (SCI) living in Switzerland. Swiss SCI Cohort Study (SwiSCI). Pain characteristics were assessed using an adapted version of the International SCI Pain Basic Data Set, adding one item of the SCI Secondary Conditions Scale to address chronic pain. Pain prevalence was calculated using stratification over demographic, SCI-related and socioeconomic characteristics; odds ratios (adjusted for non-response) for determinants of severity of chronic pain were calculated using stereotype logistic regressions. Pain (in the past week) was reported by 68.9% and chronic pain by 73.5% (significant 36.9%) of all participants (N=1549; 28% female). Most frequently reported pain type was musculoskeletal (71.1%). Back/spine was the most frequently reported pain location (54.6%). Contrasting the 'significant' to the 'none/mild' category of chronic pain, adjusted odds ratios were 1.54 (95% CI: 1.18–2.01; P

Sedentary behavior contributes to increased atherosclerotic risk in adults. Whether or not this can be extended to pediatric populations is unclear. This systematic review assessed associations of sedentary behavior with large artery structure and function in pediatric populations. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from the earliest available date to 31st of December 2018. Analyses of associations of sedentary behavior with large artery structure or function in a pediatric (sub-)population were included, adhering to the PRISMA guidelines. The protocol was published in advance on PROSPERO (CRD42018112996). Study quality and quality of evidence were analyzed using NHLBI Study Quality assessment tools and GRADE. Six observational studies found no association of exposure and outcome variables, and one had contradicting results. One intervention found reduced flow-mediated dilation after 3 h of uninterrupted sitting. Exposure and outcome measures were highly heterogeneous. Study quality was low to moderate. Quality of evidence was very low or low in the observational studies and high in the intervention.Conclusion: In pediatric populations, current evidence is limited and of low quality about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of vascular dysfunction and atherosclerotic risk. Future studies should emphasize a careful choice of the adequate type and measurement site of a biomarker for large artery structure and function as well as conduct a detailed assessment of sedentary behavior patterns.Trial registration: PROSPERO Registration Number: CRD42018112996What is known: • An independent association of sedentary behavior and biomarkers of large artery structure and function has been demonstrated in adults. • In children, sedentary behavior is directly associated with classical cardiovascular risk factors like elevated blood glucose levels, insulin resistance, high blood pressure, obesity, and elevated blood lipids.What is new: • Currently, only few studies of low quality in children and adolescents provide limited evidence about how acute effects of sedentary behavior translate into early vascular aging and the long-term development of atherosclerosis. • The type and measurement site of vascular biomarker need to be chosen carefully, and a detailed assessment of sedentary behavior patterns is important to minimize the methodological bias.

Background We aimed to investigate trajectories of mobility limitations (MLs) over a period of 24 years. In addition, we aimed to study how shift work and leisure-time physical activity (LTPA) in midlife predict assignment to MLs trajectories separately for those retired on statutory pensions (SPs) and on disability pensions (DPs). Methods Subjects who responded MLs questionnaires (1985–2009, N = 3048) in Finnish Longitudinal Study on Aging Municipal Employees were included in this prospective cohort study. LTPA and shift work were measured during baseline. International Classification of Functioning was used to code MLs. Growth mixture modeling was used to identify the trajectories of MLs. Odds ratio (OR) and their 95% Confidence interval (CI) were assessed by using multinomial logistic regression. Results We identified four trajectories of MLs, namely low persistent, low increasing, high decreasing and high persistent. Among the SP recipients, shift work with night shifts was associated with an increased risk (adjusted OR 1.49; 95% CI 1.03–2.14) of belonging to the high persistent MLs trajectory. The inactive LTPA (SP: OR 5.99, 95% CI 3.39–10.58, DP: OR 6.81, 95% CI 2.52–18.43) was similarly associated with high persistent MLs trajectory. Conclusion Nearly two-thirds of the people retired due to disability belonged to high MLs trajectory. High persistent MLs trajectory was associated with physical inactivity in midlife among those retired on SP and on DP. Shift work with night shift predicted high persistent MLs in SP strata. Active involvement in LTPA during midlife could be beneficial to spend MLs free later life.

