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Impact of APOE e4 on the association of physical activity and cognition in older adults with memory complaints
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Abstracts / Journal of Science and Medicine in Sport 15 (2012) S1–S33
56 Mediators of the relationship between sedentary behaviour and depressive symptoms amongst disadvantaged women M. Teychenne ∗ , S. Torres, J. Salmon, S. McNaughton, K. Ball Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Introduction: The association between sedentary behaviour (e.g. time spent sitting watching TV/using the computer) and physical health has been well documented, with increasing research focussing on the relationship between sedentary behaviour and poor mental health (e.g. depression). However, very little is known about the underlying factors that may explain the link between sedentary behaviour and risk of depression. The purpose of this study was to investigate the contribution of selected intrapersonal and social factors in mediating the relationship between sedentary behaviour and depressive symptoms among women. Methods: Cross-sectional survey data were provided by 4,065 women (aged 18–45). Women self-reported their sedentary behaviour (sitting time and screen time), depressive symptoms (CES-D 10), as well as a number of potential intrapersonal (weight status, leisure-time physical activity) and social (social cohesion, interpersonal trust, club membership) factors. Results: Multiple mediating analyses showed that women’s weight status, leisure-time physical activity and social cohesion partly explained the relationship between sitting time and increased risk of depression. Further, women’s weight status, social cohesion and interpersonal trust were shown to partly explain the relationship between screen time and increased risk of depression. Discussion: Acknowledging the cross-sectional nature of this study, these findings provide insights into explaining the link between sedentary behaviour and risk of depression. Specifically, findings suggest that there may be a number of underlying mechanisms at play to explain the increased risk of depression associated with greater time spent engaged in sedentary behaviour. The information may benefit the development of interventions targeting reductions in sedentary behaviour amongst women with depressive symptoms.
(n=8), community-based participants (n=8), inpatients only (n=4), or a combination (n=4). 17 studies constrained the sample to a particular diagnosis e.g. depression (n=9), a specific anxiety disorder (n=5), or schizophrenia (n=3); 7 studies included people across a range of diagnoses. Sample sizes ranged between 9 and 108 (mean=43; SD=31). Most interventions used aerobic exercise (n=9), walking only (n=4), or yoga (n=3), 10 allowed some choice in the exercise program. While not always identified, common exercise settings were hospital premises (n=8), or community gyms (n=5). Intervention duration ranged from 1–20 weeks, with the number of supervised sessions ranging from 1–7 per week. Activity programs tended to be supervised by e.g. an experienced instructor (n=10), mental health professional (n=4), or study personnel (n=4). Additional unsupervised exercise was required in 7 studies. 16 studies involved exercise in groups. Additional intervention program components included activity counselling (n=4), health seminars (n=2), individual exercise tailoring (n=2), providing exercise apparel (n=2), pairing with a staff exercise buddy (n=1), using family members to prompt exercise (n=1), and exercise monitoring by carers (n=1) or a psychologist (n=1). Incentives were used in 4 studies and included food vouchers, money or course credit. Attrition rates ranged from 0–44% (mean=17%; SD=12%). Reported rates of adherence ranged from 47% to 100% (mean=76%; SD=40%). Discussion: Most studies were group based aerobic physical activity interventions, with people with the same type of mental illness, in a hospital based or gym setting. Few studies have tailored program characteristics to participant preferences, offered programs with more physical activity options, or worked with heterogeneous patient groups. http://dx.doi.org/10.1016/j.jsams.2012.11.059 58 Impact of APOE e4 on the association of physical activity and cognition in older adults with memory complaints K. Cox 1,∗ , L. Flicker 1 , O. Almeida 1 , F. van Bockxmeer 1 , K. Greenop 2 , J. Hendriks 3 , M. Phillips 4 , N. Lautenschlager 5 1
University of Western Australia WA Child Health Institute 3 Cutin University 4 WA Institute of Medical Research 5 University of Melbourne 2
http://dx.doi.org/10.1016/j.jsams.2012.11.058 57 Characteristics of physical activity interventions for adults with mental illness: A review J. Chapman ∗ , W. Brown, N. Burton University of Queensland Introduction: Information on the characteristics of physical activity intervention studies can be used to suggest future directions in this area. The aim of this study was to examine the characteristics of physical activity intervention studies with adults with mental illness. Methods: A literature search was conducted to identify journal articles published up to February 2012 that described physical activity intervention studies with measured psychological outcomes in adults (18–70 y) with mental illness. Studies were excluded if the sample was restricted to participants with eating disorders, or if data collection was retrospective, qualitative, or focused on acute effects of exercise. Data were extracted on sample and intervention characteristics. Results: 24 unique studies met the inclusion criteria (18 RCTs, 6 pre/post). Study samples were comprised of outpatients only
