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Dec
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201
6
,
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44
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49
I
SS
N:
2252
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8806
444
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T
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a
c
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l
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).
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e
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ll
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rten
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e
p
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c
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ll
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ti
v
e
.
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o
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g
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id
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ls
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d
b
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tw
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sp
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a
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ti
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y
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sig
n
if
ica
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y
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s
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c
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d
w
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h
d
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d
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.
A
d
e
q
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a
te
p
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l
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it
y
sh
o
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ld
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re
d
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e
th
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im
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a
li
ty
o
f
li
f
e
in
g
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o
p
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ti
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n
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K
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w
o
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d
:
Co
-
m
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b
id
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d
itio
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s
Ger
iatr
ic
P
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s
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a
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t
y
P
h
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s
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i
n
ac
ti
v
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Qu
alit
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Co
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rig
h
t
©
2
0
1
6
In
stit
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te o
f
A
d
v
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n
c
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d
E
n
g
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e
e
rin
g
a
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S
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ien
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e
.
Al
l
rig
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ts
re
se
rv
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d
.
C
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p
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A
uth
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r
:
A
li
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a
Hi
s
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m
,
Dep
ar
t
m
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t o
f
C
o
m
m
u
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it
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M
ed
icin
e,
A
r
m
y
Me
d
ical
C
o
lleg
e,
Nat
io
n
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U
n
iv
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s
it
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Me
d
ical
Scie
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s
,
A
b
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Ma
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R
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Sad
d
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,
R
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w
alp
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-
4
6
0
0
0
,
P
ak
is
tan
.
E
m
ail: a
ale
y
a
@
y
a
h
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o
.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Mo
r
b
id
ity
is
d
ef
i
n
ed
as
a
d
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ased
s
tate,
d
is
ab
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,
o
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p
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o
r
h
ea
lt
h
d
u
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to
an
y
ca
u
s
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a
n
y
d
eg
r
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an
d
an
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v
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f
d
is
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e.
C
o
-
m
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b
id
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r
ef
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s
to
th
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p
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ce
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m
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d
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w
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h
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m
e
n
tal
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r
s
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co
-
o
cc
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r
r
in
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w
it
h
a
p
r
i
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d
i
s
ea
s
e
o
r
d
is
o
r
d
er
.
Hy
p
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ten
s
io
n
,
Diab
ete
s
an
d
A
r
th
r
iti
s
ar
e
f
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w
o
f
t
h
e
m
an
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co
-
m
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b
id
co
n
d
itio
n
s
t
h
at
ar
e
m
o
s
t
p
r
ev
ale
n
t
[
1
]
.
Ph
y
s
ica
l
ac
ti
v
it
y
i
s
d
ef
in
ed
as
an
y
b
o
d
il
y
m
o
v
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m
en
t
p
r
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d
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ce
d
b
y
s
k
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m
u
s
cles
th
at
r
es
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lt
in
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n
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g
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x
p
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n
d
itu
r
e
b
e
y
o
n
d
th
e
b
asal
m
etab
o
lic
r
ate
[
2
]
.
E
x
er
cise
is
a
s
u
b
s
et
o
f
p
h
y
s
ical
a
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h
at
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lan
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,
s
tr
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,
r
ep
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p
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i
n
th
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t
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at
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m
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t
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ai
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f
p
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f
it
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ess
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s
th
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o
b
j
ec
tiv
e.
P
h
y
s
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ex
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cise
is
a
d
eter
m
in
a
n
t
o
f
h
ea
lth
[
3
]
.
Hen
ce
,
lack
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f
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s
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ac
tiv
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is
t
h
e
p
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m
ar
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u
s
e
o
f
m
o
s
t
o
f
th
e
m
o
r
b
id
itie
s
[
4
]
.
Dee
m
m
e
n
tio
n
in
g
ar
e
o
b
esit
y
,
i
s
ch
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m
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h
e
ar
t
d
is
ea
s
e,
m
etab
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s
y
n
d
r
o
m
e,
t
y
p
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2
d
iab
etes,
f
att
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li
v
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is
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s
e,
h
y
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s
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n
,
s
tr
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k
e,
p
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ip
h
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al
ar
ter
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e,
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s
teo
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o
s
teo
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itis
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r
h
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m
a
to
id
ar
th
r
itis
,
d
ep
r
ess
io
n
a
n
d
an
x
iet
y
[
5
]
.
Mo
r
b
id
ities
ar
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co
n
s
id
er
ed
to
b
e
th
e
p
r
e
-
d
ea
th
d
is
o
r
d
er
s
in
v
ir
tu
a
ll
y
all
t
h
e
m
o
r
talitie
s
.
T
h
er
ef
o
r
e,
r
ed
u
cin
g
th
e
r
is
k
o
f
m
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r
b
id
ities
ca
n
r
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s
u
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t
in
b
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h
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s
p
a
n
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f
t
h
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p
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p
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latio
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w
h
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is
th
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p
r
i
m
ar
y
o
b
j
ec
tiv
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o
f
m
o
d
er
n
m
ed
icin
e
.
Mo
r
eo
v
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,
q
u
alit
y
o
f
li
f
e
ca
n
b
e
i
m
p
r
o
v
ed
an
d
an
n
u
al
d
e
ath
r
ates
ca
n
b
e
cu
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8806
A
s
s
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f P
h
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w
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C
o
-
mo
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b
id
C
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n
d
itio
n
s
in
Geria
tr
ic
P
o
p
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la
tio
n
(
A
liya
His
a
m)
445
d
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w
n
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f
c
a
u
s
es
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f
s
u
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h
m
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cc
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A
cc
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f
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t
ca
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d
ed
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ce
d
th
at
lack
o
f
p
h
y
s
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ac
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v
it
y
h
a
s
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ass
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w
it
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m
o
r
e
th
an
3
0
% o
f
a
n
n
u
al
d
ea
t
h
s
[
6
]
.
Mu
ltip
le
r
esear
ch
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s
h
a
v
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b
ee
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co
n
d
u
cted
to
ev
alu
a
te
th
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a
f
f
i
liatio
n
b
et
w
ee
n
lack
o
f
p
h
y
s
ic
al
ac
tiv
it
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an
d
in
c
id
en
ce
/p
r
ev
ale
n
ce
o
f
m
o
r
b
id
ities
[
7
]
.
