Comparison of Physical Activity, Functional Capacity and Quality of Life between Older Patients with Chronic Comorbidities and Healthy Peers: A Case of the State Hospital

Öz

Aim: This study aimed to compare physical activity (PA), functional capacity (FC), and quality of life (QoL) among older patients with chronic comorbidities and their healthy peers in a state hospital setting. Material and Methods: A total of 148 older adults, divided into groups of obesity, hypertension (HT), type 2 diabetes (T2D), and healthy, with 37 participants in each group, were included. PA, FC, and QoL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the 6-minute walk test (6MWT), and the SF-36 Quality of Life Questionnaire, respectively. The Kolmogorov-Smirnov test assessed variable distribution. Continuous variables were compared with one-way ANOVA, discrete variables with the Kruskal-Wallis test, and categorical variables with the chi-square test. Bonferroni and Mann-Whitney U tests were used for post-hoc pairwise comparisons. Results: The obesity group exhibited significantly lower PA and FC compared to all other groups (p=0.044). The QoL of the obesity group was also significantly lower than that of the HT and healthy groups (p=0.017). The HT group had significantly higher PA compared to the T2D group (p=0.046), with no significant difference between the HT and healthy groups (p=0.077). The FC in the HT group was significantly higher than in the T2D group (p=0.043) but not different from the healthy group (p=0.074). The QoL was significantly higher in the HT group compared to the T2D group (p=0.017), with no significant difference between the HT and healthy groups (p=0.803). The T2D group had significantly lower PA, FC, and QoL compared to the healthy group (p=0.040). Conclusion: PA, FC, and QoL were lowest in the obese group. Older patients with T2D also showed lower levels in these parameters compared to HT and healthy groups, though no significant differences were found between the HT and healthy peers.

Anahtar Kelimeler

• Diabetes
• Functional capacity
• Hypertension
• Obesity
• Physical activity
• Quality of life

Kronik Komorbiditeleri Olan Yaşlı Hastalar ile Sağlıklı Akranlar Arasında Fiziksel Aktivite, Fonksiyonel Kapasite ve Yaşam Kalitesinin Karşılaştırılması: Bir Devlet Hastanesi Örneği

Öz

Amaç: Bu çalışma, bir devlet hastanesi örneğinde kronik komorbiditeleri olan yaşlı hastalar ile sağlıklı akranları arasında fiziksel aktivite (FA), fonksiyonel kapasite (FK) ve yaşam kalitesini (YK) karşılaştırmayı amaçladı. Gereç ve Yöntemler: Çalışmaya, obezite, hipertansiyon (HT), tip 2 diyabet (T2D) ve sağlıklı olmak üzere dört gruba ayrılan, her grupta 37 katılımcı olmak üzere toplam 148 yaşlı birey dahil edildi. FA, FK ve YK, sırasıyla Uluslararası Fiziksel Aktivite Anketi-Kısa Formu (UFAA-KF), 6 dakika yürüme testi (6DYT) ve SF-36 Yaşam Kalitesi Anketi kullanılarak değerlendirildi. Kolmogorov-Smirnov testi değişken dağılımını değerlendirmiştir. Sürekli değişkenler tek yönlü ANOVA ile, kesikli değişkenler Kruskal-Wallis testi ile ve kategorik değişkenler ki-kare testi ile karşılaştırılmıştır. Post-hoc ikili karşılaştırmalar için Bonferroni ve Mann-Whitney U testleri kullanılmıştır. Bulgular: Obezite grubunun FA ve FK değerleri, diğer tüm gruplardan anlamlı derecede daha düşüktü (p=0,044). Ayrıca, obezite grubunun YK değerleri, HT ve sağlıklı gruplardan da anlamlı derecede daha düşüktü (p=0,017). HT grubunun FA değerleri, T2D grubuna göre anlamlı derecede daha yüksek bulunurken (p=0,046), HT ve sağlıklı gruplar arasında anlamlı bir fark bulunmadı (p=0,077). HT grubunun FK’si, T2D grubuna göre anlamlı derecede daha yüksek (p=0,043) olmasına rağmen sağlıklı gruptan farklı değildi (p=0,074). YK, HT grubunda T2D grubuna göre anlamlı derecede daha yüksekti (p=0,017), ancak HT ve sağlıklı gruplar arasında anlamlı bir fark bulunmadı (p=0,803). T2D grubunun FA, FK ve YK değerleri sağlıklı gruba kıyasla anlamlı derecede daha düşüktü (p=0,040). Sonuç: FA, FK ve YK obezite grubunda en düşük seviyedeydi. T2D'li yaşlı hastalar, bu parametrelerde HT ve sağlıklı gruplara göre daha düşük seviyeler gösterdi, ancak HT grubu ile sağlıklı akranlar arasında anlamlı bir fark bulunmadı.