Background: Assessing traditional neuromuscular fall risk factors (i.e., balance, gait, strength) in the elderly has so far mainly been done independently. Functional and integrative testing approaches are scarce. The present study proposes an agility course for an integrative assessment of neuromuscular and also cardiocirculatory capacity in seniors - and tests its criterion validity and reliability. Methods: Thirty-six seniors (age: 69.0 ± 2.8 years; BMI: 25.4 ± 3.5 kg/m2; sex: 19 males/17 females; weekly physical activity: 9.4 ± 5.5 h) participated. They completed four trials of the Agility Challenge for the Elderly (ACE)-course in two sessions separated by 1 week. The course consists of three segments focusing on different agility aspects. Cardiovascular capacity was assessed by 6-min walk test (6MWT), neuromuscular capacity by static, dynamic and perturbed standing balance tasks, habitual gait speed assessment, and rate of torque development testing. Parameters' predictive strength for the ACE performance was assessed by regression analysis. Reliability was calculated with intraclass correlation coefficients and coefficients of variation. Results: Men completed the course in 43.0 ± 5.7 s and women in 51.9 ± 4.0 s. Overall and split times were explained by 6MWT time ( η p 2 = 0.38-0.44), gait speed ( η p 2 = 0.29-0.43), and to a lesser extent trunk rotation explosive strength ( η p 2 = 0.05-0.12). Static and dynamic balance as well as plantar flexion strength explained the performance in some segments to a very small extent ( η p 2 = 0.06-0.08). Good between- and within-day reliability were observed for total course and split times: The ICC for the between-day comparison was 0.93 (0.88-0.96) and ranged between 0.84 and 0.94 for split times. The within-day ICC was 0.94 (0.91-0.97) for overall time and 0.92-0.97 for split times. Coefficients of variation were smaller than 5.7% for within and between day analyses. Conclusion: The ACE course reflects cardiocirculatory and neuromuscular capacity, with the three ACE segments potentially reflecting slightly different domains of neuromuscular (static and dynamic balance, ankle, and trunk strength) performance, whereas cardiocirculatory fitness and gait speed contribute to all segments. Our test can detect changes in overall performance greater than 5.7% and can thus be useful for documenting changes due to interventions in seniors.

Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults’ choice of transportation mode for a routine activity such as walking to the grocery store. To (1) evaluate associations between older adults’ perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people’s home, perceived facilitator and store was relevant for their transportation choice. Cross-sectional data were collected in a subsample of the ‘Life-space mobility in old age’ cohort. Multivariable logistic regression analysis on the binary outcome ‘transportation walking’ (vs. ‘motorized transportation’) was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account. Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11–31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking. Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people’s transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults’ transportation walking on a population level.

Background: Physical activity (PA) is paramount for human health and well-being. However, there is a lack of information regarding the types of PA and the way they can exert an influence on functional and mental health as well as quality of life. Studies have measured and classified PA type in controlled conditions, but only provided limited insight into the validity of classifiers under real-life conditions. The advantage of utilizing the type dimension and the significance of real-life study designs for PA monitoring brought us to conduct a systematic literature review on PA type detection (PATD) under real-life conditions focused on three main criteria: methods for detecting PA types, using accelerometer data collected by portable devices, and real-life settings. Method: The search of the databases, Web of Science, Scopus, PsycINFO, and PubMed, identified 1,170 publications. After screening of titles, abstracts and full texts using the above selection criteria, 21 publications were included in this review. Results: This review is organized according to the three key elements constituting the PATD process using real-life datasets, including data collection, preprocessing, and PATD methods. Recommendations regarding these key elements are proposed, particularly regarding two important PA classes, i.e., posture and motion activities. Existing studies generally reported high to near-perfect classification accuracies. However, the data collection protocols and performance reporting schemes used varied significantly between studies, hindering a transparent performance comparison across methods. Conclusion: Generally, considerably less studies focused on PA types, compared to other measures of PA assessment, such as PA intensity, and even less focused on real-life settings. To reliably differentiate the basic postures and motion activities in real life, two 3D accelerometers (thigh and hip) sampling at 20 Hz were found to provide the minimal sensor configuration. Decision trees are the most common classifier used in practical applications with real-life data. Despite the significant progress made over the past year in assessing PA in real-life settings, it remains difficult, if not impossible, to compare the performance of the various proposed methods. Thus, there is an urgent need for labeled, fully documented, and openly available reference datasets including a common evaluation framework.

