Objective: To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women. Design: BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey. Setting: Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments. Subjects: Postmenopausal women (n 76 016; mean age 635 (sd 73) years). Results: Women with overweight (BMI=250-299 kg/m(2)) or obesity (BMI = 300 kg/m(2)) at 18 years had greater odds (OR (95 % CI)) of SPI (151 (135, 169) and 214 (172, 265), respectively) than normal-weight (BMI=185-249 kg/m(2)) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<185 kg/m(2)) were associated with greater odds of SPI (197 (184, 211) and 135 (106, 171), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (152 (111, 209)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (052 (039, 071)). Conclusions: Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13293号 / 論社医博第14号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 松田 秀一, 教授 今中 雄一, 教授 古川 壽亮 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

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Physical function has been identified as a core outcome to be assessed in low back pain (LBP). However, all recommended physical function measures are Patient-Reported Outcome Measures (PROMs). Performance-Based Measures (PBMs) are important measures that are practical and are prone to fewer biases. Two systematic reviews provided evidence on the psychometric properties of PBMs but were not comprehensive. Therefore, the purpose of this study was to identify PBMs developed for or used to assess physical function in LBP and to review studies evaluating the psychometric properties of these PBMs systematically. The first manuscript of the thesis was the systematic review protocol developed using the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) manual 2018. The protocol was also registered on PROSPERO (CRD42020147968). The protocol also outlined the use of the COMINS Risk of Bias (COSMIN-ROB) checklist 2018; standard priory hypotheses and criterions developed to evaluate the results of each psychometric property; as well as a GRADE criterion (Grading of Recommendations, Assessment, Development and Evaluations) to assess the level of evidence. Two reviewers independently screened, evaluated, and extracted data. The second manuscript was the systematic review written in the format of a journal for future submission. Our database search identified 47 studies assessing 115 PBMs. In general, findings included five different LBP diagnoses (e.g., non-specific LBP) and different LBP durations (e.g., acute, chronic). The level of evidence of each PBM or psychometric property mainly were generated from single studies. A high risk of bias assessed by the COSMIN-ROB checklist was found for most of the included studies. Overall, the included studies' results often did not meet our priory hypotheses for good psychometric properties. Hence, most PBMs' psychometric properties were found to have a low level of evidence. There was not a single PBM that demonstrated a good level of evidence for all properties. In conclusion, significant heterogeneity was found between studies leading to a limited level of evidence. PBMs need to be used with great caution. High-quality studies that investigate PBMs' psychometric properties are needed. / Thesis / Master of Science Rehabilitation Science (MSc) / Low Back Pain (LBP) care costs the Canadian health care system millions of dollars every year. Most clinicians and researchers use self-report questionnaires filled out by their patients to assess physical function. However, performance measures where patients perform tasks while being observed are also recommended to assess physical function. Performance-based measures can be used alone or in combination with self-report measures. To select the most appropriate performance measures, we need to know how good and trustworthy these measures are. Therefore, the purpose of this study was to collect all possible performance measures that were developed or used to assess physical function in LBP patients; then summarized the available evidence on their psychometric properties (reliability, validity and responsiveness). We searched five scientific databases and found 47 studies that evaluated 115 performance measures. Most included studies were of low quality and evaluated different tests or test properties. We found that most measures were not reliable, accurate or were sensitive to change. Therefore, clinicians and researchers need caution when selecting and interpreting results of these performance measures when evaluating physical function in LBP.

Background: The development of an objective and comprehensive drug-based index of physical function for older adults has the potential to more accurately predict fall risk. Design: the index was developed using 862 adults (ages 57–85) from the National Social Life, Health, and Aging Project (NSHAP) Wave 1 study. The index was evaluated in 70 adults (ages 51–88) from a rehabilitation study of dizziness and balance. Methods: The prevalence among 601 drugs for 1,694 side effects was used with fall history to determine the magnitude of each side effect's contribution towards physical function. This information was used to calculate a Medication-based Index of Physical function (MedIP) score for each individual based on his or her medication profile. The MedIP was compared to the timed up and go (TUG) test as well as drug counts using receiver operating characteristic (ROC) analysis. The associations between various indices of physical function and MedIP were calculated. Results: Within the NSHAP data set, the MedIP was better than drug counts or TUG at predicting falls based on ROC analysis. Using scores above and below the cutpoint, the MedIP was a significant predictor of falls (OR = 2.61 [95% CI 1.83, 3.64]; P < 0.001). Using an external data set, it was shown that the MedIP was significantly correlated with fall number (P = 0.044), composite physical function (P = 0.026) and preferred gait speed (P = 0.043).

