Walking aids—particularly rollators and wheeled walkers—are among the most commonly prescribed mobility devices for older adults, intended to enhance stability and prevent falls. Paradoxically, walking aid use has been identified as a marker of elevated fall risk. Age-related muscle strength decline may alter the biomechanical strategies required for safe walking aid–assisted ambulation; however, walking aid use is multifactorial and also reflects cognitive, sensorimotor, and device-competence factors as well as underlying frailty. To date, no review has systematically mapped the intersection of muscle strength decline, walking aid use, and fall risk. This scoping review aimed to map the available biomechanical and clinical evidence linking muscle strength decline to fall risk in older walking aid users. Following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported per the PRISMA-ScR guidelines, systematic searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science Core Collection (January 2000–March 2026). The Population–Concept–Context (PCC) framework guided eligibility: the population comprised older adults (≥ 60 years) using rollators or other walking aids; the concept encompassed muscle strength decline and fall risk/incidence; and the context included all care settings. Two independent reviewers performed title/abstract and full-text screening, supported by a calibration exercise, pilot screening, and structured consensus procedures. Inter-rater reliability was quantified using Cohen’s κ. Data were charted using a standardized 76-variable extraction form, with biomechanical variables predefined a priori. Critical appraisal used JBI checklists matched to study design and AMSTAR 2 for reviews. From 328 identified records across three databases, 262 unique records remained after deduplication. Following title/abstract screening (n = 262) and full-text assessment (n = 159), 93 studies were included. Included studies enrolled older-adult populations consistent with the ≥ 60-year eligibility threshold; reported mean ages ranged from approximately 59 to 83 years, and individual study age ranges spanned approximately 60 to 98 years. Pooled participant totals could not be precisely aggregated owing to heterogeneous reporting (see Limitations). The majority were cohort studies (n = 26; 28.0
To develop an interpretable deep-learning framework to identify risk factors for dual cognitive-physical decline in older adults and evaluate the impact of physical activity (PA) on functional trajectories. Using HRS (n = 11,574) for discovery and ELSA (n = 3,810) for external validation, we employed a Temporal Attention Network (TAN) to screen 15 core variables. Six conventional machine-learning algorithms and TAN were compared, with SHAP used to interpret the best-performing model. PA associations were analyzed using Cox regression and multistate Markov models. XGBoost performed best (HRS AUC = 0.898; ELSA AUC = 0.818). Walking time was the top predictor (HR = 1.19), with its annual degradation rate in the dual-decline group being 4.9 times that of healthy controls. All PA intensities were associated with lower hazards (HR: 0.92–0.95). Among participants who were Healthy at baseline in ELSA, the probability of transitioning to Dual Decline by Wave 6 was lower in the High PA group (1.0
Key daily physical activities (e.g., standing and walking), postures (sitting and lying), and sleep constitute the 24-h day and have distinct health effects and functional implications. Traditionally studied separately, the distribution of these movement behaviours and sleep across the cognitive spectrum remains insufficiently characterised. We aimed to describe and compare the distribution of 24-h movement behaviours and sleep across the cognitive spectrum. We analysed cross-sectional, population-based data from 4,699 community-dwelling older adults (≥ 70 years) participating in the HUNT4 70 + study. Cognitive status was classified as mild cognitive impairment (MCI, n = 1,690) or dementia (n = 360) according to DSM-5 criteria. Participants not classified with MCI or dementia were categorised as cognitively unimpaired. Accelerometers worn on the thigh and lower back (≤ 7 days) were used to assess standing, walking, sitting, lying awake, and sleep using validated machine-learning models. Inverse probability weighting and multiple imputation by chained equations were used to address selection bias. Group differences were examined using survey-weighted regression models adjusted for potential confounders including age, sex, education, marital status, self-rated health, obesity, depression, alcohol consumption, and smoking. In fully adjusted models, older adults with MCI spent less time sitting (ß -12.4 [95
Heart rate recovery (HRR) is commonly used to evaluate post-exercise recovery. However, it might not fully represent the recovery of heart rate variability-derived autonomic indices in older adults. This study examined whether heart rate and heart rate variability-derived indices of cardiac autonomic modulation show divergent recovery patterns following submaximal exercise in healthy older adults. Fifty-eight community-dwelling adults aged 60–81 years completed a 5-minute submaximal step test following a 10-minute seated resting period. Heart rate (HR) and heart rate variability (HRV) parameters (RMSSD, pNN50, mean RR, SDNN, LF, HF, LF/HF ratio) were recorded during a 10-minute passive recovery period using a chest strap (Polar H10) monitor and analyzed with Kubios HRV software (version 4.0.3). Recovery dynamics were evaluated by comparing baseline values with the final 5-minute segment of the recovery phase. Heart rate and mean RR approached pre-exercise resting values during recovery, corresponding to 97.3
