Publications by authors named "Mark A Tully"

118 Publications

Changes in Sitting Time, Screen Exposure and Physical Activity during COVID-19 Lockdown in South American Adults: A Cross-Sectional Study.

Int J Environ Res Public Health 2021 May 14;18(10). Epub 2021 May 14.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.

The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina ( = 575) and Chile ( = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively; while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent <7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed.
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http://dx.doi.org/10.3390/ijerph18105239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156285PMC
May 2021

Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries.

J Affect Disord 2021 Aug 2;291:57-64. Epub 2021 May 2.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain.

Aim: Anxiety may be a risk factor for mild cognitive impairment (MCI) but there is a scarcity of data on this association especially from low- and middle-income countries (LMICs). Thus, we investigated the association between anxiety and MCI among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa), and the mediational effect of sleep problems in this association.

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis, meta-analysis, and mediation analysis were conducted to assess associations.

Results: The final sample included 32,715 individuals aged ≥50 years with preservation in functional abilities [mean (standard deviation) age 62.1 (15.6) years; 48.3% males]. Country-wise analysis showed a positive association between anxiety and MCI in all countries (OR 1.35-14.33). The pooled estimate based on meta-analysis with random effects was OR=2.27 (95%CI=1.35-3.83). Sleep problems explained 41.1% of this association.

Conclusions: Older adults with anxiety had higher odds for MCI in LMICs. Future studies should examine whether preventing anxiety or addressing anxiety among individuals with MCI can lead to lower risk for dementia onset in LMICs, while the role of sleep problems in this association should be investigated in detail.
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http://dx.doi.org/10.1016/j.jad.2021.04.076DOI Listing
August 2021

Older Adults' Experiences of a Physical Activity and Sedentary Behaviour Intervention: A Nested Qualitative Study in the SITLESS Multi-Country Randomised Clinical Trial.

Int J Environ Res Public Health 2021 04 29;18(9). Epub 2021 Apr 29.

Fundació Salut i Envelliment (Foundation on Health and Ageing)-UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain.

Background: The SITLESS programme comprises exercise referral schemes and self-management strategies and has been evaluated in a trial in Denmark, Spain, Germany and Northern Ireland. The aim of this qualitative study was to understand the implementation and contextual aspects of the intervention in relation to the mechanisms of impact and to explore the perceived effects.

Methods: Qualitative methodologies were nested in the SITLESS trial including 71 individual interviews and 12 focus groups targeting intervention and control group participants from postintervention to 18-month follow-up in all intervention sites based on a semi-structured topic guide.

Results: Overarching themes were identified under the framework categories of context, implementation, mechanisms of impact and perceived effects. The findings highlight the perceived barriers and facilitators to older adults' engagement in exercise referral schemes. Social interaction and enjoyment through the group-based programmes are key components to promote adherence and encourage the maintenance of targeted behaviours through peer support and connectedness. Exit strategies and signposting to relevant classes and facilities enabled the maintenance of positive lifestyle behaviours.

Conclusions: When designing and implementing interventions, key components enhancing social interaction, enjoyment and continuity should be in place in order to successfully promote sustained behaviour change.
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http://dx.doi.org/10.3390/ijerph18094730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124427PMC
April 2021

Older Adults' Experiences of a Physical Activity and Sedentary Behaviour Intervention: A Nested Qualitative Study in the SITLESS Multi-Country Randomised Clinical Trial.

Int J Environ Res Public Health 2021 04 29;18(9). Epub 2021 Apr 29.

Fundació Salut i Envelliment (Foundation on Health and Ageing)-UAB, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain.

Background: The SITLESS programme comprises exercise referral schemes and self-management strategies and has been evaluated in a trial in Denmark, Spain, Germany and Northern Ireland. The aim of this qualitative study was to understand the implementation and contextual aspects of the intervention in relation to the mechanisms of impact and to explore the perceived effects.

Methods: Qualitative methodologies were nested in the SITLESS trial including 71 individual interviews and 12 focus groups targeting intervention and control group participants from postintervention to 18-month follow-up in all intervention sites based on a semi-structured topic guide.

Results: Overarching themes were identified under the framework categories of context, implementation, mechanisms of impact and perceived effects. The findings highlight the perceived barriers and facilitators to older adults' engagement in exercise referral schemes. Social interaction and enjoyment through the group-based programmes are key components to promote adherence and encourage the maintenance of targeted behaviours through peer support and connectedness. Exit strategies and signposting to relevant classes and facilities enabled the maintenance of positive lifestyle behaviours.