Objective(s): The purpose of this study was to describe the impact of fatigue on quality of life (QOL), physical function, and participation in social, recreational, and daily living activities (ADLs) in women living with HIV. Methods: HIV-infected women (n=15; age 44±8 years) were recruited from the Clinical Immunological Outpatient Clinic (CIOC) and the HIV/AIDS Regional Services (HARS) in Kingston. Four questionnaires were completed to obtain information on demographics, fatigue (HIV-Related Fatigue Scale, HRFS), QOL (Medical Outcomes Survey HIV Healthy Survey (MOS-HIV), and valued social, recreational and daily living activities. Participants then performed the 6-minute walk test (6MWT) to assess their physical function. Assessments were conducted in the CIOC or in a gymnasium at another location. Results: Mean length of HIV infection was 12±5 years and 14 of the 15 women were on anti-retroviral therapy. Seven of the 15 women did not have significant issues with fatigue on the HRFS. The other 8 reported that fatigue severely interfered with ADLs, socialization and mental functioning. QOL scores were significantly lower in the fatigued group compared with the non-fatigued group in 8 of 11 sub-scales of the MOS-HIV; the values being approximately 50% of those in the non-fatigued group. Socializing with friends, walking, grocery shopping and cleaning were listed as activities in which participants experienced limitations. No significant differences were found between the fatigued and non-fatigued groups for the distance walked in the 6MWT or for the percent of predicted distance walked. Conclusions: Half of the women with HIV in this study reported that fatigue interfered with daily functioning and participation in day to day activities, impacting their QOL. These findings suggest that fatigue can be a major issue impacting QOL in this population; therefore, fatigue reduction should be one of the priorities of HIV-related medical management. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-08-29 13:51:52.993

Abstrakt Bakgrund: Medelålders och äldre män är en stor patientgrupp inom fysioterapi. Åldrande minskar kroppsliga nivåer av testosteron och tillväxthormon hos denna patientgrupp. Detta kan bidra till försämring av rörelseapparatens kapacitet. Det var därför relevant att kartlägga eventuella behandlingseffekter av testosteron och tillväxthormon på rörelseapparatens kapacitet.   Syfte: Kartlägga och sammanställa aktuell forskning gällande evidensen av hormonbehandling med enbart testosteron, eller en kombination av testosteron och tillväxthormon, på rörelseapparatens kapacitet hos medelålders och äldre män.   Metod: Litteratursökning genomfördes i databasen PubMed. Åtta artiklar inkluderades. Dessa kvalitetgranskades enligt PEDro scale, varefter evidensstyrkan bedömdes enligt SBU:s GRADE.   Resultat: Måttligt starkt vetenskapligt underlag för att behandling med testosteron har en förbättrande effekt på styrka och power. Begränsat vetenskapligt underlag för att behandling med testosteron har en förbättrande effekt på trappgång. Testosteron har ej någon förbättrande effekt på gångförmåga, men det vetenskapliga underlaget bedöms som otillräckligt. Otillräckligt vetenskapligt underlag för att testosteron och tillväxthormon har en förbättrande effekt på VO2-max.   Konklusion: Effekterna av hormonbehandling med testosteron och tillväxthormon varierar mellan enskilda delar av rörelseapparatens kapacitet hos medelålders och äldre män. Detta indikerar att fler studier med större deltagarantal är angeläget för att säkerställa effekterna av interventionen.   Nyckelord: Growth hormone, testosterone, hormone replacement therapy, physical function, elderly

Psoriatic arthritis is an inflammatory arthritis affecting a fifth of patients with skin psoriasis. Inflammation of the joints and tendons causes pain, stiffness, reduced function and disability. Work disability is increasingly recognised as an important, patient centred, functional measure of disease yet little is known about work disability in psoriatic arthritis. The overall aim of my thesis is to examine patient reported work disability in psoriatic arthritis by undertaking the following; • A systematic review of the relevant literature • Classification of a cohort of patients to study • Validation of a commonly used work outcome measure used in other rheumatic diseases • Selection of a suitable measure of structural damage to inflamed joints for investigating the associations of work disability in longitudinal observational studies. The results of the systematic review identified limited data reporting high levels of work disability associated with a wide variety of disease and non-disease related factors. The review also identified the lack of a validated outcome measure for use in psoriatic arthritis. I report the classification of a large single centre longitudinal cohort of patients with psoriatic arthritis and evidence supporting the retrospective application of a psoriatic arthritis classification criterion. Subsequently I report a preliminary validation study of the work productivity and activity impairment questionnaire to measure work disability in psoriatic arthritis and a further study comparing the existing measures of structural damage in psoriatic arthritis. Finally I developed and supervised a multicentre observational study to examine the associations of work disability in psoriatic arthritis. The study identified reduced work effectiveness to be associated with measures of disease activity, whereas unemployment was associated with recent disease onset, greater age and worse physical function. The study will provide a valuable cohort for prospective study of work disability and the effect of medical treatment and will form part of my planned post-doctoral studies.

