Resumo: Este estudo objetivou verificar os efeitos hipotéticos da substituição do comportamento sedentário por atividade física moderada a vigorosa, sono e diferentes domínios da atividade física por quantidades equivalentes sobre o declínio cognitivo em uma população idosa. Trata-se de um estudo transversal, com 473 idosos de ≥ 60 anos. O declínio cognitivo foi avaliado por meio do Mini Exame do Estado Mental. A atividade física, seus diferentes domínios e o tempo de exposição ao comportamento sedentário foram avaliados por meio do Questionário Internacional de Atividade Física. Para a análise dos dados, foram utilizados dois modelos de substituição isotemporal, por meio da regressão de Poisson. O primeiro modelo testou o efeito do tempo de sono, comportamento sedentário e atividade física moderada a vigorosa no declínio cognitivo. O segundo modelo foi utilizado para determinar o efeito dos domínios de atividade física (lazer, trabalho, transporte e casa), tempo de sono e comportamento sedentário no declínio cognitivo. A atividade física no lazer foi um fator protetivo contra declínio cognitivo em todos os domínios testados, substituindo comportamento sedentário, sono e transporte. Por outro lado, a substituição do domínio lazer por comportamento sedentário, sono e transporte foi considerada fator de risco para o declínio cognitivo. O tempo livre mostrou-se um forte fator protetor na redução do risco de declínio cognitivo, sendo necessário incentivar e estimular políticas públicas.

Resumen: Este estudio tuvo como objetivo verificar los efectos hipotéticos al reemplazar el comportamiento sedentario por actividad física de moderada a vigorosa, sueño y diferentes dominios de actividad física por cantidades equivalentes sobre el deterioro cognitivo en una población anciana. Se trata de un estudio transversal, con 473 ancianos ≥ 60 años. El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental. La actividad física, sus diferentes dominios y el tiempo de exposición al comportamiento sedentario se evaluaron mediante el Cuestionario Internacional de Actividad Física. Para el análisis de los datos, se utilizaron dos modelos de reemplazo isotemporal, utilizando la regresión de Poisson. El primer modelo probó el efecto del tiempo de sueño, comportamiento sedentario y actividad física de moderada a vigorosa en el deterioro cognitivo. El segundo modelo se utilizó para determinar el efecto de los dominios de actividad física (ocio, trabajo, transporte y hogar), tiempo de sueño y comportamiento sedentario en el deterioro cognitivo. La actividad física en el tiempo libre fue un factor protector contra el deterioro cognitivo en todos los dominios evaluados, reemplazando el comportamiento sedentario, el sueño y el transporte. Por otra parte, reemplazar el dominio del ocio por comportamiento sedentario, sueño y transporte se consideró un factor de riesgo para el deterioro cognitivo. El tiempo libre demostró ser un fuerte factor protector para reducir el riesgo de deterioro cognitivo, por lo que es necesario fomentar y estimular políticas públicas.

Abstract: This study aimed to test hypothesized effects of replacing sedentary behavior with moderate-to-vigorous physical activity, sleep, and different domains of physical activity by equivalent amounts on suggestive cognitive decline in an older adult population. This was a cross-sectional study including 473 older adults aged ≥ 60 years. Cognitive decline was assessed using the Mini-Mental Health Examination. Physical activity, its different domains and the time of exposure to sedentary behavior were assessed using the International Physical Activity Questionnaire. For data analysis, two isotemporal substitution models were constructed using Poisson regression. The first model tested the effect of sleep time, sedentary behavior, and moderate-to-vigorous physical activity on cognitive decline. The second model was used to determine the effect of physical activity domains (leisure, work, transport, and home), sleep time, and sedentary behavior on cognitive decline. Physical activity during leisure time was protective against cognitive decline among all domains tested, replacing sedentary behavior, sleep, and transport. Conversely, substitution of the leisure domain for sedentary behavior, sleep, and transport was considered a risk factor for cognitive decline. Leisure time proved to be a strong protective factor in reducing the risk of cognitive decline, and it is necessary to encourage and stimulate public policies that include it.