Conclusions: When designing and implementing interventions, key components enhancing social interaction, enjoyment and continuity should be in place in order to successfully promote sustained behaviour change.
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http://dx.doi.org/10.3390/ijerph18094730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124427PMC
April 2021

Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies.

Br J Gen Pract 2021 May 29;71(706):e372-e380. Epub 2021 Apr 29.

Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.

Background: Prevalence of erectile dysfunction (ED) in male survivors of cancer across cancer types has not been systematically analysed.

Aim: To estimate the prevalence of ED in all types of cancer and identify characteristics associated with ED in survivors of cancer.

Design And Setting: Systematic review and meta-analysis (MA) of cross-sectional studies.

Method: MEDLINE, CINAHL, PsycINFO, and EMBASE were searched, targeting reports published from inception to 1 February 2020. All retrospective or prospective studies reporting prevalence of ED in male patients with cancer and using a validated tool for detection of ED were included. A random-effects MA model was used to pool prevalence of ED as absolute estimates at three different stages, that is, 'healthy', 'at diagnosis', and 'after treatment'. A univariate MA regression including the three-level group variable as the only independent variable was used to assess the difference in ED prevalence across the three groups. Further MAs were conducted for studies involving patients at diagnosis and after treatment, and statistical inferences were made with setting for multiple testing controlling for a false discovery rate (FDR) <0.05.

Results: In total, 1301 studies were assessed for inclusion. Of these, 141 were potentially eligible and subsequently scrutinised in full text. Finally, 43 studies were included with a total of 13 148 participants. Overall, pooled data of the included studies showed an ED prevalence of 40.72% (95% confidence interval [CI] = 31.80 to 50.29) in patients with cancer, with prevalences of 28.60% (95% CI = 12.10 to 53.83) at time of diagnosis and 42.70% (95% CI = 32.97 to 53.03) after treatment, with significant difference between these two stages and across cancer locations, controlling for an FDR <0.05.

Conclusion: Erectile dysfunction was particularly high in male survivors of cancer and was associated with cancer treatment, cancer site, and age.
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http://dx.doi.org/10.3399/bjgp20X714197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087306PMC
May 2021

COVID-19 Confinement and Sexual Activity in Spain: A Cross-Sectional Study.

Int J Environ Res Public Health 2021 03 4;18(5). Epub 2021 Mar 4.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.

Restrictions of free movement have been proven effective in tackling the spread of COVID-19 disease. However, sensitive populations submitted to longer periods of restrictions may experience detrimental effects in significant areas of their lifestyle, such as sexual activity. This study examines sexual activity during the COVID-19 confinement in Spain. A survey distributed through an institutional social media profile served to collect data, whereas chi-squared tests, -tests, analyses of variance, and multiple logistic regression analysis were used to assess differences among sample subgroups. A total of 71.3% adults (N = 536) (72.8% female) reported engaging in sexual activity with a weekly average of 2.39 times (SD = 1.80), with significant differences favoring males, middle age, married/in a domestic relationship ( < 0.001), employed ( < 0.005), medium-high annual household income, living outside the Iberian Peninsula, and smoking and alcohol consumption. Analyses adjusted for the complete set of control variables showed significant odds for a lower prevalence of weekly sexual activity in women (OR = 0.44, 95% CI 0.27-0.72). Interventions to promote sexual activity in confined Spanish adults may focus on groups with lower sexual activity.
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http://dx.doi.org/10.3390/ijerph18052559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967360PMC
March 2021

Active Travel and Mild Cognitive Impairment among Older Adults from Low- and Middle-Income Countries.

J Clin Med 2021 Mar 17;10(6). Epub 2021 Mar 17.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, C/Dr.Antoni Pujadas 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.

