Knowledge of nutrition and physical activity guidelines

Introduction

Nutrition and bodily exercise are vital domains for wholesome ageing.¹ However, in older grownup populations, the danger of malnutrition is excessive² and ranges of bodily exercise are low,³ that are each related to morbidity,^4,5 mortality^6,7 and poor bodily operate.^8–11 Evidence-based pointers are meant to supply the general public with data concerning which diet and bodily exercise patterns are related to well being beneficial properties and promote a wholesome life-style.^12–14 However, regardless of their broad dissemination, in older adults, precise information of diet and bodily exercise pointers appears restricted and their implications for well being standing stay unclear.^15,16

Knowledge of diet and bodily exercise could also be related to well being outcomes that may be modified by life-style akin to bodily operate by way of bodily exercise. Previous research have recognized well being literacy as a predictor for self-reported bodily operate.^17,18 Health literacy describes one’s capability to acquire, course of, and perceive fundamental well being data wanted to make applicable well being choices. Health literacy is due to this fact a prerequisite for information attainment (eg diet and bodily exercise information), however represents a unique and ideological assemble (idea) than information.¹⁹ Further, self-reported measures of bodily operate are topic to bias.²¹ Previous research assessing information have been inconclusive and proof within the older grownup inhabitants utilizing goal measures of bodily operate is sparse. One research in community-dwelling older adults, utilizing a short 2-item questionnaire to evaluate information of bodily exercise and one goal measure of bodily operate (chair stand take a look at) reported the absence of an affiliation.²⁰ However, given the emphasis on pointers as a public well being instrument, the connection between information of diet and bodily exercise pointers and goal measures of bodily operate requires additional quantification utilizing extra in depth measures of well being information together with diet information and goal measures of bodily operate representing completely different purposeful domains.

This cross-sectional research aimed to analyze the extent of information of diet and bodily exercise pointers and their affiliation with bodily exercise and goal measures of bodily operate in an inception cohort of Dutch community-dwelling older adults who attended a public engagement occasion on wholesome ageing.

Materials and Methods

Study Design

This cross-sectional inception cohort included older adults attending a wholesome ageing public engagement occasion, “PANINI: Recipe for turning into older”, on October 1st, 2018 in Amsterdam, The Netherlands and was hosted and delivered by the Physical Activity and Nutritional INfluences In ageing (PANINI) consortium.²² Participants have been recruited by way of e-mail lists from earlier analysis, common practitioners, senior organizations, neighborhood facilities, and bridge golf equipment. No exclusion standards have been utilized. Data assortment started instantly firstly of the occasion earlier than any instructional data concerning wholesome ageing was delivered to members. This research was reviewed and permitted by the native moral committee, The Scientific and Ethical Review Board (VCWE) of the Faculty of Behavior & Movement Sciences, VU University Amsterdam (VCWE-2018-128), and was carried out in accordance with the moral requirements laid down within the 1964 Declaration of Helsinki. All members gave written knowledgeable consent.

Participant Characteristics

Self-administered questionnaires, developed by the PANINI consortium by way of the PANINI Toolkit, have been used to establish age, gender, marital standing, training, dwelling state of affairs, treatment use, medical historical past, smoking standing, and alcohol use (Supplementary Material). Height was measured to 0.1 centimeters and physique mass (weight) was measured to the closest 0.1 kg utilizing a peak and weight measuring system (DS-102; Dong Sahn Jenix Co., Seoul, Korea). Body mass index (BMI) was calculated by dividing the physique mass (kg) by peak squared (m) and expressed in kg/m². The Physical Frailty Phenotype was used to find out frailty standing and consists of 5 standards: weight reduction, exhaustion, weak point, slowness, and low bodily exercise. This instrument classifies members as strong (not one of the standards under threshold), pre-frail (1–2 standards under threshold), or frail (≥3 standards under threshold).²³