ABSTRACT BACKGROUND: Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors. OBJECTIVE: The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults. DESIGN AND SETTING: An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil METHODS: The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology. RESULTS: An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively. CONCLUSIONS: The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits. BACKGROUND individuals (SB PA. . (PA) factors OBJECTIVE sleeping moderatetovigorous moderate vigorous (MVPA SETTING crosssectional cross sectional Bahia METHODS 47 interview Questionnaire Scale RESULTS tested 40 20 20% respectively 28 17 17% CONCLUSIONS benefits (PA 4 2 1

Resumo: Este estudo objetivou verificar os efeitos hipotéticos da substituição do comportamento sedentário por atividade física moderada a vigorosa, sono e diferentes domínios da atividade física por quantidades equivalentes sobre o declínio cognitivo em uma população idosa. Trata-se de um estudo transversal, com 473 idosos de ≥ 60 anos. O declínio cognitivo foi avaliado por meio do Mini Exame do Estado Mental. A atividade física, seus diferentes domínios e o tempo de exposição ao comportamento sedentário foram avaliados por meio do Questionário Internacional de Atividade Física. Para a análise dos dados, foram utilizados dois modelos de substituição isotemporal, por meio da regressão de Poisson. O primeiro modelo testou o efeito do tempo de sono, comportamento sedentário e atividade física moderada a vigorosa no declínio cognitivo. O segundo modelo foi utilizado para determinar o efeito dos domínios de atividade física (lazer, trabalho, transporte e casa), tempo de sono e comportamento sedentário no declínio cognitivo. A atividade física no lazer foi um fator protetivo contra declínio cognitivo em todos os domínios testados, substituindo comportamento sedentário, sono e transporte. Por outro lado, a substituição do domínio lazer por comportamento sedentário, sono e transporte foi considerada fator de risco para o declínio cognitivo. O tempo livre mostrou-se um forte fator protetor na redução do risco de declínio cognitivo, sendo necessário incentivar e estimular políticas públicas. Resumo idosa Tratase Trata se transversal 47 6 anos Mental Física dados isotemporal Poisson lazer, (lazer trabalho casa, casa , casa) testados lado mostrouse mostrou públicas 4

Abstract: This study aimed to test hypothesized effects of replacing sedentary behavior with moderate-to-vigorous physical activity, sleep, and different domains of physical activity by equivalent amounts on suggestive cognitive decline in an older adult population. This was a cross-sectional study including 473 older adults aged ≥ 60 years. Cognitive decline was assessed using the Mini-Mental Health Examination. Physical activity, its different domains and the time of exposure to sedentary behavior were assessed using the International Physical Activity Questionnaire. For data analysis, two isotemporal substitution models were constructed using Poisson regression. The first model tested the effect of sleep time, sedentary behavior, and moderate-to-vigorous physical activity on cognitive decline. The second model was used to determine the effect of physical activity domains (leisure, work, transport, and home), sleep time, and sedentary behavior on cognitive decline. Physical activity during leisure time was protective against cognitive decline among all domains tested, replacing sedentary behavior, sleep, and transport. Conversely, substitution of the leisure domain for sedentary behavior, sleep, and transport was considered a risk factor for cognitive decline. Leisure time proved to be a strong protective factor in reducing the risk of cognitive decline, and it is necessary to encourage and stimulate public policies that include it. Abstract moderatetovigorous moderate vigorous population crosssectional cross sectional 47 6 years MiniMental Mini Mental Examination Questionnaire analysis regression leisure, (leisure work home, home , home) Conversely 4