Abstract Introduction Assessing lifetime physical activity is essential for understanding its cumulative impact on health and ageing; however, no validated instrument is available in Brazilian Portuguese to capture these long-term patterns. The Lifetime Total Physical Activity Questionnaire (LTPAQ) records physical activity across multiple domains and intensities throughout the life course. Objective To translate the LTPAQ into Brazilian Portuguese, perform a cross cultural validation and evaluate its measurement properties in a population of Brazilian older adults. Methods This methodological study was conducted in two phases: (1) translation and cross-cultural validation following the Beaton guidelines, and (2) measurement properties according to COSMIN standards. The pre-final version was tested in 30 older adults to assess comprehensibility, and the measurement property analyses were conducted in 80 community-dwelling older adults aged 60–80 years. Test-retest reliability, measurement error (standard error of measurement, Bland–Altman limits of agreement), interpretability (minimum detectable difference, floor and ceiling effects), and hypothesis testing and known-groups analyses for construct validity were evaluated. The calendar method was used to improve lifetime activity recall. Results The Brazilian Portuguese version of the LTPAQ required minimal cultural adaptation and achieved excellent clarity (content validity index > 0.90). Test-retest reliability was excellent (ICC = 0.89–0.96), with minimal measurement error (SEM = 1%) and low minimum detectable difference values. Narrow limits of agreement were observed for transportation and exercise/sports, while light-to-moderate activities showed wider variability. Floor effects were present in some domains, but no ceiling effects were identified. No significant correlations were observed between the LTPAQ-Brazil and the EuroQol 5-Dimension questionnaire (EQ-5D), the EuroQol Visual Analogue Scale (EQ-VAS), and the International Physical Activity Questionnaire – Short Form (IPAQ-SF). However, significant differences in lifetime physical activity scores were found according to sex, educational attainment, and socioeconomic status, supporting construct validity. Conclusion The LTPAQ-Brazil demonstrated evidence of cross-cultural validity, reliability, measurement precision, interpretability, and construct validity for assessing lifetime physical activity in Brazilian older adults. The instrument enables the characterization of physical activity exposure across the life course and may be useful for epidemiological and healthy ageing research.
Digital mobility outcomes (DMOs) measured under real-world conditions allow for differentiated insights into mobility patterns of older adults. This study provides an advanced description of real-world walking in community-dwelling older adults and identifies correlates of walking amount, pattern and speed. This cross-sectional study used baseline data from the SMART-AGE intervention trial with community-dwelling older adults (age ≥ 67 years). Assessment procedures included one-week monitoring of real-world walking using a wearable device (Axivity AX6), clinical outcomes, and tablet-based questionnaires. DMOs describing the amount (steps, walking duration), pattern (e.g., number of walking bouts [WBs]) and pace (mean and 90th percentile [P90] walking speed) of real-world walking were extracted using a validated computational pipeline. Data were included with ≥ 12 h/day wear time on ≥ 3 days. Stepwise hierarchical linear mixed modelling examined associations between DMOs and sociodemographic correlates, environmental conditions, health status (Body Mass Index), locomotor capacity (Timed Up Go [TUG]), fall-related concerns (Short FES-I) and cognitive processing speed (Symbol Search Score). The final sample of 569 participants with a mean age of 75.0 ± 5.6 years (52
Abstract Background Digital health exercise interventions are emerging as scalable solutions for sarcopenia in older adults, but their efficacy remains unclear. Main body This systematic review and meta-analysis evaluated their effects on muscle strength, mass, and physical performance in older adults with possible, confirmed, or severe sarcopenia. Eleven databases were searched up to 1st October 2025 for randomized and controlled clinical trials. Sixteen studies ( n = 1,607 participants) were included. Meta-analysis revealed that, overall, digital interventions showed no significant benefit on appendicular skeletal muscle mass index (MD = 0.16 kg/m 2 , 95% CI [-0.03, 0.36]), the timed up-and-go test (SMD=-0.02, 95% CI [-0.40, 0.37]), or gait speed (SMD = 0.06, 95% CI [-0.44, 0.56]) compared to control conditions. Crucially, subgroup analyses revealed significant differential