Archives of Gerontology and Geriatrics 58 (2014) 320–326
Contents lists available at ScienceDirect
Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger
Walking habits and health-related factors in 75-year-old Iranian women and men Zahra Mosallanezhad a,b,c,*, Mahyar Salavati b, Gholam Reza Sotoudeh d, Lena Nilsson Wikmar a, Kerstin Fra¨ndin a,e a
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran d Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden e Department of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden b c
A R T I C L E I N F O
A B S T R A C T
Article history: Received 17 April 2013 Received in revised form 21 November 2013 Accepted 21 November 2013 Available online 1 December 2013
An active life style can postpone the aging process, prevent many aspects of functional decline and improve health and quality of life. The aim of this study was to compare elderly people who walked at least 30 min a day with others who walked less, from a gender perspective, regarding perceived health and fitness, physiological capacity and functional performance. A representative sample of 75-year-olds born 1932–33 and living in Tehran, in 2007–2008 was included by randomly selecting 1100 subjects from the latest Iranian census records (1996) by the Statistical Centre of Iran using computerized methods. Participants answered questions regarding health status and physical activity and performed functional tests. Better results for Walkers were observed in most subjective and objective outcome measures. Walkers were less likely to feel generally tired, more likely to have better physical fitness and to have the maximum score on the Falls Efficacy Scale, less likely to feel unstable during walking outdoors and less likely to be dependent or unsafe in ADL. Walkers of both genders performed better in the following tests: chair stand, one leg stance, maximal walking speed and six min walking. The difference between Walkers and Non-Walkers was greater in men. In general, older women and men who walked at least 30 min daily/almost daily showed better results in most health-related outcomes, ADL and functional performance than people who walked less. This study showed gender differences in the level of physical activity and functioning that must be taken into account when planning intervention programs. ß 2013 Elsevier Ireland Ltd. All rights reserved.
Keywords: Walking habits Old people Aging Physical activity Physical function Health
1. Introduction The great increase in life expectancy is considered to be a success story for public health policies and socioeconomic development, but it also challenges society to adapt in order to maximize health and functional capacity in older people as well as their social participation and security (Kinsella & Phillips, 2012). The risk of developing disability increases with age. Based on estimates by WHO (World Health Organization, 2003, 2006), 20% of persons older than 70 years and 50% over 85 have some form of
* Corresponding author at: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 231 00, SE 141 83 Huddinge, Sweden. Tel.: +46 8 524 862 40; fax: +46 8 524 888 13. E-mail address: [email protected] (Z. Mosallanezhad). 0167-4943/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2013.11.008
disability. Considering the rate of disability, the age of 75 is viewed as the starting point of old age (World Health Organization, 2003, 2006). Heterogenic characteristics of old people, varying healthrelated behavior and socio-economic circumstances among nations lead to different rates of disability worldwide. For example, there is a decline regarding severe disability in the US, Italy and the Netherlands, status quo in Australia and Canada but an increase in Sweden and Japan (Manton, 2008; OECD Indicators, 2009). The proportion of older people in Iran is now about 7%, but it is increasing rapidly and is predicted to reach 10.5% in 2025 and 22% in 2050. Life expectancy is estimated to be age 74 for women and 70 for men (United Nations World Population Ageing, 2012). Results from previous studies on older Iranian people show a relatively low health status, high prevalence of functional impairment and poor health-related quality of life especially among women (Tajvar, Arab, & Montazeri, 2008). A recent
Z. Mosallanezhad et al. / Archives of Gerontology and Geriatrics 58 (2014) 320–326
comparison study (Mosallanezhad, Ho¨rder, Salavati, NilssonWikmar, & Fra¨ndin, 2012) showed that Iranian 75-year olds had worse physical health, worse physical function and a lower physical activity level compared to their Swedish peers (Tajvar et al., 2008). This emphasizes the necessity of drawing attention to the old population in Iran and of developing strategies to promote health, functioning and quality of life in this group. In recent decades, a great number of studies on aging have shown that an active life style can postpone the aging process, prevent many aspects of functional decline and improve health and quality of life (Brandon, Boyette, Lloyd, & Gaasch, 2004; Fiatarone Singh, 2002; Hillsdon, Brunner, Guralnik, & Marmot, 2005; Leveille, Guralnik, Ferrucci, & Langlois, 1999; Vincent, Braith, Feldman, Kallas, & Lowenthal, 2002). Regular and adequate physical activity has been demonstrated to improve physiological aspects such as maximal aerobic capacity (Vincent et al., 2002), muscle strength (Morganti et al., 1995), coordination and balance function (Barnett, Smith, Lord, Williams, & Baumand, 2003) and walking speed (Lopopolo, Greco, Sullivan, Craik, & Mangione, 