Publications by authors named "Li-Jung Chen"

54 Publications

Can physical activity eliminate the mortality risk associated with poor sleep? A 15-year follow-up of 341,248 MJ Cohort participants.

J Sport Health Sci 2021 Mar 10. Epub 2021 Mar 10.

Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.

Background: This study examined the joint associations of sleep patterns and physical activity (PA) with all-cause, cardiovascular disease (CVD), and cancer mortality.

Methods: A total of 341,248 adults (mean age = 39.7 years; men: 48.3%) were included in the study, with a 15-year follow-up. Participants reported sleep duration and disturbances (difficulty falling asleep, easily awakened, or use of sleeping medication). PA was classified into 4 levels: <7.5, 7.5-14.9, 15-29.9, and ≥30 metabolic equivalent hours per week (MET-h/week). To understand the joint associations of sleep patterns and PA with mortality, Cox proportional hazard models were conducted, with exposure variables combining sleep duration/disturbances and PA.

Results: Compared with the reference group (sleeping 6-8 h/day), individuals who slept >8 h/day had higher risk for all-cause mortality (hazard ratios (HR) = 1.31, 95% confidence interval (95%CI): 1.25-1.37), CVD mortality (HR = 1.30, 95%CI: 1.17-1.45), and cancer mortality (HR = 1.13, 95%CI: 1.04-1.22). Short sleep duration was not associated with mortality risk. Increased risk of all-cause and CVD mortality was found in participants who had difficulty falling asleep (HR = 1.12, 95%CI: 1.07-1.18; HR = 1.16, 95%CI: 1.04-1.30, respectively), and used sleeping medication (HR = 1.26, 95%CI: 1.16-1.37; HR = 1.34, 95%CI: 1.10-1.62, respectively) compared with those who slept well. Long sleep duration and sleep disturbances were not associated with risk of all-cause and CVD mortality among individuals achieving a PA level of ≥15 MET-h/week, and in particular among those achieving ≥30 MET-h/week.

Conclusions: Long sleep duration, difficulty falling asleep, and use of sleeping medication were related to a higher risk of death. Being physically active at a moderate intensity for 25-65 min/day eliminated these detrimental associations.
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http://dx.doi.org/10.1016/j.jshs.2021.03.001DOI Listing
March 2021

Nicotine supplementation enhances simulated game performance of archery athletes.

J Int Soc Sports Nutr 2021 Feb 18;18(1):16. Epub 2021 Feb 18.

Institute of Athletics, National Taiwan University of Sport, No. 16, Section 1, Shuang-Shih Road, Taichung, 40404, Taiwan.

Background: Nicotine is beneficial to mood, arousal and cognition in humans. Due to the importance of cognitive functioning for archery athletes, we investigated the effects of nicotine supplementation on the cognitive abilities, heart rate variability (HRV), and sport performance of professional archers.

Methods: Eleven college archers were recruited and given 2 mg of nicotine supplementation (NIC group) and placebo (PLA group) in a crossover design.

Results: The results showed that at 30 min after the intake of nicotine gum, the "correct rejection" time in the NIC group was significantly lower than that of the PLA group (7.29 ± 0.87 vs. 8.23 ± 0.98 msec, p < 0.05). In addition, the NIC group completed the grooved pegboard test in a shorter time than the PLA group (48.76 ± 3.18 vs. 53.41 ± 4.05 s, p < 0.05), whereas motor reaction times were not different between the two groups. Saliva α-amylase activity was significantly lower after nicotine supplementation (p < 0.01) but increased immediately after the archery test in the NIC group (p < 0.05). In addition, nicotine supplementation significantly decreased HRV and increased the archery score (290.58 ± 10.09 vs. 298.05 ± 8.56, p < 0.01).

Conclusions: Nicotine enhances the performance of archery athletes by increasing cognitive function and stimulating the sympathetic adrenergic system.
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http://dx.doi.org/10.1186/s12970-021-00413-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890628PMC
February 2021

Association of body mass index with all-cause mortality in the elderly population of Taiwan: A prospective cohort study.

Nutr Metab Cardiovasc Dis 2021 01 20;31(1):110-118. Epub 2020 Aug 20.

Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan. Electronic address:

Background And Aims: The nutritional status of the elderly is different from that of young people. Body composition changes as people age, for example, fat mass increases, muscle mass decreases, and body fat distribution is changed. We aimed to investigate the association of body mass index (BMI) with cause-specific mortality in the elderly population.

Methods And Results: The data of annual health examination for the older citizens (≥65 years old) from 2006 to 2011 in Taipei City Hospital were used. Information on baseline demographics, lifestyle behaviors, medical, and drug usage were collected by a self-administered questionnaire. Cause-specific mortality was ascertained from the National Registration of Death. Individuals were followed up until death or December 31, 2012, whichever was earlier. Univariable and multivariable Cox proportional hazard analyses were applied to investigate the association between BMI and all-cause mortality. Among 81,221 older people included in the analysis, 42,602 (52.45%) were men. The mean age was 73.85 ± 6.32 years. Among the 81,221 participants, 3398 (4.18%) were underweight, 36,476 (44.91%) were normal weight, 25,708 (31.65%) were overweight, and 15,639 (19.25%) were obese. Those in the BMI category 27 ≤ BMI<28 kg/m had the lowest all-cause mortality risk. The BMI of lowest cause-specific mortality was between 27 kg/m and 28 kg/m in infection mortality, between 28 kg/m and 29 kg/m in circulation mortality, between 29 kg/m and 30 kg/m in respiratory mortality, and between 31 kg/m and 32 kg/m in cancer mortality.

Conclusions: The current study found a J-shaped relation between BMI and cause-specific mortality in the elderly population of Taiwan.
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http://dx.doi.org/10.1016/j.numecd.2020.08.014DOI Listing
January 2021

A dose response relationship between accelerometer assessed daily steps and depressive symptoms in older adults: a two-year cohort study.

Age Ageing 2021 02;50(2):519-526

Graduate Institute of Sports and Health, National Changhua University of Education, Changhua 500, Taiwan.

Objectives: this study investigated the prospective associations of accelerometer assessed daily steps with subsequent depressive symptoms in older adults.