Objectives To evaluate the effects a home-based exercise program delivered to ill and mobility-limited elderly individuals on physical function, physical activity, quality of life, fall-related self-efficacy, and exercise self-efficacy. Design Randomized controlled trial (ISRCTN Registry, Reg.-No. ISRCTN17727272). Setting Fifteen general practitioner (GP) practices and participants' homes. Participants Chronically ill and mobility-limited individuals aged 70 and older (N = 209). Interventions An exercise therapist delivered the experimental intervention—a 12-week multidimensional home-based exercise program integrating behavioral strategies—in individual counseling sessions at the GPs' practices and over the telephone. The control intervention focused on promoting light-intensity activities of daily living. Interventions took place between February 2012 and March 2013. Measurements The primary outcome was functional lower body strength (chair-rise test). Secondary outcomes were physical function (battery of motor tests), physical activity (step count), health-related quality of life (Medical Outcomes Study 8-item Short-Form Survey), fall-related (Falls Efficacy Scale—International Version), and exercise self-efficacy (Selbstwirksamkeit zur sportlichen Aktivitaet (SSA) scale). Postintervention differences between the groups were tested using analysis of covariance (intention to treat; adjusted for baseline value and GP practice; significance level P ≤ .05). Results Participants had a mean age ± standard deviation of 80 ± 5, 74% were female, 87% had three or more chronic diseases, and 54% used a walking aid. The difference (intention to treat; experimental minus control) between adjusted postintervention chair-rise times was −0.1 (95% confidence interval = −1.8–1.7). Differences for all secondary outcomes were also nonsignificant. Conclusion The program was ineffective in the target population. Possibilities for improving the concept will have to be evaluated.

To test subgroups of a community-based sample of individuals with spinal cord injury, categorized by the application of current recommendations by the International Spinal Cord Society.Community survey.Individuals with traumatic and non-traumatic spinal cord injury residing in Switzerland.Recommended subgroups of age, gender, years since injury, severity of injury and aetiology were tested against the following criteria: (i) distribution of participants across categories; (ii) within- and between-group variability with regard to selected outcomes of functioning and quality of life.Data-sets for 1,549 participants (28.5% women; mean age 52 ± 15 years) were available for analyses. There was a number of participants in every subgroup, yet numbers were relatively small in the group with the shortest time since injury ( 1 year; n = 23) and in the oldest age group (≥ 76; n = 94). A high variability in some outcomes was detected between categories. All variables were predictive for most of the endpoints investigated.Recommended categorization could well fit the present sample. A minor concern was the low numbers of participants in some subgroups.

Overweight is a worldwide increasing public health issue. Physical exercise is a useful countermeasure. Overweight individuals choose rather low exercise intensities, but especially high exercise intensities lead to higher energy expenditure and show beneficial health effects compared to lower exercise intensities. However, especially in the morning higher exercise intensities are likely to be avoided due to higher subjective effort. Bright light exposure has shown to increase maximum performance. The aim of this study was to investigate if bright light exposure can also increase self-chosen exercise intensity. We hypothesized that morning bright light exposure increases self-chosen exercise intensity of subsequent exercise through increased mood and reduced sleepiness in overweight individuals. In this randomized controlled single-blind parallel group design, 26 overweight individuals (11 males, 15 females; age 25 ± 5.7 years; body mass index 28.9 ± 2.1 kg/mVO2max: maximum oxygen uptake; 95% CI: 95% confidence interval; SD: standard deviation.

