Measuring physical activity in older adults – one size does not fit all

np_hallgeirA study just published in PLOS ONE has compared adherence to physical activity recommendation in older adults when using absolute versus relative intensity definition of physical activity.

“I was walking with my father in a beautiful forest in Norway at a pace that was easy for me but left him breathless. The traditional method used to assess physical activity in research would not differentiate between the level of intensity my father experienced compared to myself while walking. And that’s when I had the idea to do this study”, says Nils Petter Aspvik, co-author of the study and PhD candidate at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway.

Physical activity is good for health and well-being. This is true for both the old and the young. For that reason, the public health agencies around the world advocate regular physical activity to maintain or improve health and well-being, delay onset of diseases and prolong life.

Current physical activity recommendations for both younger and older adults advocate 150 minutes of absolute or relative moderate to vigorous intensity activity per week. Absolute intensity physical activity refers to an activity that has the same energetic cost for young and old, fit and unfit. Relative intensity, on the other hand, is often given in terms of individual abilities such as fitness and is less costly for the very fit compared to the unfit individuals.

In order to evaluate the current physical activity recommendations in large populations, investigate the relationship between physical activity and health and generalize the findings, we must be able to assess adherence. Adherence to current recommendations was assessed in multiple studies, and depending on the method used, the estimates ranged from 1 % to 52 %. Comparisons between studies, populations and countries were often not possible because of differences in data analysis and methodology of physical activity assessment.

Treningsøkt i forskningsprosjektet Generasjon 100

While the public health agencies suggest that relative intensity physical activity can be used to meet the recommendations, only absolute intensity physical activity definition is applied when assessing adherence. This can be problematic, especially when it comes to older adults who are often unable to reach the absolute moderate to vigorous intensity due to declining health and fitness.

The NTNU study was part of a large randomized controlled clinical trial with the primary objective of investigating the effect of exercise training on disease and death in the older adult population. The team conducted a cross-sectional study of 1219 older adults from Norway aged 70-77 years. The scientists used accelerometers to measure adherence to recommendations while applying both the absolute and relative (adjusted for fitness and gender and derived specifically for older adults) intensity definition of physical activity.

“What we found was quite interesting. When using the absolute physical activity definition 29% of our older men and women met the recommendations, while a whopping 71% did so when relative physical activity method was applied.  We do not know if this new method will help us identify people at risk of health problems better. That is something that we need to investigate in the future”, says Aspvik. Furthermore, researchers showed that fit older adults were more likely to meet the recommendations, regardless of the method used in assessment and women were more active than men at relative but not absolute intensities.

According to Aspvik the take-home message of the study is that ”physical activity recommendations are there for a reason and should in no way be negated, but how me measure the adherence to those recommendations, especially among older adults, should be considered and adjusted to the individual, because clearly one size does not fit all”.

Hallgeir Viken, researcher at CERG and Nils Petter Aspvik, researcher at Department of Sociology and Political Science

Physical fitness & brain power: Congrats Magnus Carlsen!

Linda ErnstsenMillions of people all over the world have followed the 2016 World Chess Championship game between the reigning world champion Magnus Carlsen from Norway and a challenger Sergey Karjakin from Russia that took place in New York City, USA between 11th and 30th of November. After twelve games the result was 6-6, meaning that tie breaks were to decide the match. And finally, last night on his 26th birthday, Carlsen won the four-game rapid chess tie break with 3-1. This was somewhat surprising for many, who did not consider Carlsen to be at his best during the last 12 matches, and twho believed that Karjakin was a great opponent throughout the championship.  When asked about the game by a Norwegian journalist, Karjakin said It was perhaps a mistake that I prepared for both the black and the white portions. I looked at many varieties. But in rapid chess it’s better to be in good shape. And I was not in good shape”.

 Chess is a game that involves many aspects of high level cognition such as memory, attention, focus and problem solving. It is a demanding game that favors the physically fit during long matches and tournaments. Thus, the simple question many of us raise today is if Magnus Carlsen`s physical fitness level better than Sergey Karjakin`s? Research does support the association between cardiorespiratory fitness and cognitive function in healthy pre-adolescent children and middle-aged and older people.

