Vascular Function in Patients After Myocardial Infarction: The Importance of Physical Activity

Background: Patients after myocardial infarction have impaired vascular function. However, effects of lifestyle, e.g., physical activity level, on endothelial function and arterial stiffness remain scarce. The aim of our study was to investigate effects of physical activity level and risk factors on endothelial function and arterial stiffness.Methods: In this cross-sectional study, we ultrasonographically assessed parameters of vascular function, namely flow mediated dilation (FMD) of the brachial artery and carotid artery stiffness in patients after myocardial infarction referred to the cardiac rehabilitation. The International Physical Activity Questionnaire (IPAQ) was obtained from all participants. Based on the IPAQ, patients were classified into three groups: vigorous, moderate, and low physical activity engagement. ANOVA was used for comparison among three groups using Bonferroni correction to determine differences between two sub-groups.Results: One hundred and eight patients after myocardial infarction (mean age 53 ± 10 years) were included. There were significant differences in terms of FMD (8.2 vs. 4.2 vs. 1.9%, p < 0.001) and pulse wave velocity (PWV), a measure of arterial stiffness (6.1 vs. 6.4 vs. 6.9 m/s, p = 0.004) among groups of vigorous, moderate, and low physical activity engagement, respectively. However, in younger patients only FMD remained associated with physical activity level, while arterial stiffness was not. Low physical activity engagement was a significant predictor of both FMD and PWV in univariate and multivariate models, adjusted for age, sex, and other risk factors.Conclusion: Low physical activity level is associated with impaired endothelial function and increased arterial stiffness in patients after myocardial infarction. Future studies are warranted to address this issue in a context of cardiac rehabilitation protocols optimization in order to improve vascular function in these patients.

Measuring activity engagement in old age: An exploratory factor analysis

A growing body of literature suggests that higher engagement in a range of activities can be beneficial for cognitive health in old age. Such studies typically rely on self-report questionnaires to assess level of engagement. These questionnaires are highly heterogeneous across studies, limiting generalisability. In particular, the most appropriate domains of activity engagement remain unclear. The Victoria Longitudinal Study-Activity Lifestyle Questionnaire comprises one of the broadest and most diverse collections of activity items, but different studies report different domain structures. This study aimed to help establish a generalisable domain structure of the Victoria Longitudinal Study-Activity Lifestyle Questionnaire. The questionnaire was adapted for use in a sample of UK-based older adults (336 community-dwelling adults aged 65–92 with no diagnosed cognitive impairment). An exploratory factor analysis was conducted on 29 items. The final model retained 22 of these items in a six-factor structure. Activity domains were: Manual (e.g., household repairs), Intellectual (e.g., attending a public lecture), Games (e.g., card games), Religious (e.g., attending religious services), Exercise (e.g., aerobics) and Social (e.g., going out with friends). Given that beneficial activities have the potential to be adapted into interventions, it is essential that future studies consider the most appropriate measurement of activity engagement across domains. The factor structure reported here offers a parsimonious and potentially useful way for future studies to assess engagement in different kinds of activities.

Daily Activity Engagement Predicts More Positive Affect Especially on Days When a Person Feels Young

Engagement in a wide array of mental, social, and physical leisure activities confers several health benefits. Indeed, theories of successful aging argue that an active lifestyle serves as an important criterion for maintaining high levels of psychological, functional, and physical well-being in old age. Findings from parallel studies also show that people who hold positive (self-)views of aging exhibit higher and maintained levels of well-being over time. Yet, whether views of aging enhances the link between activity engagement and well-being - and whether they do so on a daily basis – remains unknown. This study therefore sought to extend prior literature by examining the relationship between activity engagement, subjective age, and affective ratings within-person over several days. Old adults (N = 115; Age: Range = 60 – 90, M = 64.65, SD = 4.86) in the Mindfulness and Anticipatory Coping Every Day (MACED) study completed an 8-day daily diary. Participants reported on their positive and negative affect, the age they subjectively felt compared to their actual age, and the number and types of leisure activities in which they engaged. Results from multilevel analyses indicate that people felt more positive on days when they also engaged in more activities (total across mental, social, physical types) than usual. Moreover, the effect of activity engagement was most pronounced on days when people felt younger than usual. No effects were found for negative affect. Preliminary findings suggest that people benefit psychologically from daily leisure activities and a positive self-view of aging.