effects: combined digital health interventions (exercise plus nutrition) demonstrated superior improvements in handgrip strength (MD = 2.21 kg, 95% CI [1.33, 3.09]) and quality of life (SMD = 0.65, 95% CI [0.29, 1.01]) compared to controls. Furthermore, opposing effects on BMI were observed between exercise-focused and nutrition-focused interventions. The certainty of evidence for most outcomes was rated as low or very low. Conclusion Standalone digital health exercise interventions confer limited benefit on core sarcopenia outcomes. In contrast, comprehensive digital interventions that combine exercise with nutritional support show significant promise for improving muscle strength, muscle mass, and quality of life, representing the most promising avenue. The current evidence base is characterized by low certainty, underscoring the need for more methodologically rigorous trials with longer-term follow-up to confirm these findings and identify the most effective intervention components and target populations. Trial registration CRD42024516930
Large Language Models (LLMs) are emerging as potential tools for health communication and patient education. However, their ability to translate complex medical guidelines into accessible, safe, and accurate messages for older adults remains insufficiently evaluated. To assess the capacity of ChatGPT-4, Claude AI, and Deepseek to generate exercise awareness messages for older adults, aligned with international expert consensus. This was a cross-sectional observational study conducted between April and August 2025. Using the ICFSR 2021 Global Consensus on optimal exercise recommendations as the gold standard, we evaluated messages generated by three LLMs for 13 common chronic conditions in older adults. A standardized prompt was used to generate messages addressing exercise prescription considerations, disease progression, and recommended modalities. Two independent expert evaluators; a geriatrician and a sports medicine physician assessed five dimensions using a 5-point Likert scale; accuracy, clarity, safety, behavioral relevance, and absence of fabrication. Readability was measured using Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), and Simple Measure of Gobbledygook (SMOG). Inter-rater agreement was assessed using intraclass correlation coefficient (ICC). Claude achieved the overall scores from both evaluators at 4.63 ± 0.55 and 4.60 ± 0.55, followed by ChatGPT-4 at 4.55 ± 0.50 and 4.48 ± 0.53 and Deepseek at 4.15 ± 0.87 and 4.17 ± 0.86. Inter-rater agreement was moderate was 0.668. Claude demonstrated accuracy scores at 4.58 ± 0.64, while ChatGPT-4 excelled in clarity with 5 ± 0. All models achieved perfect scores for absence of fabrication (5 ± 0). Readability indices revealed high complexity across all LLMs, with median FKGL values ranging from 10.84 to 10.93, corresponding to 10th-11th grade reading level, exceeding recommended levels for older populations. A significant correlation was found between Claude’s accuracy scores and FKGL (r = 0.599, p = 0.030). LLMs, particularly Claude, ChatGPT-4 and Deepseek demonstrate strong potential for generating accurate, safe, and hallucination-free exercise awareness messages for older adults. However, readability remains above recommended levels, requiring optimization.
Abstract Background Aging is accompanied by declines in cognitive, sensory, and motor functions that can adversely affect everyday activities, such as walking while performing a concurrent cognitive task. In this study, we investigate the effects of age and age simulation on dual-task performance, specifically focusing on gait and memory. Methods We compare three groups: young adults (n = 28, Mage = 21.82, SDage = 1.96), young adults wearing an age simulation suit (n = 28, Mage = 22.07, SDage = 1.51), and older adults (n = 28, Mage = 72.82, SDage = 6.74). Participants performed a 2-minute walking test (walking as fast as possible) and a word memory test (learning words presented on a piece of cardboard) under single- and dual- task conditions (repeated measures). Gait parameters, including walking speed, cadence, stride length, and double-support time were recorded using a wearable motion capture system. Mixed-design ANOVAs were conducted with Group as a between-subjects factor and Task Condition as a within-subjects factor. Results The analyses revealed significant main effects of Task Condition, indicating impairments in both cognitive and gait performance under dual-task conditions (both p < .001), as well as significant main effects of Group, with older adults exhibiting the poorest performance overall (both p < .001). Notably, while memory performance did not differ significantly between young adults with and without the age simulation suit (p = .729), the suit resulted in significantly slower gait speed (p < .001) and alterations in other gait parameters approximating older adults’ gait profiles. Conclusions These results underscore that declines in central attentional capacity combined with peripheral deficits contribute to dual-task interference, potentially increasing instability and fall risk in older populations. Importantly, the group differences reveal how these mechanisms contribute in different ways to age-related performance declines.