Methods: a 2-year prospective study was performed in the community. A total of 285 older adults ≥65 years (mean age = 74.5) attended the baseline assessment in 2012. The second wave of assessment was carried out in 2014 including 274 (96.1%) participants. Daily step counts were measured with a triaxial accelerometer (ActiGraph GT3X+), and participants were divided into three categories (<3,500, 3,500-6,999 and ≥ 7,000 steps/day). The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Negative binomial regression models with multivariable adjustment for covariates (baseline depressive symptoms, accelerometer wear time, age, gender, education, chronic disease, activities of daily living) were conducted to examine the association between daily steps and subsequent depressive symptoms.

Results: each 1,000-step increase in daily walking was linearly associated with a reduced rate of subsequent depressive symptoms (rate ratio [RR] = 0.95, 95% confidence interval [CI] = 0.92-0.98). Participants with daily step count in 3,500-6,999 (RR = 0.84, 95% CI = 0.70-0.99) and ≥7,000 steps (RR = 0.71, 95% CI = 0.55-0.92) per day had fewer depressive symptoms at follow-up. Sensitivity analyses assessing confounding and reverse causation provided further support for the stability of our findings.

Conclusion: older adults engaging in more daily steps had fewer depressive symptoms after 2 years. Even as few as 3,500-6,999 steps a day was associated with a protecting effect. Accumulating ≥7,000 steps a day could provide the greatest protection against depressive symptoms.
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http://dx.doi.org/10.1093/ageing/afaa162DOI Listing
February 2021

Response to the letter titled "Double counting individuals in meta-analysis artificially inflates precision".

Scand J Med Sci Sports 2020 06;30(6):1085-1086

Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan.

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http://dx.doi.org/10.1111/sms.13692DOI Listing
June 2020

Accelerometer-measured daily steps and subjective cognitive ability in older adults: A two-year follow-up study.

Exp Gerontol 2020 05 10;133:110874. Epub 2020 Feb 10.

Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan; Department of Kinesiology, National Tsing Hua University, Hsinchu, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address:

There is still a paucity of longitudinal studies examining the relationships between objectively-assessed daily steps and cognitive performance in older adults. The current study aimed to explore whether there is a dose-response relationship between accelerometer-measured daily steps and subjective cognitive decline rate after 2 years in older adults. A total of 285 community-dwelling older adults (age = 74.52 ± 6.12 years, female = 55.4%) wore accelerometers for 7 consecutive days measuring daily steps in 2012. Subjective cognitive ability was measured using a Chinese version of the Ascertain Dementia 8-item Questionnaire (AD8). In total 274 (96.1%) participants completed the follow-up study in 2014. Multivariable negative binomial regression adjusted for confounders was undertaken. Daily steps were linearly related to a reduced decline rate in subjective cognitive ability after 2 years. When daily steps were categorized into groups (<3500, 3500-6999, and ≥7000 steps/day), taking approximately 3500-6999 steps/day was associated with a reduced subjective cognitive decline rate (RR = 0.57, 95% CI = 0.37-0.89) after 2 years compared with <3500 steps/day. When accruing ≥7000 steps/day, the decline rate progressively decreased further (RR = 0.43, 95% CI = 0.23-0.82). Sensitivity analyses supported the stability of these findings. These results suggest that there is an inverse dose-response association of daily steps with subjective cognitive decline rate. Even as few as 3500-6999 steps/day was associated with a lower subjective cognitive decline rate after 2 years. Accumulating ≥7000 steps/day could provide greater protection for subjective cognitive ability.
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http://dx.doi.org/10.1016/j.exger.2020.110874DOI Listing
May 2020

Association of exercise with all-cause mortality in older Taipei residents.

Age Ageing 2020 04;49(3):382-388

Department of Health and Welfare, College of City Management, University of Taipei, Taiwan.

Background: Human life expectancy has increased rapidly in recent decades. Regular exercise can promote health, but the effect of exercise on mortality is not yet well understood.

Objective: To investigate the association of exercise with mortality in the older people.

Methods: We used data from annual health check-ups of the older citizens of Taipei in 2006. Participants were interviewed by trained nurses using a structured questionnaire to collect data on demographics and lifestyle behaviours. Overnight fasting blood was collected for measuring blood glucose, liver and renal function and lipid profiles. Exercise frequency was categorised into no exercise, 1-2 times in a week and more than 3-5 times in a week. All-cause mortality was ascertained from the National Registration of Death. All participants were followed up until death or December 312012, whichever came first. Kaplan-Meier curves and Cox proportional hazard analysis were used to investigate the association between exercise and all-cause mortality.

Results: In total, 42,047 older people were analysed; 22,838 (54.32%) were male and with a mean (SD) age of 74.58 (6.32) years. Kaplan-Meier curves of all-cause mortality stratified by exercise frequency demonstrated significant findings (Log-rank P < 0.01). Multivariate Cox regression analysis showed that older people with higher exercise levels had a significantly decreased risk of mortality (moderate exercise HR = 0.74, 95% CI: 0.68-0.81, high exercise HR = 0.65, 95% CI: 0.59-0.70) after adjusting for potential confounders, with a significant trend (P for trend<0.01).

Conclusions: Older people with increased exercise levels had a significantly decreased risk of all-cause mortality.
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http://dx.doi.org/10.1093/ageing/afz172DOI Listing
April 2020

Social Isolation, Loneliness, and All-Cause Mortality in Patients With Cardiovascular Disease: A 10-Year Follow-up Study.

Psychosom Med 2020 Feb/Mar;82(2):208-214

From the Institute of Psychology (Yu) and Nutritional Epidemiology Institute and School of Public Health (Yu), Tianjin Medical University, Tianjin, China; Department of Behavioural Science and Health (Steptoe), University College London, London, United Kingdom; Department of Exercise Health Science (Chen), National Taiwan University of Sport, Taichung; Department of Medical Research (Chen, Lin), Taichung Veterans General Hospital, Taichung; Institute of Public Health and Community Medicine Research Center (Lin), National Yang-Ming University, Taipei; Graduate Institute of Sports and Health (Ku), National Changhua University of Education, Changhua City; and Department of Kinesiology (Ku), National Tsing Hua University, Hsinchu City, Taiwan.

Objective: Social isolation and loneliness have been associated with increased incidence of cardiovascular disease (CVD), but few studies have evaluated the impact of social isolation and loneliness on mortality in people with existing CVD, and these are limited to Western populations. We examined whether social isolation and loneliness are associated with increased risk of mortality in individuals with established CVD in Taiwan.