Active travel may be an easily achievable form of physical activity for older people especially in low- and middle-income countries (LMICs), but there are currently no studies on how this form of physical activity is associated with a preclinical state of dementia known as mild cognitive impairment (MCI). Therefore, we aimed to investigate the association between active travel and MCI among adults aged ≥50 years from six LMICs. Cross-sectional, community-based data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Active travel (minutes/week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Multivariable logistic regression analysis was conducted to assess the association between active travel and MCI. Data on 32715 people aged ≥50 years (mean age 62.4 years; 52.1% females) were analyzed. Compared to the highest tertile of active travel, the lowest tertile was associated with 1.33 (95%CI = 1.14-1.54) times higher odds for MCI overall. This association was particularly pronounced among those aged ≥65 years (OR = 1.70; 95%CI = 1.32-2.19) but active travel was not associated with MCI among those aged 50-64 years. In conclusion, low levels of active travel were associated with a significantly higher odds of MCI in adults aged ≥65 years in LMICs. Promoting active travel among people of this age group in LMICs via tailored interventions and/or country-wide infrastructure investment to provide a safe environment for active travel may lead to a reduction in MCI and subsequent dementia.
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http://dx.doi.org/10.3390/jcm10061243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002501PMC
March 2021

Increase in Regular Leisure-Time Physical Activity in Spanish Adults Between 1987 and 2017.

Am J Prev Med 2021 Mar 27. Epub 2021 Mar 27.

Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.

Introduction: The prevalence of leisure-time physical activity has increased in recent decades, but values differ significantly among countries. Owing to the improvement of living standards, a higher frequency of leisure-time physical activity is expected in Western countries such as Spain, but there is a lack of research involving large, representative samples during a prolonged temporal frame to confirm this tendency.

Methods: Individual representative data from the 1987, 1993, 1995, 1997, 2001, 2011, and 2017 rounds of the Spanish National Health Survey were used. Statistical analyses were conducted from April 9, 2020 to May 5, 2020.

Results: A total of 114,813 participants (aged 43.9 [SD=16.7] years, 51.8% women) were included in the study. Crude linear trends in regular monthly and weekly leisure-time physical activity were estimated together using linear regression models across the survey years, which also served to estimate the regression coefficients (β) and 95% CIs for every year change. All age groups experienced significantly increased prevalence of regular leisure-time physical activity-either several times a month or several times a week-over time (p<0.001 for trend). Participants aged 16-17 years had the highest increase in the annual prevalence of regular leisure-time physical activity (β=0.8, 95% CI=0.7, 1.0). Additional adjusted multivariable logistic regression confirmed these trends.

Conclusions: This study shows an increase in regular leisure-time physical activity among the adult Spanish population during the period from 1987 to 2017. Younger participants consistently presented higher prevalence levels than older participants.
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http://dx.doi.org/10.1016/j.amepre.2021.02.001DOI Listing
March 2021

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65 years from six low- and middle-income countries.

Aging Clin Exp Res 2021 Mar 28. Epub 2021 Mar 28.

Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.

Background: There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs).

Methods: Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression.

Results: Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar.

Conclusions: The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.
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http://dx.doi.org/10.1007/s40520-021-01841-yDOI Listing
March 2021

Physical activity and visual difficulties in 36 low- and middle-income countries.

Eye (Lond) 2021 Mar 25. Epub 2021 Mar 25.

ICREA, Pg. Lluis Companys 23, Barcelona, Spain.

Background: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association.

Methods: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations.

Results: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA.

Conclusions: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.
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http://dx.doi.org/10.1038/s41433-021-01439-8DOI Listing
March 2021

The Effect of Chair-Based Exercise on Physical Function in Older Adults: A Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2021 02 16;18(4). Epub 2021 Feb 16.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK.

Physical activity is an important determinant of health in later life. The public health restrictions in response to COVID-19 have interrupted habitual physical activity behaviours in older adults. In response, numerous exercise programmes have been developed for older adults, many involving chair-based exercise. The aim of this systematic review was to synthesise the effects of chair-based exercise on the health of older adults. Ovid Medline, EMBASE, CINAHL, AMED, PyscInfo and SPORTDiscus databases were searched from inception to 1 April 2020. Chair-based exercise programmes in adults ≥50 years, lasting for at least 2 weeks and measuring the impact on physical function were included. Risk of bias of included studies were assessed using Cochrane risk of bias tool v2. Intervention content was described using TiDieR Criteria. Where sufficient studies (≥3 studies) reported data on an outcome, a random effects meta-analysis was performed. In total, 25 studies were included, with 19 studies in the meta-analyses. Seventeen studies had a low risk of bias and five had a high risk of bias. In this systematic review including 1388 participants, results demonstrated that chair-based exercise programmes improve upper extremity (handgrip strength: MD = 2.10; 95% CI = 0.76, 3.43 and 30 s arm curl test: MD = 2.82; 95% CI = 1.34, 4.31) and lower extremity function (30 s chair stand: MD 2.25; 95% CI = 0.64, 3.86). The findings suggest that chair-based exercises are effective and should be promoted as simple and easily implemented activities to maintain and develop strength for older adults.
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http://dx.doi.org/10.3390/ijerph18041902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920319PMC
February 2021

Changes in dietary fat intake and associations with mental health in a UK public sample during the COVID-19 pandemic.