Introduction: We have previously demonstrated that a 6month home-based physical activity (PA) program improves cognitive function in older adults with memory complaints. Posthoc analysis revealed that APOE e4 non-carriers benefitted more from the intervention than carriers. Aim: To investigate whether APOE e4 modifies the crosssectional association between PA and cognitive scores. Methods: Dementia-free participants with memory complaints (N=170) were recruited from memory clinics and the community to participate in a randomized controlled trial of PA. A pedometer worn for 7-days measured PA at baseline. We assessed memory and cognitive function with a battery of neuropsychological tests. APOE e4 genotype was determined using standard procedures. Demographic, lifestyle, medical, physical and psychological characteristics were determined. We examined the relationship between baseline cognitive measures and PA stratified according to the presence of the APOE e4 allele taking into account other measured factors in multiple regression models. Results: Mean age was 68.5 (±SD 8.6) years; 29% were doing 10,000 or more steps/day and 51% were women. Lower age (P<0.01) higher education (P<0.01) higher PA (P<0.01) and lower
Abstracts / Journal of Science and Medicine in Sport 15 (2012) S1–S33
waist/hip ratio (P<0.05) were associated with higher memory scores (word list immediate recall from the Cognitive battery of the Consortium to Establish Register for Alzheimer’s disease). Higher education (P<0.01) higher PA (P<0.001) and being an APOE e4 allele non-carrier (P<0.05) were associated with a better cognitive and functional level (CDR sum of boxes, Clinical Dementia Rating). Lower age (P<0.001), no family history of neurological conditions (P<0.05) and higher PA level were associated with a higher score on a global measure of cognition (Mini Mental State Examination–MMSE). This model showed a significant interaction of PA and APOE e4 (P<0.05) with the PA effect for APOE e4 allele non-carriers being three-fold that of carriers. Discussion: Higher level of PA was consistently associated with better cognitive and functional level. The APOE e4 genotype attenuated the effect of PA on cognition and function suggesting that genetic factors might impact on the beneficial effects of PA. Identifying those who are likely to benefit the most from PA interventions may enhance the effectiveness of interventions. It will also enable more targeted combined interventions to be designed for those individuals less likely to achieve the benefits of PA alone. http://dx.doi.org/10.1016/j.jsams.2012.11.060 59 Dose-response relationship between cardiorespiratory fitness and morbidity/mortality: a systematic review and meta-analysis S. Sawada 1,∗ , M. Miyachi 2 , H. Murakami 2 , R. Kawakami 2 , S. Tanaka 3 , K. Ishikawa-Takata 4 , I. Tabata 5 , Y. Oida 6 , Y. Oguma 7 , N. Miyatake 8 , T. Okamoto 1 , K. Tsukamoto 1 , H. Tanaka 9 , I. Lee 10 , S. Blair 11 1
Health Promotion Center, Tokyo Gas Co Ltd, Tokyo, Japan 2 Department of Health Promotion and Exercise, National Institute of Health and Nutrition, Tokyo, Japan 3 Department of Nutritional Science, National Institute of Health and Nutrition, Tokyo, Japan 4 Department of Nutritional Education, National Institute of Health and Nutrition, Tokyo, Japan 5 Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan 6 School of Life Science and Technology, Chukyo University, Aichi, Japan 7 Sports Medicine Research Center, Keio University, Kanagawa, Japan 8 Faculty of Medicine, Kagawa University, Kagawa, Japan 9 Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan 10 Department of Epidemiology, Harvard School of Public Health, USA 11 Department of Exercise Science, Arnold School of Public Health, University of South Carolina, USA Introduction: A low level of cardiorespiratory fitness is associated with higher risk of several types of morbidity and mortality. In 2006, Japan’s Ministry of Health, Labour and Welfare published “Exercise and Physical Activity Reference for Health Promotion 2006”. This report showed reference values and ranges of maximal oxygen uptake for health promotion. However, there are few epidemiological studies that have investigated the relationship between these values and ranges in relation to morbidity and mortality. Thus, we performed a systematic review and meta-analysis to assess the dose-response relationship between cardiorespiratory fitness and several types of morbidity as well as all-cause mortality risk reduction for men under 60 years of age in the general population. Furthermore, we evaluated the reference values and ranges using the pooled dose-response regression equation.