Anahtar Kelimeler

• Diyabet
• Fiziksel aktivite
• Fonksiyonel kapasite
• Hipertansiyon
• Obezite
• Yaşam kalitesi

Kaynakça

1. 1. Peralta M, Ramos M, Lipert A, Martins J, Marques A. Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand J Public Health. 2018;46(5):522-9.
2. 2. World Health Organization. Obesity and overweight 2024 [Available from: https://www.who.int/news-room/fact-sheets/ detail/obesity-and-overweight.
3. 3. World Health Organization. Hypertension: WHO; 2023 [Available from: https://www.who.int/news-room/fact-sheets/ detail/hypertension.
4. 4. Wang Y, Beydoun MA. The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6-28.
5. 5. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. International Journal of Epidemiology. 2014;43(1):116-28.
6. 6. Jain A, Paranjape S. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility. Indian Journal of Endocrinology and Metabolism. 2013;17(Suppl1):S318-S22.
7. 7. Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Quality of Life Research. 2008;17:1063-71.
8. 8. Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121(6):21-33.

9. 9. Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat Rev Nephrol. 2019;15(6):367-85.
10. 10. O’Donnell CJ, Elosua R. Cardiovascular Risk Factors. Insights From Framingham Heart Study. Revista Española de Cardiología (English Edition). 2008;61(3):299-310.
11. 11. Sharma SK, Ghimire A, Radhakrishnan J, Thapa L, Shrestha NR, Paudel N, Gurung K, R M, Budathoki A, Baral N, Brodie D. Prevalence of hypertension, obesity, diabetes, and metabolic syndrome in Nepal. International journal of hypertension. 2011;2011(1):821971.
12. 12. Hajian-Tilaki K, Heidari B, Hajian-Tilaki A. Solitary and combined negative influences of diabetes, obesity and hypertension on health-related quality of life of elderly individuals: A population-based cross-sectional study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2016;10(2, Supplement 1):S37-S42.
13. 13. Shah S, Abbas G, Aslam A, Randhawa FA, Khan FU, Khurram H, Chand UR, Butt MH, Mallhi TH, Khan YH. Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity. PLoS One. 2023;18(8):e0289502.
14. 14. Cleven L, Krell-Roesch J, Nigg CR, Woll A. The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012. BMC public health. 2020;20:1-15.
15. 15. Hajian-Tilaki K, Heidari B, Hajian-Tilaki A. Solitary and combined negative influences of diabetes, obesity and hypertension on health-related quality of life of elderly individuals: a population-based cross-sectional study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2016;10(2):S37-S42.
16. 16. Sertel M, Şimşek TT, Yümin ET. The effects of body mass index on balance, mobility, and functional capacity in older adults. Topics in Geriatric Rehabilitation. 2017;33(2):104-12.
17. 17. Bölükbaşı S. Yaşlı Obezlerde Egzersiz Yaklaşımı ve Etkileri. Turk J Diab Obes. 2020;4:54–59.
18. 18. Pataky Z, Armand S, Müller‐Pinget S, Golay A, Allet L. Effects of obesity on functional capacity. Obesity. 2014;22(1):56-62.
19. 19. Zhu H, Yan W, Ge D, Treiber FA, Harshfield GA, Kapuku G, Snieder H, Dong Y. Relationships of cardiovascular phenotypes with healthy weight, at risk of overweight, and overweight in US youths. Pediatrics. 2008;121(1):115-22.
20. 20. De Lorenzo A, Romano L, Di Renzo L, Di Lorenzo N, Cenname G, Gualtieri P. Obesity: A preventable, treatable, but relapsing disease. Nutrition. 2020;71:110615.
21. 21. Figueiredo VN, Yugar-Toledo JC, Martins LC, Martins LB, de Faria AP, de Haro Moraes C, Sierra C, Coca A, Moreno H. Vascular stiffness and endothelial dysfunction: Correlations at different levels of blood pressure. Blood pressure. 2012;21(1):31-8.