Resumen: Este estudio tuvo como objetivo verificar los efectos hipotéticos al reemplazar el comportamiento sedentario por actividad física de moderada a vigorosa, sueño y diferentes dominios de actividad física por cantidades equivalentes sobre el deterioro cognitivo en una población anciana. Se trata de un estudio transversal, con 473 ancianos ≥ 60 años. El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental. La actividad física, sus diferentes dominios y el tiempo de exposición al comportamiento sedentario se evaluaron mediante el Cuestionario Internacional de Actividad Física. Para el análisis de los datos, se utilizaron dos modelos de reemplazo isotemporal, utilizando la regresión de Poisson. El primer modelo probó el efecto del tiempo de sueño, comportamiento sedentario y actividad física de moderada a vigorosa en el deterioro cognitivo. El segundo modelo se utilizó para determinar el efecto de los dominios de actividad física (ocio, trabajo, transporte y hogar), tiempo de sueño y comportamiento sedentario en el deterioro cognitivo. La actividad física en el tiempo libre fue un factor protector contra el deterioro cognitivo en todos los dominios evaluados, reemplazando el comportamiento sedentario, el sueño y el transporte. Por otra parte, reemplazar el dominio del ocio por comportamiento sedentario, sueño y transporte se consideró un factor de riesgo para el deterioro cognitivo. El tiempo libre demostró ser un fuerte factor protector para reducir el riesgo de deterioro cognitivo, por lo que es necesario fomentar y estimular políticas públicas. Resumen anciana transversal 47 6 años Mental Física datos isotemporal Poisson ocio, (ocio trabajo hogar, hogar , hogar) evaluados parte públicas 4

ABSTRACT BACKGROUND: Frailty syndrome is associated with various physical, cognitive, social, economic, and environmental factors. Although frailty syndrome occurs progressively with age, prevention and treatment are possible. Reducing or eliminating risks and increasing protective factors may be potential strategies for reducing the prevalence of injuries related to frailty. One of the most effective actions is to decrease the time spent in sedentary behavior (SB) by increasing regular physical activity (PA). OBJECTIVE: To examine the hypothetical effect of substitution of the time spent in sleep or SB with an equivalent time spent performing moderate or vigorous PA on frailty syndrome in the older population. DESIGN AND SETTING: An analytical cross-sectional study conducted using exploratory methods of survey, carried out in Alcobaça city, Bahia, Brazil. METHODS: A total of 456 older adults of both sexes, aged ≥ 60 years, participated in this study. Frailty syndrome was identified according to the criteria of the Study of Osteoporotic Fractures. PA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. The effects of time substitution on these behaviors were verified using Poisson regression. RESULTS: The replacement of 60 min/day of SB (prevalence ratio, PR = 0.52; 95% confidence interval, CI: 0.28–0.96) or sleep (PR = 0.52; 95% CI: 0.27–0.98) with 60 min/day of moderate PA (MPA) was associated with a 48% reduction in the prevalence of frailty syndrome. CONCLUSIONS: Replacing the time spent sitting or sleeping with the same amount of MPA time may reduce frailty; the longer the duration of time spent in the substitution of sleep or SB with MPA, the greater the benefits.