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Methods: We did electronic searches in the PubMed and the ICHUSI, which is the largest medical database in Japan, and manual searching of reference lists until March 2011. We searched for papers to identify prospective cohort studies investigating cardiorespiratory fitness and non-communicable diseases (NCD–obesity, metabolic syndrome, hypertension, dyslipidemia, diabetes, stroke, heart disease, cancer, osteoporosis, dementia et al.) morbidity and all-cause mortality among males. We used meta-regression analysis for trend estimation to derive pooled dose-response estimates, and random-effects meta-analysis to estimate risk reduction in each cardiorespiratory fitness category. Results: Thirty one cohort studies were included in the overall analysis, which incorporated 428,279 participants free of NCD at baseline. The pooled linear regression equation was log y=-0.05615 -0.03154 METs (P<0.001). This equation indicates that 1 MET increment of cardiorespiratory fitness is associated with a 3.1% lower risk of NCD morbidity and mortality. In categorical analyses, individuals who had 10.9 METs (nearly reference value of 2006 guidelines for 40 to 49 years old males) had a 34% lower risk of NCD morbidity and mortality (relative risk, 0.66; 95% confidence interval, 0.62 to 0.70) compared with lowest fitness value (8.2 METs). Discussion: These results show that there is a significant dose-response relationship between cardiorespiratory fitness and morbidity/mortality among men. Men in the upper range of the reference values of maximal oxygen uptake for health promotion have a lower relative risk. http://dx.doi.org/10.1016/j.jsams.2012.11.061 60 Low dose physical activity attenuates cardiovascular disease mortality in men and women with clustered metabolic risk factors M. Hamer 1,2 , E. Stamatakis 1,2,∗ 1 University College London, Department of Epidemiology and Public Health 2 University College London, Population Health Domain Physical Activity Research Group (UCL-PARG)
Introduction: Physical activity may ameliorate the health hazards of metabolic disorders but evidence is inconclusive, and estimates of the minimal threshold for protection remain unknown. Methods: The sample comprised 23,747 men and women (aged 54.1±[SD 12.7 yrs], 45.2% men) without known history of CVD at baseline who were drawn from the Health Survey for England and the Scottish Health Survey. Based on blood pressure, HDL-cholesterol, diabetes, waist circumference, and low grade inflammation (C-reactive protein ≥3 mg/l), participants were classified as metabolically healthy (0 or 1 metabolic abnormality) or unhealthy (≥2 metabolic abnormalities). Self-reported weekly frequency of physical activity of moderate to vigorous intensity (including but not limited to walking for any purpose, cycling for any purpose, team sports, racquet sports, fitness club/gym-based activities, aerobics, dancing, golf, and running) was assessed at baseline. Cox proportional hazards models were used to examine the association of clustered metabolic risk and physical activity with mortality, controlling for age, sex, smoking, socioeconomic group, CVD medication, and self- rated health. Results: Over 7.0±3.0 years follow up there were 2264 all-cause and 717 CVD deaths, respectively. A physical activity threshold of at least one session per week (lasting for at least 30 minutes for walking or for at least 15 minutes for cycling and other sports/exercise modes) was found to provide protection against mortality, for
Abstracts / Journal of Science and Medicine in Sport 15 (2012) S1–S33
56 Mediators of the relationship between sedentary behaviour and depressive symptoms amongst disadvantaged women M. Teychenne ∗ , S. Torres, J. Salmon, S. McNaughton, K. Ball Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Introduction: The association between sedentary behaviour (e.g. time spent sitting watching TV/using the computer) and physical health has been well documented, with increasing research focussing on the relationship between sedentary behaviour and poor mental health (e.g. depression). However, very little is known about the underlying factors that may explain the link between sedentary behaviour and risk of depression. The purpose of this study was to investigate the contribution of selected intrapersonal and social factors in mediating the relationship between sedentary behaviour and depressive symptoms among women. Methods: Cross-sectional survey data were provided by 4,065 women (aged 18–45). Women self-reported their sedentary