In this post, Daniel Aggio, a PhD student at PCPH, discusses some of his PhD work that was recently published in BMJ Open and has had widespread media coverage in the UK and across the pond in America.

There is a considerable body of research suggesting that physical activity tracks from childhood into adulthood. In other words, being an active child means you are more likely to be active as an adult. Something that has been less explored is how physical activity tracks during the transition to old age, an important period when many major life events are likely to occur.

This study utilises data from the British Regional Heart Study, a prospective cohort study involving over 7000 middle-aged men recruited between 1978 and 1980 from 24 towns across Britain. One of the main assets of the British Regional Heart study is the lengthy follow up data, including measures of physical activity throughout the transition to old age. By exploiting these data, we were able to explore how physical activity tracks during this period and identify the types of activity in midlife that are most likely to predict an active lifestyle in later life.

It did not come as much of a surprise to find that being active in midlife more than doubled the odds of being active in old age, but we were struck by how strongly midlife sport participation, and particularly if it was initiated earlier in life, predicted being active in old age. For example, men who had played sports for 25 years or more were nearly 5 times as likely to be physically active in later life compared with men who did not play sports. But even taking up sport relatively late in midlife (i.e. less than 4 years ago) significantly increased the odds of being active in old age. Higher levels of walking and recreational activity in midlife also increased the odds of being active in later life, but they were not as strongly associated as sport participation. Until we carry out more research we can only speculate as to why this is the case. Plausibly, people who keep up sport may simply do so because they enjoy it. We also suspect that sport plays a pivotal role in the development and maintenance of key motor skills, which may prove vital in later life.

Although sport participation may be more stable and more likely to predict activity in later life than other types of activity, walking was the most likely to increase during later life, possibly because retirement might free up more time and functional declines may limit capability for more intense activities. From a public health perspective, promoting walking may be more feasible in later life as we show that many older adults are already increasing their walking during the transition to old age.

Being active in midlife, particularly playing sport, is important for maintaining an active lifestyle into old age. Sport participation may be crucial for establishing lifelong physical activity and should be promoted throughout the lifecourse, especially in early life. Strategies to increase physical activity in later life may also need to target other forms of activity that can be widely adopted, such as walking.

Click here to read the full published article.

In this post Danielle Roberts describes her experience during her four-month academic placement with PCPH’s British Regional Heart Study (BRHS) research team. 

I am a foundation year 2 (FY2) doctor; this means I am in my second year of working as a doctor after finishing medical school. Foundation doctors undertake 4-monthly placements, rotating around different hospital departments, general practice or other community posts. The aim is to provide newly-qualified doctors with rich and varied experiences before we apply for speciality training posts.

I was fortunate enough to have secured a place on an academic foundation programme, which meant that one of my 4-month placements was designated to be a research post. With these bespoke academic placements, there is a lot of flexibility with what you can pursue depending on your areas of interest. My future career plans are to become an academic GP, with research interests in public health; and thus it was a great privilege for me to be able to spend my research placement within UCL’s PCPH department. With such a plethora of leading research groups within PCPH, I was spoilt for choice; however considering my main passion for cardiovascular disease and diabetes, I decided to join with the British Regional Heart Study (BRHS) research group.

The BRHS research group are a very friendly, helpful, supportive and fun team to work with. Not only was the placement overwhelmingly productive, but I had an enjoyable four months too. Whoever said research is boring……we had several social trips out for lunch, lots of food and lots of laughs!

The BRHS has a wealth of data from an original cohort of 7735 middle-aged men aged 40-59 years  from 24 British towns, initially recruited in 1978-1980. These men have been regularly followed-up  for morbidity and mortality since including a physical re-examination in 1998-2000 when aged 60-79 years.   My research project investigated the prospective association of individual socioeconomic position and neighbourhood-level socioeconomic deprivation with incident type 2 diabetes mellitus in older British men (60-79 years). We found that diabetes risk was higher in lower social classes and in areas of greater socioeconomic deprivation. For manual social class this was mostly explained by body mass index and triglycerides. For neighbourhood-level socioeconomic deprivation it was largely explained by body mass index and to a lesser extent, other lifestyle factors (smoking, alcohol, physical activity, diet etc.). Our results support the need for public health campaigns specifically targeting obesity as a fundamental means towards preventing type 2 diabetes and reducing socioeconomic inequalities in older adults.