Methods: The cohort was composed of 1267 patients with confirmed CVD 65 years or older followed up for up to 10 years. Cox proportional hazard regression models were used to examine the association between social isolation and loneliness at baseline and mortality at follow-up by adjusting for demographic variables, health-related behaviors, and health status.

Results: There were 593 deaths during the follow-up period. Social isolation was associated with increased risk of mortality after accounting for established risk factors (hazard ratio [HR] = 1.16; 95% confidence interval [CI] = 1.06-1.26), whereas loneliness was not associated with increased risk of mortality (HR = 0.95; 95% CI = 0.82-1.09). When both social isolation and loneliness were included in the model, social isolation maintained an association with mortality (HR = 1.16; 95% CI =1.07-1.27).

Conclusions: Social isolation is associated with an increased risk of mortality in patients with CVD, and the effects are independent of loneliness. These findings expand our knowledge about the impact of social isolation on the outcomes of CVD in non-Western countries. Efforts to reduce isolation may have substantial benefits in terms of mortality in patients with CVD.
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http://dx.doi.org/10.1097/PSY.0000000000000777DOI Listing
January 2021

Device-measured light-intensity physical activity and mortality: A meta-analysis.

Scand J Med Sci Sports 2020 Jan 6;30(1):13-24. Epub 2019 Oct 6.

Department of Exercise Health Science, National Taiwan University of Sport, Taichung City, Taiwan.

Introduction: The association of light-intensity physical activity (LPA) with mortality is poorly understood. This meta-analysis of cohort studies aimed to examine the dose-response relationships between daily device-measured LPA and mortality in adults aged 18 or older and to explore whether the associations were independent of moderate-to-vigorous physical activity (MVPA).

Methods: Searches for prospective cohort studies providing effect estimates of daily LPA (exposure) on all-cause mortality (outcome) were systematically undertaken in electronic databases up to April 30, 2019. Subgroup analyses and meta-regression analyses with random-effects models were performed to quantify the dose-response relationships between daily LPA and mortality. Sensitivity analyses were also conducted to assess the stability of the results.

Results: A total of 11 studies were included in the meta-analysis. Analyses contained 49 239 individuals (mean age 60.7, SD = 13.6) who were followed up for a mean 6.2 years (2.3-14.2 years), during which 3669 (7.5%) died. In comparison with the reference group (<3 h/d), the pooled HRs (and 95% CIs) of mortality were 0.71 (0.62-0.82), 0.68 (0.59-0.79), 0.56 (0.44-0.71) for groups 3 to <5 h/d, 5 to <7 h/d, and more than 7 hours a day LPA, respectively. Meta-regression models indicated that there was a log-cubic dose-response relationship between daily LPA and mortality in adults and older people, independent of MVPA.

Conclusions: Time spent in daily LPA was associated with reduced risks of mortality in adults and older people. These data support the inclusion of LPA in the future physical activity guidelines.
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http://dx.doi.org/10.1111/sms.13557DOI Listing
January 2020

A Threshold of Objectively-Assessed Daily Sedentary Time for All-Cause Mortality in Older Adults: A Meta-Regression of Prospective Cohort Studies.

J Clin Med 2019 Apr 25;8(4). Epub 2019 Apr 25.

Department of Exercise Health Science and Graduate Institute of Recreational Sport Management, National Taiwan University of Sport, Taiwan. No. 16, Section 1, Shuang-Shih Rd., Taichung 404, Taiwan.

This meta-analysis aimed to estimate the shape of the dose-response association between objectively-assessed daily sedentary time (ST) and all-cause mortality, and to explore whether there is a threshold of ST above which there is an increase in mortality risk in older adults. Searches for prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were undertaken in five databases up to 31 March 2019. A random-effects meta-regression model was conducted to quantify the dose-response relationship between daily ST and all-cause mortality. Sensitivity analyses were also performed to test the stability of the results. Our analysis of pooled data from 11 eligible studies did not reveal a consistent shape of association between ST and mortality. After excluding three studies with potential confounding bias, there was a log-linear dose-response relationship between daily ST and all-cause mortality. Overall, higher amounts of time spent in sedentary behaviors were associated with elevated mortality risks in older adults. Visual assessments of dose-response relationships based on meta-regression analyses indicated that increased mortality risks became significant when total ST exceeded approximately 9 h/day. Based on a limited number of studies, this meta-analysis provides a starting point for considering a cut-off of daily sedentary time, suggesting older adults spend less time in daily sitting.
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http://dx.doi.org/10.3390/jcm8040564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517908PMC
April 2019

Effects of an Acute Bout of Light-Intensity Walking on Sleep in Older Women With Sleep Impairment: A Randomized Controlled Trial.

J Clin Sleep Med 2019 04 15;15(4):581-586. Epub 2019 Apr 15.

Graduate Institute of Sports and Health, National Changhua University of Education, Taiwan.

Study Objectives: This study aimed to explore the effects of a single bout of light-intensity walking on sleep in older women with mild sleep impairment.

Methods: A total of 40 women aged 55 years or older with mild sleep impairment were randomized to either a treadmill walking session for 50 minutes or a quiet-rest control. All participants completed the study (mean age: 60.4 ± 4.7 years). Sleep quality was assessed by ActiGraph for 2 nights before (pretest) and 2 nights after exercise (posttest). A mixed-design analysis of variance was used with group as the between-subjects factor and time point as the within-subjects factor.

Results: No significant group difference in demographic variables, body mass index, physical and mental status, and eight sleep parameters were observed at baseline. Significant group-time interactions existed for sleep latency ( < .001) and sleep efficiency ( = .025). After the intervention, the walking group reduced sleep latency by 3.3 minutes ( = .001) and also had greater sleep efficiency (increase 3.8%, = .008), but no significant change was found in the control group. No significant group-time interactions were present for the other six sleep parameters (activity counts, total sleep time, wake after sleep onset, number and length of awakenings, or time in bed).

Conclusions: A single session of light-intensity walking led to a modest reduction in sleep latency and improvement of sleep efficiency in older women with mild sleep impairment.
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http://dx.doi.org/10.5664/jcsm.7718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457511PMC
April 2019

Prospective associations of physical fitness and cognitive performance among inpatients with Schizophrenia.