Resistance training is recognized as an effective way to improve muscle strength, metabolic health, and functional fitness in older adults. However, there is little agreement on the ideal number of resistance training sessions per week. It is important to clarify the comparative effects of various training frequencies, especially with accessible low-load methods like elastic bands, to create practical and effective exercise recommendations for this population. This study compared the effects of two (2 sessions/week;2SW) versus three (3 sessions/week;3SW) low-load elastic band resistance training sessions over 12 weeks on metabolic biomarkers and functional fitness in elderly women. Eighty-two women (75.1 ± 8.6 years) were randomly assigned to 2SW (n = 41) or 3SW (n = 41) groups. In this single blind randomized controlled trial, both groups performed equal training volume per session:2 sets of 12–15 repetitions at 40–50
Mobility decline is a gradual process that begins earlier than recognized. Locomotive syndrome (LS) captures early mobility impairment using performance tests and a self-reported questionnaire. Although physical activity is important for maintaining mobility, whether simple self-reported exercise habits and daily activity relate to long-term age-specific risk of incident LS has not been fully investigated. This study examined age-specific associations of exercise habits and daily activity with the eight-year cumulative incidence of LS. This cohort study included 21,339 Japanese adults aged 21–84 (median, 48) years without LS at baseline who participated in annual health checkups between 2016 and 2024. Baseline exercise habits and daily activity were assessed by self-report using dichotomous questionnaire items, and participants were classified into four groups according to the combination of these responses: inactive (Ex−/Da−), daily activity only (Ex−/Da+), exercise only (Ex+/Da−), and both exercise and daily activity (Ex+/Da+). Analyses were stratified by age (≤ 39, 40–64, ≥ 65 years). Incident LS was defined based on the two-step test, stand-up test, and 25-item Geriatric Locomotive Function Scale. Cumulative incidence was estimated using Kaplan–Meier methods, and associations were assessed with multivariable Cox proportional hazards models adjusted for lifestyle-related factors. Over eight years, 7183 participants developed incident LS. Among adults aged 40–64 years, cumulative LS incidence at 8 years showed a statistically significant decline from 0.45 in the Ex−/Da− group to 0.37 in the Ex+/Da+ group (log-rank P < 0.001), which showed the lowest adjusted risk (hazard ratio, 0.79, 95
Abstract Background Age-related declines in somatosensory and cognitive function impair gait and increase fall risk, particularly under dual-tasking where cognitive and motor demands compete for limited resources. Functional reserve, the difference between one’s maximum capacity and the minimum required for daily functioning, may buffer cognitive-motor interference. This study examines dual-task costs (DTCs) in healthy older adults, focusing on the roles of functional reserve, age-cohort effects, fall history and behavioural strategies such as “Stops Walking When Talking” (SWWT). Methods A sample of 4,443 healthy older adults (mean age: 74.8 years, range: 60.05–97.43) completed the Basel Motor-Cognition Dual-Task Paradigm. Participants walked at preferred speed (single task) and performed concurrent cognitive tasks during dual-task walking, targeting semantic (animal naming) and working memory (counting backwards) during walking or as single-tasks. Functional reserve was calculated as the proportional difference between preferred and fast walking speeds. Cognitive and motor DTCs were defined as proportional performance decline from single- to dual-task conditions. Linear mixed models identified predictors of DTCs and assessed logistic-linked fall history. Cohort was residualized from age. Results Significant cognitive-motor DTCs emerged, with both semantic and working memory tasks reflecting substantial performance declines when simultaneously walking. Working memory task induced less interference on walking whereas walking interferes more on working memory task, than semantic task, indicating domain-specific competition. Higher functional reserve predicted lower DTCs (motor, p < .001; cognitive, p = .006), suggesting its protective role. Age and cohort independently influenced DTCs, with more recent cohorts exhibiting higher cognitive-motor DTCs despite comparable ages. Fear of falling strongly predicted fall history ( p < .001). SWWT was rare (2.8%), yet associated with higher motor DTCs but not falls, suggesting compensatory strategy. Subject-specific cognitive DTC did not correlate negatively to motor DTC after accounting fix effects, thus no trade-off was detected ( r = − .024, p = .270). Conclusion Functional reserve mitigates cognitive-motor interference in aging, while SWWT may reflect adaptive compensation. These findings identify functional reserve as potential intervention target and highlight the complexity of resource allocation, given the absence of a motor-cognitive trade-off and the presence of domain-specific effects. Future longitudinal studies should examine behaviour markers and refine cognitive-motor metrics.
