Physical activity and the progression of coronary artery calcification

BackgroundThe association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults.MethodsProspective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline.ResultsWe analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC.ConclusionWe found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.

Physical Activity as a Predictor of Cognitive Decline in an Elderly Essential Tremor Cohort: A Prospective, Longitudinal Study

Background: Essential tremor (ET), one of the most common neurological diseases, is associated with cognitive impairment. Surprisingly, predictors of cognitive decline in ET remain largely unidentified, as longitudinal studies are rare. In the general population, however, lower physical activity has been linked to cognitive decline.Objectives: To determine whether baseline physical activity level is a predictor of cognitive decline in ET.Methods: One hundred and twenty-seven ET cases (78.1 ± 9.5 years, range = 55–95), enrolled in a prospective, longitudinal study of cognition. At baseline, each completed the Physical Activity Scale for the Elderly (PASE), a validated, self-rated assessment of physical activity. Cases underwent an extensive battery of motor-free neuropsychological testing at baseline, 1.5 years, and 3 years, which incorporated assessments of cognitive subdomains. Generalized estimating equations (GEEs) were used to assess the predictive utility of baseline physical activity for cognitive change.Results: Mean follow-up was 2.9 ± 0.4 years (range = 1.3–3.5). In cross-sectional analyses using baseline data, lower physical activity was associated with lower overall cognitive function as well as lower cognitive scores in numerous cognitive domains (memory, language, executive function, visuospatial function and attention, all p < 0.05). In adjusted GEE models, lower baseline physical activity level significantly predicted overall cognitive decline over time (p=0.047), and declines in the subdomains of memory (p = 0.001) and executive function (p = 0.03).Conclusions: We identified reduced physical activity as a predictor of greater cognitive decline in ET. The identification of risk factors often assists clinicians in determining which patients are at higher risk of cognitive decline over time. Interventional studies, to determine whether increasing physical activity could modify the risk of developing cognitive decline in ET, may be warranted.

Do people with rheumatoid arthritis maintain their physical activity level at treatment onset over the first year of methotrexate therapy?

Objectives To describe how many people with rheumatoid arthritis (RA) reduce their baseline physical activity (PA) level over the first year of methotrexate (MTX) treatment, and which factors predict this. Methods Data came from the Rheumatoid Arthritis Medication Study (RAMS), a prospective cohort of people with early RA starting MTX. Participants reported demographics and completed questionnaires at baseline, six and 12 months, including reporting the number of days per week they performed ≥20 min of PA; coded as none, low (1–3 days) or high (4–7 days). The PA levels of participants over 12 months are described. Predictors of stopping PA were assessed using multivariable logistic regression. Results In total, 1468 participants were included (median [interquartile range] age: 60 [50, 69] years; 957 [65.2%] women). At baseline, the PA levels of the people with RA were: none = 408 (27.8%), low = 518 (35.3%), high = 542 (36.9%). 80% of participants maintained some PA or began PA between assessments (baseline to 6-months = 79.3%, 6-months to 12-months = 80.7%). 24.1% of participants reduced PA and 11.3% of participants stopped performing PA between baseline and 6-months (6-months to 12 months: 22.6% and 10.2% respectively). Baseline smoking, higher disability and greater socioeconomic deprivation were associated with stopping PA. Conclusion Many people with early RA were not performing PA when starting MTX, or stopped performing PA over the first year of treatment. These people may require interventions to stay active. These interventions need to be mindful of socioeconomic barriers to PA participation.

Physical Activity Improves Anxiety and Apathy in Early Parkinson's Disease: A Longitudinal Follow-Up Study

Objective: In a prospective study, we investigated the association between physical activity and various motor, non-motor outcomes, and quality of life in early Parkinson's disease (PD) participants in the PD Longitudinal Singapore Study.Background: Prospective studies that examined the association between physical activity and motor and non-motor domains in early PD are lacking.Methods: 121 PD participants were followed-up prospectively to evaluate the association of physical activity with various symptom domains. The Physical Activity Scale for the Elderly (PASE) was used to measure physical activity annually. PD-related symptoms were categorized by motor, non-motor, and quality of life measures. Multivariate regression with gain score analysis was performed to understand the association of baseline PASE scores with the change of each variable at 1-year follow-up.Results: Higher baseline PASE scores (greater activity) were associated with a younger age, lower MDS-UPDRS motor scores, a smaller levodopa equivalent daily dose, better attention and memory scores, and better QoL. Activity scores in early PD declined on follow-up. Multivariate analysis revealed higher baseline physical activity to be associated with decreased anxiety and apathy scores at 1-year follow-up, after adjusting for demographic variables and medications.Conclusion: We demonstrated that higher baseline physical activity was associated with improved anxiety and apathy symptoms in early PD over a 1-year period.

Abstract 13282: Patients With Peripheral Artery Disease Perceptions of an Ankle Foot Orthosis: A Comparison by Physical Activity Level

Introduction: Peripheral Artery Disease (PAD) restricts blood flow to the legs. Its most common manifestation is claudication, a severe impairment of physical activity produced by ischemia-related leg pain and tiredness during walking. We are conducting a trial to evaluate the possibility that an ankle foot orthosis could reduce claudication symptoms and increase the physical activity of patients with PAD. The perceptions of patients with PAD on wearing the ankle foot orthosis and how they vary by baseline physical activity level are unknown. Therefore, this study explored the perceptions of patients with PAD while using an ankle foot orthosis and if these perceptions varied by level of physical activity. Hypothesis: We hypothesize that those who are more physically active will perceive more benefits as a result of using the ankle foot orthosis. Methods: Participants (n=21) wore an ankle foot orthosis for 3 months. Baseline median step count was used to divide patients into high (n=10) or low (n=11) active groups. Semi-structured interviews were conducted at midpoint and post. Data were analyzed using a summative content analysis. Results: Patients averaged 3233 ± 1523 steps/day with a median of 3137 steps/day at baseline. 45% of participants’ initial responses described a positive perception of their time wearing the ankle foot orthosis. 71.4% of participants reported an overall positive impact of wearing the ankle foot orthosis, primarily being able to walk further. Comparison by baseline physical activity level revealed 36.4% of participants with low physical activity reported seeing improvements in daily tasks (walking in the grocery store) versus 10% of those with high physical activity. Conclusions: In conclusion, our interview data demonstrate that perceived quality of physical activity in patients with PAD improved with the use of the ankle foot orthosis. Contrary to our hypothesis, minimal differences in perceptions of ankle foot orthosis use were found between patients with low versus high baseline physical activity levels.