Knowledge Assessment of Dutch Dietary and Dutch Physical Activity Guidelines

Self-administered questionnaires (Supplementary Material) developed by the PANINI consortium have been used to evaluate information and subjective success of the Dutch dietary pointers¹³ and the Dutch bodily exercise pointers.¹⁴ Both information questionnaires in English have been despatched to consultants of their respective fields to test for accuracy and consistency and piloted in older adults in 5 completely different international locations, then refined primarily based upon their efficiency and suggestions, and eventually translated into Dutch. The questionnaires have been designed to include questions pertaining to information of pointers, attitudes in the direction of following these pointers, and evaluations of the outcomes of the wholesome conduct by way of a sequence of brief multiple-choice questions akin to: “Do you suppose the next meals merchandise are a great supply of protein?” have been requested with attainable response choices, “poultry”, “cheese”, “fruit”, “butter”, and/or “nuts” (a number of solutions appropriate); “What is the advisable most quantity of salt consumption each day to pursue a wholesome dietary sample?” with attainable responses “2 grams per day”, “4 grams per day”, “6 grams per day”, or “I don’t know”; “Which of the next actions constitutes average depth bodily exercise?” with attainable responses “watching TV sitting”, “strolling at standard tempo”, “washing the dishes”, “dancing”, “biking at a tempo that raises your coronary heart charge”, and/or “I don’t know” (a number of solutions appropriate); “How many minutes every week ought to one take part in average bodily exercise to pursue a wholesome life-style?” with attainable responses “at the least 60 minutes per week”, “at the least 150 minutes per week”, “at the least 300 minutes per week”, and “I don’t know.” Questionnaires have been scored primarily based on issue by weighting every query primarily based on the frequency of an accurate reply. The PANINI diet information questionnaire consisted of 11 questions (attainable rating of 0–36) (Supplementary Material, questions #20–30) and the PANINI bodily exercise information questionnaire consisted of 9 questions (attainable rating of 0–13) (Supplementary Material, questions #37–45) with greater scores indicating larger information.

Measures of Physical Function and Physical Activity

Gait Speed

Gait pace, a measure of bodily operate, was assessed by a four-meter stroll take a look at the place members have been requested to stroll a course of 5 meters at their regular strolling pace. Participants have been instructed to not decelerate earlier than the four-meter line and their quickest time to achieve the four-meter line, of two trials, was recorded, expressed in meters per second (m/s) and used for evaluation.²⁴

Hand Grip Strength (HGS)

HGS represents a participant’s skill to squeeze a handheld dynamometer (Jamar 5030J1 hand dynamometer; Sammons Preston Rolyan, Bolingbrook, IL, USA) as onerous as attainable with every hand 3 times and is a measure of bodily operate.²⁵ The maximal HGS was recorded in kilograms (kg) and used for evaluation.

Physical Activity

Self-reported bodily exercise was assessed by an tailored model of the brief Minnesota Leisure Time Physical Activity Questionnaire.²⁶ Activities have been expanded from these on the unique questionnaire primarily based on the inhabitants (Supplementary Material). The complete minutes of bodily exercise per week (minutes/week) have been calculated and used for evaluation.

Statistical Analysis

Descriptive statistics for steady variables have been offered as imply and normal deviation (SD) when knowledge have been distributed usually or as median interquartile vary [IQR] if the info had a skewed distribution. Categorical variables have been reported because the pattern dimension/quantity (n) and the share (%) of the overall research inhabitants. Knowledge scores have been assessed constantly and categorized primarily based on the median scores of the diet and bodily exercise questionnaires, respectively, into three teams: information in neither, at the least one, or each area(s) above the median(s). Pearson’s correlation (R) was used to find out the affiliation between diet and bodily exercise information scores and a scatterplot was used to visualise the outcomes. Linear regression evaluation was used to check the affiliation between steady and categorical information scores with every of the three outcomes measures of bodily operate and bodily exercise. Results are offered as unstandardized regression coefficients (B) with their 95% confidence interval (95% CI) and p-value, stratified by gender and carried out unadjusted (crude mannequin) and adjusted for age (Model 1). All analyses have been performed utilizing SPSS (Statistical Package for the Social Sciences), model 24.0 (SPSS Inc. Chicago, IL, USA). A p-value of lower than 0.05 was thought of statistically vital.