I
n
an
I
n
ter
n
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n
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C
r
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s
s
-
Sectio
n
al
St
u
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d
s
r
atio
o
f
C
HD
in
s
ed
en
tar
y
w
o
m
en
w
a
s
f
o
u
n
d
to
b
e
2
.
1
%
(
9
5
%
C
I
1
.
0
-
4
.
3
,
P
=0
.
0
4
6
)
[
8
]
.
I
n
an
o
th
er
C
r
o
s
s
-
Sectio
n
al
Stu
d
y
,
p
r
ev
alen
ce
o
f
s
ed
en
tar
y
l
if
e
s
t
y
le
i
n
h
y
p
er
te
n
s
i
v
e
p
atie
n
ts
w
a
s
6
0
%
[
9
]
.
A
Natio
n
a
l
p
ap
er
r
ep
o
r
ts
th
at
in
ad
eq
u
ate
p
h
y
s
ical
ac
ti
v
it
y
(
e.
g
.
w
atc
h
in
g
T
V
f
o
r
2
h
r
s
d
ail
y
)
i
n
cr
ea
s
es
th
e
r
is
k
o
f
d
iab
etes
m
ellit
u
s
t
y
p
e
2
b
y
1
4
%
a
n
d
co
n
tr
ib
u
tes
to
w
ar
d
s
in
cr
ea
s
i
n
g
t
h
e
r
is
k
o
f
o
t
h
er
co
-
m
o
r
b
id
ities
a
s
w
ell
[
1
0
]
.
W
h
er
ea
s
,
b
r
is
k
w
al
k
i
n
g
1
h
r
/d
a
y
d
ec
r
ea
s
es r
is
k
f
o
r
d
iab
etes b
y
3
4
%
[
1
1
-
12]
.
T
h
is
r
esear
ch
en
co
m
p
as
s
es
t
h
e
s
ig
n
if
ican
ce
o
f
p
h
y
s
ical
ac
ti
v
it
y
i
n
g
er
iatr
ic
s
an
d
its
as
s
o
ciatio
n
w
it
h
co
-
m
o
r
b
id
co
n
d
itio
n
s
p
r
ev
ale
n
t i
n
P
ak
is
ta
n
i c
o
m
m
u
n
it
y
.
A
d
eq
u
ate
p
h
y
s
ica
l a
cti
v
it
y
ca
n
r
e
d
u
ce
t
h
e
r
is
k
o
f
co
-
m
o
r
b
id
co
n
d
itio
n
s
an
d
i
m
p
r
o
v
e
th
e
q
u
alit
y
o
f
li
f
e
i
n
g
er
iatr
ic
s
.
T
h
is
r
esear
ch
u
p
h
o
ld
s
th
at
a
co
m
m
u
n
i
t
y
b
ased
ef
f
o
r
t
ca
n
b
e
g
e
n
er
ated
to
e
n
co
u
r
ag
e
p
eo
p
le
to
w
ar
d
s
ap
p
r
o
p
r
iate
p
h
y
s
ical
ac
tiv
i
t
y
t
h
at
w
ill
r
ed
u
ce
t
h
e
m
o
r
b
id
it
y
r
ate
s
w
h
ic
h
w
o
u
ld
ce
r
tain
l
y
h
elp
in
in
cr
ea
s
i
n
g
th
e
h
ea
lth
s
p
an
o
f
t
h
e
co
m
m
u
n
it
y
,
th
e
m
aj
o
r
g
o
al
o
f
m
o
d
er
n
m
ed
ici
n
e.
2.
RE
S
E
ARCH
M
E
T
H
O
D
2
.
1
.
Study
Desig
n a
nd
P
o
pu
la
t
io
n
A
d
escr
ip
ti
v
e
cr
o
s
s
s
ec
tio
n
al
s
tu
d
y
w
as
co
n
d
u
cted
in
r
esid
en
tial
co
lo
n
ie
s
o
f
0
4
cities
o
f
P
ak
is
tan
in
cl
u
d
in
g
R
a
w
alp
in
d
i,
I
s
la
m
a
b
ad
,
P
esh
a
w
ar
a
n
d
L
a
h
o
r
e.
St
u
d
y
w
a
s
7
m
o
n
t
h
s
d
u
r
atio
n
f
r
o
m
Au
g
u
s
t,
2
0
1
4
to
Feb
r
u
ar
y
,
2
0
1
5
.
2
.
2
.
Sa
m
pli
ng
T
ec
hn
i
qu
e
a
nd
Sa
m
p
le
Size
No
n
-
p
r
o
b
ab
ilit
y
co
n
v
en
ien
ce
s
a
m
p
li
n
g
w
a
s
u
s
ed
.
Usi
n
g
W
HO
s
a
m
p
le
s
ize
ca
lc
u
lato
r
,
th
e
s
a
m
p
l
e
s
ize
w
a
s
ca
lcu
la
ted
to
b
e
a
p
p
r
o
x
i
m
atel
y
1
1
4
w
ith
C
o
n
f
id
e
n
ce
L
e
v
el
(
C
L
)
o
f
9
5
%,
A
n
ti
cip
ated
p
o
p
u
latio
n
p
r
o
p
o
r
tio
n
(
P
)
o
f
0
.
6
an
d
Ab
s
o
lu
te
P
r
ec
is
io
n
(
d
)
o
f
0
.
1
5
.
I
n
d
iv
id
u
als
5
0
y
ea
r
s
a
n
d
a
b
o
v
e
w
er
e
s
elec
ted
.
T
h
o
s
e
w
h
o
w
er
e
b
ed
r
id
d
en
,
p
h
y
s
icall
y
d
is
ab
led
o
r
m
e
n
tal
l
y
d
i
s
o
r
ien
ted
(
i
n
ti
m
e,
p
lace
an
d
p
er
s
o
n
)
an
d
/o
r
u
n
w
illi
n
g
w
er
e
ex
cl
u
d
ed
f
r
o
m
s
t
u
d
y
.
Ver
b
al
i
n
f
o
r
m
ed
co
n
s
e
n
t
f
r
o
m
p
ar
ticip
an
t
s
an
d
p
er
m
is
s
io
n
f
r
o
m
t
h
e
E
th
ical
C
o
m
m
ittee
w
a
s
tak
e
n
.
2
.
3
.
Da
t
a
Co
llect
io
n T
o
o
l
a
nd
P
r
o
ce
du
r
e
Data
C
o
llectio
n
to
o
l
is
a
v
a
lid
ated
q
u
esti
o
n
n
air
e
titl
ed
R
ap
id
Ass
e
s
s
m
en
t
o
f
P
h
y
s
ic
al
A
ct
iv
i
t
y
(
R
A
P
A
)
.