J Public Health (Oxf) 2021 Mar 1. Epub 2021 Mar 1.

Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, BT37 0QB, UK.

Background: Consumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic.

Methods: Data were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks' Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models.

Results: Eight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health.

Conclusions: A higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.
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http://dx.doi.org/10.1093/pubmed/fdab009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989334PMC
March 2021

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities.

Int J Environ Res Public Health 2021 02 4;18(4). Epub 2021 Feb 4.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey BT37 0QB, UK.

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults' use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.
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http://dx.doi.org/10.3390/ijerph18041491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914589PMC
February 2021

Objectively quantified physical activity and sedentary behaviour in a young UAE population.

BMJ Open Sport Exerc Med 2021 7;7(1):e000957. Epub 2021 Jan 7.

Sport and Exercise Sciences Research Institute, Ulster University, Newtownabbey, Antrim, UK.

Objectives: There is a lack of public awareness of the importance of engaging in physical activity (PA) in the United Arab Emirates (UAE). Nearly 58% of the UAE adult population self-reports as being physically inactive although little accelerometer data currently exists. The aim of this study was to obtain the first dataset that objectively quantifies PA and sedentary behaviour (SB) in young UAE adults.

Methods: This cross-sectional study recruited 140 university students. Body composition and accelerometry was assessed using a Tanita body composition analyser and ActiGraph accelerometer. Differences (p≤0.05) between gender (male vs female) and body mass index (normal vs overweight/obese) were determined using independent samples t-tests and χ tests for nominal variables.

Results: Both males and females spent high amounts of time in SB, encompassing ~80% of waking hours. PA was primarily light intensity (14.1%), although males spent significantly greater time in moderate-to-vigorous intensity activity. Moreover, 50% of males compared with 76.6% of females were classified as sedentary/low active according to daily step counts.

Conclusion: Our data provide evidence of high levels of SB among young adults in the UAE with PA being predominantly light intensity, therefore, both PA and SB should be carefully monitored in this country.
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http://dx.doi.org/10.1136/bmjsem-2020-000957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797257PMC
January 2021

Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults.

Drug Alcohol Depend 2021 02 28;219:108488. Epub 2020 Dec 28.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom.

Background: The aim was to examine the correlates of increased alcohol consumption during the COVID-19 pandemic-related restrictions that were implemented in a sample of UK adults.

Methods: This paper presents analyses of data from a cross-sectional study. Adults aged 18 years and over, residing in the UK and self-isolating from others outside their own household were eligible to participate. Participants reported increase or no increase in their level of alcohol consumption from before to during lockdown, as well as symptoms of anxiety, depression and mental wellbeing. Socio-demographic characteristics were compared between adults with and without reported increased alcohol consumption. The associations between reported increased alcohol consumption and mental health outcomes were investigated using logistic and linear regression analyses.

Results: 691 adults (61.1 % women; 48.8 % aged 35-64 years) were included in the analysis. Of these, 17 % reported increased alcohol consumption after lockdown. A higher proportion of 18-34-year olds reported increased alcohol consumption compared to older groups. The prevalence of poor overall mental health was significantly higher in individuals with increased alcohol consumption (vs. no increase) (45.4 % versus 32.7 %; p-value = 0.01). There was a significant association between increased alcohol consumption and poor overall mental health (OR = 1.64; 95 % CI = 1.01, 2.66), depressive symptoms (unstandardized beta = 2.93; 95 % CI = 0.91, 4.95) and mental wellbeing (unstandardized beta=-1.38; 95 % CI=-2.38, -0.39).

Conclusions: More than one in six UK adults increased their alcohol consumption during lockdown and a higher proportion of these were younger adults. Increased alcohol consumption was independently associated with poor overall mental health, increased depressive symptoms and lower mental wellbeing. These findings highlight the importance of planning targeted support as we emerge from lockdown and plan for potential second and subsequent waves.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768217PMC
February 2021

Hand-Washing Practices among Adolescents Aged 12-15 Years from 80 Countries.

Int J Environ Res Public Health 2020 12 27;18(1). Epub 2020 Dec 27.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ICREA, Sant Boi de Llobregat, 08830 Barcelona, Spain.