RESUMO Esta pesquisa teve como objetivo analisar a associação do nível de atividade física (AF) combinado à exposição ao comportamento sedentário (CS) com a dinapenia em idosos. Estudo epidemiológico, transversal, conduzido com 208 idosos de Aiquara, Bahia, Brasil. A AF habitual e o CS foram quantificados pelo International Physical Activity Questionnaire. A partir destas informações, dividiu-se os participantes em grupos (G): G1) suficientemente ativos e baixo CS; G2) suficientemente ativos e elevado CS; G3) insuficientemente ativos e baixo CS; e G4) insuficientemente ativos e elevado CS. A avaliação da dinapenia foi realizada a partir dos valores, em quilograma-força (kgf), da força de preensão manual (mulheres: 18,37 kgf; homens: 26,75 kgf). A análise descritiva foi conduzida por meio de frequências absolutas e relativas, média e desvio padrão. Para a análise inferencial utilizou-se a regressão de Poisson, com estimador robusto, cálculo das Razões de Prevalência (RP) e de seus respectivos Intervalos de Confiança (IC) de 95,0%. Observou-se que as médias de idade das mulheres e dos homens, foram, respectivamente, 71,0 ± 6,7 e 72,3 ± 8,1 anos e a prevalência de dinapenia observada foi na ordem de 24,5%. Ademais, averiguou-se que os idosos insuficientemente ativos com baixo CS (G3) (RP: 2,28; IC95%: 1,09-4,76), e os insuficientemente ativos com elevado CS (G4) (RP: 4,14; IC95%: 1,95-8,70), apresentaram maior probabilidade ao desfecho analisado. As evidências verificadas mostraram que, entre os idosos de Aiquara, a prevalência de dinapenia foi elevada na presença do nível de AF insuficiente, especialmente quando combinado a uma maior exposição ao CS. (AF (CS epidemiológico transversal 20 Aiquara Bahia Brasil Questionnaire informações dividiuse dividiu se G (G) G1 G2 G3 G4 valores quilogramaforça quilograma kgf, kgf , (kgf) (mulheres 1837 18 37 18,3 homens 2675 26 75 26,7 kgf. . kgf) relativas padrão utilizouse utilizou Poisson robusto RP (RP IC (IC 950 95 0 95,0% Observouse Observou respectivamente 710 71 71, 67 6 7 6, 723 72 3 72, 81 8 1 8, 245 24 5 24,5% Ademais averiguouse averiguou (G3 2,28 228 2 28 IC95% IC95 1,094,76, 109476 1,09 4,76 09 4 76 1,09-4,76) (G4 4,14 414 14 1,958,70, 195870 1,95 8,70 70 1,95-8,70) analisado insuficiente (G (kgf 183 18, 267 26, 9 95,0 24,5 2,2 22 IC9 094 1,094,76 10947 109 1,0 476 4,7 1,09-4,76 4,1 41 958 1,958,70 19587 195 1,9 870 8,7 1,95-8,70 95, 24, 2, 1,094,7 1094 10 1, 47 4, 1,09-4,7 1,958,7 1958 19 87 1,95-8,7 1,094, 1,09-4, 1,958, 1,95-8, 1,094 1,09-4 1,958 1,95-8 1,09- 1,95-

ABSTRACT This research aimed to analyze the association of physical activity (PA) level combined with exposure to sedentary behavior (SB) with dynapenia in older people. Epidemiological, cross-sectional study, conducted with 208 older adults in Aiquara, Bahia, Brazil. Habitual PA and SB were quantified using the International Physical Activity Questionnaire. Based on this information, participants were divided into groups (G): G1) sufficiently active and low SB; G2) sufficiently active and high SB; G3) insufficiently active and low SB; and G4) insufficiently active and high SB. Assessment of dynapenia was performed based on the values of the handgrip strength measured in kilogram-force (kgf) (women: 18.37 kgf; men: 26.75 kgf). Descriptive analysis was conducted using absolute and relative frequencies, mean and standard deviation. For the inferential analysis, Poisson regression was used, with a robust estimator, calculation of Prevalence Ratios (PRs) and their relevant Confidence Intervals (CIs) of 95.0%. It was observed that the mean age of women and men were, respectively, 71.0 ± 6.7 and 72.3 ± 8.1 years and the prevalence of dynapenia observed was about 24.5%. Furthermore, it was found that the insufficiently active older adults with low SB (G3) (PR: 2.28; 95%CI: 1.09-4.76), and those insufficiently active with high SB (G4) (PR: 4, 14; 95%CI: 1.95-8.70), were more likely to experience the assessed outcome. Evidence showed that, among the older adults in Aiquara the prevalence of dynapenia was high in the presence of an insufficient level of PA, especially when combined with greater exposure to SB (PA (SB people Epidemiological crosssectional cross sectional study 20 Bahia Brazil Questionnaire information G (G) G1 G2 G3 G4 kilogramforce kilogram force kgf (kgf (women 1837 18 37 18.3 2675 26 75 26.7 kgf. . kgf) frequencies deviation used estimator PRs (PRs CIs (CIs 950 95 0 95.0% respectively 710 71 71. 67 6 7 6. 723 72 3 72. 81 8 1 8. 245 24 5 24.5% Furthermore (G3 PR (PR 2.28 228 2 28 95%CI 95CI CI 1.094.76, 109476 1.09 4.76 , 09 4 76 1.09-4.76) (G4 14 1.958.70, 195870 1.95 8.70 70 1.95-8.70) outcome (G 183 18. 267 26. 9 95.0 24.5 2.2 22 094 1.094.76 10947 109 1.0 476 4.7 1.09-4.76 958 1.958.70 19587 195 1.9 870 8.7 1.95-8.70 95. 24. 2. 1.094.7 1094 10 1. 47 4. 1.09-4.7 1.958.7 1958 19 87 1.95-8.7 1.094. 1.09-4. 1.958. 1.95-8. 1.094 1.09-4 1.958 1.95-8 1.09- 1.95-

