Satisfaction With Leisure Activities Can Improve Cognitive Functioning Among the Elderly.
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The bear upon of leisure activities on older adults' cognitive part, concrete function, and mental health
- Giovanni Sala,
- Daniela Jopp,
- Fernand Gobet,
- Madoka Ogawa,
- Yoshiko Ishioka,
- Yukie Masui,
- Hiroki Inagaki,
- Takeshi Nakagawa,
- Saori Yasumoto,
- Tatsuro Ishizaki
x
- Published: November 8, 2019
- https://doi.org/10.1371/journal.pone.0225006
Figures
Abstruse
Engagement in leisure activities has been claimed to be highly beneficial in the elderly. Practicing such activities is supposed to help older adults to preserve cognitive role, physical function, and mental health, and thus to contribute to successful aging. We used structural equation modeling (SEM) to analyze the impact of leisure activities on these constructs in a large sample of Japanese older adults (North = 809; age range 72–74). The model exhibited an excellent fit (CFI = 1); engaging in leisure activities was positively associated with all the three successful aging indicators. These findings corroborate previous research carried out in Western countries and extend its validity to the population of Eastern older adults. Admitting correlational in nature, these results suggest that active engagement in leisure activities tin can assist older adults to maintain cognitive, physical, and mental wellness. Future enquiry will clarify whether there is a causal relationship between engagement in leisure activities and successful crumbling.
Commendation: Sala Thousand, Jopp D, Gobet F, Ogawa M, Ishioka Y, Masui Y, et al. (2019) The impact of leisure activities on older adults' cognitive role, physical function, and mental health. PLoS ONE fourteen(11): e0225006. https://doi.org/ten.1371/periodical.pone.0225006
Editor: Stephen D. Ginsberg, Nathan S Kline Constitute, UNITED STATES
Received: June 25, 2019; Accepted: Oct 25, 2019; Published: November 8, 2019
Copyright: © 2022 Sala et al. This is an open access article distributed nether the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original writer and source are credited.
Data Availability: According to the approval by the Institutional Review Board of Osaka University Graduate School of Dentistry (blessing number H22-E9), our dataset cannot be made available for others. If the other researcher requests to use our dataset, he/she should be canonical equally a co-researcher by our IRB. If someone requires to use the dataset, please contact the information access committee at first: sonic@hus.osaka-u.air conditioning.jp. In gild to reproduce the main models, we provide the covariance matrices and R codes (https://osf.io/csvwt/).
Funding: This work was supported by the Nihon Society for the Promotion of Science [17F17313 to GS; 17H02633 to YG], the Ministry of Education, Civilisation, Sports, Scientific discipline, and Technology of Japan [21330152 to YG; 26310104 to YG], the Grant for promoting Human being Sciences research past Osaka university Graduate school of Man Sciences and the International Joint Research Promotion Plan at Osaka. The funders had no role in report pattern, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors take declared that no competing interests exist.
Introduction
Leisure activities (hereafter LA) can be divers as activities people engage in during free time [1]. Engagement in LAs has been found to exist positively associated with cognitive function, concrete function, and mental wellness in belatedly machismo and in the elderly. The possible protective effects of LA engagement confronting aging-related decline accept thus been the object of investigation in the last two decades.
Of these 3 outcomes, preserved cognitive part has received well-nigh attention and the link with LA appointment in the elderly is well established [ii–five]. Three possible explanations have been proposed for the observed relationship between cognitive function and LA engagement. First, practicing mentally challenging activities (e.g., music, board games, video games, and encephalon grooming) may heighten overall cerebral function [half-dozen]. However, this idea has received niggling adequate empirical support [7–9] in the full general population. Second, people exhibiting superior overall cerebral role may be more probable to engage in LAs that are cognitive demanding. This hypothesis has been corroborated by numerous studies in the field of chess and music [ten,xi]. Finally, engaging in intellectually demanding LAs may slow downwards cognitive pass up. This idea relies on the then-called "use it or lose it" hypothesis according to which engaging in intellectually demanding activities helps to preserve cognitive part in the elderly [12,13]. This hypothesis has received some support by studies implementing dual-change approaches to examination for causality betwixt LA engagement and preserved cognitive role [14,15].
Compared to the link betwixt LA engagement and cognitive office, the impact of LA appointment on concrete office has been less studied [16]. Most research has focused on the agin effects of disease and injuries on LA engagement. Reduced LA engagement has, in turn, detrimental effects on indicators of mental health such as well-being and life satisfaction [17]. The field has thus paid more attention to how physical role influences LA engagement rather than vice-versa. Another line of research has examined the effects of physical activity and LAs (equally contained variables) on cognitive function [12,eighteen].
