University of Pittsburgh Associate Professor of Psychiatry, Stephen Smagula talks about routines that are best for seniors to keep them moving.
Interview conducted by Ivanhoe Broadcast News in 2023.
Where are junior researchers looking at, in terms of activity patterns for older Americans?
SMAGULA: I think a lot of people know about being active is important. And they know that getting enough sleep is important. People hear this all the time. What people don’t know as much about is the rhythm or the patterning of that and not all activity and not all sleep is created the same actually, the timing and the patterning of it actually seems relevant to your health.
What is important to know, in terms of those patterns?
SMAGULA: Well, I think it’s really obvious but people don’t think about it all the time. Like we are on a rotating planet. We evolve on planet with 24-hour light-dark cycles. So we tend to be active during the day, awake when the sun is out, and we tend to be resting and sleeping at night. And so your sleep and your activity follow a pattern. And I think that’s because we evolved on this planet to interact with each other all at the same time. Think if we were all on different schedules, we can never get anything done.
Knowing that we have the sleep and wake cycles, tell me a little bit about your study. How did you build your study around this?
SMAGULA: Well, so we’ve known for a long time that disruption to this pattern, say being up a lot at night, sleeping during the day, not following a consistent routine, we know that that’s bad for your health. But we didn’t really know how common it is. And so this study we examined these patterns in the sample that was designed to represent all the older adults in United States. And so we could estimate how common is disruption to the sleep-wake pattern and is it related to bad things like depression or low cognitive performance like early signs of dementia?
How did you measure this?
SMAGULA: So we have this device called an actograph. It contains an accelerometer inside it. This is an Apple watch but the inside all of these types of devices and we have research devices that look like this. And so you just literally put this on someone’s wrist. All it does is measures movement. And when you do that over a repeated 24-hour periods, you can start to see, is the movement happening at the same time each day or they’re following a pattern.
And in terms of sleep, does an actograph also measure sleep?
SMAGULA: It can estimate sleep but it’s- the thing that it’s truly measuring is movement. And so by the lack of movement we infer people are sleeping and resting. And there’s scientific studies to back that. Yeah, you can pretty reliably estimate if someone is sleeping based on how long they’re not moving and that type of thing.
So, you have people wearing these actographs. What do you do after they’ve done this for a certain period of time?
SMAGULA: So you get the data back and the data you plug it into a computer and you get the data and you extract all these funny different measures that scientists use that say, is this person following a pattern? The problem is there’s like 10 or 20 of these different measures and nobody knows what they mean. And we scientists know that they’re all measuring the same thing and so what we did in the study was we leveraged many of these different measures to see, are the people who have disruption on measure A, the same people who have disruption on measure B, and so on. And that was the case.
And when you had that information, were you able to take it a step further? Were you able to look at their health?
SMAGULA: That’s right.
How was their general health?
SMAGULA: So, we correlated whether you had a strong pattern or a weak pattern, which group you belonged to based on your activity patterns with things like depression and things like cognitive performance. And we found pretty robust associations so if your pattern was disrupted you were more than twice as likely to have significant depression symptoms and more than twice as likely to have a psychometric definition of low cognitive performance.
On the flip side, what can people do if we’re seeing the negative aspects of not having that pattern? What does this suggest?
SMAGULA: Well, so on the one hand we have to think why- why are people having a strong pattern or a weak pattern? And we think it’s because of things going on in their lives. A hyperbolic example would be you break your leg you’re not able to move around. But I think there’s subtler examples in our lives. Stress, you’re depressed, you have a disease, things go on maybe you feel isolated. Maybe you don’t feel like getting out of bed in the morning. And so we think that health problems are causing people to have disrupted rhythms. The problem is that the disrupted rhythms can make things worse.
So you get on a cycle. Is it a downward spiral?
SMAGULA: Yeah, we think so. We think that there’s feedback where you’re sick or you’re stressed it makes your pattern worse and then having a lack of- a strong rhythm over time can actually feed back and make your diseases of aging worse.
You talk about a strong rhythm. What does that entail? Is it just movement?
SMAGULA: So it is but we’re talking about our movement behaviors. So if you- if you wake up, say at seven o’clock and you stay in bed and some days you get up at 9:00, some days you get up at 10:00 but it’s variable, that’s probably going to be a weak rhythm. Now the people who have strong rhythms are getting up at the same time every day before seven o’clock, same time every day getting up. And then throughout the day, they were very active and engaged and they intended to go down and rest at the same time every day.
How long were they active during the day?
SMAGULA: So, that’s the other factor that came up here was the act of- the length of the act of periods differed across the groups that we found. And so the health group was active for about 15 hours a day. And that- but I’m not talking about running a marathon for 15 hours a day, I’m just talking about probably light activity, staying engaged with the households, staying engaged with family and friends, basically not just sitting there.
From what junior colleagues have found, can you make suggestions to an older population for better health?
SMAGULA: Well, I think that we observed these correlations. That’s all we’re observing here. But there’s lots of reasons to believe that there are things we can do to make our health better along these lines. For example, the healthiest group, the group that had the lowest levels of depression, the best thinking performance, this was a group that was getting up at the same time every day. So if you’re worried about these things one of these- one thing you could try is trying to get up sufficiently early at the same time every day and there’s many reasons why that could improve your health.
And you said before seven o’clock?
SMAGULA: Well, I think it varies. I think that was- that was the average in the sample, but I think it varies for everybody. I think everybody knows when their body tells them it’s time to get up and I think some people don’t listen to that.
So is it more listening to your own circadian rhythm?
SMAGULA: It’s listening to when your body is saying, “Hey, I’m awake and alert.” Because we know that that sleep if you try to keep sleeping it’s not the same type of sleep. That- actually, the activity or the sleep that you’re doing it’s not just the level but when it occurs really matters for your health.
What was the age range on the sample?
SMAGULA: These were people all 65 and older.
Is there anything that you would want to make sure that people know about the study of patterns?
SMAGULA: Yeah, I think the thing we didn’t really touch on is that people don’t want to be depressed. People don’t want to have dementia. And people might not want to get up at the same time every day. But of those three things, getting up at the same time every day is something you can do. Something you can control. And so while the depression might be causing you to not want to get going, you can’t directly change your depression but you can actually get up every day. And I would encourage people to do something that they enjoy because telling yourself, oh, I need to get healthy I need to get up at the same time every day and I’m going to go start doing some crazy exercise regime or eating only vegetables or something that’s really extreme, that’s not sustainable. People aren’t going to do that. My feeling is that the patterns that are healthy and robust are ones that people are doing meaningful and enjoyable activities for themselves.
END OF INTERVIEW
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