The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status. Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (&gt;60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia. Cluster analyses (n = 496, Paper II) revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 1–5.7) and women (OR, 3; 95% CI, 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency room visits. Men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.7) and women’s cardiopulmonary cluster (OR, 1.7; 95% CI, 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.4) and one of the women’s ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization. In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% CI, 1.1–4) and cleaning (OR, 2.2; 95% CI, 1.2–4.2) than their normal weight counterparts. Although obesity was also associated with multimorbidity (OR, 3; 95% CI, 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1). In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty. In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living. / Att åldras innebär inte bara en utveckling över tid utan också en förändring av människans fysiologi och funktion. Vi har många olika bilder av åldrandet. Ofta överväger de negativa bilderna som betonar sjuklighet och höga samhällskostnader för vård och omsorg. ELSA 85, en förkortning av the Elderly in Linköping Screening Assessment, påbörjades 2007 med avsikt att kartlägga 85-åringars hälsotillstånd och funktion. Syftet med denna avhandling var att fördjupa kunskapen om faktorer med betydelse för bevarande av hälsa hos dessa 85-åringar. Populationsstudien genomfördes via enkätutskick (bl.a. livssituation, livskvalitet), hembesök (bl.a. aktiviteter i dagliga livet (ADL), kognitiva funktioner) och mottagningsbesök (bl.a. nutritionsstatus, rörelseförmåga, kroppslig undersökning, blodprover, läkemedel) under perioden mars 2007 till mars 2008. Vi kartlade även deltagarnas sjukvårdsbesök samt sjukvårdskostnader. Tre år senare, när individerna var 88 år, analyserades även kroppssammansättningen hos delar av populationen. Totalt 496 Linköpingsbor födda 1922, deltog i studien. Andelen som svarade på enkäten var 78 % av alla då levande 85-åringar. Resultaten visar att majoriteten av 85-åringarna klarade att sköta sin hygien (85%) samt huvudsakliga aktiviteter (74%). Sextio procent skattade sin hälsorelaterade livskvalitet som hög trots förekomst av flera kroniska sjukdomar och frekvent användning av hjälpmedel för att förbättra rörligheten. Oberoende riskfaktorer för slutenvård var multipla besök hos distriktsläkare, användande av flera hjälpmedel, förekomst av minst två sjukdomar eller förekomst av hjärtsvikt och arytmi. Multimorbiditet (förekomst av minst två kroniska sjukdomar) var vanligt hos 85-åringarna (68%). Olika kombinationer av sjukdomar hade varierande betydelse för behovet av sjukvård. I clusteranalys, där man försöker gruppera diagnoser med hög sannolikhet att förekomma hos en enskild individ, fann vi några cluster som var starkare relaterade till inläggning i slutenvård än andra. Clustren såg dessutom olika ut mellan män och kvinnor. För män var t.ex. kardiella