Depressive Symptoms, Leisure Activity Engagement, and Global Cognition in Non-Hispanic White and Black Older Adults

Prior research has linked more depressive symptoms to worse global cognition in older adulthood through lower leisure activity engagement. Less is known regarding which types of activities drive these associations. Additionally, depressive symptoms disproportionately affect cognition in Non-Hispanic Blacks (NHB) versus Non-Hispanic Whites (NHW). This cross-sectional study used data from the Michigan Cognitive Aging Project (n=453, 52% NHB, Mage=63.60 years) to examine whether distinct leisure activities (solitary-cognitive, solitary-creative, community-social, physical, intergenerational-social, cognitive-games) mediated the association between depressive symptoms and global cognition and whether race moderated these associations. Lower engagement in solitary-cognitive activities partially mediated the negative association between depressive symptoms and global cognition. In multi-group models, this indirect effect was only evident in NHBs, who showed a stronger negative association between depressive symptoms and activity engagement than NHWs. While cross-sectional, findings indicate that depressive symptoms may negatively impact cognition by reducing engagement in activities that promote cognitive reserve.

Activity Engagement Patterns Among Older Chinese Immigrants

Activity engagement is a major component of well-being in later life. However, very few studies have focused on older immigrants who are often at risk for social isolation and psychological distress. We aim to map the pattern of activity engagement and examine its variations in relation to immigration-related factors and social aspects of neighborhoods in a representative sample of older Chinese immigrants. We used data from the Population Study of Chinese Elderly in Chicago (PINE), a population-based epidemiological study of US Chinese older adults that were conducted between 2011 and 2013 (N=3,157). Latent class analysis and multinominal regression analysis were conducted to identify activity engagement patterns and examine the associated factors. Four patterns of activity engagement were identified: restricted (15%), diverse (31%), informal social (32%), and community-based social (21%). Acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment measured by social network size, positive social support, neighborhood cohesion, and sense of community were associated with the probabilities of class membership relative to the restricted class. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants. Efforts are needed to assist the vulnerable restricted group and recent older immigrants while meeting the demands of older immigrants who are less educated and less acculturated. Creating a supportive environment is important to provide information, access, and resources needed for activity engagement in the marginalized minority aging populations

Association Between Music Engagement and Mortality in Middle-Aged and Older Adults in the US

Music engagement is a universal human activity that transcends cultural and geographic boundaries. Current evidence suggests that music engages many diverse brain networks with wide-ranging effects on physiological, cognitive, and affective processes. As a result, music activity engagement may be associated with enhanced cognitive reserves and reduced stress. However, it remains unclear whether music activity engagement is associated with any survival advantage in the general population. This study tested this hypothesis in a nationally-representative sample of middle-aged and older adults in the U.S. A cohort of 3,540 respondents from the Health and Retirement Study was followed from 2002 to 2018. Music engagement was measured by self-reported participation in passive and/or active music activities. Potential confounders included socio-demographics, health and functional status, and health-related behaviors. We plotted the Kaplan-Meier survival curves by music engagement level and used Cox proportional hazards model to examine the independent effect of music engagement on mortality. Musical engagement levels were significantly associated with mortality in both the unadjusted and adjusted analyses. Respondents who reported engaging with music at a moderate or high level had lower mortality risk as compared to those who did not (HR=.83, p=0.015; HR=.78, p=0.003, respectively). These findings suggest that music engagement in the middle to late life may have an independent beneficial effect in promoting longevity. Future research should examine whether this observed effect was causal and existed in other populations. If confirmed, interventions should be designed to promote music engagement among middle-aged and older adults.

Technology Based Cognitive Behavioral Therapy On Psychological Distress: Exploring Health, Pain, And Activity

This randomized controlled trial investigates two technologically based self-administered cognitive behavioral depression treatments (CBT) on psychological distress in older adults. Health may change the ability to participate in types of activities, thereby impacting mental well-being and treatment response. The aims of this research are 1) to understand the impact of technologically based cognitive behavioral treatment on psychological distress 2) explore how health, pain, and activity engagement may affect treatment response. Fifty one participants recruited were randomized to one of 3 groups: audio-based cognitive behavioral therapy, computer-based cognitive-behavioral therapy, and control group. The combined treatment groups are compared to the control group. Health was examined in multiple ways; the Vulnerable Elders Scale-13 score ; (Saliba et al., 2001); and a reported chronic pain condition. For overall psychological distress, improvement on the Brief Symptom Inventory General Severity Index (GSI; Derogatis & Spencer, 1983) scores from baseline to post-treatment indicated treatment response. The California Older Person’s Pleasant Events Scale (COPPES; Rider, Gallagher-Thompson, & Thompson, 2004) measured activity engagement. While controlling for the Time 1 GSI score, an ANOVA revealed a significant difference in psychological distress between the CBT treatment group and control group F(1, 43) =4.22, p=.046. A linear regression analysis with the VES-13 score and GSI baseline score as predictors and the GSI posttreatment score as the dependent variable, found that health did not significantly predict psychological distress outcomes. Observation of the descriptives and these analyses suggest that CBT can impact psychological distress, potentially even with variations in health and pain.