Finally, LA engagement seems to exist related to mental wellness as well. Mental health aspects such too-beingness and life satisfaction accept been plant to positively correlate with LA engagement in several studies (for a review, run across [17]). Studies implementing a longitudinal pattern accept confirmed these findings [19]. However, the amount of robust experimental evidence is still modest [20].
Considering its positive furnishings for key dimensions of functioning in older age, LA appointment seems to have an important role for successful aging. In their seminal commodity, Rowe and Kahn [21] introduced the concept of successful crumbling in opposition to usual crumbling. While usual aging emphasizes the non-pathological aging (e.one thousand., absence of disease), successful aging captures an optimal aging process. Successful aging is, according to Rowe and Kahn, best characterized by the concurrent presence of iii dimensions, namely high cognitive and concrete function, low probability of disease and disability, and agile engagement in life. The latter captures the interest in productive and social activities, giving those activities a like importance as health and functioning for successful aging. The importance of activities for successful crumbling has likewise been stressed very early on in other seminal theories, including activity theory by Havighurst, Neugarten, and Tobin [22]. Such more multidimensional conceptualizations of successful aging have resulted in complementing prior approaches past including mental-wellness related dimensions such equally well-being [17,23–25]. Here, nosotros investigate the human relationship between engagement in LAs and central dimensions of successful crumbling such as cerebral function, concrete function, and mental wellness.
The present investigation
This study examines the touch of date in LAs on cognitive function, physical function, and mental health in a group (N = 809) of Japanese older adults. Equally most of the studies in the field are based on samples from Western countries (due east.g., US and Germany), little is known near this upshot in not-Western countries. The present study aims to fill this gap by adding new information from a state of the Far Eastward (i.east., Japan). Moreover, prior studies usually suffer from limitations such as relying on subjective measures of cognitive and physical part [26,27] and dichotomization of continuous variables [27,28]. Also, the utilise of multiple-indicator latent variables, which is necessary to reduce measurement fault and, hence, produce more reliable estimates, has been sporadic [2]. The present study employs objective measures of functioning as well every bit multiple indicators assuasive complex modeling and controls for measurement error.
Furthermore, previous studies of both Western and Eastern populations have focused on the association between LA appointment and other components of successful aging (e.g., cognitive role) one at a time. By contrast, here we report the relationship betwixt LA engagement and cerebral function, physical part, and mental health in a single model. This approach allows united states to examine not but the straight furnishings of LA appointment on indicators of successful aging, but also how cerebral office, concrete function, and mental health influences each other. Contempo enquiry into the field has in fact shown that mutual relationships occur between cognitive part, concrete function, and mental wellness [17,29–31]. However, these bi-directional effects have never been studied in relationship with LA date.
Nosotros aim to address the to a higher place limitations with Structural Equation Modeling (SEM). An SEM model allows u.s.a. to analyze the impact of LA engagement on all the variables of interest–cognitive function, concrete function, and mental health–simultaneously (i.e., in a single SEM model). Such a model rules out potential confounds (eastward.yard., Blazon I error due to a missing covariate) and takes into business relationship the bidirectional paths betwixt the endogenous latent variables. This fashion, the model estimates the unique (i.e., not confounded past other correlated variables) bear on of LA engagement on the other dimensions of successful aging. To the best of our knowledge, no such report has been carried out in this field and then far. Likewise, SEM models tin can estimate latent constructs of interest (i.e., cerebral function, physical function, and mental health), which are psychometrically more than precise and reliable than observed indicators (i.e., test and questionnaires scores). Finally, while the studies in the field have usually assessed physical function with cocky-report questionnaires [19], the indicators we utilize are objective measures.
To sum up, the study aims (a) to exam the previous claims about the relationship between LA engagement and successful aging by employing a more robust and comprehensive modeling approach; (b) to extend the current empirical evidence–which is mostly on cognitive role–by examining the bear upon of LA engagement on less studied dimensions of successful aging such as physical part and mental health; (c) to quantify both direct and indirect effects of LA appointment; and (d) to extend the relatively pocket-size amount of data concerning the role played by LA engagement in the successful aging dimensions of Eastern populations.
Materials and methods
Participants
The study included a full of 809 Japanese participants (381 men and 428 women). The age range was 72 to 74. The data were retrieved from the second moving ridge of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) survey. These particular study cohort and moving ridge were selected because they reported the most all-encompassing and detailed LA-date questionnaire.