The objectives were to (1) assess the prevalence of hand-washing practices across 80 countries and (2) assess frequency of hand-washing practice by economic status (country income and severe food insecurity), in a global representative sample of adolescents. Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Data on age, sex, hand-washing practices in the past 30 days, and severe food insecurity (i.e., proxy of socioeconomic status) were self-reported. Multivariable logistic regression and meta-analysis with random effects based on country-wise estimates were conducted to assess associations. Adolescents ( = 209,584) aged 12-15 years [mean (SD) age 13.8 (1.0) years; 50.9% boys] were included in the analysis. Overall, the prevalence of hand-washing practices were as follows: never/rarely washing hands before eating (6.4%), after using toilet (5.6%), or with soap (8.8%). The prevalence of never/rarely washing hands after using the toilet (10.8%) or with soap (14.3%) was particularly high in low-income countries. Severe food insecurity was associated with 1.34 (95%CI = 1.25-1.43), 1.61 (95%CI = 1.50-1.73), and 1.44 (95%CI = 1.35-1.53) times higher odds for never/rarely washing hands before eating, after using the toilet, and with soap, respectively. A high prevalence of inadequate hand washing practices was reported, particularly in low-income countries and those with severe food insecurity. In light of the present COVID-19 pandemic and the rapid expansion being observed in low- and middle-income locations, interventions that disseminate good hand-washing practices are urgently required. Such interventions may also have cross-over benefits in relation to other poor sanitation-related diseases.
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http://dx.doi.org/10.3390/ijerph18010138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794697PMC
December 2020

Is Physical Activity Associated With Loneliness or Social Isolation in Older Adults? Results of a Longitudinal Analysis Using the Irish Longitudinal Study on Ageing.

J Aging Phys Act 2020 Dec 20:1-11. Epub 2020 Dec 20.

Social relationships are central to the health and well-being of older adults. Evidence exploring the association of physical activity (PA) with social isolation and loneliness is limited. This study uses a path analysis to investigate the longitudinal association between loneliness and social isolation with PA using the Irish Longitudinal Study on Ageing. Higher levels of social isolation measured using the Berkman-Syme Social Network Index were directly and indirectly associated with lower levels of walking, moderate PA, and vigorous PA over 6 years. Additionally, higher levels of walking were associated with lower levels of loneliness measured using a modified version of the University of California, Los Angeles loneliness scale over a 3-year period. Future interventions should target individuals who are more socially isolated and explore the effects of different types of PA on loneliness over time.
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http://dx.doi.org/10.1123/japa.2020-0159DOI Listing
December 2020

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review.

Prev Med 2021 02 30;143:106349. Epub 2020 Nov 30.

Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, United Kingdom.

As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.
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http://dx.doi.org/10.1016/j.ypmed.2020.106349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701882PMC
February 2021

Health-Related Behaviors Among School-Aged Children and Adolescents During the Spanish Covid-19 Confinement.

Front Pediatr 2020 11;8:573. Epub 2020 Sep 11.

Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, United Kingdom.

In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, -paired test and -test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (-102.5, 159.6) ( < 0.001), an increase of daily hours of screen exposure (2.9, 2.1) ( < 0.001), and a reduction of daily fruit and vegetable consumption (-0.2, 1.6) ( < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (-0.3, 0.1) ( < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40-0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.
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http://dx.doi.org/10.3389/fped.2020.00573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516648PMC
September 2020

Associations of sedentary behavior bouts with community-dwelling older adults' physical function.

Scand J Med Sci Sports 2021 Jan 29;31(1):153-162. Epub 2020 Sep 29.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK.

The study aim was to explore associations between sedentary behavior (SB) bouts and physical function in 1360 community-dwelling older adults (≥65 years old). SB was measured using an ActiGraph wGT3X + accelerometer for seven consecutive days at the dominant hip and processed accordingly. Various SB bout lengths were assessed including: 1- to 9-minutes; 10- to 29-minutes; 30- to 59-minutes; and ≥60-minutes, as well as maximum time spent in a SB bout. Total SB time was adjusted for within the SB bout variables used (percentage SB time in the SB bout length and number of SB bouts per total SB hour). Physical function was assessed using the 2-minute walk test (2MWT), 5-times sit-to-stand (chair stand) test, and unipedal stance test (UST). Hierarchical linear regression models were utilized. Covariates such as moderate-vigorous physical activity (MVPA), demographic and health characteristics were controlled for. Lower percentage time spent in ≥60-minute SB bouts was significantly (P < .05) associated with longer 2MWT distance while lower numbers of ≥60-minute SB bouts were associated with longer 2MWT distance, shorter chair stand time and longer UST time. There were mixed associations with physical function for 10- to 29-minute SB bouts. In a large cohort of European older adults, prolonged SB bouts lasting ≥60-minutes appear to be associated with reduced physical function after controlling for MVPA and numerous other important covariates. Besides reducing SB levels, these findings suggest there is a need to regularly interrupt prolonged SB to improve physical function in older adults.
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http://dx.doi.org/10.1111/sms.13827DOI Listing
January 2021