R
A
P
A
is
a
n
i
n
e
-
ite
m
q
u
est
io
n
n
air
e
w
ith
t
h
e
r
esp
o
n
s
e
o
p
tio
n
s
o
f
y
es
o
r
n
o
to
q
u
esti
o
n
s
co
v
er
i
n
g
t
h
e
r
an
g
e
o
f
lev
el
s
o
f
p
h
y
s
ical
ac
tiv
it
y
f
r
o
m
s
ed
e
n
tar
y
to
r
eg
u
l
ar
v
ig
o
r
o
u
s
p
h
y
s
ical
ac
ti
v
it
y
as
w
ell
as
s
tr
en
g
t
h
tr
ain
i
n
g
a
n
d
f
lex
ib
ili
t
y
.
T
h
e
i
n
s
tr
u
ctio
n
s
f
o
r
co
m
p
leti
n
g
t
h
e
q
u
esti
o
n
n
air
e
p
r
o
v
id
e
a
b
r
ief
d
escr
ip
tio
n
o
f
t
h
r
ee
lev
els
o
f
p
h
y
s
ica
l
ac
tiv
it
y
(
l
i
g
h
t,
m
o
d
er
ate,
an
d
v
i
g
o
r
o
u
s
)
w
it
h
g
r
ap
h
ic
a
n
d
tex
t
d
ep
icti
o
n
s
o
f
t
h
e
t
y
p
e
s
o
f
ac
tiv
itie
s
t
h
at
f
all
in
to
ea
ch
ca
teg
o
r
y
.
I
t
h
as
t
w
o
s
ec
t
io
n
s
,
R
A
P
A
1
a
n
d
R
A
P
A
2
.
I
n
R
A
P
A
1
,
t
h
e
to
tal
s
co
r
e
o
f
t
h
e
f
ir
s
t
s
ev
e
n
ite
m
s
i
s
f
r
o
m
1
to
7
p
o
in
ts
,
w
i
th
t
h
e
r
esp
o
n
d
en
t’
s
s
co
r
e
ca
te
g
o
r
ized
in
to
o
n
e
o
f
f
iv
e
lev
e
ls
o
f
p
h
y
s
ical
ac
ti
v
it
y
:
1
=sed
en
tar
y
,
2
=u
n
d
er
ac
tiv
e,
3
=
r
eg
u
lar
u
n
d
er
ac
tiv
e
(
lig
h
t
ac
ti
v
itie
s
)
,
4
=r
eg
u
lar
u
n
d
er
ac
tiv
e,
an
d
5
=
r
eg
u
lar
ac
ti
v
e.
I
n
R
A
P
A
2
,
r
esp
o
n
s
es
to
th
e
s
t
r
en
g
t
h
tr
ai
n
i
n
g
a
n
d
f
lex
ib
ili
t
y
ite
m
s
ar
e
s
co
r
ed
s
ep
ar
atel
y
,
w
i
th
ca
teg
o
r
izatio
n
a
s
:
s
tr
en
g
t
h
tr
ai
n
i
n
g
=1
,
f
le
x
ib
ilit
y
=2
,
b
o
th
=
3
o
r
n
o
n
e=
0
.
I
n
d
iv
id
u
als
w
er
e
f
u
r
t
h
er
ca
te
g
o
r
ized
as
p
h
y
s
ic
all
y
i
n
ac
ti
v
e
i
f
t
h
e
y
w
er
e
at
f
ir
s
t
4
le
v
el
s
(
s
ed
en
tar
y
,
u
n
d
er
ac
tiv
e,
r
eg
u
lar
u
n
d
er
ac
ti
v
e
o
r
r
eg
u
lar
u
n
d
er
ac
tiv
e)
an
d
as p
h
y
s
icall
y
ac
tiv
e
i
f
th
e
y
w
er
e
at
lev
e
l 5
.
2
.
4
.
Da
t
a
Ana
ly
s
i
s
Data
w
as
e
n
ter
ed
an
d
an
aly
ze
d
in
SP
SS
v
er
s
io
n
2
0
.
Descr
ip
tiv
e
s
tat
is
tic
s
ar
e
p
r
esen
ted
a
s
f
r
eq
u
en
c
ies
a
n
d
p
er
ce
n
tag
e
s
.
Fo
r
q
u
an
titat
iv
e
d
ata
t
h
at
i
s
a
g
e,
m
ea
n
a
n
d
s
ta
n
d
ar
d
d
ev
iati
o
n
w
er
e
ca
lcu
lated
.
C
h
i
-
s
q
u
ar
e
test
o
f
s
ig
n
i
f
ica
n
c
e
w
it
h
9
5
%
co
n
f
id
en
ce
lev
e
l
w
as
u
s
ed
to
f
i
n
d
ass
o
ciatio
n
b
et
w
ee
n
b
et
w
ee
n
p
h
y
s
ical
ac
ti
v
it
y
a
n
d
co
m
o
r
b
id
co
n
d
itio
n
s
.
A
p
-
v
a
lu
e
o
f
<
0
.
0
5
w
a
s
tak
e
n
as s
tatis
t
icall
y
s
i
g
n
i
f
ica
n
t.
3.
RE
SU
L
T
S
A
ND
AN
AL
Y
SI
S
Am
o
n
g
1
1
4
p
ar
ticip
an
ts
,
t
h
e
r
e
w
er
e
6
6
(
5
7
.
9
%)
m
ale
s
a
n
d
4
8
(
4
2
.
1
%)
f
em
a
les.
Me
an
ag
e
o
f
p
ar
ticip
an
ts
w
a
s
5
7
.
0
4
±
7
.
3
4
8
y
ea
r
s
.
Ge
n
d
er
w
as
n
o
t si
g
n
i
f
ic
an
tl
y
a
s
s
o
ciate
d
w
it
h
p
h
y
s
ical
ac
tiv
it
y
(
p
=0
.
9
3
3
)
.
De
m
o
g
r
ap
h
ic
v
ar
iab
les d
etail
s
ar
e
s
h
o
w
n
i
n
T
ab
le
1.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
J
P
HS
Vo
l.
5
,
No
.
4
,
Dec
em
b
er
20
1
6
:
44
4
–
4
49
446
T
ab
le
1
.