The SONIC is an ongoing survey whose main purpose is to identify the correlates of salubrious aging. It includes both urban and rural (ratio 2:i) customs-abode older adults. The participants were recruited from residential registries and contacted by postal mail. They gave their informed consent on site prior to starting the survey. For all the details about the SONIC survey, see [32].
Variables
Leisure-action (LA) appointment.
This questionnaire included 158 aye/no items regarding the participant'south engagement in as many activities. The questionnaire was based on the questionnaires presented in Karp et al. and Jopp and Hertzog's studies [4,33], and it was extended past adding common activities amongst Japanese older adults (e.g., playing shogi, practicing tai chi, and going to a public bath [onsen]). The questionnaire showed skillful internal consistency (Cronbach'southward α = .88). The list of the activities is reported in the Supplemental materials available online. A latent factor representing LA engagement was extracted from the questionnaire with the ltm R package and used in the analyses [34].
Cognitive function.
Three measures of cognitive ability were used to estimate a latent variable representing cognitive office: the Japanese version of the Montreal Cognitive Assessment (MoCA-J; [35]); the number series completion chore from the Brief Test of Adult Cognition by Telephone as a measure for reasoning skills [36]; and the retrieve subtest of the Alzheimer's Illness Assessment Calibration (ADAS; [37]). For all tests, a specific score was obtained, with higher values indicating higher capacity.
Concrete part.
Two measures of concrete function from the Brusk Physical Performance Battery (SPPB; [38]) were administered: the participants' gait speed and chair stand examination. For both tests, performance indicators were captured in seconds, with fewer seconds to consummate the job indicating better health operation. The third measure was the 10-second open-close stepping test [39], for which a smaller number of steps to complete the task indicated improve functional health.
Mental health.
Three measures of mental health were administered: the Japanese versions of the WHO-five well-being index questionnaire [40], positive section of the Positive and Negative Affect Scales (PANAS; [41]), and Satisfaction With Life Calibration [42]. In all the indicators, higher numbers indicate better mental health.
Covariates.
We included gender (male person, female), education and wealth as covariates to control for their potential effect on LA engagement or its link to the successful aging outcomes. Teaching consisted of three levels indicating the highest caste achieved by the participant (1 = primary/middle school, two = loftier school, and 3 = academy/college education). Wealth described the participant's economic situation and included five levels (from 1 = difficult economic state of affairs to 5 = very expert economic situation). These two variables were added to assure that the effect of LA engagement was not confounded with SES-related variables such as educational activity and wealth status. Finally, gender was used every bit a group variable to test for measurement invariance across males and females. The rationale of this selection is that SES variables (such equally education and wealth) may not e'er be equally good predictors of the constructs of interests between males and females. For example, it is reasonable to suppose that, in the fifties, intellectually gifted males were more likely to accelerate in their studies than equally intellectually gifted females.
Data preparation and analysis
Variables transformation and outlier treatment.
All the continuous variables were normalized and standardized. Normalization reduces the inflation of absolute measures of fit (eastward.1000., χ2) and incidence of outliers in the dataset. Also, normalization tends to linearize the relationship among multiple measures of the same construct [43], and thus reduces biases due to potential non-linear relationships between indicators. The normalization was run with the bestNormalize R packet [44].
The normalized variables were inspected for possible outliers. A value was considered every bit an outlier if information technology fell outside of the following range [Q1–2.2*IQR; Q3 + 2.2*IQR], where Q1, Q3, and IQR were the commencement quartile, the third quartile, and the interquartile range of the variable, respectively [45]. Only two outliers were detected (both in the MoCA-J scores) and winsorized.
Power calculation.
The statistical ability for not-shut fit hypothesis testing was estimated [43]. Bold the nada RMSEA = .050, alternative RMSEA = .010, and α = .050, the statistical power was very loftier (> 99%). The number of participants recruited was thus more than than adequate for global fit testing and rejection of fake models. These analyses were run with the semTools R package [46].
SEM modeling
The lavaan R package [47] was used to run all the SEM models. An equality constraint between two factors (concrete function and mental health) was added to place the models. Nosotros built one model including all the variables. LA engagement, subjective wealth, and pedagogy were predictors of the three latent variables cognition, physical function, and mental health in the regression equations. Also, since some studies have provided show of a bidirectional human relationship between physical role, cognitive function, and mental health [17,29,30], feedback loops were included between the latent variables. Due to the inclusion of 2 ordinal variables (education and subjective wealth), we chose the unweighted weighted to the lowest degree squares estimator (ULS). (An additional set up of analyses was carried out with an alternative reckoner [WLSM] that does non presume multivariate normality.) Gender was used for multiple-group analysis.