behaviour (sitting time and screen time), depressive symptoms (CES-D 10), as well as a number of potential intrapersonal (weight status, leisure-time physical activity) and social (social cohesion, interpersonal trust, club membership) factors. Results: Multiple mediating analyses showed that women’s weight status, leisure-time physical activity and social cohesion partly explained the relationship between sitting time and increased risk of depression. Further, women’s weight status, social cohesion and interpersonal trust were shown to partly explain the relationship between screen time and increased risk of depression. Discussion: Acknowledging the cross-sectional nature of this study, these findings provide insights into explaining the link between sedentary behaviour and risk of depression. Specifically, findings suggest that there may be a number of underlying mechanisms at play to explain the increased risk of depression associated with greater time spent engaged in sedentary behaviour. The information may benefit the development of interventions targeting reductions in sedentary behaviour amongst women with depressive symptoms.
(n=8), community-based participants (n=8), inpatients only (n=4), or a combination (n=4). 17 studies constrained the sample to a particular diagnosis e.g. depression (n=9), a specific anxiety disorder (n=5), or schizophrenia (n=3); 7 studies included people across a range of diagnoses. Sample sizes ranged between 9 and 108 (mean=43; SD=31). Most interventions used aerobic exercise (n=9), walking only (n=4), or yoga (n=3), 10 allowed some choice in the exercise program. While not always identified, common exercise settings were hospital premises (n=8), or community gyms (n=5). Intervention duration ranged from 1–20 weeks, with the number of supervised sessions ranging from 1–7 per week. Activity programs tended to be supervised by e.g. an experienced instructor (n=10), mental health professional (n=4), or study personnel (n=4). Additional unsupervised exercise was required in 7 studies. 16 studies involved exercise in groups. Additional intervention program components included activity counselling (n=4), health seminars (n=2), individual exercise tailoring (n=2), providing exercise apparel (n=2), pairing with a staff exercise buddy (n=1), using family members to prompt exercise (n=1), and exercise monitoring by carers (n=1) or a psychologist (n=1). Incentives were used in 4 studies and included food vouchers, money or course credit. Attrition rates ranged from 0–44% (mean=17%; SD=12%). Reported rates of adherence ranged from 47% to 100% (mean=76%; SD=40%). Discussion: Most studies were group based aerobic physical activity interventions, with people with the same type of mental illness, in a hospital based or gym setting. Few studies have tailored program characteristics to participant preferences, offered programs with more physical activity options, or worked with heterogeneous patient groups. http://dx.doi.org/10.1016/j.jsams.2012.11.059 58 Impact of APOE e4 on the association of physical activity and cognition in older adults with memory complaints K. Cox 1,∗ , L. Flicker 1 , O. Almeida 1 , F. van Bockxmeer 1 , K. Greenop 2 , J. Hendriks 3 , M. Phillips 4 , N. Lautenschlager 5 1
University of Western Australia WA Child Health Institute 3 Cutin University 4 WA Institute of Medical Research 5 University of Melbourne 2
http://dx.doi.org/10.1016/j.jsams.2012.11.058 57 Characteristics of physical activity interventions for adults with mental illness: A review J. Chapman ∗ , W. Brown, N. Burton University of Queensland Introduction: Information on the characteristics of physical activity intervention studies can be used to suggest future directions in this area. The aim of this study was to examine the characteristics of physical activity intervention studies with adults with mental illness. Methods: A literature search was conducted to identify journal articles published up to February 2012 that described physical activity intervention studies with measured psychological outcomes in adults (18–70 y) with mental illness. Studies were excluded if the sample was restricted to participants with eating disorders, or if data collection was retrospective, qualitative, or focused on acute effects of exercise. Data were extracted on sample and intervention characteristics. Results: 24 unique studies met the inclusion criteria (18 RCTs, 6 pre/post). Study samples were comprised of outpatients only