Completing the project during the placement was a big achievement in itself, as I had never used sophisticated statistical software before; yet under the guidance of my supervisors, I was able to write and run my own codes by the end of the project. I also started to write up the first draft of my project as a scientific paper. This was my first experience of writing a research paper. Writing the draft enabled me to develop skills in literature searching and the ability to read and critically appraise evidence. By the end of the four months, I successfully submitted my abstract to an international Public Health conference in Canada, and so I will be presenting our work there in June 2017.

What I really liked about this placement was the flexibility. The BRHS team were very accommodating, so I was able to pursue various interests alongside my primary goal of completing the research project. For example, I wanted to develop my teaching skills, and so I attended a formal “Training to Teach” course and then used the skills I had learnt to teach 4^th year UCL medical students together with GP trainees. Additionally, as my future career plans are towards general practice, I was able to arrange some GP taster sessions during my placement, which allowed me to gain further experience.

Believe it or not, this is just a highlight of some the things I was able to achieve during my 4-month placement with the BRHS team! This list could go on, but I want to just take this opportunity to say a massive thank you to all the members of the team who supported me and enabled me to make the most out of the time I had. For any future FY2 doctors, who are searching for a rich and varied academic placement, with a strong research focus, but with the flexibility to allow for the pursuit of other interests too, I cannot think of any group more suitable than PCPH’s British Regional Heart Study group.

The British Regional Heart Study (BRHS) group have been busy over the summer presenting their work at national and international conferences, which were well received by their audiences, generating lots of discussion. The BRHS is a longitudinal study with over 35 years of follow-up of men from across Britain now in their 70s through to 90s.  At recent conferences, the BRHS team members presented a variety of exciting research ranging from physical activity, sensory impairments, cognition, to oral health of older people.

Dr Barbara Jefferis attended the ISBNPA, a physical activity conference, in Edinburgh. She presented new findings using the activity monitor data looking at the importance of accumulating physical activity in bouts in relation to measures of adiposity (obesity) and metabolic syndrome- challenging the government guidelines requiring that physical activity be accumulated in bouts of 10 minutes or more.

Dr Jefferis and Claudio Sartini gave presentations at ICAMPAM in Limerick, highlighting their work using the activity monitor data to investigate how patterns of activity are affected by diurnal and seasonal variations. This work showed that people in poorer health states or older age groups lose out on the peak of activity in the morning.

In early September the Society for Social Medicine held its 59^th annual scientific meeting at University College Dublin. Eight members of staff and PhD students from the BRHS attended the conference and by the end of the conference most attendees had probably heard about our work!  Three of the team arrived a day before the conference to attend the pre-conference event for early career researchers which covered everything from job applications and fellowships to how to deal with difficult people and thinking strategically about your career.

Dr Tessa Parsons presented her work on physical activity and carotid intima-media thickness, a vascular marker for cardiovascular disease. It looks as though all activity is important, even if it is accumulated in bouts of less than 10 minutes. Light activity was found to have a potentially protective effect, and this might inform updates of the physical activity guidelines which at the moment make no mention of light activity.

Ann Liljas presented work from her PhD on hearing and vision impairments in older men and subsequent risk of cardiovascular disease (CVD) including heart attack and stroke, and CVD mortality. Ann’s work showed that men with a self-reported hearing problem had an increased risk of stroke compared to those with no hearing problem, even after taking factors such as age, social class, smoking and obesity into consideration. Early identification of hearing impairment in older adults could be important in preventing stroke.

Dr Steven Papachristou presented his work on the relationships between obesity and sarcopenia (loss of skeletal muscle mass and strength as a result of ageing) with cognitive function in older age. The adiposity measures considered were not restricted to anthropometric characteristics but also included detailed measurements obtained from bio-impedance analysis. Interestingly, his findings show that BMI, peripheral fat mass (fat that accumulates under the skin and is evenly distributed over the body’s surface area) and visceral fat mass (excessive abdominal fat around the stomach, but not waist circumference or central adiposity, are associated with severe cognitive impairments in later life after adjustments for metabolic and inflammatory markers.

Dr Sheena Ramsay presented new findings on oral health in older people. Her work on socioeconomic inequalities showed that neighbourhood deprivation was strongly associated with tooth loss, and to some extent with acute periodontal (gum) disease. This adds to the evidence on the importance of neighbourhood deprivation on various aspects of the health of older people including oral health.

Finally, we said farewell to Janice Atkins, who submitted her PhD in September entitled Body composition, dietary patterns, cardiovascular disease and mortality in older age. We wish Janice every success in her new job as a Research Fellow at the University of Exeter.

This study is funded by the BHF and receives further support from the MRC, NIHR and NSPCR.  The views expressed are those of the authors and not necessarily those of the funding bodies.