Psychiatry Res 2018 12 22;270:738-743. Epub 2018 Oct 22.

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom. Electronic address:

There is a paucity of longitudinal research investigating fitness and cognitive performance in people with schizophrenia. This study examined the prospective associations of physical fitness and cognitive performance among inpatients with schizophrenia. A prospective cohort study over two years was undertaken in 190 inpatients with schizophrenia. Four domains of physical fitness (body composition, muscle endurance, flexibility, and cardiovascular fitness) were measured at baseline in addition to the cognitive domains of attention, hand dexterity and working memory. At baseline, compared to general population normative data, more than one third of the sample had poor cardiovascular fitness, and over half were overweight/obese, had poor muscular fitness and poor flexibility. In the schizophrenia sample, better cardiovascular fitness at baseline was significantly associated with better attention, dexterity, and memory. However, the relationships dissipated after adjusting for baseline cognitive scores. In the final models, aside from baseline cognitive scores, only illness duration was significantly associated with dexterity, and smoking status and duration of hospitilization were associated with working memory. Our data suggest that in a cohort of people with established schizophrenia who already had evidence of cognitive dysfunction, better physical fitness was not associated with improved cognitive performance over two years.
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http://dx.doi.org/10.1016/j.psychres.2018.10.044DOI Listing
December 2018

Associations between walking parameters and subsequent sleep difficulty in older adults: A 2-year follow-up study.

J Sport Health Sci 2018 Jan 18;7(1):95-101. Epub 2017 Jan 18.

Department of Neurosurgery, Taipei City Hospital and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan 11221, China.

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults.

Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later. The 5-item Athens Insomnia Scale (AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value (MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise (excluding walking), and sleep difficulty at baseline.

Results: Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume (incident rate ratios = 1.61,  = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty (after the model was adjusted for covariates and baseline sleep difficulty). Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable.

Conclusion: Total amount of walking (especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults.
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http://dx.doi.org/10.1016/j.jshs.2017.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180541PMC
January 2018

The Associations between Near Visual Activity and Incident Myopia in Children: A Nationwide 4-Year Follow-up Study.

Ophthalmology 2019 02 20;126(2):214-220. Epub 2018 Jun 20.

Department of Epidemiology and Public Health, University College London, UK; Department of Exercise Health Science, National Taiwan University of Sport, Taiwan. Electronic address:

Objective: This nationwide population-based study aimed to examine the prospective association between near visual activities and incident myopia in Taiwanese children 7 to 12 years old over a 4-year follow-up period.

Design: Prospective cohort design.

Participants: There were 1958 children aged 7 to 12 years from the Taiwan 2009 National Health Interview Survey who were linked to the 2009 through 2013 claims data from the National Health Insurance system.

Methods: Multivariable Cox proportional hazard models were used to estimate the associations between 3 types of near visual activities in sedentary posture, namely reading (< 0.5, 0.5-0.9, ≥1.0 hours per day [h/d]), use of computer, Internet, and games (<0.5, 0.5-0.9, ≥1.0 h/d), and "cram school" attendance (<0.5, 0.5-1.9, ≥2.0 h/d), and incident myopia.

Main Outcome Measures: Prevalent myopia was defined as those who had ≥2 ambulatory care claims (International Classification of Diseases code 367.1) in 2008-2009. Incident myopia was defined by those who had at least 2 ambulatory care claims (International Classification of Diseases code 367.1) during the 4-year follow-up period (2010-2013) after excluding prevalent cases.

Results: Overall, 26.8% of children had myopia at baseline, and 27.7% of those without myopia at baseline developed incident myopia between 2010 and 2013. On average, they spent 0.68±0.86 h/d on computer/Internet use, 0.63±0.67 h/d on reading, and 2.78±3.53 h/d on cram school. The results showed that children attending cram schools ≥2 h/d (hazard ratio, 1.31; 95% confidence interval, 1.03-1.68) had a higher risk of incident myopia. The effects of these activities remained similar in sensitivity analyses.

Conclusions: Cram school attendance for ≥2 h/d may increase the risk of children's incident myopia. This effect may be due to increased near visual activity or reduced time outdoors.
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http://dx.doi.org/10.1016/j.ophtha.2018.05.010DOI Listing
February 2019

A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants.

BMC Med 2018 May 25;16(1):74. Epub 2018 May 25.

Department of Exercise Health Science, National Taiwan University of Sport, No. 16, Section 1, Shuang-Shih Rd., Taichung, 404, Taiwan.

Background: The appropriate limit to the amount of daily sedentary time (ST) required to minimize mortality is uncertain. This meta-analysis aimed to quantify the dose-response association between daily ST and all-cause mortality and to explore the cut-off point above which health is impaired in adults aged 18-64 years old. We also examined whether there are differences between studies using self-report ST and those with device-based ST.

Methods: Prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were identified via MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar databases until January 2018. Dose-response relationships between daily ST and all-cause mortality were examined using random-effects meta-regression models.

Results: Based on the pooled data for more than 1 million participants from 19 studies, the results showed a log-linear dose-response association between daily ST and all-cause mortality. Overall, more time spent in sedentary behaviors is associated with increased mortality risks. However, the method of measuring ST moderated the association between daily ST and mortality risk (p < 0.05). The cut-off of daily ST in studies with self-report ST was 7 h/day in comparison with 9 h/day for those with device-based ST.

Conclusions: Higher amounts of daily ST are log-linearly associated with increased risk of all-cause mortality in adults. On the basis of a limited number of studies using device-based measures, the findings suggest that it may be appropriate to encourage adults to engage in less sedentary behaviors, with fewer than 9 h a day being relevant for all-cause mortality.
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http://dx.doi.org/10.1186/s12916-018-1062-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998593PMC
May 2018

Prospective associations of social isolation and loneliness with poor sleep quality in older adults.

Qual Life Res 2018 Mar 30;27(3):683-691. Epub 2017 Nov 30.

Department of Epidemiology and Public Health, University College London, London, UK.

Purpose: There is evidence for negative associations between social isolation and loneliness and sleep quality in older adults. However, it is unclear to what extent these two factors independently affect sleep quality. This study examined the simultaneous associations of social isolation and loneliness with sleep quality in a longitudinal study of older adults.