och för kvinnor t.ex. hjärt-lung-cluster starkare relaterade till slutenvård än enskilda diagnoser. Personer med fetma (body mass index (BMI) ≥30 kg/m2) hade mer problem med rörlighet och instrumentell ADL (IADL) jämfört med de med normal- eller övervikt. Trots ett klart samband mellan fetma och multimorbiditet hade de normalviktiga individerna nästan tre gånger så höga hälso-sjukvårds kostnader som personer med fetma. Bland 88-åriga kvinnor, hade personer med fetma högre bukomfång, mer fettmassa (FM) och mer fettfri massa (FFM) men lägre handstyrka (HS) än de normal- eller överviktiga. Relativ HS, handstyrka i form av kvoter (HS/Vikt, HS/BMI, HS/FFM and HS/FM) hade starkare samband med fysisk funktion (Short Form-36, SF-36PF) än andra enskilda parametrar. Två enskilda parametrar (bukomfång och HS) samt HS/Vikt och HS/FFM var associerade med antal aktiviteter utan svårighet i IADL. Sammanfattningsvis är 85-åringarna inte så skröpliga som de ofta beskrivs. Studien ELSA 85 visar en övervägande positiv bild med bevarad hälsa och funktion för en övervägande del av populationen. De flesta 85-åringarna klarar sig ganska bra trots förekomst av flera sjukdomar. Vissa mönster av multimorbiditet med hjärt- och lungsjukdomar är mer relaterade till slutenvård medan hjärtsvikt hade hög risk för akutmottagningsbesök. Därför är det viktigt att beakta en komplexitet av sjukdomar, inte bara enskilda diagnoser eller antalet diagnoser, i planeringen av den framtida vården. Personer med normal- eller övervikt klarar sin funktion bättre och lever mer självständigt än de som lider av fetma. Den betydande andelen feta med begränsad rörlighet och funktion bland äldre kan komma att påverka behovet av tyngre omsorgsinsatser för den gruppen och är således en varningssignal inför framtiden. / 【目的】      通过研究高龄老人的医疗情况，躯体功能和营养状态，提高对高龄老人健康维护相关因素的理解。 【方法】      ELSA 85 项目（林雪平老年人普查，Elderly in Linköping Screening Assessment）是一个以瑞典林雪平城市中85岁高龄老人（1922年出生， n = 650）为研究对象的人群研究。(1) 2007/03–2008/03：通过邮寄问卷，家庭访问及门诊检查的三个步骤， 我们搜集的数据包括：个人和家庭的背景信息（居住情况，既往的学历和工作程度，健康相关的生活质量EQ-5D等），身体机能（日常生活活动能力ADL评定，移动性测试等）和营养状态（人体测量等）。我们同时还阅览了所有注册的电子病历和每位老年人的年卫生费用。（2） 2010/06–2010/10: 在3年后的随访中，我们对所有88岁的女性老年人增加了人体组成测定和SF-36健康调查量表之生理功能子量表（SF-36PF）的评估。 ELSA 85 项目还包括了其他医学检查项目以及为期一年的随访（2008–2009）, 但这些数据统计并未列入本论文中。 【结果】      论文1：共496人（参与率78％）回寄并参与了问卷调查。总体而言，虽然慢性多病以及日常生活中频繁使用辅助身体移动的器具在85岁高龄老人中非常普遍，多数老年人仍然能够完成个人卫生自理和常规日常活动。他们在健康相关评价问卷中的评估自身健康状态多为良好 (EQ-5D评估）。与住院相关的风险因素包括：全科医生的年就诊次数，有共患疾病（存在两种或两种以上的慢性病征），或者是心力衰竭和心律失常两个单病种。 论文 2：运用聚类分析和性别分层对共患疾病归类，生成男女组各五个集群：血管性类疾病集群，心肺疾病集群，心源性疾病集群（只存于男性组内），躯体-精神心理疾病集群（只存于男性组内），精神心理性疾病集群（只存于女性组内），以及三个和老化过程有关的集群（男性组内1组，女性组内2组）。心力衰竭 （男性组内的比值比 OR = 2.4，95% 的可信区间CI = 1–5.7；女性组内 OR = 3，95% CI = 1.3–6.9) 作为单一病种在预测急诊就诊的模型中比任一共患疾病集群都能解释更多的变量值。男性组内的心源性疾病集群 （OR = 1.6，95% CI = 1–2.7） 和女性组内的心肺疾病集群（OR = 1.7，95% CI = 1.2–2.4）与预测是否住院显著有关。在住院模型中， 心肺疾病集群与男性的心源性疾病集群（OR = 1.6，95% CI = 1–2.4）， 或与女性组内的老化相关集群（OR = 0.5，95% CI = 0.3–0.8）具有显著的交互作用。 论文3：超重（体重指数 BMI：25–29.9 kg/m2）和肥胖（BMI ≥30 kg/m2）者在工具性日常生活活动评定（IADL）比正常体重者（BMI: 18.5–24.9 kg/m2）有更多的困难，再者也比正常体重者有更高伴发疾病的风险。但是在控制了混杂变量（社会人口因素）后，对照正常体重组，只有肥胖者而不是超重者的IADL（户外活动：OR= 2.1，95% CI=1.1–4；居室清洁：OR= 2.2，95% CI= 1.2–4.2）存在更大的困难。