The relationship between physical activity and mental health in a sample of the UK public: A cross-sectional study during the implementation of COVID-19 social distancing measures.

Ment Health Phys Act 2020 Oct 24;19:100345. Epub 2020 Jul 24.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.

Aim: The aim of the present study was to investigate the cross-sectional association between physical activity levels with depressive symptoms, anxiety symptoms, and positive mental well-being in a sample of the UK public social distancing owing to COVID-19.

Method: This paper presents pre-planned interim analyses of data from a cross-sectional epidemiological study. Levels of physical activity during COVID-I9 social distancing were self-reported. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Participants also reported on sociodemographic and clinical data. The association between physical activity and mental health was studied using regression models.

Results: 902 adults were included in this study (63.8% of women and 50.1% of people aged 35-64 years). After adjusting for covariates, there was a negative association between moderate-to-vigorous physical activity per day in hours and poor mental health (OR = 0.88, 95% CI = 0.80-0.97). Similar findings were obtained for moderate-to-severe anxiety symptoms, moderate-to-severe depressive symptoms and poor mental wellbeing.

Conclusions: In the present sample of UK adults social distancing owing to COVID-19 those who were physically active have better overall mental health. Owing, to the cross-sectional design of the present study the direction of the association cannot be inferred.
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http://dx.doi.org/10.1016/j.mhpa.2020.100345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378001PMC
October 2020

Comparison of physical activity levels in Spanish adults with chronic conditions before and during COVID-19 quarantine.

Eur J Public Health 2021 02;31(1):161-166

Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB1 1PT, UK.

Background: This is the first study analyzing levels of physical activity in a sample of quarantined adults with chronic conditions. The aim of this study was to compare moderate- and vigorous-intensity physical activity levels in Spanish adults with chronic conditions before and during coronavirus disease 2019 (COVID-19) quarantine.

Methods: A cross-sectional online survey was administered during the COVID-19 quarantine in Spain. A total of 163 participants with chronic conditions (113 females and 47 males; age range 18-64 years) completed the survey. A total of 26 chronic conditions were included. Participants self-reported average minutes/day of moderate and vigorous physical activity before and during quarantine. Differences in moderate- and vigorous-intensity physical activity levels before and during COVID-19 quarantine (overall, by gender, by age, by number of chronic conditions and by each chronic condition) were assessed by Wilcoxon-signed rank test.

Results: During COVID-19 quarantine, there was a significant decrease of moderate-intensity physical activity in Spanish people with chronic conditions (in both males and females, in those aged 18-24, 25-34, 35-44 and 55-64 years, in those with multimorbidity, in those with one/two chronic condition/s, and in those diagnosed with asthma/hypercholesterolaemia/chronic skin disease/haemorrhoids). Also, there was a significant decrease of vigorous-intensity physical activity in Spanish males with chronic conditions and in those with multimorbidity.

Conclusions: These results should be considered to develop effective strategies of physical activity promotion targeting these specific groups when new quarantine or restriction measures are implemented, in order to avoid new significant decreases of physical activity in these vulnerable populations.
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http://dx.doi.org/10.1093/eurpub/ckaa159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454536PMC
February 2021

Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional survey in Brazil.

Psychiatry Res 2020 10 27;292:113339. Epub 2020 Jul 27.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, UK.

This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.
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http://dx.doi.org/10.1016/j.psychres.2020.113339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384423PMC
October 2020

Bullying victimization and obesogenic behaviour among adolescents aged 12 to 15 years from 54 low- and middle-income countries.

Pediatr Obes 2021 01 29;16(1):e12700. Epub 2020 Jul 29.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.

Background: Data on the association between obesogenic behaviours and bullying victimization among adolescents are scarce from low- and middle-income countries.

Objectives: To assess the associations between obesogenic behaviours and bullying victimization in 54 low- and middle-income countries.