22. 22. Saini DC, Kochar A, Poonia R. Clinical correlation of diabetic retinopathy with nephropathy and neuropathy. Indian Journal of Ophthalmology. 2021;69(11):3364-8.
23. 23. Akyol Güner T, Bayraktaroğlu T, Seval M. Yaşlı Tip 2 Diyabetli Bireylerde Diyabet Yükünün İncelenmesi: Zonguldak İli Örneği. Turk J Diab Obes. 2020;4:108–118.
24. 24. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Medicine & science in sports & exercise. 2003;35(8):1381-95.
25. 25. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L. International physical activity questionnaire: reliability and validity of the Turkish version. Perceptual and motor skills. 2010;111(1):278-84.
26. 26. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-7.
27. 27. Ware Jr JE, Sherbourne CD. The MOS 36-ltem short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care. 1992;30(6):473-83.
28. 28. Kocyigit H. Reliability and validity of the Turkish version of short form-36 (SF-36): a study in a group of patients will rheumatic diseases. Turk J Drugs Ther. 1999;12:102-6.
29. 29. Demiral Y, Ergor G, Unal B, Semin S, Akvardar Y, Kivircik B, Alptekin K. Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population. BMC public health. 2006;6:1-8.
30. 30. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91.
31. 31. Shah S, Abbas G, Aslam A, Randhawa FA, Khan FU, Khurram H, Chand UR, Butt MH, Mallhi TH, Khan YH. Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity. PLoS One. 2023;4;18(8).
32. 32. Meredith SJ, Cox NJ, Ibrahim K, Higson J, McNiff J, Mitchell S, Rutherford M, Wijayendran A, Shenkin SD, Kilgour AHM, Lim SER. Factors that influence older adults’ participation in physical activity: a systematic review of qualitative studies. Age Ageing. 2023;52(8).
33. 33. Günal AM. Weight Matters: Investigating Overweight and Obesity Prevalence Among Municipal Bus Drivers and Its Nexus with Physical Activity, Stress, Emotional Eating, and Diet. Turk J Diab Obes. 2023;7:182–190.
34. 34. National Center for Chronic Disease Prevention and Health Promotion. Report: Adults 50 and Older Need More Physical Activity 2024 [Available from: https://www.cdc.gov/physical- activity/php/reports/adults-50-and-older.html.
35. 35. Moczulska B, Żechowicz M, Leśniewska S, Nowek P, Osowiecka K, Gromadziński L. Obesity is associated with higher heart rate and excessive dyspnea with fatigue in the six-minute walk test. Pol Merkur Lekarski. 2022;50(300):342-7.
36. 36. Buch A, Marcus Y, Shefer G, Zimmet P, Stern N. Approach to Obesity in the Older Population. J Clin Endocrinol Metab. 2021;106(9):2788-805.
37. 37. Jiesisibieke D, Feng Y, Jiesisibieke ZL, Liu J, Tao L. Trends of underweight, overweight, and obesity among older adults in China from 2008 to 2018: a national observational survey. BMC Public Health. 2023;23(1):1373.
38. 38. Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med. 2016;11:28.
39. 39. Arranz L-I, Rafecas M, Alegre C. Effects of obesity on function and quality of life in chronic pain conditions. Current rheumatology reports. 2014;16:1-8.
40. 40. Almeida, A. S. D., Fontes, P. A., Reinaldo, J. M., Feitosa, M. D. L., Sampaio, R. A. C., Silva, R. J. D. S., & Wichi, R. B. Influence of overweight on functional capacity of physically active older women. Revista Brasileira de Cineantropometria & Desempenho Humano. 2020;22:e67000.
41. 41. Gretebeck KA, Sabatini LM, Black DR, Gretebeck RJ. Physical activity, functional ability, and obesity in older adults: A gender difference. Journal of gerontological nursing. 2017;43(9):38- 46.
42. 42. Hecker J, Freijer K, Hiligsmann M, Evers S. Burden of disease study of overweight and obesity; the societal impact in terms of cost-of-illness and health-related quality of life. BMC Public Health. 2022;22:1-13.