A
s
s
o
ciatio
n
o
f
De
m
o
g
r
ap
h
ic
Var
iab
les
w
it
h
P
h
y
s
ic
al
A
cti
v
it
y
.
(
n
=1
1
4
)
D
e
mo
g
r
a
p
h
i
c
V
a
r
i
a
b
l
e
s
N
u
mb
e
r
o
f
p
e
r
so
n
s/
e
v
e
n
t
s
P
e
r
c
e
n
t
a
g
e
s
p
-
v
a
l
u
e
A
g
e
(
me
a
n
+
S
D
)
5
7
.
0
4
+
7
.
3
5
y
e
a
r
s
G
e
n
d
e
r
1.
M
a
l
e
2.
F
e
mal
e
66
48
5
7
.
8
9
4
2
.
1
0
.
9
3
3
O
c
c
u
p
a
t
i
o
n
1.
M
e
d
i
c
a
l
f
i
e
l
d
2.
G
o
v
e
r
n
me
n
t
3.
B
u
s
i
n
e
ss
4.
A
r
m
y
/
s
e
c
u
r
i
t
y
5.
H
o
u
se
w
i
f
e
6.
R
e
t
i
r
e
d
7.
O
t
h
e
r
s
17
19
7
9
17
20
25
1
4
.
9
1
6
.
7
6
.
1
7
.
9
1
4
.
9
1
7
.
5
2
1
.
9
0
.
8
6
9
Co
-
mo
r
b
i
d
c
o
n
d
i
t
i
o
n
s
1.
H
y
p
e
r
t
e
n
si
o
n
2.
D
i
a
b
e
t
e
s me
l
l
i
t
u
s
3.
A
n
g
i
n
a
4.
A
r
t
h
r
i
t
i
s
43
37
17
40
3
7
.
7
3
2
.
5
1
4
.
9
3
5
.
1
0
.
1
9
1
0
.
0
4
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[
1
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14]
.
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[
1
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]
.
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[
16]
.
An
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s
to
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n
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r
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ed
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itiv
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li
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g
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e
c
h
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ce
s
f
o
r
d
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elo
p
in
g
NI
DDM
[
1
7
-
18]
.
A
r
t
h
r
itis
ac
ts
as
a
d
o
u
b
le
ed
g
ed
s
w
o
r
d
i.e
.
lack
o
f
p
h
y
s
i
ca
l
ac
tiv
it
y
is
f
o
u
n
d
to
b
e
o
n
e
o
f
th
e
ca
u
s
ati
v
e
f
ac
to
r
s
o
f
ar
th
r
i
tis
w
h
er
ea
s
ar
th
r
i
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it
s
el
f
lead
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t
o
i
m
p
air
ed
p
h
y
s
ical
f
u
n
c
tio
n
i
n
g
o
f
th
e
b
o
d
y
.
T
h
is
p
atter
n
w
as
o
b
s
er
v
ed
in
o
u
r
s
t
u
d
y
a
s
w
ell
as
a
s
t
u
d
y
co
n
d
u
cted
b
y
Am
er
ican
co
lleg
e
o
f
R
h
e
u
m
ato
lo
g
y
[
1
9
-
2
0
]
.
I
n
o
n
e
s
tu
d
y
,
p
ai
n
i
n
te
n
s
it
y
,
f
r
eq
u
e
n
c
y
d
u
r
atio
n
a
n
d
n
u
m
b
er
o
f
s
i
tes
w
er
e
ass
o
ciate
d
w
it
h
d
e
m
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
t
ics
in
5
0
4
p
ar
ticip
an
ts
a
g
ed
6
0
y
ea
r
s
an
d
o
v
er
.
I
t
co
n
cl
u
d
e
d
th
at
i
n
ter
v
e
n
tio
n
s
f
o
r
in
cr
ea
s
in
g
p
h
y
s
ical
ac
ti
v
it
y
s
h
o
u
ld
b
e
e
m
p
h
a
s
ized
also
m
o
r
e
in
t
h
o
s
e
i
n
d
i
v
id
u
als
wh
o
h
a
v
e
m
o
r
e
p
ain
in
te
n
s
it
y
,
ar
e
m
o
r
e
d
ep
r
ess
ed
an
d
w
h
o
ar
e
ab
o
v
e
7
5
y
ea
r
s
o
r
o
ld
er
.
Ou
r
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d
y
m
o
s
tl
y
co
n
ce
n
tr
ated
o
n
5
0
y
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a
n
d
ab
o
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d
o
n
co
m
o
r
b
id
o
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th
e
in
d
i
v
id
u
a
ls
.
Dep
r
ess
io
n
a
n
d
p
ain
ele
m
e
n
t
s
ar
e
n
o
t
ad
d
r
ess
ed
in
th
e
ar
ticle
b
u
t
ca
n
b
e
i
n
cl
u
d
ed
in
f
u
r
th
er
s
tu
d
ies
[
2
1
]
.
A
m
e
t
an
al
y
s
is
w
a
s
co
n
d
u
cted
f
o
r
ass
ess
in
g
p
h
y
s
ica
l
ac
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i
n
ter
v
e
n
tio
n
s
i
n
ad
u
lt
s
s
p
ec
i
f
icall
y
o
n
t
h
eir
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e.
I
t
w
a
s
f
o
u
n
d
th
at
a
d
ec
r
ea
s
e
i
n
b
lo
o
d
p
r
ess
u
r
e
w
as
o
b
s
er
v
ed
in
th
e
in
ter
v
en
tio
n
g
r
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u
p
w
h
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n
o
u
r
s
t
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t
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n
o
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-
s
ig
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t a
s
s
o
ciat
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n
w
it
h
p
h
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s
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ac
t
iv
it
y
[
2
2
]
.
Dan
iela
Di
a
n
d
co
lleag
u
es
c
o
n
d
u
cted
s
t
u
d
y
o
n
f
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m
ales
w
it
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h
e
u
m
ato
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itis
to
s
ee
its
ass
o
ciatio
n
w
it
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p
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ac
t
i
v
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.
T
h
e
s
tu
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y
w
as
co
n
d
u
cte
d
o
n
a
lar
g
e
co
h
o
r
t
o
f
w
o
m
en
(
3
0
1
1
2
p
ar
ticip
an
ts
)
an
d
co
n
clu
d
ed
a
s
ig
n
if
ican
t
a
s
s
o
ciatio
n
o
f
p
h
y
s
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ac
tiv
i
t
y
h
as
p
r
o
tectiv
e
e
f
f
ec
t
f
o
r
ar
th
r
itis
.