Abstract Background Structured physical activity programs are increasingly promoted to maintain functional capacity in older adults; however, evidence regarding their implementation in real-world community settings, particularly in socioeconomically vulnerable populations, remains limited. Multimodal interventions integrating physical and cognitive components may provide additional benefits, yet feasibility data from resource-constrained environments are scarce. This single-arm feasibility study evaluated the feasibility, safety, and adherence of a combined physical and cognitive training program delivered in a community aging center serving a socioeconomically vulnerable population with exploratory assessment of functional and cognitive outcomes. Methods In this single-arm feasibility study, 50 community-dwelling adults aged > 55 years attending a community aging center serving a socioeconomically vulnerable population were enrolled following medical, physical, and neuropsychological screening; 46 completed the intervention and post-intervention assessment. Participants attended one-hour sessions conducted on alternate days for four months, alternating between structured physical exercise and supervised cognitive activities. Primary feasibility outcomes included recruitment, retention, adherence, and safety. Secondary exploratory outcomes included functional capacity assessed by the Six-Minute Walk Test (6MWT) and cognitive performance assessed using the abbreviated NEUROPSI battery. Within-participant changes were analyzed descriptively and inferentially. Results Of 50 enrolled participants, 46 (92%) completed the intervention and post-intervention assessment. Mean attendance was 18.7 ± 9.3 h (range 3–39). No adverse events attributable to the intervention were reported. Mean 6MWT distance increased from baseline to post-intervention by 140 m (Cohen’s d = 1.58, p < 0.001), while oxygen saturation and blood pressure responses remained stable. Improvements in walking distance were moderately associated with session attendance. Modest increases were also observed in global cognitive performance at post-intervention. Given the single-arm design and interval between baseline and intervention, outcome findings should be interpreted as exploratory. Conclusions A structured combined physical and cognitive training program was feasible and safe in a community aging center serving a socioeconomically vulnerable population, with high retention and no intervention-related adverse events. Improvements in functional capacity were observed, with exploratory evidence of cognitive change. These findings support the practicality of implementing supervised multimodal programs in real-world community environments and provide a foundation for future controlled studies.
Abstract Background While pain has been widely studied in relation to physical activity (PA), less is known about how habitual patterns of activity relate to pain in older adults. This study examined associations between pain characteristics and activity patterns in older adults, and whether these associations differ by age and sex. Methods Cross-sectional data from 665 older adults in the Swedish National Study on Aging and Care–Kungsholmen (SNAC-K, 2016–2019) were analysed. PA and sedentary behaviour were measured using the activPAL3™ accelerometer, and pain characteristics were collected via questionnaires. Latent Class Analysis identified three activity classes (named Active-, Balanced and Sedentary Movers) based on steps/day, sedentary time- and bout duration, light PA, moderate-to-vigorous PA, and number of light-/moderate-to-vigorous PA events. Multinomial logistic regression assessed associations between activity classes and pain, testing modification by age and sex. Results In the total sample, higher pain intensity was associated with membership in the Sedentary Movers class (RRR: 2.16, 95% CI: 1.06, 4.40, p = 0.034), characterised by low PA and predominant sedentary behaviour, compared with the Active Movers (reference), characterised by high activity levels with substantial light- and moderate-to-vigorous PA. The interaction analysis displayed that associations were concentrated in women and the oldest-old (≥ 80 years). No significant associations were observed for pain and the Balanced Movers vs. Active Movers classes. Conclusion Activity patterns characterised by high sedentary behaviour were associated with specific pain characteristics in older adults, particularly among women and the oldest-old. Longitudinal studies are needed to clarify the direction of these associations.