Introduction: We have previously demonstrated that a 6month home-based physical activity (PA) program improves cognitive function in older adults with memory complaints. Posthoc analysis revealed that APOE e4 non-carriers benefitted more from the intervention than carriers. Aim: To investigate whether APOE e4 modifies the crosssectional association between PA and cognitive scores. Methods: Dementia-free participants with memory complaints (N=170) were recruited from memory clinics and the community to participate in a randomized controlled trial of PA. A pedometer worn for 7-days measured PA at baseline. We assessed memory and cognitive function with a battery of neuropsychological tests. APOE e4 genotype was determined using standard procedures. Demographic, lifestyle, medical, physical and psychological characteristics were determined. We examined the relationship between baseline cognitive measures and PA stratified according to the presence of the APOE e4 allele taking into account other measured factors in multiple regression models. Results: Mean age was 68.5 (±SD 8.6) years; 29% were doing 10,000 or more steps/day and 51% were women. Lower age (P<0.01) higher education (P<0.01) higher PA (P<0.01) and lower
Abstracts / Journal of Science and Medicine in Sport 15 (2012) S1–S33
waist/hip ratio (P<0.05) were associated with higher memory scores (word list immediate recall from the Cognitive battery of the Consortium to Establish Register for Alzheimer’s disease). Higher education (P<0.01) higher PA (P<0.001) and being an APOE e4 allele non-carrier (P<0.05) were associated with a better cognitive and functional level (CDR sum of boxes, Clinical Dementia Rating). Lower age (P<0.001), no family history of neurological conditions (P<0.05) and higher PA level were associated with a higher score on a global measure of cognition (Mini Mental State Examination–MMSE). This model showed a significant interaction of PA and APOE e4 (P<0.05) with the PA effect for APOE e4 allele non-carriers being three-fold that of carriers. Discussion: Higher level of PA was consistently associated with better cognitive and functional level. The APOE e4 genotype attenuated the effect of PA on cognition and function suggesting that genetic factors might impact on the beneficial effects of PA. Identifying those who are likely to benefit the most from PA interventions may enhance the effectiveness of interventions. It will also enable more targeted combined interventions to be designed for those individuals less likely to achieve the benefits of PA alone. http://dx.doi.org/10.1016/j.jsams.2012.11.060 59 Dose-response relationship between cardiorespiratory fitness and morbidity/mortality: a systematic review and meta-analysis S. Sawada 1,∗ , M. Miyachi 2 , H. Murakami 2 , R. Kawakami 2 , S. Tanaka 3 , K. Ishikawa-Takata 4 , I. Tabata 5 , Y. Oida 6 , Y. Oguma 7 , N. Miyatake 8 , T. Okamoto 1 , K. Tsukamoto 1 , H. Tanaka 9 , I. Lee 10 , S. Blair 11 1
Health Promotion Center, Tokyo Gas Co Ltd, Tokyo, Japan 2 Department of Health Promotion and Exercise, National Institute of Health and Nutrition, Tokyo, Japan 3 Department of Nutritional Science, National Institute of Health and Nutrition, Tokyo, Japan 4 Department of Nutritional Education, National Institute of Health and Nutrition, Tokyo, Japan 5 Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan 6 School of Life Science and Technology, Chukyo University, Aichi, Japan 7 Sports Medicine Research Center, Keio University, Kanagawa, Japan 8 Faculty of Medicine, Kagawa University, Kagawa, Japan 9 Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan 10 Department of Epidemiology, Harvard School of Public Health, USA 11 Department of Exercise Science, Arnold School of Public Health, University of South Carolina, USA Introduction: A low level of cardiorespiratory fitness is associated with higher risk of several types of morbidity and mortality. In 2006, Japan’s Ministry of Health, Labour and Welfare published “Exercise and Physical Activity Reference for Health Promotion 2006”. This report showed reference values and ranges of maximal oxygen uptake for health promotion. However, there are few epidemiological studies that have investigated the relationship between these values and ranges in relation to morbidity and mortality. Thus, we performed a systematic review and meta-analysis to assess the dose-response relationship between cardiorespiratory fitness and several types of morbidity as well as all-cause mortality risk reduction for men under 60 years of age in the general population. Furthermore, we evaluated the reference values and ranges using the pooled dose-response regression equation.