I
n
o
u
r
s
tu
d
y
alth
o
u
g
h
s
a
m
p
le
s
ize
w
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t
lar
g
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b
u
t
s
i
g
n
i
f
ican
t
ass
o
ciati
o
n
w
a
s
estab
li
s
h
ed
b
et
w
ee
n
p
h
y
s
ical
ac
ti
v
it
y
an
d
g
en
d
er
[
2
3
]
.
I
n
an
o
th
er
s
tu
d
y
,
h
y
p
er
ten
s
io
n
,
d
iab
etes
an
d
also
o
b
esit
y
w
a
s
ev
al
u
ated
in
ter
m
s
o
f
p
h
y
s
ical
ac
tiv
it
y
.
C
o
n
cl
u
s
io
n
w
as
t
h
at
all
th
e
s
e
th
r
ee
co
m
o
r
b
id
ar
e
s
i
g
n
i
f
ica
n
tl
y
as
s
o
ciate
d
w
it
h
p
h
y
s
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in
ac
t
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t
y
b
u
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
J
P
HS
Vo
l.
5
,
No
.
4
,
Dec
em
b
er
20
1
6
:
44
4
–
4
49
448
n
o
t
al
w
a
y
s
s
ig
n
i
f
ica
n
t
i
n
f
e
m
ale
’
s
g
e
n
d
er
w
h
ic
h
co
n
tr
as
t
o
u
r
s
t
u
d
y
r
es
u
lt
s
as
g
en
d
e
r
w
as
s
i
g
n
if
ica
n
tl
y
ass
o
ciate
d
w
it
h
p
h
y
s
ical
ac
ti
v
it
y
.
R
ea
s
o
n
m
ig
h
t
b
e
o
u
r
s
m
al
l
s
a
m
p
le
s
ize.
Fu
r
t
h
er
s
t
u
d
ies
n
ee
d
to
ass
e
s
s
th
i
s
asp
ec
t f
u
r
t
h
er
[
2
4
]
.
T
h
e
af
o
r
e
m
e
n
tio
n
ed
a
s
s
o
ciat
io
n
b
et
w
ee
n
p
h
y
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ac
t
iv
i
t
y
,
s
ed
e
n
tar
y
li
f
est
y
le
p
atter
n
s
a
n
d
co
-
m
o
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b
id
co
n
d
itio
n
s
s
h
o
w
s
a
s
ig
n
if
ican
t
l
y
d
ec
r
ea
s
ed
r
is
k
i
n
p
h
y
s
ica
ll
y
ac
t
iv
e
i
n
d
iv
id
u
al
s
.
T
h
e
r
esu
lts
also
in
d
icate
a
d
i
f
f
er
e
n
t
d
is
ea
s
e
p
atter
n
f
o
r
th
e
t
w
o
g
e
n
d
er
s
b
u
t
th
at
is
o
u
t
o
f
t
h
e
s
co
p
e
o
f
t
h
is
s
t
u
d
y
.
P
r
o
b
ab
ly
s
o
m
e
b
io
lo
g
ical
d
i
f
f
er
e
n
ce
s
o
r
m
et
h
o
d
o
lo
g
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co
n
s
id
er
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n
s
w
er
e
r
esp
o
n
s
ib
le
f
o
r
t
h
e
v
ar
i
atio
n
b
et
w
ee
n
b
o
t
h
th
e
s
e
x
es.
T
h
e
p
r
im
ar
y
s
tr
en
g
t
h
o
f
t
h
is
s
tu
d
y
w
a
s
t
h
e
q
u
a
n
ti
f
icat
io
n
o
f
p
h
y
s
ica
l
ac
ti
v
it
y
ca
r
r
ied
o
u
t
b
y
t
h
e
s
a
m
p
l
e
p
o
p
u
latio
n
a
n
d
th
e
f
r
eq
u
en
cies
o
f
h
y
p
er
te
n
s
io
n
,
d
iab
etes,
an
g
i
n
a
an
d
ar
th
r
iti
s
in
th
e
p
o
p
u
latio
n
.
Desp
ite
m
ea
g
er
r
eso
u
r
ce
s
,
p
o
p
u
latio
n
f
r
o
m
d
i
f
f
er
en
t
s
o
cio
e
co
n
o
m
ic
class
e
s
f
r
o
m
f
o
u
r
cit
ies
o
f
P
ak
is
tan
w
a
s
in
cl
u
d
ed
in
th
e
s
tu
d
y
.
A
ls
o
th
e
m
aj
o
r
co
-
m
o
r
b
id
co
n
d
itio
n
s
p
r
ev
ale
n
t
i
n
o
u
r
r
eg
io
n
w
e
r
e
tak
e
n
in
to
co
n
s
id
er
atio
n
.
P
eo
p
le
f
r
o
m
al
l
w
al
k
s
o
f
li
f
e
w
er
e
in
cl
u
d
ed
in
r
esear
ch
w
h
ic
h
h
elp
ed
in
h
a
v
in
g
a
b
r
o
ad
er
id
ea
ab
o
u
t th
e
lev
e
l o
f
p
h
y
s
ical
ac
t
i
v
it
y
o
f
t
h
e
o
v
er
all
p
o
p
u
latio
n
.
A
m
aj
o
r
lim
ita
tio
n
to
th
i
s
s
t
u
d
y
w
as
t
h
at
t
h
e
r
esear
ch
was
ca
r
r
ied
o
u
t
o
n
a
s
am
p
le
p
o
p
u
latio
n
in
v
o
l
v
i
n
g
f
e
w
citie
s
o
f
P
ak
is
t
an
h
e
n
ce
it
ca
n
n
o
t
b
e
g
en
er
ali
ze
d
to
en
tire
p
o
p
u
latio
n
o
w
in
g
to
th
e
u
s
e
o
f
n
o
n
-
p
r
o
b
a
b
ilit
y
co
n
v
e
n
ie
n
ce
s
a
m
p
lin
g
.
A
l
s
o
,
in
clu
s
io
n
o
f
o
n
l
y
E
n
g
lis
h
lan
g
u
ag
e
i
n
th
e
q
u
esti
o
n
n
air
e
p
o
s
s
ib
l
y
r
esu
lted
i
n
b
ias
b
ec
au
s
e
s
o
m
e
p
r
o
p
o
r
tio
n
o
f
t
h
e
p
o
p
u
latio
n
w
a
s
p
o
o
r
at
u
n
d
er
s
tan
d
i
n
g
th
e
q
u
esti
o
n
n
a
ir
e.