Abstract Background The ability to engage in physical activity reflects preserved physical function, autonomy, and well-being in older adults, making physical activity a key outcome of healthy aging. Walking is a common form of physical activity in later life, so understanding how walking speed is associated with overall activity is particularly important. This study examined 4‑year changes in physical activity energy expenditure (PAEE) in community‑dwelling older adults and assessed preferred walking speed in relation to PAEE. Methods This study used data from AGNES, a 4-year follow-up study of initially 75-, 80-, and 85-year-old adults. PA was measured using thigh-worn accelerometers and ECG monitors, with PAEE estimated using a branched equation model integrating heart rate and acceleration data. Preferred walking speed was measured using a self-paced six-minute walk test. Associations between PAEE, walking speed, and their 4-year changes were examined using linear mixed models. Results Among 299 participants, PAEE declined by 16.9 kJ·kg − 1 ·day − 1 over 4 years. Preferred walking speed showed a positive association with PAEE, with each 1 km·h − 1 higher speed corresponding to 4.7 kJ·kg − 1 ·day − 1 higher PAEE. There was limited evidence for an association between changes in preferred walking speed and changes in PAEE over the 4‑year follow‑up period. Conclusions In community-dwelling older adults, PAEE declined substantially with age, more steeply than in total physical activity previously reported in similar cohorts. Walking speed was strongly associated with PAEE, but its change was not consistently associated with changes in PAEE.
Neurodegenerative disorders impose a major burden on patients and their families worldwide, and finding effective ways to treat or prevent these disorders is essential but challenging. In recent years, physical exercise interventions have attracted considerable attention as a potential approach to modify cognitive decline, which is a major shared symptom of these disorders. In this systematic review and meta-analysis, we focused on studies investigating the effectiveness of physical exercise interventions for various cognitive domains in patients with Alzheimer’s disease (AD), Parkinson’s disease (PD) or mild cognitive impairment (MCI), who presented with initial cognitive deficits. We performed a systematic literature search in PubMed, Embase and CENTRAL for randomized controlled trials (RCTs) published in English until October 2025. We considered them eligible when they investigated the effects of physical exercise on cognitive functioning in AD, PD or MCI patients who all already had cognitive deficits before the start of the study. A random-effects model was applied to explore the effects of physical exercise on four main cognitive domains: global cognition, executive function, memory and attention. In total, 28 RCTs were eligible for inclusion in this review (AD n = 8; MCI n = 16; PD n = 4). Patient subgroup analyses revealed that physical exercise significantly improved global cognition, executive function, memory and attention in both the MCI and AD patient groups, whereas no significant effects were observed in PD patients. These findings indicate that exercise-related benefits extend across multiple cognitive domains in AD and MCI patients and support its potential as a non-pharmacological strategy for individuals with neurodegenerative disorders. In PD, evidence remains limited and inconclusive. Despite substantial variability in exercise interventions, consistent effects were observed, suggesting that cognitive benefits may be broadly applicable across different modalities. However, the limited number of studies including patients with objectively verified cognitive impairment, particularly in PD, as well as the focus on global cognition in many AD studies, highlight important gaps in the current literature. Future research should specifically target cognitively impaired populations and include sufficiently large and well-characterized samples to improve the precision and clinical applicability of the evidence.
Abstract Background Physical activity (PA) is a protective factor of brain health. Existing literature has predominately examined total PA volume or sedentary time in relation to cognitive health, with limited attention to the distributional features of the movement activity bouts. Variability in the duration of daily movement activity bouts may influence cognitive function beyond total exposure to PA or sedentary time. This study investigates whether daily PA and sedentary bout distributions are associated with daily cognitive function in older adults, and further explores whether these associations differ across the days of the week. Methods Older adults (n = 87, age = 68.5 ± 7.0 years, 38% male, 21% non-White) with elevated dementia risk completed 14 days of ecological momentary assessment (EMA). Participants wore an accelerometer (activPAL) and completed smartphone-based cognitive assessments of processing speed four times each day. The number and duration of sedentary, light (LPA), or moderate-to-vigorous physical activity (MVPA) bouts (≥ 1 min) were calculated from the activPAL data. Median response time (RT) and number of correct trials from the symbol search task were aggregated at the day level. Two distributional indicators (alpha and Gini) were each calculated for daily sedentary, LPA, and MVPA bouts to investigate their associations with the symbol search outcomes. Functional regression models examined the associations between the distributional indicators and cognitive outcomes by each day of the week (Sunday-Saturday). Results On most weekdays, higher Gini (greater variations) in daily MVPA bout length was associated with faster RT (p<.001, R2=0.138); higher Gini of daily LPA bout length was also associated with more accurate trials (p<.05, R2=0.022). Conversely, higher Gini in daily sedentary bout length was associated with slower RT (p<.05, R2=0.164). Conclusions This study provides proof-of-concept that the distribution of daily movement behavior bouts is associated with variations in daily cognition. It also illustrates how integrating accelerometry with repeated ambulatory cognitive measures can capture within-person dynamics. The findings can support future research to examine whether specific daily movement patterns may represent appropriate targets for interventions aimed at promoting cognitive health in older adults.