2006). It can also prevent diseases such as cardiovascular insufficiency (Myoclinic, 2012), type 2 diabetes (Brandon, Gaasch, Boyette, & Lloyd, 2003), osteoporosis (Allen & Morelli, 2011), and cancer (Newton & Galva˜o, 2008), as well as mental disturbances such as depression and even cognitive decline (Erickson & Kramer, 2009). Current recommendations, supported by WHO and the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), include moderate-intensity exercise, like walks, for a minimum of 30 min five days a week, or vigorous-intensity exercise for a minimum of 20 min three days a week (Haskell et al., 2007). The present study forms part of an international comparison study on health, physical activity patterns and physical functioning in community-dwelling older adults living in Iran and Sweden. The aim of this study, located in Iran, was to compare persons who walked at least 30 min a day with others who walked less, from a gender perspective, regarding perceived health and fitness, physiological capacity and functional performance. 2. Methods 2.1. Participants A representative sample of 75-year-olds born 1932–33 and living in Tehran, Iran, 2007–2008 was included by randomly selecting 1100 subjects from the latest Iranian census records (1996) by the Centre of Statistics in Iran using computerized methods. The sample size was based on an expected drop-out rate of about 20%. All elderly people of this randomly selected sample could be included in the study, but subjects with severe functional disability (not able to fulfill the most of functional tests) and/or communication deficits (not able to communicate) were excluded from the study. Unintentionally, the sample obtained for this study only included people living in private households. Finally, the study sample included 851 subjects, 395 women and 456 men (Fig. 1). 2.2. Procedure The participants were invited to take part in interviews and test sessions through telephone calls. Instruments and questionnaires that had been used in the Swedish study, one of the longitudinal Gerontological and Geriatric Population Studies in Gothenburg, H70 (Eriksson, Mellstro¨m, & Svanborg, 1987), were selected. A standard method of forward/backward translation was used to provide a Persian version (Mosallanezhad et al., 2011). Interviews and objective tests of functional capacity were carried out by a physiotherapist.
321
Fig. 1. Flowchart indicating the procedure for recruiting the 75-year-old participants in Tehran, Iran.
2.3. Ethics The study was approved by the Ethics Committee of the Ministry of Health, Treatment and Medical Education, Tehran, Iran. Informed consent was obtained from each participant at the time of administration. 2.4. Data collection 2.4.1. Subjective measures Participants were asked about background data including overall years of education, job status, marital status and number of children. To evaluate health-related behavior, they were asked to determine their walking habits, physical activity level and smoking habits. Walking habits were defined based on walking days per week (daily/almost daily, 3–4 days a week, 1–2 days a week, almost never or never) and the general duration of the walks (
Contents lists available at ScienceDirect
Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger
Walking habits and health-related factors in 75-year-old Iranian women and men Zahra Mosallanezhad a,b,c,*, Mahyar Salavati b, Gholam Reza Sotoudeh d, Lena Nilsson Wikmar a, Kerstin Fra¨ndin a,e a
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran d Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden e Department of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden b c
A R T I C L E I N F O
A B S T R A C T
Article history: Received 17 April 2013 Received in revised form 21 November 2013 Accepted 21 November 2013 Available online 1 December 2013
An active life style can postpone the aging process, prevent many aspects of functional decline and improve health and quality of life. The aim of this study was to compare elderly people who walked at least 30 min a day with others who walked less, from a gender perspective, regarding perceived health and fitness, physiological capacity and functional performance. A representative sample of 75-year-olds born 1932–33 and living in Tehran, in 2007–2008 was included by randomly selecting 1100 subjects from the latest Iranian census records (1996) by the Statistical Centre of Iran using computerized methods. Participants answered questions regarding health status and physical activity and performed functional tests. Better results for Walkers were observed in most subjective and objective outcome measures. Walkers were less likely to feel generally tired, more likely to have better physical fitness and to have the maximum score on the Falls Efficacy Scale, less likely to feel unstable during walking outdoors and less likely to be dependent or unsafe in ADL. Walkers of both genders performed better in the following tests: chair stand, one leg stance, maximal walking speed and six min walking. The difference between Walkers and Non-Walkers was greater in men. In general, older women and men who walked at least 30 min daily/almost daily showed better results in most health-related outcomes, ADL and functional performance than people who walked less. This study showed gender differences in the level of physical activity and functioning that must be taken into account when planning intervention programs. ß 2013 Elsevier Ireland Ltd. All rights reserved.