Background and aims Higher cardiorespiratory fitness is associated with lower pulse wave velocity and arterial stiffness in normal weight individuals, and this has not been examined in obese individuals. It is unclear whether an altered body composition acts as a modifier of the association between cardiorespiratory fitness and arterial stiffness. We examined the association between peak oxygen uptake and brachial-ankle pulse wave velocity and analysed whether body composition attenuates this association in obese middle-aged individuals. Methods Bio-impedance analysis-derived body composition assessment in 212 healthy and sedentary either overweight or obese individuals was followed by measurement of brachial-ankle pulse wave velocity and spiroergometric peak oxygen uptake. Multivariate analysis was performed to analyse the association between peak oxygen uptake and brachial-ankle pulse wave velocity and to assess the moderating effect of several body composition-related interaction terms (BMI, total body mass, body fat mass, waist circumference, waist-to-height ratio) on this association. Results Peak oxygen uptake was inversely associated with brachial-ankle pulse wave velocity (β = −0.059, 95% CI = −0.099; −0.018, p = 0.005). Testing for the impact of different body composition-related interaction terms on this association showed no significance, 95% CI lateralized towards positivity. Conclusions This study shows an inverse association between cardiorespiratory fitness and arterial stiffness in middle-aged obese individuals. We also found a tendency towards an attenuating impact of an obese body composition on this association. Physical fitness seems to be a stronger modulator of cardiovascular risk than body composition but the success of training efforts may be compromised by obesity.

To examine the prevalence and determinants of handbike use in persons living with spinal cord injury in Switzerland.A population-based cross-sectional survey in Switzerland.The crude prevalence of handbike use among the 1549 participants was 22.6%, varying between 25.3% in men and 17.7% in women. Prevalence was higher in complete than in incomplete spinal cord injury (SCI) (41.5% versus 11.9% in paraplegia, 25.6% versus 11.1% in tetraplegia). Multivariable analysis of handbike use confirmed differences with lesion characteristics and gender and showed a decline with age, lowest rates in the low-income group, variation with language, but no association with level of education or cause of spinal cord injury. In total, 45.8% of users reported to engage in handcycling at least once a week. Frequent contextual reasons for refraining from handcycling were: no interest (26%); inability due to disability (20%); unfamiliarity with the handbike (19%) and financial constraints (14%).Conditional on the major determinants that include demographic factors and lesion characteristics, main barriers involve contextual factors that can principally be overcome. Our findings thus suggest scope for promoting handcycling as a means towards a healthy and more physically active lifestyle in persons living with SCI.Handcycling is an effective means of improving health and quality of life of persons with a spinal cord injury. Persons with the following traits are most likely to use the handbike: persons younger than 62 years, with a complete paraplegia, who are German-speaking (vs. French/Italian) and having a middle or high net income. Indicated reasons for not using a handbike varied by SCI characteristics and included disinterest, inability related to the level of impairment, unfamiliarity and financial costs. Barriers that involve the above mentioned contextual factors can principally be overcome by targeted policy or information campaigns.

Objective: To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Swiss Spinal Cord Injury Community Survey 2012. Participants: Individuals aged 16 or older with chronic SCI living in Switzerland. Interventions: Not applicable. Outcome measures: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship. Results: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship. Conclusion: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.

To determine the prevalence of shoulder pain and to identify factors associated with shoulder pain in a nationwide survey of individuals living with spinal cord injury (SCI) in Switzerland.Data was collected through the 2012 community survey of the Swiss SCI Cohort Study (SwiSCI) (N = 1549; age 52.3 ± 14.8; 29% female). Sociodemographic and socioeconomic circumstances, SCI characteristics, health conditions as well as mobility independence and sporting activities were evaluated as predictor variables. Analyses were adjusted for item non-response (using multiple imputation) and unit-nonresponse (using inverse probability weighting).The adjusted prevalence of shoulder pain was 35.8% (95% CI: 33.4-38.3). Multivariable regression analysis revealed higher odds of shoulder pain in females as compared to males (odds ratio: 1.89; 95% CI: 1.44-2.47), and when spasticity (1.36; 1.00-1.85) and contractures (2.47; 1.91-3.19) were apparent. Individuals with complete paraplegia (1.62; 1.13-2.32) or any tetraplegia (complete: 1.63; 1.01-2.62; incomplete: 1.82; 1.30-2.56) showed higher odds of shoulder pain compared to those with incomplete paraplegia.This survey revealed a high prevalence of shoulder pain. Sex, SCI severity, and specific health conditions were associated with having shoulder pain. Implications for rehabilitation Individuals with spinal cord injury have a high prevalence of shoulder pain. Females, individuals with complete paraplegia or any tetraplegia and individuals with contractures and spasticity should receive considerable attention in rehabilitation programmes due to their increased odds of having shoulder pain.

