Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study

Abstract

BackgroundEvidence is lacking on whether health-benefiting community-based interventions differ in their effectiveness according to socioeconomic characteristics. We evaluated whether the benefit of a structured physical activity intervention on reducing mobility disability in older adults differs by education or income.MethodsThe Lifestyle Interventions and Independence for Elders (LIFE) study was a multicentre, randomised trial that compared a structured physical activity programme with a health education programme on the incidence of mobility disability among at-risk community-living older adults (aged 70–89 years; average follow-up of 2.6 years). Education (≤ high school (0–12 years), college (13–17 years) or postgraduate) and annual household income were self-reported (<$24 999, $25 000 to $49 999 and ≥$50 000). The risk of disability (objectively defined as loss of ability to walk 400 m) was compared between the 2 treatment groups using Cox regression, separately by socioeconomic group. Socioeconomic group×intervention interaction terms were tested.ResultsThe effect of reducing the incidence of mobility disability was larger for those with postgraduate education (0.72, 0.51 to 1.03; N=411) compared with lower education (high school or less (0.93, 0.70 to 1.24; N=536). However, the education group×intervention interaction term was not statistically significant (p=0.54). Findings were in the same direction yet less pronounced when household income was used as the socioeconomic indicator.ConclusionsIn the largest and longest running trial of physical activity amongst at-risk older adults, intervention effect sizes were largest among those with higher education or income, yet tests of statistical interactions were non-significant, likely due to inadequate power.Trial registration numberNCT01072500.

Socioeconomic inequities and cardiovascular disease-related disability in China

“…The incidence of mobility disability was clearly reduced among those with a higher level of education compared with those with a lower level of education. [37] This similar association was also observed across European countries. [37] Moreover, socioeconomic inequalities were reduced by improving educational opportunities, income distribution, health-related behavior, and access to health care.…”

“… [37] This similar association was also observed across European countries. [37] Moreover, socioeconomic inequalities were reduced by improving educational opportunities, income distribution, health-related behavior, and access to health care. [41] Additionally, wealth inequalities appeared to be more strongly associated with health issues, that is, cardiovascular and all-cause mortality, than other socioeconomic position factors.…”

“…Socioeconomic inequalities in health were observed among various socioeconomic statuses in recent decades, [ 30 31 32 ] including race, [33] gender, [ 34 35 36 ] education,[ 37 38 ] occupation, and household income,[ 39 40 ] but some of these inequalities are modifiable. The incidence of mobility disability was clearly reduced among those with a higher level of education compared with those with a lower level of education.…”

Salivary Cortisol and Regional Brain Volumes Among Veterans With and Without Posttraumatic Stress Disorder

“…In the case of evening basal cortisol it requires interpreting the failure to achieve lower evening levels as indicative of HPA inflexibility or hysteresis. Like blunted cortisol reactivity, higher evening Babson 14 cortisol concentrations have been associated with diverse conditions indicative of, or conferring risk for, chronic stress, including low socio-economic status (42), work strain (43), reduced cognitive function and frailty in the elderly (44), all-cause mortality following coronary bypass surgery (45) and cancer diagnosis (46). In this study, cortisol range during a stressor (TSST trial 1) and cortisol range over the day were modestly positively correlated.…”

Condiciones de salud y factores relacionados con discapacidad en adultos mayores -Una reflexión para la atención-

“…Sin embargo, no se puede tomar el ejercicio como una sola intervención para reducir la discapacidad, pues hay investigaciones en los que no se encontró evidencia estadísticamente significativa, de que los beneficios de la actividad física reduzcan el riesgo de discapacidad de movilidad y difieran según la educación o el grupo de ingresos. La falta de beneficios diferenciales indica que esta forma de atención, si se establece de forma más amplia, no aumentará ni reducirá el impacto de las desigualdades socioeconómicas en la discapacidad (41) , por tanto no debe ser una intervención aislada y descontextualizada a la hora de atender población AM, cuando se tiene el propósito de mejorar sus niveles de funcionalidad.…”