An
o
th
er
li
m
i
tatio
n
i
s
w
h
et
h
e
r
th
e
p
h
y
s
ical
in
ac
t
iv
i
t
y
w
as
p
r
ec
ed
ed
b
y
co
m
o
r
b
id
co
n
d
itio
n
s
o
r
n
o
t?
T
h
is
asp
ec
t n
ee
d
to
b
e
ev
alu
ated
b
y
d
etail
co
h
o
r
t stu
d
ies.
4.
CO
NCLU
SI
O
N
T
h
e
lack
o
f
p
h
y
s
ical
ac
ti
v
it
y
is
s
i
g
n
if
ican
tl
y
a
s
s
o
ciate
d
w
i
th
d
iab
etes
m
e
llit
u
s
a
n
d
ar
th
r
itis
i
n
g
er
iatr
ic
p
o
p
u
latio
n
.
A
w
ar
en
ess
a
n
d
co
u
n
s
elli
n
g
at
p
h
y
s
i
cian
le
v
el
r
eg
ar
d
i
n
g
ad
eq
u
a
t
e
p
h
y
s
ical
ac
ti
v
it
y
s
h
o
u
ld
b
e
p
e
r
f
o
r
m
ed
to
in
cr
ea
s
e
p
atien
t’
s
ac
tiv
it
y
le
v
el
an
d
th
u
s
i
m
p
r
o
v
e
th
e
q
u
ali
t
y
o
f
lif
e
in
g
er
iatr
i
c
p
o
p
u
latio
n
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
e
s
tu
d
y
w
as
s
u
p
p
o
r
ted
b
y
Natio
n
al
Un
iv
er
s
it
y
o
f
Me
d
ical
Scien
ce
(
NUM
S)
an
d
A
r
m
y
Me
d
ica
l
C
o
lleg
e
(
A
M
C
)
.
T
h
e
au
th
o
r
s
a
r
e
v
er
y
th
a
n
k
f
u
l to
NUM
S a
n
d
A
M
C
f
o
r
th
e
i
r
en
co
u
r
a
g
e
m
e
n
t a
n
d
s
u
p
p
o
r
t.
RE
F
E
R
E
NC
E
S
[1
]
V
a
silo
p
o
u
lo
s T
.
,
e
t
a
l.
,
“
Co
m
o
rb
id
it
y
a
n
d
Ch
ro
n
ic Co
n
d
it
io
n
s in
th
e
Na
ti
o
n
a
l
S
o
c
ial
L
i
f
e
,
He
a
lt
h
a
n
d
Ag
in
g
P
ro
jec
t
(NSHA
P
)
,
”
W
a
v
e
2
.
J
Ge
ro
n
t
o
l
B
Psy
c
h
o
l
S
c
i
S
o
c
S
c
i
,
v
o
l/
issu
e
:
(
6
9
)2
,
p
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[2
]
I
.
Re
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ter
,
“
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g
in
g
,
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y
sic
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l
Ac
ti
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i
ty
a
n
d
Dise
a
se
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v
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o
n
,
”
J
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Res
,
2
0
1
2
.
[3
]
W
.
Qid
w
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t
a
l.
,
“
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sic
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l
e
x
e
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ise
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s
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e
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lt
h
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e
term
in
a
n
t
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m
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g
p
a
ti
e
n
t
,
”
J
C
o
ll
Ph
y
sic
i
a
n
s
S
u
r
g
P
a
k
,
v
o
l/
issu
e
:
1
3
(7
)
,
p
p
.
4
2
1
-
2
,
2
0
0
3
.
[4
]
Ch
a
stin
S
.
F
.
,
e
t
a
l.
,
“
A
ss
o
c
iatio
n
s
b
e
tw
e
e
n
o
b
jec
ti
v
e
ly
-
m
e
a
su
re
d
se
d
e
n
tary
b
e
h
a
v
io
r
a
n
d
p
h
y
sic
a
l
a
c
ti
v
it
y
w
it
h
b
o
n
e
m
in
e
ra
l
d
e
n
sity
in
a
d
u
lt
s an
d
o
l
d
e
r
a
d
u
lt
s,
t
h
e
NH
A
NES
stu
d
y
,
”
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n
e
,
v
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l/
issu
e
:
6
4
(7
)
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p
p
.
2
5
4
-
62
,
2
0
1
4
.
[5
]
B
.
El
sa
wy
a
n
d
K.
E
.
Hig
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in
s
,
“
P
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sic
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l
A
c
ti
v
it
y
G
u
id
e
li
n
e
s f
o
r
Old
e
r
A
d
u
lt
s
,
”
Am
Fa
m P
h
y
sic
ia
n
,
v
o
l/
issu
e
:
8
1
(
1
)
,
p
p
.
55
-
59
,
2
0
1
0
.
[6
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
“
Th
e
to
p
ten
c
a
u
se
s
o
f
d
e
a
th
s
,
”
2
0
1
4
.
Cit
e
d
o
n
No
v
.
2
0
1
4
.
A
v
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il
a
b
le
o
n
ww
w
.
w
h
o
.
in
t/
m
e
d
iac
e
n
tre/fa
c
tsh
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e
ts/fs3
1
0
/en
/
[7
]
S
a
lau
d
e
e
n
A
.
,
e
t
a
l.
,
“
Kn
o
w
led
g
e
a
n
d
p
re
v
a
len
c
e
o
f
risk
f
a
c
to
rs
f
o
r
a
rteria
l
h
y
p
e
rten
sio
n
a
n
d
b
lo
o
d
p
re
ss
u
re
p
a
tt
e
rn
a
m
o
n
g
b
a
n
k
e
rs an
d
tra
f
f
ic
w
a
rd
e
n
s in
I
lo
ri
n
,
Nig
e
ria
,
”
Af
r He
a
lt
h
S
c
i
.
,
v
o
l/
issu
e
:
1
4
(3
)
,
p
p
.
5
9
3
-
9
,
2
0
1
4
.
[8
]
Eato
n
C
.
B
.
,
e
t
a
l
.