Objectives: To evaluate in a sample of initially middle-aged municipal employees whether leisure time (LPA) or occupational physical activity (OPA) was associated with mobility limitation (ML) in old age. Design: Prospective population-based follow-up. Setting: Municipalities in Finland. Participants: Public sector employees from the Finnish Longitudinal Study on Municipal Employees (FLAME) initially aged 44 to 58 (N = 5,200). Measurements: Baseline data were collected in 1981, including LPA (average exercise within previous year: inactive (no exercise), moderate (some form of exercise ?1 time per week), vigorous (brisk exercise ?1 time per week)) and OPA (usual activities at work within previous year: light (light work sitting, standing, or moving around), moderate (moderate work moving around), vigorous (heavy physical work)). Number of MLs was assessed using a questionnaire (8 items) in 1985, 1992, 1997, and 2009; the latest mobility score available for each subject was used for analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for LPA and OPA predicting ML were estimated in a joint Poisson regression model adjusted for survival data; the other type of PA; and sociodemographic, socioeconomic, and health-related factors. Results: Mean age at baseline was 50.3 ± 3.6; 56.9% of participants were female. Participants with vigorous OPA in midlife had greater risk of a unit increase in ML in old age than those with light OPA (fully adjusted IRR = 1.09, 95% CI = 1.03�1.16). Participants with vigorous LPA had lower risk of ML than inactive participants (fully adjusted IRR = 0.81, 95% CI = 0.76�0.86). Conclusion: Findings suggest that LPA and OPA in midlife have independent, inverse effects on mobility in old age in terms of a harmful effect of vigorous OPA and a protective effect of vigorous LPA.

To investigate the provision, use, and unmet need of assistive devices for personal mobility in the Swiss population with spinal cord injury (SCI).Community survey 2012 of the Swiss Spinal Cord Injury Cohort Study.Individuals aged 16 or older with traumatic or non-traumatic SCI residing in Switzerland.Not applicable.Provision, frequency of use, and unmet need (i.e. perceiving the need of a device but it not being provided) of 11 mobility devices were assessed by self-report and analyzed descriptively. Provision of devices was further analyzed by sex, age, SCI etiology, SCI severity, and time since SCI.Devices reported highest for provision (N = 492; mean age 55.3 ± 15.1 years; 28.9% female) were adapted cars (78.2%) and manual wheelchairs (69.9%). Provision of various devices markedly varied with age and SCI severity (e.g. 34.6% of those aged 76+ had a walking frame compared to 3.1% of those aged 31-45; 50.0% of participants with complete tetraplegia had a power wheelchair compared to 7.6% of those with complete paraplegia). Many devices were mostly used daily (e.g. manual wheelchair) while others were mostly used less frequently (e.g. handbikes). Unmet need was highest for arm braces (53.2% of those in need) and power assisted wheelchairs (47.3%), and lowest for crutches (11.4%) and manual wheelchairs (4.8%).The devices individuals have or use is largely dependent on their age and SCI severity. While most participants have access to basic mobility devices, there is still a considerable degree of unmet need for certain devices.

Secondary data analysis from the cross-sectional survey of the Swiss Spinal Cord Injury Cohort Study. To explore associations with physical activity (PA) levels in people with spinal cord injury (SCI) with the specific aim to identify aspects that potentially explain being physically active (PHYS-ACT) and the achievement of the World Health Organization recommendations on PA. Community sample (n=485). Participants who completely answered four items of the Physical Activity Scale for Individuals with Physical Disabilities were included. Two outcome measures were defined: (1) being PHYS-ACT vs being completely inactive and (2) achieving WHO recommendations on PA (ACH-WHO-REC) (at least 2.5 h per week of at least moderate intensity) vs performing less. Independent variables were selected from the original questionnaire by applying the ICF framework. Multivariate logistic regression analyses were conducted. In the participants (aged 52.8±14.8; 73.6% male) older age decreased, but being a manual wheelchair user increased the odds of achieving both outcomes. Social support and self-efficacy increased the odds of being PHYS-ACT. Use of an intermittent catheter increased, whereas dependency in self-care mobility and coping with emotions decreased the odds for ACH-WHO-REC. Experiencing hindrances due to accessibility is associated with increased odds for ACH-WHO-REC. Being PHYS-ACT at all and achieving the WHO recommendations on PA are associated with different aspects. Applying the ICF framework contributes to a comprehensive understanding of PA behavior in people with SCI, which can tailor the development of interventions. Longitudinal studies should be initiated to test these associations for causal relationships.