Results
The descriptive statistics (untransformed means and standard deviations) are reported in Table 1.
The SEM model in which LA appointment predicted cognitive office, physical function, and mental health as concurrent successful aging outcomes, and controlling for SES (i.e., education and wealth), proved to take an excellent fit: χ2(79) = 70.34, RMSEA = 0.000, SMRM = 0.037, CFI = 1.000. Comparative fit testing showed that this model outperformed the homologous model without the group variable (i.due east., gender; CFI = 1.000). Measurement invariance analysis showed that the weak (metric) invariance was not rejected (p = .356). The strong (i.e., scalar) invariance hypothesis was rejected (p < .001), suggesting the presence of a differential additive response style [43] between genders. The model structure is in Fig 1.
The latent variables and regression coefficients are summarized in Tabular array 2. LA appointment was positively related to all the latent factors in both male and female participants (all ps ≤ .003). The size of the furnishings was moderate (Std.Est ranging between 0.185 and 0.306; Table two), yet comparable or even superior to the ane of instruction and wealth. Also, the results showed a statistically significant reciprocal effect between cognitive function and physical role (Std.Est ranging between 0.113 and 0.201). No significant effect was observed between mental health and physical function or cognitive function. Finally, no meaningful difference was observed with the WLSM estimator (see the OSF link). Fig ii highlights the statistically pregnant paths in the SEM model.
Fig 2. Representation of the pregnant paths in the SEM model.
The numbers bespeak the standardized path coefficients in males and females, respectively. Non-significant paths in either males or females and the indicators of the latent variables (all significant) are omitted for the sake of clarity.
https://doi.org/ten.1371/periodical.pone.0225006.g002
Word
This paper quantified the impact of LA appointment on measures of successful crumbling including cognitive function, physical part, and mental health in a sample of Japanese older adults. LA engagement appears to be positively related to all these three constructs in both men and women (all pdue south ≤ .003). The implementation of a comprehensive SEM model allowing to consider unlike successful aging indicators meantime, the excellent goodness of fit, the high statistical power, and the implementation of latent constructs based on tasks measuring objective performance (cognitive function and physical part) and reliable self-reported questionnaires (mental health) make the findings of the nowadays study more reliable than near of previous research.
Substantive findings
Overall, the present results corroborate the idea that LA engagement contributes to explaining the private differences in cognitive function, physical function, and mental health. LA appointment was positively associated with successful aging indicators. The results are in line with the "apply it or lose information technology" theoretical framework and previous findings in Western populations [3,13,48]. Thus, the findings of the nowadays study support the position that leading an active lifestyle, hither assessed by date in leisure activities, is a universal and culture-independent means contributing to successful aging, invariant beyond unlike countries and cultures.
Inspection of the regression standardized path coefficients (Std.Est column in the Table two) indicates that the impact of LA engagement on the iii latent variables is statistically significant and comparable (or even superior; range of Std.Est 0.185–0.306) to the one exerted by education and self-perceived wealth. Furthermore, the touch on of LA engagement is systematically superior to the 1 exerted by the iii endogenous variables on each other (range -0.096–0.201). Nonetheless, the size of these effects is somewhat smaller than the ones reported in those few studies implementing an SEM approach (e.g., 0.490; [3]). This discrepancy is probably due to the inclusion of iii endogenous latent variables connected to each other with feedback loops in a single non-recursive model. Such a model controls for the potential confounding effects of one latent variable on the others. Part of the variance that it would exist intercepted past LA appointment is instead absorbed past the paths connecting the 3 latent variables. Only put, the model controls, for example, that the positive relationship between LA engagement and cognitive part does not only stem from improve mental health or physical office. That being said, overall, LA appointment appears to contribute significantly to explaining unique variance in individual differences in important aspects of successful aging.
Some indirect effects were observed for LA date, specifically when considering cognitive and physical part. In item, cognitive office and concrete part influenced each other in a feedback loop, which supports recent show showing that the human relationship betwixt noesis and concrete health is bidirectional [29,30]. LA engagement thus seems to exert an indirect effect on cerebral function mediated by physical function and vice versa. On this regard, the benefits of physical activeness on cognitive function can be attributed to an ameliorated overall wellness condition (due east.yard., brain oxygenation and stimulation of neurogenesis [49]). Why better cognition should lead to improved physical health is less obvious. A possible explanatory mechanism could be an overall better cocky-regulation enabling the participant to exist more physically agile [29]. However, due to the correlational nature of the present report, no causal inference in either direction tin be made and, thus, none of these hypotheses tin can be tested.