Exercise is important as medicine for treatment of heart and lifestyle related diseases and for increasing the likelihood and preservation of good heart and brain throughout life. This is true even for the winners of the World Chess Championship.

We congratulate Magnus Carlsen who yet again is the world’s best chess player, and probably the world’s fittest chess player as well.

Linda Ernstsen, Associate Professor, CERG

It’s time for doctors to routinely assess their patients’ fitness level – it may save lives

ulrik-wisloffThe New Scientific Statement from the American Heart Association (AHA) has just been published and it identifies cardiorespiratory fitness (CRF) as a vital sign, which should be used in clinical practice. Plethora of evidence points to CRF as a better predictor of adverse health outcomes than the traditionally utilized risk factors such as high blood pressure, smoking, obesity and type 2 diabetes. CRF is either directly measured as maximal oxygen uptake (VO2max) using cardiopulmonary exercise testing or it is estimated as exercise capacity from an exercise test.

Even very small improvements in CRF were found to associate with significant reductions in risk of developing heart disease and dying prematurely, improved cardiovascular outcomes, and improved outcomes for certain forms of cancer, surgical risk, dementia, Alzheimer’s disease, depression and Type 2 diabetes.

Yet, while low CRF is one of the most important factors when determining health outcomes, it is often neglected by clinicians in the risk assessment of patients.

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“With the increase in lifestyle-related diseases around the world, estimated fitness is an easy, cost-effective method that could significantly help medical professionals identify people at high risk and improve patient management,” says co-author Carl J. Lavie, MD, and lead cardiologist from the John Ochsner Heart and Vascular Institute, New Orleans, US.

“Routine estimation of CRF in clinical practice is no more difficult than measuring blood pressure. The addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and encourage lifestyle-based strategies designed to reduce cardiovascular risk”, says Dr. Wisloff, Head of K.G. Jebsen Center of Exercise in Medicine at Norwegian University of Science and Technology, and the last author of the statement.

“The evidence reviewed by our writing group clearly demonstrates that more than half the reduction in cardiovascular disease mortality occurs in response to a very modest increase in CRF.  This is good news as for many people, moderate levels of physical activity that increase fitness level may be all that is needed to derive a clinically significant benefit for habitually sedentary individuals,” says Dr. Ross of Queen’s University in Kingston, Canada and first author of the statement.

One of the calculators for estimating fitness that the AHA suggests should be used on a regular basis by both the medical professionals and the general public was created by the researchers at K.G. Jebsen Center for Exercise in Medicine at NTNU.  The calculator has been used by more than 5 million people worldwide, with the number of users increasing daily. The fitness calculator is freely available online and as App for Android and iOS.

Ulrik Wisløff, head of CERG

CERG now a member of EPINOR

trude_larsCERG has become a member of EPINOR, the national research school in population based epidemiology. Five Norwegian universities and three research institutes make up the EPINOR consortium. Today, the EPINOR network consist of around 150 PhD students and their associated research groups.

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The essence on how to increase physical activity in the population

Forsker ved CERG, Øivind RognmoPhysical inactivity is one of the major health challenges of our time. Health authorities advise us to be physically active because there is convincing evidence on the health benefits of physical activity. Still, only about 30% of us reach these recommendations, and this is due to a combination of increasing mechanisation, digitisation, motorisation and urbanisation that continues to inexorably squeeze essential physical activity out of our daily lives.

It is therefore a global goal for all countries to reduce physical inactivity. The Toronto Charter for Physical Activity has good documentation on how to increase the proportion of physically active . In this context, Scottish researchers have adapted the contents of the Toronto Charter in an infographic to illustrate the content of this important document.

This is made in a form that can easily be shared as a picture on popular social media like facebook, twitter, etc.. The idea is that the figure should communicate the key messages in seconds, and act as a guide to the Toronto Charter. Let’s hope that the figure runs its course in social media.

Øivind Rognmo, researcher at CERG