S25
Methods: We did electronic searches in the PubMed and the ICHUSI, which is the largest medical database in Japan, and manual searching of reference lists until March 2011. We searched for papers to identify prospective cohort studies investigating cardiorespiratory fitness and non-communicable diseases (NCD–obesity, metabolic syndrome, hypertension, dyslipidemia, diabetes, stroke, heart disease, cancer, osteoporosis, dementia et al.) morbidity and all-cause mortality among males. We used meta-regression analysis for trend estimation to derive pooled dose-response estimates, and random-effects meta-analysis to estimate risk reduction in each cardiorespiratory fitness category. Results: Thirty one cohort studies were included in the overall analysis, which incorporated 428,279 participants free of NCD at baseline. The pooled linear regression equation was log y=-0.05615 -0.03154 METs (P<0.001). This equation indicates that 1 MET increment of cardiorespiratory fitness is associated with a 3.1% lower risk of NCD morbidity and mortality. In categorical analyses, individuals who had 10.9 METs (nearly reference value of 2006 guidelines for 40 to 49 years old males) had a 34% lower risk of NCD morbidity and mortality (relative risk, 0.66; 95% confidence interval, 0.62 to 0.70) compared with lowest fitness value (8.2 METs). Discussion: These results show that there is a significant dose-response relationship between cardiorespiratory fitness and morbidity/mortality among men. Men in the upper range of the reference values of maximal oxygen uptake for health promotion have a lower relative risk. http://dx.doi.org/10.1016/j.jsams.2012.11.061 60 Low dose physical activity attenuates cardiovascular disease mortality in men and women with clustered metabolic risk factors M. Hamer 1,2 , E. Stamatakis 1,2,∗ 1 University College London, Department of Epidemiology and Public Health 2 University College London, Population Health Domain Physical Activity Research Group (UCL-PARG)
Introduction: Physical activity may ameliorate the health hazards of metabolic disorders but evidence is inconclusive, and estimates of the minimal threshold for protection remain unknown. Methods: The sample comprised 23,747 men and women (aged 54.1±[SD 12.7 yrs], 45.2% men) without known history of CVD at baseline who were drawn from the Health Survey for England and the Scottish Health Survey. Based on blood pressure, HDL-cholesterol, diabetes, waist circumference, and low grade inflammation (C-reactive protein ≥3 mg/l), participants were classified as metabolically healthy (0 or 1 metabolic abnormality) or unhealthy (≥2 metabolic abnormalities). Self-reported weekly frequency of physical activity of moderate to vigorous intensity (including but not limited to walking for any purpose, cycling for any purpose, team sports, racquet sports, fitness club/gym-based activities, aerobics, dancing, golf, and running) was assessed at baseline. Cox proportional hazards models were used to examine the association of clustered metabolic risk and physical activity with mortality, controlling for age, sex, smoking, socioeconomic group, CVD medication, and self- rated health. Results: Over 7.0±3.0 years follow up there were 2264 all-cause and 717 CVD deaths, respectively. A physical activity threshold of at least one session per week (lasting for at least 30 minutes for walking or for at least 15 minutes for cycling and other sports/exercise modes) was found to provide protection against mortality, for