Abstract Background Sedentary behavior (SB) increases the risk of disease and mortality, even in physically active individuals. Adults living with multimorbidity may be particularly vulnerable. Although factors such as age, body mass index (BMI), and social support have been suggested, evidence is largely based on self-reported activity that tends to underestimate SB; therefore, correlates of objectively measured SB in adults with medical conditions remain insufficiently described. We investigated clinical and sociodemographic correlates of accelerometer-measured SB among adults with medical conditions, including multimorbidity. Methods We used backwards stepwise regression to investigate associations between clinical characteristics, sociodemographic factors, and SB in Danish adults (≥ 18 years) with ≥ 1 medical condition and valid accelerometer data from the Lolland-Falster Health Study (n = 1,728). Multimorbidity was present in 963 participants. SB was measured using accelerometers and expressed as daily sedentary time and weighted median sedentary bout length. Results BMI, number of medical conditions, civil and employment status, sex, and mental well-being were associated with sedentary time and/or weighted median sedentary bout length. Obesity class III was associated with 1.43 more sedentary hours/day compared with underweight/normal weight, and having three or ≥ 4 medical conditions was associated with 0.30 and 0.28 more sedentary hours/day, respectively, compared with one medical condition. Living alone was associated with 0.30 more sedentary hours/day and 8.50 seconds longer sedentary bout length compared with being married/living with a partner. Being unemployed/other or retired was associated with 0.64 and 0.39 more sedentary hours/day, respectively, compared with paid employment. Women spent 0.23 fewer sedentary hours/day than men, and reduced mental well-being was associated with 0.23 more sedentary hours/day compared with moderate-to-high mental well-being. Conclusion Several clinical and sociodemographic factors were associated with SB in adults with medical conditions. These results can inform the identification of groups who may benefit from strategies to reduce sedentariness, including people living with multimorbidity.
Abstract Background Mobile health plays a vital role in providing personalized treatment and management for older adults with frailty by enhancing physical activity interventions. However, there is a lack of comprehensive evidence on the efficacy of mobile health interventions in this context. This study aims to assess the impact and implementation of mobile health interventions on physical activity among adults with frailty. Methods We conducted literature searches across multiple databases from inception to October 27, 2025, including PubMed, Web of Science, The Cochrane Library, EMBASE, CINAHL, China National Knowledge Internet (CNKI), Sinomed, WanFang Data, and Cqvip. Two reviewers independently screened and selected the publications, extracted the data, and assessed risk of bias. This study included randomized controlled trials and quasi-experimental designs. Review Manager 5.4 was used for data analysis. Results Our systematic review identified 14 eligible studies comprising 876 participants. The modalities used in mobile health interventions included wearable devices, phone calls, internet platforms, WeChat, smartphone applications, video conferencing platform or mini programs, or a combination of technologies. The meta-analysis showed that the mobile health intervention among older adults with frailty significantly reduce frailty severity as measured by continuous indices (SMD = − 1.11, 95%CI = − 1.71, − 0.51, P < 0.001), and increased physical activity levels (daily step count (SMD = 0.89, 95%CI = 0.41, 1.38, P < 0.001), and Moderate-to-Vigorous Physical Activity (MVPA)(SMD = 0.40, 95%CI = 0.10, 0.70, P < 0.05)), physical function outcomes (gait speed (SMD = 1.25, 95%CI = 0.91, 1.59, P < 0.05), TUG (MD = − 2.21, 95%CI = − 3.63, − 0.80, P = 0.002), and Short Physical Performance Battery (SPPB) (MD = 1.32, 95%CI = 0.73, 1.92, P < 0.05)), and mental domain of quality of life (MCS) (MD = 3.34, 95%CI = 0.16, 6.52, P = 0.04). Conclusions Physical activity interventions for older adults with frailty using mobile health technologies are beneficial for managing frailty, improving physical function, and increasing physical activity levels effectively. High-quality research is warranted to bolster the evidence in these fields in the future.