Methods: Data were analyzed from the Social Environment and Biomarkers of Aging Study in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66.14, SD 7.26). Poisson regression models were conducted to examine the association of social isolation and/or loneliness with sleep quality at follow-up after adjusting for multiple confounding variables.

Results: Univariate analysis showed that sleep quality was inversely associated with both social isolation and loneliness. After demographic, health, cognitive factors, and depressive symptoms were controlled in multivariable analysis, social isolation at the baseline still predicted poor sleep quality 6 years later (incident rate ratio, IRR 1.14; 95% CI 1.04-1.24; p < 0.01), while the association between loneliness and sleep quality was no longer significant (IRR 1.08; 95% CI 0.94-1.23; p = 0.27). The results were unchanged when participants who had poor sleep quality at the baseline were excluded from the analysis.

Conclusions: These findings confirm an adverse effect of social isolation on the sleep quality of older adults, but indicate that this effect is independent of loneliness. Social isolation and loneliness seem to have distinct pathways in affecting the sleep quality of older adults.
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http://dx.doi.org/10.1007/s11136-017-1752-9DOI Listing
March 2018

Leisure-Time, Domestic, and Work-Related Physical Activity and Their Prospective Associations With All-Cause Mortality in Patients With Cardiovascular Disease.

Am J Cardiol 2018 01 19;121(2):177-181. Epub 2017 Oct 19.

Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. Electronic address:

This study aimed to examine the prospective associations between total physical activity, leisure-time physical activity (LTPA), and domestic and work-related physical activity (DWPA) involving heavy physical labor, with all-cause mortality in patients with cardiovascular disease (CVD). A 7-year follow-up cohort design was used based on the data from the Taiwan 2005 National Health Interview Survey, which was linked to the 2005 to 2012 Taiwan National Health Insurance claims data. Multivariable Cox proportional hazard models were utilized to assess the associations between physical activity and all-cause mortality in 2,370 patients with CVD. Participants who achieved a volume of all physical activities of ≥1,000 kcal/week experienced lower risks of all-cause mortality than those who achieved less. Additionally, an inverse relation between LTPA and all-cause mortality was observed. Furthermore, participants who reported exertions (1 to 999 kcal/week) in DWPA had the lowest risk of all-cause mortality. This study provides evidence that patients with CVD who achieve at least a moderate volume of physical activity reduce their mortality risk. It also reveals that both LTPA and DWPA may be important contributors to the reduced risk of premature death among this clinical population.
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http://dx.doi.org/10.1016/j.amjcard.2017.10.003DOI Listing
January 2018

Higher levels of objectively measured sedentary behavior is associated with worse cognitive ability: Two-year follow-up study in community-dwelling older adults.

Exp Gerontol 2017 12 28;99:110-114. Epub 2017 Sep 28.

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, UK; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK. Electronic address:

Background: A number of cross-sectional studies have suggested that higher levels of sedentary behavior (SB) are associated with worse cognitive abilities in older age. There is a paucity of longitudinal studies investigating this relationship utilizing objectively assessed SB. This study investigated the relationship between objectively assessed SB and future cognitive abilities in a cohort of older adults.

Methods: A longitudinal study over 22.12±1.46months including 285 community-dwelling older adults across 14 regions in Taiwan was undertaken. Cognitive ability was ascertained using a Chinese version of the Ascertain Dementia 8-item Questionnaire (AD8) and SB captured by 7days accelerometer data. Multivariable negative binomial regression models adjusted for confounders were undertaken.

Results: 274 community-dwelling older adults finished the study (age=74.6±6.2, % female=54.4%). At baseline, 20.1% (n=55), 48.5% (n=133) and 31.4% (n=86) of the sample engaged in high (11+h), medium (7-10.99h) and low (<7h) of SB respectively. In the fully adjusted model, higher levels of SB were associated with an increased risk of worse cognitive ability at follow up (adjusted rate ratio (ARR)1.09 (95%CI:1.00-1.19)), with the strongest relationship evident in those engaging in over 11h of SB (ARR 2.27 (95%CI:1.24-4.16)). The relationship remained evident after adjusting for depressive symptoms and physical activity.

Conclusion: Our data suggests that objectively assessed SB, particularly when over 11h a day, is independently associated with worse cognitive ability over a two year period. Our data adds to the pressing reasons to reduced SB in older age.
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http://dx.doi.org/10.1016/j.exger.2017.09.014DOI Listing
December 2017

Accelerometer-assessed light physical activity is protective of future cognitive ability: A longitudinal study among community dwelling older adults.

Exp Gerontol 2017 05 3;91:104-109. Epub 2017 Mar 3.

Graduate Institute of Sports and Health, National Changhua University of Education, Taiwan. Electronic address:

Objective: Physical activity (PA), especially moderate-to-vigorous intensity, could protect older adults from cognitive impairment. However, most literature is based on self-reported PA which is limited by recall bias. Light PA is popular among older adults, but a paucity of objective longitudinal data has considered the relationship between light PA and cognitive ability. We examined if a higher level of objectively measured light PA, independent of moderate-to-vigorous physical activity (MVPA), was prospectively associated with better cognitive ability in older adults.

Methods: A longitudinal study over 22.12 (±1.46) months including 274 community-dwelling older adults across 14 regions in Taiwan was undertaken. Cognitive ability was obtained using a Chinese version of the Ascertain Dementia 8-item Questionnaire (AD8) and light PA and MVPA captured by 7days accelerometer positioned on waist. Multivariable negative binomial regression adjusted for confounders were undertaken.

Results: 274 participants (74.52years, 45.6% male) attended the follow-up (96.1%). Higher light PA, independent from MVPA, was associated with a reduced rate of decline in cognitive ability (rate ratio 0.75 [0.60-0.92]). MVPA, was also associated with a reduced decline in cognitive ability (rate ratio 0.85 [0.75-0.95]). Light PA was protective of cognitive ability in sensitivity analyses removing participants with activities of daily living difficulties, depressive symptoms and cognitive impairment at baseline.

Conclusion: Our data suggest that light PA may offer a protective influence of future cognitive ability in community dwelling older adults. The promotion of light PA may be a valuable means to maintain cognitive ability in older age.
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http://dx.doi.org/10.1016/j.exger.2017.03.003DOI Listing
May 2017

Prospective associations of exercise and depressive symptoms in older adults: the role of apolipoprotein E4.