Cognition and Subjective Age Predict Physical Activity Engagement: A Longitudinal Study of Impaired Older Adults

Physical activity is an important factor in preventing or slowing cognitive decline. However, the predictors of fluctuations in physical activity in a population that is already experiencing cognitive impairment is not well understood. Subjective age, such as how old one feels, has been tied to many health indicators in cognitively intact populations. Thus, we focused on the within-person associations between subjective age and physical activity as they unfold over time within a sample of cognitively impaired participants. The current study examined 400 reports from measurement burst data consisting of 5 weekly surveys conducted twice across 6 months from 68 cognitively impaired participants (M age = 70.14 (6.63), range = 60-92). Participants completed a battery of cognitive tests at baseline. At each weekly assessment, participants reported on their physical activity (e.g., exercise, outdoor, flexibility, and strength activities; Yes/No) and subjective age with respect to how old they feel overall and how old they feel mentally. There were longitudinal decreases in physical activity across the bursts, but on occasions when participants felt younger overall or younger mentally there were increases in physical activity. In addition, the effects of mental subjective age depended on cognitive ability, with those scoring lower in cognitive ability appearing to benefit the most from decreases (feeling younger) in mental subjective age. These findings suggest that perceptions of aging, especially within the domain of mental age, are tied to physical activity engagement for older adults with cognitive impairment.

Longitudinal Relationship Between Living Alone and Activity Engagement of Chinese Older Adults

The living arrangement of older adults plays a key role in their health status and psychological well-being. Yet the relationship between living arrangement and activity engagement remains unclear. Using data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) with a study sample of 7,479 respondents aged 60 or older, this study examined the effect of living alone on the frequency of activity engagement among Chinese older adults. Two types of activity engagement were examined in this study, including social interaction with friends and leisure activity (i.e., play chess, go to a sport or club). The multinomial logistic regression analyses were performed using generalized structural equation modeling (GSEM). Compared with those living with others, older adults living alone were older, more likely to be female and living in urban areas, and with fewer years of education and more functional limitations. The results also indicated that after controlling for a set of covariates, living alone status was significantly associated with the increased likelihood of high and medium frequency of both social interaction and leisure activity in reference to no engagement. This study not only improves the understanding of activity engagement preference of Chinese older adults who are living alone but also indicates the importance of improving community facilities and outdoor spaces to promote activity engagement among older adults.

The Effect of Behavioral Activation on Older Adults' Engagement and Wellbeing: A Randomized Control Trial Protocol

Meaningful activity engagement in later life is widely recognized as crucial for ageing well, but age-related changes and transitions can impede such participation. A behavioral activation framework can provide a person-centred, value-consistent therapeutic approach to increasing activity engagement that is both easy to administer, cost effective and accessible to a broad audience. Although there is evidence supporting the utility of behavioral activation as a treatment for depression in older adults, this study will be the first to examine whether a behavioral activation is more effective in increasing activity engagement and psychological wellbeing among a non-clinical sample of older adults, compared to a multi component positive psychology intervention. This randomized controlled trial will examine the impact of two therapeutic approaches on activity engagement and wellbeing among older adults. One hundred and fifty adults aged 65+ who have relatively lower scores on a measure of engagement with life will be randomized to either a behavioral activation-based intervention, or a multi-component positive psychology intervention. The interventions will involve six individual weekly sessions conducted via telephone or video conference. Participants will be assessed pre-, post-intervention, and at three months follow-up. Outcome measures will include activity engagement, positive affect, and psychological wellbeing. Intra-individual variability will also be assessed via micro-longitudinal data in the behavioral activation condition. This study will be the first to provide evidence to the effectiveness of behavioral activation as an intervention to increase activity engagement and wellbeing among older adults, compared to other therapeutic approaches to increase psychological wellbeing.