BACKGROUND: Health conditions in people with spinal cord injury are major determinants for disability, reduced well-being, and mortality. However, population-based evidence on the prevalence and treatment of health conditions in people with spinal cord injury is scarce. OBJECTIVE: To investigate health conditions in Swiss residents with spinal cord injury, specifically to analyse their prevalence, severity, co-occurrence, and treatment. METHODS: Cross-sectional data (n = 1,549) from the community survey of the Swiss Spinal Cord Injury (SwiSCI) cohort study, including Swiss residents with spinal cord injury aged over 16 years, were analysed. Nineteen health conditions and their self-reported treatment were assessed with the spinal cord injury Secondary Conditions Scale and the Self-Administered Comorbidity Questionnaire. Prevalence and severity were compared across demographics and spinal cord injury characteristics. Co-occurrence of health conditions was examined using a binary non-metric dissimilarity measure and multi-dimensional scaling. Treatment rates were also examined. RESULTS: Number of concurrent health conditions was high (median 7; interquartile range 4-9; most frequent: spasticity, chronic pain, sexual dysfunction). Prevalence of health conditions increased with age and was higher in non-traumatic compared with traumatic spinal cord injury. Spinal cord injury specific conditions co-occurred. Relative frequencies of treatment were low (median 44%, interquartile range 25-64%), even for significant or chronic problems. DISCUSSION: A high prevalence of multimorbidity was found in community-dwelling persons with spinal cord injury. Treatment for some highly prevalent health conditions was infrequent. Language: en

To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI).Community Survey (2011-2013) as part of the Swiss Spinal Cord Injury Cohort Study.Community.Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10-100 m).Not applicable.Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains "changing basic body position," "transferring oneself" and "moving around." Binary outcomes ("independence" vs. "no independence") were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions).Regression analyses (N = 949; 27% women; median age 51, interquartile range 41-61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for "changing basic body position" (age 16-30 (reference), 31-45 (0.99; 0.53-1.83), 46-60 (0.64; 0.33-1.21), 61-75 (0.45; 0.22-0.92), 76+ (0.18; 0.07-0.44); P 0.001), "transferring oneself" (age 16-30 (reference), 31-45 (0.77; 0.37-1.61), 46-60 (0.39; 0.18-0.84), 61+ (0.05; 0.02-0.14); P 0.001), and "moving around" (age 16-30 (reference), 31-45 (0.79; 0.42-1.48), 46-60 (0.49; 0.26-0.94), 61-75 (0.49; 0.24-1.01), 75+ (0.11; 0.04-0.30); P 0.001).Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.

Der vorliegende Bericht beschreibt ein vom Bundesministerium für Gesundheit gefördertes Vorhaben zum «Leuchtturmprojekt Demenz» im Themenfeld 1 «Therapie und Pflegemaßnahmen: Wirksamkeit unter Alltagsbedingungen». Hierbei handelt es sich um eine multizentrische randomisierte Interventionsstudie, die den Einfluss von Sport (multimodale sportliche Aktivität) unter kontrollierten Bedingungen auf die kognitive Entwicklung von Alzheimer-Patienten im frühen Stadium prüft. In einem zweiarmigen Design werden je 150 Patienten mit früher AD unter Verum- bzw. Kontroll-Bedingungen untersucht. Die Verum-Gruppe erhält ein spezifisches sportliches Trainingsprogramm. In der Kontrollgruppe werden lediglich Dehnungsübungen durchgeführt. Primäre Endpunkte der Studie sind die kognitive Leistung der Patienten sowie deren Alltagskompetenz im Verlauf. Die gesundheitsbezogene Lebensqualität der Patienten sowie etwaige Verhaltensstörungen und depressive Symptome werden als sekundäre Endpunkte erfasst. Darüber hinaus werden die Angehörigen zur krankheitsbezogenen Belastung befragt und auf depressive Symptome untersucht. Angelehnt an die Hypothesen der «Initiative Demenzversorgung in der Allgemeinmedizin» (IDA) sollen entsprechende nicht-medikamentöse Versorgungsangebote dazu beitragen, dass Patienten länger in ihrem gewohnten häuslichen Umfeld leben. Im Sinne der Nachhaltigkeit der zu erwartenden Ergebnisse wird ein «Do it yourself»-Manual erstellt, mit dem das Trainingsprogramm auch ohne professionelle Anleitung, z. B. im Rahmen von Selbsthilfegruppen durchgeführt werden kann. Die weitere Implementierung (z. B. in Internetforen und weiteren Medien) wird durch einen Beirat der lokalen Krankenkassen, Gesundheitsämter und der Deutschen Alzheimer-Gesellschaft unterstützt.