Qual Life Res 2017 07 3;26(7):1799-1808. Epub 2017 Mar 3.

Department of Epidemiology and Public Health, University College London, London, UK.

Purpose: Exercise is associated with reduced risk of depressive symptoms at older ages, while recent work suggests that the apolipoprotein E type 4 allele (APOE-e4) may increase risk. There are no studies of whether APOE-e4 moderates the relationship between exercise and later life depressive symptoms. This study aimed to explore whether the prospective associations between exercise and subsequent depressive symptoms were distinct between APOE-e4 carriers and non-carriers using nationwide data.

Methods: Data from 639 participants (mean age = 66.14, SD = 7.26) in 2000 with 6 years of follow-up were studied. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale. Exercise and the APOE genotype were also assessed at baseline. Negative binomial regression models were conducted to examine the combined effects of exercise and APOE-e4 status on subsequent depressive symptoms when controlling for baseline depressive symptoms and other covariates. Sensitivity analyses to test for confounding, reverse causality, and attrition were conducted.

Results: Among APOE-e4 carriers, there was no significant difference in depressive symptoms between high active and low active groups. In contrast, high active APOE-e4 non-carriers had fewer depressive symptoms than low active APOE-e4 non-carriers. The beneficial effect of exercise on depressive symptoms is restricted to APOE-e4 non-carriers. Sensitivity analyses provided further support for the robustness of these findings.

Conclusions: This is the first prospective study investigating whether APOE-e4 moderates the association between exercise and depressive symptoms. It proposes that genetic variation in APOE may influence the effect of exercise on depressive symptoms.
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http://dx.doi.org/10.1007/s11136-017-1537-1DOI Listing
July 2017

Physical activity, smoking, and the incidence of clinically diagnosed insomnia.

Sleep Med 2017 02 25;30:189-194. Epub 2016 Nov 25.

Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan. Electronic address:

Objective: This study was designed to examine the independent and combined associations of physical activity and smoking on the incidence of doctor-diagnosed insomnia using a nationally representative sample over seven years, taking into account other relevant covariates.

Methods: Participants aged 18 years or older in the 2005 Taiwan National Health Interview Survey (NHIS) with links to National Health Insurance (NHI) claim data between 2005 and 2012 and without diagnosed insomnia before 2005, were selected into this study (n = 12,728). Participants were classified as having insomnia with International Classification of Diseases, Ninth Revision (ICD-9) CM codes 307.41, 307.42, or 780.52. Self-reported smoking status and frequency, duration, and types of leisure-time and non-leisure-time physical activities were collected. Metabolic equivalent (MET) intensity levels for each activity were assigned, and weekly energy expenditure of each activity was calculated and summed.

Results: Inactive participants had a higher risk of incident insomnia [hazard ratio (HR) = 1.22, 95% confidence interval (CI) = 1.06-1.42, p = 0.007] than the active group, and ever-smokers were more likely to have incident insomnia than never smokers (HR = 1.45, 95% CI = 1.20-1.76, p < 0.001). Compared with the nonsmoker/active group, the ever-smoker/inactive group had a higher risk of incident insomnia (HR = 1.78, 95% CI = 1.41-2.25, p < 0.001). Sensitivity analyses excluding individuals diagnosed with other sleep disorders or mental disorders yielded similar results, with the ever-smoker/inactive group having the highest risk of insomnia.

Conclusions: Inactive adults and smokers are at higher risk for incident insomnia, highlighting the importance of a healthy lifestyle and pointing to strategies such as encouraging smoking cessation and physical activity to avoid insomnia among adults.
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http://dx.doi.org/10.1016/j.sleep.2016.06.040DOI Listing
February 2017

Prospective relationship between objectively measured light physical activity and depressive symptoms in later life.

Int J Geriatr Psychiatry 2018 Jan 9;33(1):58-65. Epub 2017 Feb 9.

Department of Epidemiology and Public Health, University College London, London, UK.

Background: The use of self-report measures of physical activity is a serious methodological weakness in many studies of physical activity and depressive symptoms. It is still equivocal whether light physical activity protects older adults from depressive symptoms.

Objective: This study aimed to explore whether objectively measured light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in older adults.

Methods: This was a 2-year prospective cohort study. A total of 285 community-dwelling older adults aged 65 years or older were interviewed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in physical activity at different intensities was assessed using triaxial accelerometers. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Negative binomial regression models with adjustment for baseline depressive symptoms, accelerometer wear time, socio-demographic variables, lifestyle behaviors, and chronic disease conditions were conducted.

Results: Time spent in moderate-to-vigorous and light physical activities were both inversely related to depressive symptoms at follow-up. Sedentary time was associated with an increased risk of subsequent depressive symptoms. When sedentary or moderate-to-vigorous activity were included in the multivariable-adjusted regression models with light physical activity simultaneously, only light physical activity remained significant. Sensitivity analyses for assessing confounding and reverse causation provided further support for the stability of these findings.

Conclusion: Light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in later life. Copyright © 2017 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/gps.4672DOI Listing
January 2018

Physical activity ameliorates the association between sedentary behavior and cardiometabolic risk among inpatients with schizophrenia: A comparison versus controls using accelerometry.

Compr Psychiatry 2017 04 20;74:144-150. Epub 2017 Jan 20.

Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK; Graduate Institute of Sports and Health, National Changhua University of Education, 1, Jin-De Road, Changhua 500, Taiwan. Electronic address:

Objective: A lack of clarity exists regarding the relationship between objectively measured physical activity (PA) and sedentary behavior (SB) and cardiometabolic outcomes in people with schizophrenia. We conducted a large study investigating the independent relationships of PA and SB among inpatients with schizophrenia versus healthy controls (HCs).

Methods: A cross sectional study including 199 inpatients with schizophrenia (mean age 44.0years, mean illness duration 23.8years) versus 60 age/sex/body mass index matched HCs. Participants wore accelerometers for 7days to capture SB and daily steps. Cardiometabolic outcomes included blood pressure, fasting blood glucose (FBG), triglycerides, high-density lipoprotein cholesterol (HDL-C) and waist circumference (WC). Multivariate regression analyses adjusting for multiple confounders were undertaken.