Methods: Cross-sectional data from the global school-based student health survey were analyzed. Data on bullying victimization and obesogenic behaviours were collected. The association between bullying victimization and the different types of obesogenic behaviour (anxiety-induced insomnia, fast-food consumption, carbonated soft-drink consumption, no physical activity and sedentary behaviour) were assessed by country-wise multivariable logistic regression analysis adjusting for age, sex, food insecurity and obesity with obesogenic behaviours being the outcome.

Result: The sample consisted of 153 929 students aged 12 to 15 years [mean (SD) age 13.8 (1.0) years; 49.3% girls]. Overall, bullying victimization (vs no bullying victimization) was significantly associated with greater odds for all types of obesogenic behaviour with the exception of physical activity, which showed an inverse association. Specifically, the ORs (95% CIs) were: anxiety-induced sleep problems 2.65 (2.43-2.88); fast-food consumption 1.36 (1.27-1.44); carbonated soft-drink consumption 1.14 (1.08-1.21); no physical activity 0.84 (0.79-0.89); and sedentary behaviour 1.34 (1.25-1.43).

Conclusion: In this large representative sample of adolescents from low- and middle-income countries, bullying victimization was found to be associated with several, but not all, obesogenic behaviours.
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http://dx.doi.org/10.1111/ijpo.12700DOI Listing
January 2021

Sedentary behavior, physical activity, and mental health in older adults: An isotemporal substitution model.

Scand J Med Sci Sports 2020 Oct 28;30(10):1957-1965. Epub 2020 Jul 28.

Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark.

Introduction: Regular moderate-to-vigorous physical activity (MVPA) is associated with improved mental health, but the evidence for the effect of reducing sedentary behavior (SB) or increasing light PA (LPA) in older adults is lacking. Using isotemporal substitution (IS) models, the aim of this paper was to investigate the effect of substituting SB with LPA or MVPA on associations with mental health in older adults.

Methods: Data from 1360 older adults (mean age 75.18 years) in four countries were utilized. PA and SB was measured using ActiGraph wGT3X-BT + accelerometers worn for 7 days. Self-rated mental health was measured using the Hospital and Anxiety Depression Scale (HADS). IS models estimated cross-sectional associations when 30 minutes of one behavior was substituted with another. Models were adjusted for age, sex, marital status, and educational attainment.

Results: Substituting 30 minutes of SB with LPA (β -.37; 95% CI -0.42, -0.32) or MVPA (β -.14; 95% CI -0.21, -0.07) and substituting LPA with MVPA (β -.11; 95% CI -0.18, -0.04) were associated with improvements in anxiety. However, substituting 30 minutes of SB with LPA (β .55; 95% CI 0.49, 0.62) was associated with increased depression.

Conclusion: Replacing 30 minutes of SB with LPA or MVPA was associated with improved anxiety symptoms in older adults. Greater benefits were observed when shifting SB and LPA to MVPA.
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http://dx.doi.org/10.1111/sms.13762DOI Listing
October 2020

COVID-19 Confinement and Health Risk Behaviors in Spain.

Front Psychol 2020 4;11:1426. Epub 2020 Jun 4.

Faculty of Sport Sciences, University of Murcia, Murcia, Spain.

The World Health Organization (WHO) has declared a world pandemic due to COVID-19. In response, most affected countries have enacted measures involving compulsory confinement and restrictions on free movement, which likely influence citizens' lifestyles. This study investigates changes in health risk behaviors (HRBs) with duration of confinement. An online cross-sectional survey served to collect data about the Spanish adult population regarding health behaviors during the first 3 weeks of confinement. A large sample of participants ( = 2,741) (51.8% women; mean age 34.2 years [SD 13.0]) from all Spanish regions completed the survey. Binomial logistic regressions adjusted for socioeconomic characteristics (i.e., gender, age, civil status, education, and occupation), body mass index (BMI), previous HRBs, and confinement context (i.e., solitude and exposure to COVID-19) were conducted to investigate associations between the number of weeks confined and a set of six HRBs (physical activity, alcohol consumption, fresh fruit and vegetable consumption, smoking, screen exposure, and sleep hours). When adjusted, we observed significantly lower odds of experiencing a higher number of HRBs than before confinement overall in a time-dependent fashion: OR 0.63; 95% CI: 0.49-0.81 for the second and OR 0.47; 95% CI: 0.36-0.61 for the third week of confinement. These results were equally consistent in all age and gender subgroup analyses. The present study indicates that changes toward a higher number of HRBs than before confinement, as well as the prevalence of each HRB except screen exposure, decreased during the first 3 weeks of COVID-19 confinement, and thus the Spanish adult population may have adapted to the new situational context by gradually improving their health behaviors.
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http://dx.doi.org/10.3389/fpsyg.2020.01426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287152PMC
June 2020

Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies.