ABSTRACT BACKGROUND: Dynapenia is characterized by mobility limitations in the older population when combined with aggravating behavioral factors that can increase the risk of morbidity and mortality. OBJECTIVE: To investigate the hypothetical effects of reallocation of time spent on sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and sleep on dynapenia in older adults. DESIGN AND SETTING: A prospective cohort study using exploratory surveys in Alcobaça City, Bahia State, Brazil. METHODS: In total, 176 older adults (≥ 60 years) of both sexes participated in this study. Dynapenia was assessed using the handgrip strength test with cutoff points of < 27 kg for men and < 16 kg for women. MVPA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. RESULTS: Effects on reallocation were found for the shortest times, such as 10 minutes (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.85–0.99); substituting MVPA with SB increased the chances of dynapenia by 58.0% (95% CI: 1.01–2.49). Analyzing the substitution of 60 minutes/day of SB with 60 minutes/day of MVPA revealed a protective effect, with a lower OR for dynapenia of 37.0% (OR 0.63; 95% CI: 0.40–0.99). The reallocation of sleep time did not significantly reduce dynapenia. CONCLUSIONS: Substituting the time spent sitting with the same amount of time spent on MVPA can reduce dynapenia, and a longer reallocation time confers greater health benefits in older adults. BACKGROUND mortality OBJECTIVE SB, , (SB) moderatetovigorous moderate to vigorous MVPA, (MVPA) SETTING City State Brazil METHODS total 17 ≥ ( 6 years 2 1 women Questionnaire Index RESULTS times odds 0.92 092 0 92 95 CI (CI) 0.85–0.99 085099 85 99 0.85–0.99) 580 58 58.0 (95 1.01–2.49. 101249 1.01–2.49 . 01 49 1.01–2.49) minutesday day effect 370 37 37.0 0.63 063 63 0.40–0.99. 040099 0.40–0.99 40 0.40–0.99) CONCLUSIONS (SB (MVPA 0.9 09 9 (CI 0.85–0.9 08509 8 5 58. (9 10124 1.01–2.4 4 3 37. 0.6 06 04009 0.40–0.9 0. 0.85–0. 0850 1012 1.01–2. 0400 0.40–0. 0.85–0 085 101 1.01–2 040 0.40–0 0.85– 08 1.01– 04 0.40– 0.85 1.01 0.40 0.8 1.0 0.4 1.