Results: Compared to HCs, patients engaged in more sedentary behavior and less daily steps versus HCs (p<0.001). Patients with higher levels of SB (n=89) had increased fasting glucose compared to patients with low levels of SB (105.2 vs. 96.3mg/dl, p<0.05). In the multivariate analysis, sedentary behavior was associated with higher FBG (β = .146, p=.041) but this was ameliorated when daily steps were inserted in to the model (β = .141, p=.059). In the final model, higher daily steps were associated with more favorable HDL-C (β=-.226, p=.004), independent of SB and other confounders.

Conclusions: Our data suggest that higher than while sedentary behavior is related to worse fasting glucose, this relationship is attenuated when PA is taken into account. Physical activity is also associated with favorable HDL-C. Interventions targeting replacing sedentary behavior with PA may improve metabolic risk.
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http://dx.doi.org/10.1016/j.comppsych.2017.01.010DOI Listing
April 2017

Prospective association between late-life physical activity and hospital care utilisation: a 7-year nationwide follow-up study.

Age Ageing 2017 05;46(3):452-459

Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.

Background: it is still equivocal whether there is a potential role of late-life physical activity in ameliorating the challenges of increasing healthcare expenditure due to the consequence of global population ageing.

Objective: this study aimed to examine the prospective association between physical activity and subsequent hospital care utilisation in older adults and to explore the optimal dose of physical activity required to reduce hospital care utilisation.

Design: this was a prospective cohort study based on the data from the Taiwan 2005 National Health Interview Survey, which were linked to the 2005-12 claims data from the National Health Insurance system.

Participants: 1,760 older adults aged 65 or more.

Methods: the frequency, duration and intensity for physical activity were assessed, and total physical activity energy expenditure was estimated. The average annualised hospital care utilisation for the period 2006 through 2012, including number of hospitalisations, number of days in hospital and the costs of hospitalisation, were calculated.

Results: older adults engaging in at least moderate volume of physical activity (≥1,000 kcal/week) experienced fewer subsequent hospital admissions and fewer days in hospital than did sedentary individuals, after adjusting for covariates. Trends for reduced hospitalisation costs were also found. These associations persisted in sensitivity analyses, including tests of reverse causation.

Conclusion: this study has provided evidence that older adults who are at least moderately active may minimise utilisation of hospital care services. The findings highlight the importance of maintaining a physically active lifestyle in later life.
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http://dx.doi.org/10.1093/ageing/afw202DOI Listing
May 2017

Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study.

Ann Behav Med 2017 Apr;51(2):251-260

Department of Epidemiology and Public Health, University College London, London, UK.

Background: Obesity has been associated with increased physical limitations among older adults, although few studies have adjusted for important covariates. There is limited information about the relationship between apolipoprotein E (APOE) polymorphisms and physical limitations, and the findings have been inconsistent.

Purpose: This study examined the longitudinal associations of obesity and APOE ε4 with difficulties in activities of daily living (ADLs) over a 6-year follow-up period controlling for multiple covariates.

Methods: Data were analyzed from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66). Body mass index (BMI) was used to define obesity at a baseline, and the APOE genotype was classified into an APOE ε4 carrier and non-carrier status. The combination of basic and instrumental activities of daily living (ADLs and IADLs) was used to define impaired ADLs.

Results: APOE ε4 carriers had greater difficulties in combined ADLs (incident rate ratio; IRR = 1.87, 95 % CI = 1.40-2.51) than non-carriers. Obese but not overweight adults had greater difficulties in activities of daily living (IRR = 1.59, 95 % CI = 1.20-2.10) compared with the normal/underweight group. Obese older adults without APOE ε4 had greater subsequent difficulties in ADLs than non-obese non-carriers. Among APOE ε4 carriers, obesity was not a significant risk factor for the development of impaired ADLs in older adults, indicating an interaction between genotype and obesity.

Conclusions: The interaction between genotype and obesity phenotype adds new information about the determinants of physical impairment.
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http://dx.doi.org/10.1007/s12160-016-9848-yDOI Listing
April 2017

Associations between sleep quality and inflammatory markers in patients with schizophrenia.

Psychiatry Res 2016 Dec 21;246:154-160. Epub 2016 Sep 21.

Department of Epidemiology and Public Health, University College London, London, 1-19 Torrington Place, London WC1E 6BT, UK; Department of Exercise Health Science, National Taiwan University of Sport, No 16, Sec 1, Shuan-Shih Road, Taichung 404, Taiwan. Electronic address:

Sleep disorder is a risk factor for several systemic inflammation-related diseases and there are extensive data showing that schizophrenia is associated with chronic low-grade systemic inflammation. This study investigated the associations between sleep quality and inflammatory markers in patients with schizophrenia, which has not been examined before. Sleep quality (total sleep time, sleep efficiency, sleep onset latency, total activity counts, wake after sleep onset, number of awakening, and average length of awakening) was measured using actigraphy in 199 schizophrenia inpatients. The state of inflammation was measured using blood concentration of white blood cells (WBC) and neutrophils, together with neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The results showed that total sleep time was negatively associated with NLR and PLR, and sleep efficiency was negatively associated with neutrophil counts and NLR. Sleep onset latency, total activity counts, wake after sleep onset, and number of awakening were positively associated with WBC and neutrophil counts. The average length of awakening was positively associated with NLR and PLR. This is the first report to suggest that improving sleep quality may modulate the state of inflammation in patients with schizophrenia.
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http://dx.doi.org/10.1016/j.psychres.2016.09.032DOI Listing
December 2016

Relationship Between Objectively Measured Sedentary Behavior and Cognitive Performance in Patients With Schizophrenia Vs Controls.

Schizophr Bull 2017 05;43(3):566-574

Department of Epidemiology and Public Health, University College London, London, UK.

Objective: Sedentary behavior (SB) is associated with poor cognitive performance in the general population. Although people with schizophrenia are highly sedentary and experience marked cognitive impairments, no study has investigated the relationship between SB and cognition in people with schizophrenia.

Methods: A total of 199 inpatients with schizophrenia (mean [SD] age 44.0 [9.9] years, 61.3% male, mean [SD] illness duration 23.8 [6.5]) and 60 age and sex matched controls were recruited. Sedentary behavior and physical activity (PA) were captured for 7 consecutive days with an accelerometer. Cognitive performance was assessed using the Vienna Test System, and the Grooved Pegboard Test. Multivariate regression analyses adjusting for important confounders including positive and negative symptoms, illness duration, medication, and PA were conducted.