虽然肥胖与共患疾病相关（OR= 3，95% CI=1.2–8），有共患疾病的正常体重者的卫生服务消费却是共患疾病的肥胖者的近三倍（ratio= 2.9，95% CI= 1.1–8.1）。 论文 4：88岁女性肥胖组相比正常体重和超重组而言，其腰围值、脂肪群值和祛脂肪群值较大。肥胖者的绝对握力值在校正祛脂肪群后以及握力比值（握力/体重，握力/BMI，握力/祛脂肪群，等等）都较其他两组低。在控制个体的体力活动程度和慢性疾病数量后，握力比值对生理功能（SF-36PF）的解释度（R2：0.52–0.54）高于任何单一人体测量指标或人体组成成分的测定值（R2：0.45–0.51）。腰围值、绝对握力值及握力比值（握力/体重和握力/祛脂肪群）与IADL中无困难的活动项目数显著相关。 【结论】      ELSA 85 人群研究显示了一个相对健康的，个体功能良好的，且使用卫生服务较低的高龄老年群体。心源性和肺部疾病的共患与住院风险相关，而心力衰竭作为单一病种与急诊就诊有显著相关。对85岁高龄老人而言，肥胖（但不是超重）与个体的活动限制和伴发疾病有关。居住于自己住所内的超重高龄老人，其健康水平与正常体重者相近。在88岁女性高龄老人中，肥胖者有较大的腰围值和较低的握力比值（握力/体重和握力值/祛脂肪群）。这些指标比体重指数更好地反映了生理功能及高龄老人的日常独立生活能力。 / Elderly in Linköping Screening Assessment, ELSA 85

Background and Purpose: Physical activity is significantly lower in the end-stage renal disease (ESRD) population compared with age-matched sedentary controls. Self-efficacy is a significant contributing factor to exercise behaviour in the healthy and various chronic disease populations; however, little information is available on self-efficacy and exercise in the ESRD population. The purpose of this study was to examine the relationship between self-efficacy and physical activity levels in individuals with ESRD and to determine factors which may contribute to this relationship. Participants: Patients (127 hemodialysis and 5 peritoneal dialysis) were recruited from the Kingston General Hospital renal units. Methods: Self-efficacy was measured using the Exercise Self-Efficacy Scale (ESES) and the Chronic Disease Self-Efficacy Scale (CDSES). Physical activity was measured using the Human Activity Profile (HAP). Responses on the HAP resulted in 2 scores: the maximum activity score (MAS) and the adjusted activity score (AAS). Contributing factors, such as age, co-morbidities, length on dialysis (vintage), medications, dialysis efficacy (Kt/V), albumin, prealbumin, total protein, protein catabolic rate (PCR) and hemoglobin (HgB) were collected from patient records. Results: The average MAS and AAS scores were 62.5±15.6 and 49.1± 21.0 (SD), respectively, which are substantively lower than those in the healthy population. Serum albumin was the sole contributing factor to physical activity such that AAS in those with lower levels of albumin (24-30g/L, 31-34 g/L) was less than those with higher levels of albumin (p<0.05). Both MAS and AAS were significantly lower in those with diabetes (n=66) compared to those without (n=66), as was the difference between MAS and AAS. Age and self-efficacy explained 51% of the variance in MAS. Age, self-efficacy and serum albumin level explained 59% of variance in AAS. Discussion and Conclusion: Individuals on dialysis have lower functional capability within their maximal energy ability at any age and this difference is more pronounced among those with diabetes. Physical activity was substantially influenced by an individual’s self-efficacy, age and serum albumin level. These findings indicate that self-efficacy must be taken into account and used to promote greater participation in physical activity in the ESRD population. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2010-04-27 09:47:12.764