,
“
S
e
d
e
n
tary
li
f
e
st
y
l
e
a
n
d
risk
o
f
c
o
ro
n
a
ry
h
e
a
rt
d
ise
a
se
in
w
o
m
e
n
,
”
M
e
d
S
c
i
S
p
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rts
Exe
rc
,
v
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l/
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e
:
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7
(1
1
)
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p
p
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5
3
5
-
9
,
1
9
9
5
.
[9
]
G
u
e
d
e
s
N
.
G
.
,
e
t
a
l.
,
“
P
re
v
a
len
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e
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f
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d
e
n
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li
f
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st
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le
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a
ls
w
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h
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ig
h
b
lo
o
d
p
re
ss
u
r
e
,
”
In
t
J
Nu
rs
T
e
rm
in
a
l
Cl
a
ss
if
,
v
o
l
/i
ss
u
e
:
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(
2
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p
p
.
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-
6
,
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0
1
0
.
[1
0
]
Hu
F
.
B
.
,
e
t
a
l.
,
“
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sic
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ti
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it
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n
d
tele
v
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n
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a
tch
in
g
in
re
lat
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n
to
risk
f
o
r
t
y
p
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d
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e
tes
m
e
ll
it
u
s
in
m
e
n
,
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Arc
h
In
ter
n
M
e
d
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l/
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p
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2
-
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,
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0
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1
.
[1
1
]
M
.
U
.
Kh
a
n
,
“
L
if
e
st
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l
e
m
o
d
if
ic
a
ti
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n
th
e
P
re
v
e
n
ti
o
n
o
f
Ty
p
e
-
II
d
iab
e
tes
m
e
ll
it
u
s
,
”
Om
a
n
M
e
d
J
.
,
v
o
l/
issu
e
:
2
7
(
2
)
,
p
p
.
1
7
0
-
17
,
2
0
1
2
.
[1
2
]
W
il
li
a
m
s
P
.
T
.,
“
R
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d
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c
e
d
to
tal
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n
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c
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sp
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i
f
ic
m
o
rtalit
y
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ro
m
w
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lk
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a
n
d
ru
n
n
i
n
g
in
d
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e
tes
,
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M
e
d
S
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S
p
o
rts
Exe
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.
,
v
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l/
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e
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,
p
p
.
9
3
3
-
9
,
2
0
1
4
.
[1
3
]
P
.
T.
W
il
li
a
m
s
,
“
V
ig
o
ro
u
s
e
x
e
rc
ise
,
f
it
n
e
ss
a
n
d
in
c
id
e
n
t
h
y
p
e
rten
sio
n
,
h
ig
h
c
h
o
les
tero
l,
a
n
d
d
iab
e
tes
,
”
M
e
d
S
c
i
S
p
o
rts
Exe
rc
,
v
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l/
issu
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:
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0
(6
)
,
p
p
.
9
9
8
-
1
0
0
6
,
2
0
0
8
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
SS
N:
2252
-
8806
A
s
s
o
cia
tio
n
o
f P
h
ysica
l A
ctivity
w
ith
C
o
-
mo
r
b
id
C
o
n
d
itio
n
s
in
Geria
tr
ic
P
o
p
u
la
tio
n
(
A
liya
His
a
m)
449
[1
4
]
F
o
rd
E
.
S
.
,
e
t
a
l
.
,
“
S
e
d
e
n
tary
b
e
h
a
v
io
r,
p
h
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sic
a
l
a
c
ti
v
it
y
,
a
n
d
th
e
m
e
tab
o
li
c
s
y
n
d
ro
m
e
a
m
o
n
g
U.S
.
a
d
u
l
ts
,
”
Ob
e
s
Res
.
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v
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l/
issu
e
:
1
3
(
3
)
,
p
p
.
6
0
8
-
14
,
2
0
0
5
.
[1
5
]
Ka
tz
m
a
rz
y
k
P
.
T
.
a
n
d
L
e
a
r
S
.
A
.,
“
P
h
y
sic
a
l
a
c
ti
v
it
y
f
o
r
o
b
e
se
in
d
iv
id
u
a
ls:
a
sy
ste
m
a
ti
c
re
v
ie
w
o
f
e
ffe
c
ts
o
n
c
h
r
o
n
ic
d
ise
a
s
e
risk
f
a
c
to
rs
,
”
Ob
e
s R
e
v
.
,
v
o
l/
issu
e
:
1
3
(
2
)
,
p
p
.
95
-
1
0
5
,
2
0
1
2
.
[1
6
]
W
e
rn
h
a
rt
S
.
,
e
t
a
l.
,
“
P
re
v
e
n
ti
o
n
o
f
c
a
rd
io
v
a
sc
u
lar
d
ise
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se
s
th
ro
u
g
h
sp
o
rt
a
n
d
p
h
y
sic
a
l
a
c
t
i
v
it
y
:
A
q
u
e
stio
n
o
f
in
ten
sity
?
”
He
r
z
,
v
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l/
issu
e
:
4
0
(3
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p
p
.
3
6
1
-
3
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8
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2
0
1
5
.
[1
7
]
W
.
He
n
r
ik
ss
o
n
H
.
,
e
t
a
l
.
,
“
Ex
e
rc
ise
in
th
e
m
a
n
a
g
e
m
e
n
t
o
f
n
o
n
-
in
su
l
in
-
d
e
p
e
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d
e
n
t
d
iab
e
tes
m
e
ll
it
u
s
,
”
S
p
o
rts
M
e
d
.
,
v
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l/
issu
e
:
2
5
(1
)
,
p
p
.
25
-
35
,
1
9
9
8
.
[1
8
]
L
e
h
m
a
n
n
R
.
a
n
d
S
p
i
n
a
s
G
.
A
.,
“
Ro
le
o
f
p
h
y
sic
a
l
a
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ti
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th
e
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ra
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n
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n
ti
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f
Ty
p
e
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tes
m
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it
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s
,
”
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h
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r Um
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3
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1
2
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p
.
9
2
5
-
33
,
19
96
.
[1
9
]
L
e
e
J
.
,
e
t
a
l.
,
“
S
e
d
e
n
tary
b
e
h
a
v
io
r
a
n
d
p
h
y
sic
a
l
f
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n
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ti
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n
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jec
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e
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id
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f
ro
m
th
e
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ste
o
a
rth
ri
ti
s
in
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ti
a
ti
v
e
”
,
Arth
riti
s Ca
re
Res
(
Ho
b
o
k
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,
v
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l
/i
ss
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:
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7
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,
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p
.