J Sport Health Sci 2021 05 19;10(3):290-295. Epub 2020 Jun 19.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK. Electronic address:

Purpose: The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.

Methods: An umbrella review of systematic reviews with meta-analyses of observational studies was conducted. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

Results: From 504 articles returned in a search of the literature, 8 systematic reviews were included in our review, with a total of 11 outcomes. Overall, nine of the 11 of the outcomes reported nominally significant summary results (p < 0.05), with 4 associations surviving the application of the more stringent p value (p < 10). No outcome presented convincing evidence. Three associations showed Class II evidence (i.e., highly suggestive): (1) higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population (n = 34 studies; sample size = 1,855,817; relative risk = 0.72, 95% confidence interval (95%CI): 0.67-0.78), (2) cardiovascular death risk in mixed populations (n = 15 studies; relative risk = 0.84, 95%CI: 0.78-0.91), and (3) incidence of disability (n = 7 studies; relative risk = 0.76, 95%CI: 0.66-0.87).

Conclusion: The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality, as well as disability. To further inform intervention strategies, future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.
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http://dx.doi.org/10.1016/j.jshs.2020.06.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167328PMC
May 2021

Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents.

Psychiatry Res 2020 09 29;291:113138. Epub 2020 May 29.

Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK. Electronic address:

Background: The aim was to assess the impact of COVID-19 self-isolation/social distancing on mental health, and potential correlates, among a sample of the UK population.

Methods: A cross-sectional study. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Data collected on predictors included sex, age, marital status, employment, annual income, region, current smoking, current alcohol consumption, physical multimorbidity, any physical symptoms experienced during self-isolation/social distancing, and the number of days of self-isolation/social distancing. The association between potential predictors and poor mental health was studied using a multivariable logistic regression.

Results: 932 participants were included. Factors associated with poor mental health were sex (reference: male; female: OR=1.89, 95%CI=1.34-2.68), age (18-24 years: reference;45-54 years: OR=0.27, 95%CI=0.14-0.53; 55-64 years: OR=0.24, 95%CI=0.12-0.47; 65-74years: OR=0.10, 95% CI=0.05-0.22; and ≥75years: OR=0.08,95% CI=0.03-0.24),annual income (<£15,000: reference; £25,000-<£40,000: OR=0.54, 95% CI=0.31-0.93; £40,000-<£60,000: OR=0.39, 95% CI=0.22-0.69; and ≥£60,000: OR=0.38, 95% CI=0.21-0.67), current smoking (yes: OR=2.59, 95%CI=1.62-4.20), and physical multimorbidity (OR=2.35, 95%CI=1.61-3.46).

Conclusions: In this sample of UK adults self-isolating/social distancing females, younger age groups, those with a lower annual income, current smokers and those with physical multimorbidity were associated with higher levels of poor mental health.
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http://dx.doi.org/10.1016/j.psychres.2020.113138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258801PMC
September 2020

Is There an Association Between Self-Reported Physical Activity and Self-Rated Vision Over Time? Results From the Irish Longitudinal Study of Ageing.

J Aging Phys Act 2020 May 22:1-8. Epub 2020 May 22.

Research suggests that physical activity (PA) has many health benefits for an aging population. Evidence exploring the association between PA and vision is limited. This study includes the measures of self-reported PA (International Physical Activity Questionnaire) and self-rated vision at three points in time over a 6-year period used in the Irish Longitudinal study of Ageing, a cohort of community-dwelling older adults (50 years or older). A path analysis found that PA was indirectly associated with vision over 6 years controlling for age, sex, marital status, employment, education, depression (Centre for Epidemiologic Studies Depression Scale), self-reported general health, cardiovascular disease (e.g., heart attack), high blood pressure, diabetes, eye disease (e.g., glaucoma, diabetic eye disease, macular degeneration, cataract), and disabilities associated with activities of daily living. Further research is needed to fully understand the relationship over time and generalize the findings.
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http://dx.doi.org/10.1123/japa.2019-0371DOI Listing
May 2020