Results

Participant Characteristics

This research included 106 Dutch older adults, with a imply age of 70.1 (SD 6.6) years. Participants have been principally feminine (69.8%), independently dwelling (95.2%), and extremely educated (83.0%). The majority of members have been categorised as strong (81.2%), 18.8% have been categorised as pre-frail and no participant was categorised as frail (Table 1).

Table 1 Participant Characteristics

Knowledge of Nutrition and Physical Activity Guidelines

Average information scores have been 21.2 (SD=4.9) out of 36 factors and 5.5 (SD=1.8) out of 13 factors for the diet and bodily exercise questionnaires, respectively. On common, 58.9% of diet questions have been answered accurately, in comparison with, 42.3% of bodily exercise questions. Knowledge of diet scores and bodily exercise scores weren’t considerably related to one another (R²=0.013, p=0.245) (Figure 1).

Figure 1 Scatterplot of weighted diet and bodily exercise scores. Marker dimension (scale) represents the variety of members.

Most members had information in at the least one area (73.6%), adopted by smaller parts having information in each domains (29.2%), and information in neither (26.4%).

Associations of Knowledge with Physical Function and Physical Activity

A major constructive affiliation was discovered between diet information and HGS energy in males earlier than adjustment. A one-unit improve in diet rating was related to 0.64 kg (95% CI: 0.05, 1.22; p=0.034) higher HGS in males. This affiliation didn’t persist after adjustment for age and was not current in females. Effect sizes have been constantly constructive for associations between diet information and outcomes gait pace and bodily exercise and conversely, impact sizes have been constantly detrimental for associations between bodily exercise information with these outcomes. (Table 2).

Table 2 The Association of Knowledge of (a) Nutrition and (b) Physical Activity Guidelines with Physical Function and Physical Activity

Similarly, categorical measures of information confirmed an absence of an affiliation with end result measures. In females, information in at the least one area was related to a 0.10 m/s (95% CI: 0.01, 0.19; p=0.044) slower gait pace in comparison with with out information in both area. After adjustment for age, this affiliation turned non-significant. No different vital associations have been discovered (Table 3).

Table 3 The Association of Knowledge in (a) at Least One Domain and (b) Knowledge in Both Domainsa with Physical Function and Physical Activity

Discussion

No vital associations between the information of diet or bodily exercise pointers have been discovered with goal measures of bodily operate or bodily exercise in comparatively extremely educated and usually wholesome Dutch older adults. Knowledge of pointers within the domains of diet and bodily exercise was restricted, indicating the presence of information gaps and thus room to enhance information and consciousness of pointers in every area.

Previous research in community-dwelling older adults utilizing particular questionnaires to seize information of diet or bodily exercise pointers, respectively, have had contrasting outcomes in comparison with the present research.27–31 The discrepancies between these prior research and the present research could also be associated to the excessive ranges of bodily exercise reported within the present inhabitants in addition to methodological limitations in earlier research together with fundamental assessments of information and points concerning the validity of the self-reported measures to evaluate bodily operate. Although, Cheung et al 2020 used a really temporary evaluation of information of bodily exercise pointers, their research recognized non-significant associations with self-reported bodily exercise and an goal measure of bodily operate (chair stand take a look at), which is in step with our outcomes regardless of using completely different bodily efficiency exams.²⁰

One clarification for the non-significant findings could be that the members on this research have been recruited primarily based on curiosity in attending a wholesome ageing occasion at a college, which (as we anticipated) attracted a particular inhabitants of members. There was a overrepresentation of extremely educated people and there was an absence of frailty on this pattern, in comparison with inhabitants estimates of prevalence between 4.0% and 17.0% in community-dwelling older adults.³² Furthermore, gait pace, HGS, and bodily exercise group scores have been properly above generally used cut-off factors to display for poor operate and low exercise.^33–36 Subsequently, the absence of an affiliation discovered within the current research could also be reflective of a ceiling impact with respect to this extremely educated, typically wholesome and well-performing inhabitants that has not been recognized in earlier research.