3
6
6
-
73
,
2
0
1
5
.
[2
0
]
Du
n
lo
p
D
.
D
.
,
e
t
a
l.
,
“
P
h
y
sic
a
l
a
c
ti
v
it
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lev
e
ls
a
n
d
f
u
n
c
ti
o
n
a
l
p
e
rfo
rm
a
n
c
e
in
th
e
o
ste
o
a
rth
rit
is
i
n
i
ti
a
ti
v
e
:
a
g
r
a
d
e
d
re
lati
o
n
sh
i
p
,
”
Art
h
riti
s R
h
e
u
m
,
v
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l/
issu
e
:
6
3
(1
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,
p
p
.
1
2
7
-
36
,
2
0
1
1
.
[2
1
]
S
il
v
a
A
.
G
.
,
e
t
a
l.
,
“
Hig
h
e
r
P
a
in
In
ten
sity
,
De
p
re
ss
io
n
,
a
n
d
Be
in
g
7
5
Ye
a
rs
o
r
Old
e
r
a
re
A
ss
o
c
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ted
w
it
h
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o
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r
L
e
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o
f
S
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f
-
Re
p
o
rted
P
h
y
si
c
a
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A
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v
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in
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it
h
P
a
in
A
tt
e
n
d
in
g
P
rim
a
r
y
Ca
re
,
”
Cli
n
ica
l
Ge
ro
n
to
l
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ist
,
v
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l/
issu
e
:
3
9
(4
)
,
p
p
.
3
2
4
-
41
,
2
0
1
6
.
[2
2
]
S
e
m
li
tsc
h
T
.
,
e
t
a
l.
,
“
In
c
re
a
sin
g
p
h
y
sic
a
l
a
c
ti
v
it
y
f
o
r
th
e
trea
t
m
e
n
t
o
f
h
y
p
e
rten
sio
n
:
a
s
y
ste
m
a
ti
c
re
v
ie
w
a
n
d
m
e
ta
-
a
n
a
ly
sis
,
”
S
p
o
rts M
e
d
.
,
v
o
l/
issu
e
:
4
3
(
1
0
)
,
p
p
.
1
0
0
9
-
23
,
2
0
1
3
.
[2
3
]
D
.
G
iu
se
p
p
e
D
.
,
e
t
a
l.
,
“
P
h
y
sic
a
l
a
c
ti
v
it
y
a
n
d
risk
o
f
rh
e
u
m
a
to
id
a
rth
rit
is
i
n
w
o
m
e
n
:
a
p
o
p
u
latio
n
-
b
a
se
d
p
ro
sp
e
c
ti
v
e
stu
d
y
,
”
Arth
riti
s re
se
a
rc
h
&
th
e
ra
p
y
,
v
o
l/
issu
e
:
1
7
(
1
)
,
p
p
.
40
,
2
0
1
5
.
[2
4
]
A
s
sa
h
F
.
,
e
t
a
l.
,
“
P
a
tt
e
rn
s
a
n
d
c
o
rre
late
s
o
f
o
b
jec
ti
v
e
l
y
m
e
a
su
re
d
fre
e
-
li
v
in
g
p
h
y
si
c
a
l
a
c
ti
v
it
y
in
a
d
u
lt
s
in
ru
ra
l
a
n
d
u
rb
a
n
Ca
m
e
ro
o
n
,
”
I
n
t
J
Ob
e
s R
e
l
a
t
M
e
ta
b
Diso
rd
.
,
v
o
l/
issu
e
:
2
6
(7
)
,
p
p
.
1
0
0
9
-
16
,
2
0
0
2
.
B
I
O
G
RAP
H
I
E
S
O
F
AUTH
O
RS
Dr
.
Aliy
a
H
isa
m
is
w
o
rk
in
g
in
a
f
a
c
u
lt
y
m
e
m
b
e
r
o
f
A
r
m
y
M
e
d
ica
l
Co
ll
e
g
e
,
NU
M
S
,
Ra
wa
lp
in
d
i
P
a
k
istan
.
S
h
e
h
a
s
d
o
n
e
M
BBS
,
M
P
H,
F
C
P
S
(Co
m
m
u
n
it
y
M
e
d
ic
in
e
).
S
h
e
is
a
lso
a
n
a
ss
istan
t
e
d
it
o
r
i
n
P
a
k
istan
A
r
m
e
n
d
F
o
rc
e
s M
e
d
ica
l
Jo
u
r
n
a
l
(
P
A
F
M
J).
A
b
o
u
t
1
0
y
e
a
rs t
e
a
c
h
in
g
e
x
p
e
rien
c
e
f
ro
m
re
c
o
g
n
ize
d
in
stit
u
tes
o
f
P
a
k
istan
a
n
d
M
e
d
ica
l
De
n
tal
Co
u
n
c
il
a
lo
n
g
w
it
h
f
ield
e
x
p
e
rien
c
e
w
it
h
in
tern
a
ti
o
n
a
l
o
rg
a
n
iza
ti
o
n
s
.
S
h
e
h
a
s
p
u
b
li
sh
e
d
a
rt
icle
s
in
W
-
c
a
to
g
o
ry
jo
u
rn
a
ls
a
n
d
h
a
s
a
ls
o
p
re
se
n
ted
t
h
e
m
in
c
o
n
f
e
re
n
c
e
s.
M
a
h
m
o
o
d
U
r
Ra
h
m
a
n
is
c
u
rre
n
tl
y
w
o
rk
in
g
a
s
H
e
a
d
o
f
Co
m
m
u
n
it
y
M
e
d
icin
e
Dp
e
a
rtme
n
t
o
d
A
r
m
y
M
e
d
ica
l
Co
ll
e
g
e
,
N
UMS
,
Ra
wa
lp
in
d
i
P
a
k
istan
.
He
h
a
s
d
o
n
e
M
BBS
,
DP
H,
M
P
H,
M
S
C
,
F
C
P
S
(Co
m
m
u
n
it
y
M
e
d
icin
e
).
He
h
a
s
a
v
a
st
e
x
p
e
rien
c
e
o
f
P
u
b
ll
i
c
He
a
lt
h
a
n
d
re
se
a
rc
h
.
He
h
a
s
e
x
ten
siv
e
e
x
p
e
rien
c
e
in
re
se
a
rc
h
,
tea
c
h
in
g
a
n
d
p
o
li
c
y
m
a
k
in
g
.
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