43. 43. Dalle Grave R, Soave F, Ruocco A, Dametti L, Calugi S. Quality of Life and Physical Performance in Patients with Obesity: A Network Analysis. Nutrients. 2020;12(3).
44. 44. Stephenson J, Smith C, Kearns B, Haywood A, Bissell P. The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study. BMC Public Health. 2021;21:1-9.
45. 45. Cleven L, Krell-Roesch J, Nigg CR, Woll A. The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012. BMC Public Health. 2020;20(1):726.
46. 46. Lu Y, Lu M, Dai H, Yang P, Smith-Gagen J, Miao R, Zhong H, Chen R, Liu X, Huang Z, Yuan H. Lifestyle and Risk of Hypertension: Follow-Up of a Young Pre-Hypertensive Cohort. Int J Med Sci. 2015;12(7):605-12.
47. 47. Stenehjem JS, Hjerkind KV, Nilsen TIL. Adiposity, physical activity, and risk of hypertension: prospective data from the population-based HUNT Study, Norway. J Hum Hypertens. 2018;32(4):278-86.
48. 48. Mota TA, Alves MB, Silva VAd, Oliveira FAd, Brito PMCd, Silva RSd. Factors associated with the functional capacity of elderly individuals with hypertension and/or diabetes mellitus. Escola Anna Nery. 2019;24(1):e20190089.
49. 49. Pescatello LS. Effects of exercise on hypertension: from cells to physiological systems: Springer; 2015.
50. 50. Krousel-Wood M, Peacock E, Joyce C, Li S, Frohlich E, Re R, Mills K, Chen J, Stefanescu A, Whelton P, Tajeu G, Kronish I, Muntner P. A hybrid 4-item Krousel-Wood Medication Adherence Scale predicts cardiovascular events in older hypertensive adults. J Hypertens. 2019;37(4):851-9.
51. 51. Carvalho MA, Silva IB, Ramos SB, Coelho LF, Gonçalves ID, Figueiredo Neto JA. Quality of life of hypertensive patients and comparison of two instruments of HRQOL measure. Arq Bras Cardiol. 2012;98(5):442-51.
52. 52. Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;2006(3):Cd002968.
53. 53. Lidegaard LP, Schwennesen N, Willaing I, Faerch K. Barriers to and motivators for physical activity among people with Type 2 diabetes: patients’ perspectives. Diabet Med. 2016;33(12):1677-85.
54. 54. Amerzadeh, M., Bahrami, M., Samie, F., Khatooni, M., Hosseinkhani, Z., Yousefi, B., & Taherkhani, O. Level of physical activity in patients with type 2 diabetes. Journal of Diabetes & Metabolic Disorders. 2023:1-8.
55. 55. Awotidebe TO, Adedoyin RA, Yusuf AO, Mbada CE, Opiyo R, Maseko FC. Comparative functional exercise capacity of patients with type 2-diabetes and healthy controls: a case control study. Pan African Medical Journal. 2014;19(1).
56. 56. Macedo ACP, Schaan CW, Bock PM, Pinto MB, Botton CE, Umpierre D, Schaan BD. Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Archives of Endocrinology and Metabolism. 2023;67(5):e230040.
57. 57. Jing X, Chen J, Dong Y, Han D, Zhao H, Wang X, Gao F, Li C, Cui Z, Liu Y, Ma J. Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis. Health Qual Life Outcomes. 2018;16(1):189.
58. 58. Akgül Gündoğdu N, Selçuk Tosun A, Balcı Ş. Quality of Life and Factors Affecting it in Elderly Individuals with Type 2 Diabetes. Turk J Diab Obes. 2022;6:104–112.
59. 59. Nyberg M, Gliemann L, Hellsten Y. Vascular function in health, hypertension, and diabetes: effect of physical activity on skeletal muscle microcirculation. Scand J Med Sci Sports. 2015;25 Suppl 4:60-73.
60. 60. Akeren Z, Semerci Çakmak V, Demirağ H. Kronik Hastaların Metabolik Sendrom Bilgi Düzeyleri ve Farkındalıkları. Turk J Diab Obes. 2024;8:35–42.
61. 61. Virdis A, Neves MF, Duranti E, Bernini G, Taddei S. Microvascular endothelial dysfunction in obesity and hypertension. Curr Pharm Des. 2013;19(13):2382-9.