To describe physical activity (PA) levels in persons with spinal cord injury (SCI) and to investigate associated factors. PA behavior of people with SCI in Switzerland was assessed in a community survey with four items from the Physical Activity Scale for individuals with physical disabilities (PA of light, moderate, and strenuous intensity and muscle-strengthening exercises). In addition to descriptive analyses, the odds of performing PA according to the WHO recommendations (at least 2.5 h/week of at least moderate intensity) were analyzed by multivariable logistic regression. Participants (n = 485; aged 52.9 ± 14.8; 73.6 % male) carried out PA a total of 6.0 h/week (median). 18.6 % were physically inactive, 50.3 % carried out muscle-strengthening exercises, and 48.9 % fulfilled the WHO recommendations. Regression analyses showed that women, people aged 71+, and people with complete tetraplegia had significantly lower odds of fulfilling the WHO recommendations than participants in the respective reference category (men, ages 17–30, incomplete paraplegia). PA levels of people with SCI in Switzerland are rather high. However, some subgroups need special consideration when planning interventions to increase PA levels.

Little is known about the wellbeing and mobility limitation of older disability retirees. Personal and environmental factors, such as time spent in working life, may either exacerbate or mitigate the onset of mobility limitation in general population. We aimed to study perceived midlife work ability as a determinant of self-reported mobility limitation in old age among municipal employees who transitioned into non-disability and disability retirement. METHODS: 4329 participants of the Finnish Longitudinal Study of Municipal Employees (FLAME) had retired during January 1985 and July 2000. They had data on retirement, perceived work ability in 1985, and self-reported mobility limitation (non-disability retirement n = 2870, men 39 %; and diagnose-specific disability retirement n = 1459, men 48 %). Self-reported mobility was measured in 1985, 1992, 1997 and 2009. The latest score available was used to assess the number of mobility limitation. Work ability was measured by asking the respondents to evaluate their current work ability against their lifetime best in 1985. Incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) for work ability predicting mobility limitation in non-disability and diagnose-specific disability retirement groups were calculated using Poisson regression models. RESULTS: The prevalence of mobility limitation for those who transitioned into non-disability retirement (Incidence Rate, IR = 0.45, 95 % CI = 0.44-0.46) was lower compared to those who retired due to disability (IR = 0.65, CI = 0.63-0.66). A one-point increase in the work ability score decreased the risk for having one more mobility limitation among non-disability and all diagnose-specific retirement groups (musculoskeletal disease, cardiovascular disease, mental disorder, and other diseases). CONCLUSIONS: Better midlife work ability may protect from old age mobility limitation among those who retire due to non-disability and disability. Promoting work ability in midlife may lead to more independent, active aging, regardless of type of retirement. BioMed Central open access

The aim was to study various types of older adult's activity destinations (counts, frequency of visitation, and distance from home) in the pre-COVID-19 era, and to study prospectively how COVID-19-related regulations limiting mobility affected these. Using a map-based questionnaire, 75-85-year-old participants reported activity destinations, that is, any destinations for physical exercise, destinations facilitating one's outdoor mobility, and destinations for other activities, which they had visited several times during the past month. At baseline, a variety of activity destinations was reported, but during COVID-19, destinations reported markedly declined in number, they were reported predominantly for physical exercise, and they were located closer to home. peerReviewed