Findings from the WHI Objective Physical Activity and Cardiovascular Health (OPACH) Study in Older Women
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1 Findings from the WHI Objective Physical Activity and Cardiovascular Health (OPACH) Study in Older Women Andrea Z. LaCroix, PhD Professor and Chief of Epidemiology Director, Women s Health Center of Excellence Department of Family Medicine and Public Health University of California, San Diego
2 GSA and AHA Talks November 2015 and March OPACH Overview - Andrea LaCroix, UC San Diego 2. Associations of PA/SB with CVD Risk Factors - Andrea LaCroix 3. Associations of PA/SB with SPPB - David Buchner/Michael LaMonte, University at Buffalo, SUNY 4. Falls associated with physical activity - Steve Marshall, UNC 5. SB and Fall History - Dori Rosenberg, Group Health Research Institute 6. PA, SB and Predicted CVD Risk (Reynolds Score) Mike LaMonte, University of Buffalo, SUNY
3 Overview of the OPACH Study
4 WHI LLS and OPACH Long Life Study (LLS): women from the WHI Extension II Medical Records Cohort In-home visit with blood draw, clinical assessment, functional status Objective Physical Activity and Cardiovascular Health (OPACH) Ancillary study of LLS: R01 HL (PI: Andrea LaCroix) Aims to determine associations of PA and SB with cardiovascular events, total mortality, and incident falls Adding accelerometry, self-reported PA (PAQ and CHAMPS) and Falls calendar for a year N=7048 participated, 6489 completed 7-day accelerometer and sleep log
5 Physical Activity (PA) Intensity by METs Sedentary behavior (SB): <1.5 METs Light activity: METs MVPA: >3.0 METs 2008 PA Guidelines for Americans 150 min/week moderate, or 75 min vigorous Bouts of at least 10 minutes, throughout the week Double the amount for additional benefits
6 Accelerometers Wearable device to measure movement 1-axis (vertical) vs. 3-axis Unit of raw data: g Actigraph GT3X+: worn on hip/wrist
7 OPACH calibration study Cutpoints are population and device specific Previous cutpoints were derived using 1-axis device, and for young adults No consensus on cutpoints for older adults, to determine intensity thresholds (SB/light/MVPA) Calibration study N=200 Standardized tasks (DVD, doing dishes, puzzle, mop, walk, treadmill) Accelerometer and METs (oxygen consumption by portable calorimeter)
8 OPACH calibration study
9 OPACH calibration study Derived cut points using vector magnitude counts (vs. vertical axis): Sedentary: 0-18 Light low: Light high: MVPA: 519+ Evenson Wen, Herring et al. Calibrating physical activity intensity for hip-worn accelerometry in women aged years: The Women s Health Initiative OPACH Calibration Study. Preventive Medicine Reports 2 (2015)
10 OPACH PA summary variables Total PA volume (counts) Intensity-specific time and volume SB, light low, light high, MVPA Two versions of summary data 24-hour data Awake time data (exclude sleep)
11 Strobe Flow Chart for OPACH Study
12 OPACH sample by age groups Total N (%) (10.3) 2600 (40.1) 2953 (45.5) 270 (4.2) % White % College Grad % Non-Smoker % Obese
13 OPACH sample by age group Total Mean Physical Function Score Mean (EPESE) SPPB Score Mean (self-reported) Total MET-hours/wk % Self-report sitting 10 hours/day % Fell 2 in Past Year
14 Physical Activity and Falls
15 Risk of Fall & Fall-Related Injury Hypothetical U - shaped Relationship Between Physical Activity & Fall Risk Muscle Function Cardio- Respiratory Fear of Falling Gait Dysfunction Neuromuscular Co-ordination Social Integration Exposure to Environmental Hazards Fatigue Overuse Injury Muscle Function Balance & Postural Stability Fear of Falling Too Little Optimal Level of Physical Activity Too Much
16 Falls and PA-related Falls Approx. ⅓ Reported a Fall in the past 12 months Approx. ⅔ of Falls were PA-related (1294/2078=62%) All subjects Most recent fall was physical activity related Most recent fall was unrelated to physical activity Did not Fall Falls Data Missing (20.1) 784 (12.2) 4165 (64.7) 194 (3.0) 63% of fallers reported one fall in the past 12 months 32% of fallers reported 1-3 falls in the past 12 months 5% of fallers reported 4 or more falls in the past 12 months
