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Epidemiol Health > Accepted Articles Original article Epidemiology and Health 2022;e2022026. DOI: https://doi.org/10.4178/epih.e2022026 [Accepted] Published online Feb 21, 2022. The medium-term consequences of COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary, cardiovascular, and musculoskeletal-diseases, depression, and cancer Irene Rodríguez-Gómez1 , Coral Sánchez-Martín1 , Francisco J. García-García2 , Esther García-Esquinas3 , Marta Miret4 , Germán Vicente-Rodriguez5 , Narcís Gusi6 , Asier Mañas7 , José A. Carnicero8 , Marcela Gonzalez-Gross9 , José L. Ayuso-Mateos10 , Fernando Rodríguez-Artalejo11 , Leocadio Rodríguez-Mañas12 , Ignacio Ara Royo1 1Universidad de Castilla-La Mancha, Toledo, Spain 2Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain 3Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Korea 4Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain 5Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain 6Instituto Internacional de Investigación e Innovación en Envejecimiento, Universidad de Extremadura, Cáceres, Spain 7Universidad de Castilla-La Mancha, Toledo, Spain 8University Hospital. Getafe, Spain, Getafe, Spain 9ImFINE Research Group, Universidad Politécnica de Madrid. , Madrid, Spain 10Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid , Madrid, Spain 11Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain 12University Hospital. Getafe, Spain, Getafe, Spain Correspondence Ignacio Ara Royo ,Email: Ignacio.Ara@uclm.es Received: Oct 14, 2021 Accepted after revision: Feb 21, 2022 Abstract Objectives: To assess the influence of different chronic diseases on lifestyle and health behaviours changes after COVID-19 lockdown in Spanish older people compared to people without these diseases and compare the differences in these changes between both periods. Method: 1092 participants (80.3±5.6y;66.5%women) from two Spanish cohorts were included. Telephone-based questionaries were used to evaluate health risk behaviours and lifestyle during lockdown and 7-months later. Self-reported physician-based diagnosis of chronic diseases was also reported. Cox-proportional models adjusted for main confounders were applied. Results: Improvements concerning lifestyle were found in older people with chronic diseases, although they worsened the physical component (except cancer). When they were compared to those without these diseases, hypertension was associated with a lower frequency of increased alcohol consumption (Hazard ratio:0.73[95% confidence interval:0.55;0.99]). Pulmonary diseases were associated with a lower risk of both decreased sedentary time (0.58[0.39;0.86]) and worsening sleep quality (0.56[0.36;0.87]), while CVD was only associated with a lower frequency of decreased sedentary time (0.58[0.38;0.88]). Depression was linked to a higher risk of increasing diet quality (1.53[1.00;2.36]). Cancer was less likely to worsen sleep quality (0.44[0.22;0.89]), but more likely to worsen their social contact frequency (2.05[1.05;3.99]). No significant association related to musculoskeletal diseases. Conclusions: Beneficial changes in health risk behaviours and lifestyle after the COVID-19 lockdown in older people with chronic diseases were found. Particularly, older people with hypertension, pulmonary disease and cancer showed beneficial changes after lockdown compared to their counterparts without diseases. Those with CVD and depression showed lifestyles that could involve a health risk.

The purposes of this study were: (i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; (ii) to provide cut-of points for low relative STS power (STSrel), (iii) to provide normative data for well functioning older adults and (iv) to assess the association of low STSrel with negative outcomes. Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used. Among men, STSrel showed a negative association with age up to the age of 85 years (− 1.2 to − 1.4%year−1; p < 0.05). In women, a negative association with age was observed throughout the old adult life (− 1.2 to − 2.0%year−1; p < 0.001). Cut-of values for low STSrel were 2.5W ­kg−1 in men and 1.9W ­kg−1 in women. Low STSrel was associated with frailty (OR [95% CI] = 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR [95% CI] = 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR [95% CI] = 6.9 [4.5, 10.5]) low HGS (OR [95% CI] = 2.9 [2.0, 4.1]), disability in activities of daily living (OR [95% CI] = 2.1 [1.4, 3.2]), and low quality of life (OR [95%CI] = 1.7 [1.2, 2.4]) in women. STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-of points can be used as a clinical tool to identify low STSrel among older adults.

Frailty syndrome is a condition of increased vulnerability related to aging that leads to a number of adverse health outcomes, including disability, falls, hospitalization, and death. Due to the high pre-frailty and frailty prevalence and the world's population aging, the prevention and reduction of this syndrome is one of the most crucial challenges facing public health authorities. Reducing the levels of sedentary behaviour and increasing physical activity have been recognized to be key strategies for achieving healthy aging. However, there is a lack of evidence regarding the relationship between sedentary behaviour and physical activity with frailty. Therefore, the general aim of this PhD thesis was to study the role that objectively measured sedentary and physical activity patterns specifically plays in frailty. Methods The present PhD thesis is composed by 7 studies. The systematic review (study 1) was conducted and reported in accordance with the PRISMA statement using PubMed and Web of Science online databases. The participants of the observational studies were taken from the Toledo Study for Healthy Aging (TSHA). For studies 2 and 3, data were collected from wave 2 with a total subsample of 519 participants finally included. For studies 4 and 5, data were collected from wave 2 and 3 with a total subsample of 771 participants with a single assessment point between both waves. Longitudinal studies (studies 6 and 7) were based on both two data collection waves separated by 4-years with 186 subjects with complete data on all exposures and outcomes. Briefly, sedentary patterns and physical activity were measured by accelerometry. Frailty Trait Scale (FTS) was used to determine frailty levels. Age, sex, educational status, income, and marital status were self-reported by the participants and used as confounding variables in the statistical analyses. Moreover, other health-related outcomes such as body mass index, waist-to-hip ratio, number of drugs, functional fitness, comorbidity status, and cognitive function were assessed with standard procedures and also used as confounding variables. Significance levels were set at P

The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from ccelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women (p 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM (p 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men.In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.

This study compared the reliability and validity of different protocols evaluating the force-velocity (F-V) relationship and muscle power in older adults. Thirty-one older men and women (75.8 ± 4.7 years) underwent two F-V tests by collecting the mean and peak force and velocity data exerted against increasing loads until one repetition maximum (1RM) was achieved in the leg press exercise. Two attempts per load were performed, with a third attempt when F-V points deviated from the linear F-V regression equation. Then, the subjects performed 2 × 3 repetitions at 60 % 1RM to compare purely concentric and eccentric- concentric repetitions. The Short Physical Performance Battery was conducted to assess the validity of the different protocols. Significant differences were found in maximal power (Pmax) between mean and peak values and between protocols differing in the number of attempts per load (p < 0.01). Registering mean values, a third attempt, and multiple loads (>3), was significantly more reliable (Pmax: CV = 2.6 %; ICC = 0.99) than the other alternatives. Mean values were also observed to be more associated with physical function than peak values (R2 = 0.34 and 0.15, respectively; p < 0.05). No significant differences were observed between concentric and eccentric-concentric repetitions. Thus, collecting mean force and velocity values against multiple loads, while monitoring the linearity of the F-V relationship, seemed to be the more adequate procedure to assess the F-V profile and muscle power in older adults.