Results: The 199 patients with schizophrenia engaged in significantly more SB vs controls (581.1 (SD 127.6) vs 336.4 (SD 107.9) min per day, P < .001) and performed worse in all cognitive performance measures (all P < .001). Compared to patients with high levels of SB (n = 89), patients with lower levels of SB (n = 110) had significantly (P < .05) better motor reaction time and cognitive processing. In the fully adjusted multivariate analysis, SB was independently associated with slower motor reaction time (β = .162, P < .05) but not other cognitive outcomes. Lower levels of PA were independently associated with worse attention and processing speed (P < .05).

Conclusion: Our data suggest that higher levels of sedentary behavior and physical inactivity are independently associated with worse performance across several cognitive domains. Interventions targeting reductions in SB and increased PA should be explored.
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http://dx.doi.org/10.1093/schbul/sbw126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463792PMC
May 2017

Prospective associations of objectively assessed physical activity at different intensities with subjective well-being in older adults.

Qual Life Res 2016 11 6;25(11):2909-2919. Epub 2016 May 6.

Department of Epidemiology and Public Health, University College London, London, UK.

Purpose: This study aimed to examine the longitudinal independent associations of objectively assessed physical activity at different intensities, including moderate-to-vigorous physical activity, light physical activity, and sedentary behaviors, with dimensions of subjective well-being in older adults.

Methods: A total of 307 community-dwelling older adults aged 65 or older in Taiwan were interviewed in 2012. Physical activity was assessed using triaxial accelerometry. Subjective well-being was measured using the Chinese Aging Well Profile. Among them, 295 attended an 18-month follow-up study in 2013. Hierarchical linear regression models with adjustment for socio-demographic variables, lifestyle behaviors, health status, accelerometer wear time, and state of well-being at baseline were performed.

Results: The hierarchical regression models (step one) demonstrated that moderate-to-vigorous physical activity was associated with higher levels of follow-up general and specific dimensions of well-being (β = 0.19-0.24) with the exception of material and environmental well-being. After light physical activity was further included in the models (step two), the associations of moderate-to-vigorous physical activity with general, physical, and independence well-being remained, while the contribution of light physical activity was not significant. In contrast, light physical activity was a significant predictor of psychological, learning and growth, and social well-being in these models (β = 0.20-0.24), while these associations with moderate-to-vigorous physical activity were attenuated or not significant. Sedentary time was not related to any dimension of well-being.

Discussion: The findings indicate that moderate-to-vigorous physical activity and light physical activity are associated with different dimensions of well-being, suggesting that different intensities of late-life physical activity make distinct contributions to well-being.
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http://dx.doi.org/10.1007/s11136-016-1309-3DOI Listing
November 2016

Late-Life Exercise and Difficulty with Activities of Daily Living: an 8-Year Nationwide Follow-up Study in Taiwan.

Ann Behav Med 2016 Apr;50(2):237-46

Institute of Epidemiology and Health Care, University College London, London, UK.

Background: Many studies have shown that low levels of exercise in later life are associated with the progression of difficulties with activities of daily living. However, few have assessed the independent effect of exercise components on difficulty in performing activities of daily living and explored whether the relationship between exercise and activities of daily living is reciprocal.

Purposes: This study aimed to examine, in a nationally representative sample of older Taiwanese, the independent effect of the frequency, duration, and intensity of exercise on difficulty with activities of daily living. A secondary objective was to explore the degree to which the relationship of late-life exercise with activities of daily living is bi-directional.

Methods: Data from a fixed cohort (n = 1268, aged 70+) in 1999 with 8 years of follow-up were analyzed. Generalized estimating equation models with multivariate adjustment were performed.

Results: Participants engaging in higher levels of exercise had less difficulty with subsequent activities of daily living. Among the components of exercise, only duration, especially 30 min or more per session, was associated with fewer difficulties with activities of daily living. The relationship between exercise and activities of daily living was reciprocal, although the influence of activities of daily living on subsequent exercise levels was weaker.

Conclusions: Exercise in later life may be able to minimize the difficulties in activities of daily living and help maintain the mobility and independence of older adults.
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http://dx.doi.org/10.1007/s12160-015-9749-5DOI Listing
April 2016

Associations of exercise, sedentary time and insomnia with metabolic syndrome in Taiwanese older adults: A 1-year follow-up study.

Endocr Res 2015 13;40(4):220-6. Epub 2015 Jul 13.

f Graduate Institute of Sports and Health, National Changhua University of Education , Changhua , Taiwan.

Background: Understanding the risk factors of metabolic syndrome (MetS) is important to public health, since individuals with MetS have an increased risk of health problems. This study examined the associations of exercise, sedentary time and insomnia with incident MetS among older adults 1 year later.

Method: A total of 1,359 older adults receiving hospital health examinations in 2012 were studied, and 779 subjects had a follow-up after 1 year. The components of MetS (waist, blood pressure, high-density lipoprotein cholesterol, fasting glucose and triglyceride) were defined by the Program's Adult Treatment Panel III report. Exercise, sedentary time and insomnia data were obtained through self-report questionnaires. Physical fitness (body fatness, balance and hand grip strength) was measured. Two logistic regressions were computed to examine the associations of exercise/physical fitness, sedentary time and insomnia at baseline with incident MetS 1 year later. The first regression included age, sex, smoking and alcohol as covariates. The second regression was further adjusted with the components of MetS.

Results: Sex, exercise/balance, sedentary time and insomnia were significant predictors of MetS. The risk of MetS incidence was 3.36 (95% CI 1.96-5.77) for women, 1.92 (95% CI 1.01-3.63) for those who did not exercise, 2.52 (95% CI 1.37-4.63) for those who sat more than 5 h/day, and 2.17 (95% CI 1.13-4.15) for those with insomnia. Poor balance was significantly associated with greater risk of MetS (AOR = 1.07, 95% CI 1.02-1.12). Sex, sedentary time, insomnia and balance remained significant after adjusting with the components of MetS.

Conclusions: Cultivating exercise habits, reducing sedentary time and improving sleep quality may be important strategies for MetS prevention among older adults.
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http://dx.doi.org/10.3109/07435800.2015.1020547DOI Listing
August 2016