17 Self-Reported Fall Injuries Injury Falls: 43.2% of Falls similar for PA and non-pa falls Physician Treatment Falls: 22.7% of Falls similar for PA and non-pa falls Overnight Inpatient Stay Falls: 5.6% of Falls PA falls ~2x more likely to result in Inpatient Stay Most recent fall was physical activity related Most recent fall was unrelated to physical activity Physical Activity-Related Fall (reference) compared to Non-Physical Activity- Related Fall N (%) N (%) Age-Adjusted OR (95% CI) Had Any Injury from a fall in past 12 months 573 (45.4) 324 (42.0) 0.87 ( ) Received Medical Treatment for Injury 292 (22.6) 180 (23.0) 1.08 ( ) Required Overnight Stay in Hospital for Injury 56 (7.7) 60 (4.3) 2.02 ( )
18 CHAMPS Physical Activity Small in PA Falls ; Major in non-pa Falls Fell one or more times in past 12 months Most recent fall was Most recent fall was physical activity related unrelated to physical activity Did not Fall (past 12 months) All Physical Activity, MET-hours (CHAMPS) 0 - < (17.5) 267 (18.6) 827 (57.6) 10 - < (20.2) 170 (11.4) 982 (65.9) (21.1) 347 (9.9) 2356 (67.1) Moderate and Vigorous Physical Activity, MET-hours (CHAMPS) 0 - < (19.6) 529 (15.0) 2167 (61.6) 10 - < (20.5) 120 (9.1) 895 (68.1) (20.9) 135 (8.4) 1103 (68.9)
19 PAQ Physical Activity Small in PA Falls ; Major in non-pa Falls Fell one or more times in past 12 months Most recent fall was Most recent fall was physical activity related unrelated to physical activity Did not Fall (past 12 months) All Physical Activity, MET-hours (CHAMPS) 0 - < (20.4) 535 (14.6) 2289 (62.4) 10 - < (20.4) 138 (10.0) 929 (67.2) (19.5) 110 (8.2) 942 (69.8) Moderate and Vigorous Physical Activity, MET-hours (CHAMPS) 0 - < (20.3) 630 (13.3) 2988 (63.1) 10 - < (20.4) 102 (9.9) 695 (67.3) (18.1) 52 (7.7) 482 (71.6)
20 Summary 62% of Falls were related to Physical Activity (PA) Predominantly walking outside the home More Physical Activity was NOT associated with an Increased Risk of PA Falls More Physical Activity WAS associated with Decreased Risk of non-pa Falls Limitations Self-report falls in past 12 months Cross-sectional
21 Risk of Fall & Fall-Related Injury Hypothetical U - shaped Relationship Between Physical Activity & Fall Risk Muscle Function Cardio- Respiratory Fear of Falling Gait Dysfunction Neuromuscular Co-ordination Social Integration Exposure to Environmental Hazards Fatigue Overuse Injury Muscle Function Balance & Postural Stability Fear of Falling Too Little Optimal Level of Physical Activity Too Much
22 Risk of Fall & Fall-Related Injury Observed Relationship Between Physical Activity & Fall Risk Muscle Function Cardio- Respiratory Fear of Falling Gait Dysfunction Neuromuscular Co-ordination Social Integration Older Adults may selfmoderate Physical Activity that increases their Fall Risk Muscle Function Balance & Postural Stability Fear of Falling Too Little Optimal Level of Physical Activity
23 Next Steps
24 OPACH Presentations 1. GSA Nov PA and Incident Falls (Buchner) 2. Intl. Assn. of Gerontology and Geriatrics July 2017 MVPA and Falls (Buchner) SB and Falls (Rosenberg) Antihypertensive Medications and Falls (Margolis) Self-efficacy and Falls (Hua) Mortality and Falls (LaCroix/LaMonte) 3. ACSM June 2017 (Denver, CO) 4. ISBNPA June 2017 (Victoria, CA) 5. ICAMPAM June 2017 (Bethesda)
25 GSA Meeting
26 OPACH Papers in Progress 2 papers published so far 26+ manuscript proposals approved Primary paper on MVPA and incident falls to be submitted in summer 2016 Primary paper on CVD and mortality outcomes to include events through 2016 and be submitted in 2017
27 NIH Grants using OPACH Data 1. WHISH U01 (Kooperberg, LaCroix, Stefanick) 2. WHISH-2-Prevent Heart Failure (Eaton) 3. Novel methods for analyzing accelerometry data (Di) 4. Unraveling Physical Activity and Sedentary Behavior Associations with Cancer Combining Two Cohorts (Evenson) 5. Sedentary Time Interrupted P01 (LaCroix, Kerr) 6. Evidence to Inform Guidelines Regarding Physical Activity and Sedentary Behavior to Reduce Fracture Risk in Older Women (Crandall) 7. Non-fracture fall-related injuries (Strotmeyer)
28 New WHI Investigators Junior Faculty and Doctoral Students Aladdin Shadyab, PhD (LaCroix) John Belletiere (LaCroix) Kelsie Full (Kerr) Andrew Hua (Buchner) Dori Rosenberg, PhD (LaCroix) Priya Palta (Evenson)
29 OPACH Team (some of us)
30 Acknowledgement WHI-CCC Andrea LaCroix Eileen Rillamas-Sun Chongzhi Di Julie Hunt Lesley Tinker Kyle Campbell Todd Panek Sheri Greaves Yuzheng Zhang University of Illinois David Buchner Stanford Marcia Stefanick William Haskell Harvard I-Min Lee UNC Kelly Evenson Molly Wen Amy Herring Steve Marshall University of Buffalo Michael LaMonte UAB Beth Lewis Johns Hopkins Ciprian Crainiceanu Jiawei Bai
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