ABSTRACT BACKGROUND: Dynapenia is characterized by mobility limitations in the older population when combined with aggravating behavioral factors that can increase the risk of morbidity and mortality. OBJECTIVE: To investigate the hypothetical effects of reallocation of time spent on sedentary behavior (SB), moderate-to-vigorous physical activity (MVPA), and sleep on dynapenia in older adults. DESIGN AND SETTING: A prospective cohort study using exploratory surveys in Alcobaça City, Bahia State, Brazil. METHODS: In total, 176 older adults (≥ 60 years) of both sexes participated in this study. Dynapenia was assessed using the handgrip strength test with cutoff points of < 27 kg for men and < 16 kg for women. MVPA and SB were assessed using the International Physical Activity Questionnaire, and sleep was assessed using the Pittsburgh Sleep Quality Index. RESULTS: Effects on reallocation were found for the shortest times, such as 10 minutes (odds ratio (OR) 0.92; 95% confidence interval (CI): 0.85–0.99); substituting MVPA with SB increased the chances of dynapenia by 58.0% (95% CI: 1.01–2.49). Analyzing the substitution of 60 minutes/day of SB with 60 minutes/day of MVPA revealed a protective effect, with a lower OR for dynapenia of 37.0% (OR 0.63; 95% CI: 0.40–0.99). The reallocation of sleep time did not significantly reduce dynapenia. CONCLUSIONS: Substituting the time spent sitting with the same amount of time spent on MVPA can reduce dynapenia, and a longer reallocation time confers greater health benefits in older adults.

ABSTRACT OBJECTIVE To examine the effects of physical activity (PA) and sedentary behaviour (SB), in isolation and combination, on all-cause mortality in older adults. METHODS Prospective, population-based cohort study. The data were collected from first wave in 2015 and the follow-up continued until 2020. The sample consisted of 332 older adult people aged ≥ 60 years-old, out of which 59 died. The level of PA and SB was assessed by the International Physical Activity Questionnaire (IPAQ). The older adults were divided into PA categorized as sufficiently active and insufficiently active and into high and low SB. We built four combinations of PA and SB. Also, we used the Cox proportional hazards regression with a 95% confidence interval with hazard ratio estimate so as to verify the mortality risks between PA, SB, and the combinations of PA and SB. RESULTS Insufficiently active individuals had higher risks of mortality compared to sufficiently active people. We observed no associations between SB and mortality separately; however, when evaluated in a combined way, insufficiently active individuals and with a high SB time had a higher chance of mortality compared to active individuals with a low SB time. CONCLUSION Our isolated analyses demonstrate that complying with PA recommendations reduces the risk of mortality; however, no association was found between the time of PA exposure with the time of SB. When analysing the combination, being physically inactive and with a long time of SB showed higher mortality rates, with SB being an enhancer of this risk. The results of this study show the interdependence of SB for PA performed at moderate to vigorous intensity. The understanding of this interrelation must be considered in the formulation of public health guidelines.

ABSTRACT OBJECTIVE To examine the effects of physical activity (PA) and sedentary behaviour (SB), in isolation and combination, on all-cause mortality in older adults. METHODS Prospective, population-based cohort study. The data were collected from first wave in 2015 and the follow-up continued until 2020. The sample consisted of 332 older adult people aged ≥ 60 years-old, out of which 59 died. The level of PA and SB was assessed by the International Physical Activity Questionnaire (IPAQ). The older adults were divided into PA categorized as sufficiently active and insufficiently active and into high and low SB. We built four combinations of PA and SB. Also, we used the Cox proportional hazards regression with a 95% confidence interval with hazard ratio estimate so as to verify the mortality risks between PA, SB, and the combinations of PA and SB. RESULTS Insufficiently active individuals had higher risks of mortality compared to sufficiently active people. We observed no associations between SB and mortality separately; however, when evaluated in a combined way, insufficiently active individuals and with a high SB time had a higher chance of mortality compared to active individuals with a low SB time. CONCLUSION Our isolated analyses demonstrate that complying with PA recommendations reduces the risk of mortality; however, no association was found between the time of PA exposure with the time of SB. When analysing the combination, being physically inactive and with a long time of SB showed higher mortality rates, with SB being an enhancer of this risk. The results of this study show the interdependence of SB for PA performed at moderate to vigorous intensity. The understanding of this interrelation must be considered in the formulation of public health guidelines.