By contrast, mental health was not associated with either of the other two latent variables. In particular, the absence of any link between concrete part and mental wellness appears to contradict previous findings in the field [17,50]. Mayhap, this discrepancy is explained past the use of subjective measures of physical function in prior studies. In fact, while self-reported measures of physical function and mental health may reverberate individuals' perception of their overall health condition, objective measures of physical function may not be correlated with subjective measures of mental health. It is further of note that we used exclusively residual and gait measures as indicators of physical office, which may also have contributed to the lack of relation betwixt our physical and mental health latent construct. That beingness said, the topic is certainly worth of further investigation.
Finally, there is no clear bear witness that the event of LA engagement on the three latent constructs differed between males and females. The relevant standardized path coefficients were relatively homogeneous when comparison the patterns across genders. A notable departure betwixt the models for males and females was, however, the amount of explained variance, which was nearly twice every bit big in males compared to females. This is probably because the covariates were associated with greater gene loadings in males than in females. Basically, considering gender through multi-group testing improved the goodness of fit but had no notable impact on the relationship between LA engagement and the endogenous variables (i.east., cognitive function, physical function, and mental health).
Recommendations for future enquiry
In this report, we have considered LA engagement as a single trait. This assumption is upheld by the high internal consistency of our LA questionnaire (Cronbach's α = .88) and is in line with substantial findings in the field [3]. Withal, it is possible that engagement in particular types of activities (e.g., playing strategy games, technology use) is more strongly linked to specific constructs such as cognitive part [10,11,33,48]. In hereafter studies, it is thus recommendable to test whether overall LA appointment subsumes specific types of activities impacting differently on the examined constructs, or whether specific activities are more of import for certain successful aging aspects than others. The main drawback of this arroyo is that requires larger sample sizes than the ones usually included in surveys. Reducing the number of activities in the questionnaire is an alternative [2] just it has the serious shortcoming of decreasing the overall reliability of the measure. In fact, some individuals may practise relatively unusual LAs that would be necessarily excluded in a shorter questionnaire.
Another indicate of interest is the frequency of LA engagement. The sheer number of activities skillful by older adults is certainly a good proxy for their appointment in LA, but it is not necessarily the all-time possible 1. How often an activity is adept may play a significant office too. A further improvement may thus exist, for instance, the utilize of a Likert scale to assess the frequency with which the participants engage in the activities they do [3,33]. It is worth noting, however, that including frequency may non meaningfully enhance the predictive power of the measure. In fact, previous research suggests that most health benefits of an agile life-style in the elderly occur later on simply a moderate amount of engagement [51].
Finally, a fundamental caveat needs to exist mentioned. Our analysis is correlational in nature, and thus cannot establish any direction of causality between LA engagement and measures of successful aging. In our stance, there are 3 possible explanations for our results: (a) LA engagement causes improvements in cognitive function, physical function, and mental wellness; (b) people with superior cognitive function, physical function, and mental health, are more than likely to appoint in LA; and (c) LA and the iii constructs influence each other, that is, LA engagement positively affects measures of successful crumbling which, in turn, promotes LA engagement. This latter possibility is, in our stance, the most likely explanation. That being said, studies implementing an LA intervention are necessary to test this hypothesis. Specifically, a longitudinal non-recursive SEM model would allow researchers to appraise this presumed "virtuous circumvolve" betwixt LA engagement and measures of successful crumbling by imposing a feedback loop between the variables at unlike fourth dimension points.
Conclusions
The present study reported an SEM model examining the relationship between LA appointment and three essential dimensions of successful aging (i.east., cerebral function, concrete role, and mental health) in a big sample of Japanese older adults. In line with substantial research into the field, the results confirmed the link between LA engagement and cognitive function. However, the size of the result was meaningfully smaller than the one reported in previous studies. Similar effects were found for physical function and mental health.
The investigation significantly extends our cognition in the field. Starting time, thanks to a more comprehensive modeling approach, the study provides a more reliable estimate of the impact of LA engagement on cognitive role. Second, due to the use of multiple and objective concrete indicators, it adds much-needed evidence of a link between LA appointment and preservation of proficient physical function in the elderly. Similar considerations utilise to the influence of LA engagement in older adults' mental health. Third, the findings suggest that the office played by LA engagement is cultural-independent. Finally, our study sheds some lite on mechanisms of LA engagement that have non been much (if not at all) investigated and then far, such as the bidirectional effects of practicing LAs on cognitive role and physical part.
Acknowledgments
We gratefully thank all the participants for their time and effort. We also thank Fred Oswald and Yves Rosseel for their aid in the statistical analysis.
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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225006
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