Keywords: Walking habits Old people Aging Physical activity Physical function Health
1. Introduction The great increase in life expectancy is considered to be a success story for public health policies and socioeconomic development, but it also challenges society to adapt in order to maximize health and functional capacity in older people as well as their social participation and security (Kinsella & Phillips, 2012). The risk of developing disability increases with age. Based on estimates by WHO (World Health Organization, 2003, 2006), 20% of persons older than 70 years and 50% over 85 have some form of
* Corresponding author at: Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 231 00, SE 141 83 Huddinge, Sweden. Tel.: +46 8 524 862 40; fax: +46 8 524 888 13. E-mail address: [email protected] (Z. Mosallanezhad). 0167-4943/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2013.11.008
disability. Considering the rate of disability, the age of 75 is viewed as the starting point of old age (World Health Organization, 2003, 2006). Heterogenic characteristics of old people, varying healthrelated behavior and socio-economic circumstances among nations lead to different rates of disability worldwide. For example, there is a decline regarding severe disability in the US, Italy and the Netherlands, status quo in Australia and Canada but an increase in Sweden and Japan (Manton, 2008; OECD Indicators, 2009). The proportion of older people in Iran is now about 7%, but it is increasing rapidly and is predicted to reach 10.5% in 2025 and 22% in 2050. Life expectancy is estimated to be age 74 for women and 70 for men (United Nations World Population Ageing, 2012). Results from previous studies on older Iranian people show a relatively low health status, high prevalence of functional impairment and poor health-related quality of life especially among women (Tajvar, Arab, & Montazeri, 2008). A recent
Z. Mosallanezhad et al. / Archives of Gerontology and Geriatrics 58 (2014) 320–326
comparison study (Mosallanezhad, Ho¨rder, Salavati, NilssonWikmar, & Fra¨ndin, 2012) showed that Iranian 75-year olds had worse physical health, worse physical function and a lower physical activity level compared to their Swedish peers (Tajvar et al., 2008). This emphasizes the necessity of drawing attention to the old population in Iran and of developing strategies to promote health, functioning and quality of life in this group. In recent decades, a great number of studies on aging have shown that an active life style can postpone the aging process, prevent many aspects of functional decline and improve health and quality of life (Brandon, Boyette, Lloyd, & Gaasch, 2004; Fiatarone Singh, 2002; Hillsdon, Brunner, Guralnik, & Marmot, 2005; Leveille, Guralnik, Ferrucci, & Langlois, 1999; Vincent, Braith, Feldman, Kallas, & Lowenthal, 2002). Regular and adequate physical activity has been demonstrated to improve physiological aspects such as maximal aerobic capacity (Vincent et al., 2002), muscle strength (Morganti et al., 1995), coordination and balance function (Barnett, Smith, Lord, Williams, & Baumand, 2003) and walking speed (Lopopolo, Greco, Sullivan, Craik, & Mangione, 2006). It can also prevent diseases such as cardiovascular insufficiency (Myoclinic, 2012), type 2 diabetes (Brandon, Gaasch, Boyette, & Lloyd, 2003), osteoporosis (Allen & Morelli, 2011), and cancer (Newton & Galva˜o, 2008), as well as mental disturbances such as depression and even cognitive decline (Erickson & Kramer, 2009). Current recommendations, supported by WHO and the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), include moderate-intensity exercise, like walks, for a minimum of 30 min five days a week, or vigorous-intensity exercise for a minimum of 20 min three days a week (Haskell et al., 2007). The present study forms part of an international comparison study on health, physical activity patterns and physical functioning in community-dwelling older adults living in Iran and Sweden. The aim of this study, located in Iran, was to compare persons who walked at least 30 min a day with others who walked less, from a gender perspective, regarding perceived health and fitness, physiological capacity and functional performance. 2. Methods 2.1. Participants A representative sample of 75-year-olds born 1932–33 and living in Tehran, Iran, 2007–2008 was included by randomly selecting 1100 subjects from the latest Iranian census records (1996) by the Centre of Statistics in Iran using computerized methods. The sample size was based on an expected drop-out rate of about 20%. All elderly people of this randomly selected sample could be included in the study, but subjects with severe functional disability (not able to fulfill the most of functional tests) and/or communication deficits (not able to communicate) were excluded from the study. Unintentionally, the sample obtained for this study only included people living in private households. Finally, the study sample included 851 subjects, 395 women and 456 men (Fig. 1). 2.2. Procedure The participants were invited to take part in interviews and test sessions through telephone calls. Instruments and questionnaires that had been used in the Swedish study, one of the longitudinal Gerontological and Geriatric Population Studies in Gothenburg, H70 (Eriksson, Mellstro¨m, & Svanborg, 1987), were selected. A standard method of forward/backward translation was used to provide a Persian version (Mosallanezhad et al., 2011). Interviews and objective tests of functional capacity were carried out by a physiotherapist.
321
Fig. 1. Flowchart indicating the procedure for recruiting the 75-year-old participants in Tehran, Iran.
2.3. Ethics The study was approved by the Ethics Committee of the Ministry of Health, Treatment and Medical Education, Tehran, Iran. Informed consent was obtained from each participant at the time of administration. 2.4. Data collection 2.4.1. Subjective measures Participants were asked about background data including overall years of education, job status, marital status and number of children. To evaluate health-related behavior, they were asked to determine their walking habits, physical activity level and smoking habits. Walking habits were defined based on walking days per week (daily/almost daily, 3–4 days a week, 1–2 days a week, almost never or never) and the general duration of the walks (