The purpose of this research was to not predict bodily operate from conduct, because it was opportunistic and applied a cross-sectional design. However, the shortage of an affiliation discovered is supported by well being psychology prediction fashions and theories of well being conduct suggesting that beliefs, particularly, attitudes, perceived norms, and perceived management are extra vital than information alone.^20,37 In line with this, the NU-AGE research recognized that self-reported bodily operate was related to nutrition-related attitudes, however not nutrition-related information.²⁷ Behavioral interventions to enhance well being standing ought to appropriately deal with the angle and notion parts that drive well being conduct. Further, whereas bodily exercise was very excessive within the present inhabitants, you will need to acknowledge {that a} lack of alternatives and assets for older adults to interact in bodily exercise represents a barrier, which is vital to think about within the context of well being conduct and must be a focus for well being promotion efforts.³⁸

This research recognized information gaps inside a bunch of extremely educated, motivated, and usually wholesome people, which signifies that information of pointers shouldn’t be assumed to be enough and offers route for public well being training. Poor information of pointers on this inhabitants might mirror restricted laymen translation and spotlight points concerning accessibility. Despite the shortage of an affiliation recognized within the present research, older adults ought to have the information to have the ability to make wholesome choices. A energy of this research is that no inclusion or exclusion standards have been utilized and using goal measures of bodily operate. The small pattern represents a limitation to this research and it could even be restricted by means of a personalized questionnaire that was not extensively validated.

Conclusion

Despite gaps in information, in an inception cohort of well-functioning and usually wholesome Dutch older adults, information of diet and bodily exercise pointers usually are not related to measures of bodily exercise or goal measures of bodily operate. These findings strengthen the proof that restricted information of pointers, as a barrier to wholesome life-style and outcomes, will not be simple and could also be extremely depending on different components, akin to attitudes, perceptions, assets, and alternatives. Future research ought to prioritize these components and purpose to determine the position and capability for will increase in information to synergistically have an effect on life-style and well being standing, whereas focusing on interventions to those that want it most.

Acknowledgments

We want to thank Stéphanie M.L.M. Looijaard for her contribution to this venture. We would really like additionally prefer to thank all members of the PANINI consortium: Anna C. Whittaker, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK; Evans A. Asamane, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK; Justin Aunger, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK; Kally Bhartti, School of Sport, Exercise & Rehabilitation Science, University of Birmingham, UK; Maria Giulia Bacalini, Institute of Neurological Sciences (IRCCS), Bologna, Italy; Dmitriy Bondarev, Gerontology Research Center & Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Bart Bongers, Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands; Andrea Cabbia, Department of Biomedical Engineering, Eindhoven University of Technology, Netherlands; Massimo Delledonne, Personal Genomics, University of Verona, Italy; Paul Doody, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK; Taija Finni, Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Claudio Franceschi, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; Paolo Garagnani, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; Noémie Gensous, Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; Carolyn Greig, School of Sport, Exercise & Rehabilitation Sciences & MRC–Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, UK; Peter Hilbers, Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Barbara Iadarola, Personal Genomics, University of Verona, Italy; Victor Kallen, The Netherlands Organisation for Applied Scientific Research, The Netherlands; Katja Kokko, Gerontology Research Center & Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Anna Elisa Laria, Personal Genomics, University of Verona, Italy; Janet Lord, Institute of Inflammation and Ageing, Medical School & MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, UK; Andrea B. Maier, Department of Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, The Netherlands & Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Carel G.M. Meskers, Department of Rehabilitation Medicine, VU University Medical Center & Amsterdam Movement Sciences, Amsterdam, The Netherlands; Paola Pazienza, Personal Genomics, University of Verona, Italy; Esmee M. Reijnierse, Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Belina Rodrigues, School of Medicine, University of Minho, Portugal; Nadine Correia Santos, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, and ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal; Nuno Sousa, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, and ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal; Sarianna Sipila, Gerontology Research Center & Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Keenan A. Ramsey, Department of Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Muhammad Rizwan Tahir; The Netherlands Organisation for Applied Scientific Research, The Netherlands; Marijke C Trappenburg, Department of Internal Medicine, VU University Medical Center & Amstelland Hospital, The Netherlands; Janice L. Thompson, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK; Nico van Meeteren, Health~Holland, The Hague, & Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands; Natal van Riel, Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Suey Yeung, Department of Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, The Netherlands.

Disclosure

Professor Janice Thompson studies grants from European Commission, in the course of the conduct of the research. The authors report no conflicts of curiosity on this work.

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