The role of physical activity in the association between disability and mortality among US older adults: a nationwide prospective cohort study

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Abstract

To examine whether physical activity can mitigate the mortality risk associated with disability in activities of daily living and instrumental activities in daily living among older adults. This analysis comprised 177,360 US participants (104,556 women), aged ≥ 60 years, with valid data from the 1997 through 2018 waves of the US National Health Interview Survey. Participants reported the frequency and duration of leisure-time PA, and their disabilities in activities of daily living and instrumental activities in daily living. Mortality data were obtained from the National Death Index. Over a mean (SD) follow-up of 8.02 (5.43) years, 66,694 deaths occurred from all-cause, 22,673 from cardiovascular disease, and 13,845 from cancer. Among people with disability in activities in daily living, those reaching physical activity recommendations had 25%, 24% and 33% lower risk of all-cause mortality, cardiovascular diseases, and cancer death, respectively, compared with those who do not meet physical activity recommendations. Values were 23%, 22% and 24% for those with disability in instrumental activities in daily living. Risk reductions associated with reaching the recommended physical activity ranged 16% to 29% for people without disability. Combining disability type and compliance with physical activity, individuals with disability in activities of daily living or instrumental activities in daily living who meet the recommended physical activity had moderately higher mortality than those without disability who did not achieve the recommended physical activity. Compliance with physical activity recommendations can partially mitigate excess mortality resulting from disability in activities in daily living or instrumental activities in daily living in older adults.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11357-024-01072-9.

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Most cited references 27

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World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)

Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.

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The Physical Activity Guidelines for Americans

Katrina L Piercy, Richard Troiano, Rachel M Ballard … (2018)

Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

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Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

Ulf Ekelund, Jakob Tarp, Jostein Steene-Johannessen … (2019)

Abstract Objective To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality. Design Systematic review and harmonised meta-analysis. Data sources PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018. Eligibility criteria Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals. Data extraction and analysis Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis. Main outcome measure All cause mortality. Results 39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56). Conclusion Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults. Systematic review registration PROSPERO CRD42018091808.

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Author and article information

Contributors

Rocio Izquierdo-Gomez: rocio.izquierdo@uca.es

Journal

Journal ID (nlm-ta): GeroScience

Journal ID (iso-abbrev): Geroscience

Title: GeroScience

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2509-2715

ISSN (Electronic): 2509-2723

Publication date (Electronic): 22 January 2024

Publication date PMC-release: 22 January 2024

Publication date Collection: June 2024

Volume: 46

Issue: 3

Pages: 3275-3285

Affiliations

[1 ]GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, ( https://ror.org/04mxxkb11) Cádiz, Spain

[2 ]Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, ( https://ror.org/02s5m5d51) Cádiz, Spain

[3 ]Universidad de Cádiz, ( https://ror.org/04mxxkb11) Avda. República Saharahui, S/N. Campus de Puerto Real, 11519 Cádiz, Puerto Real Spain

[4 ]Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, ( https://ror.org/01cby8j38) Madrid, Spain

[5 ]GRID grid.466571.7, ISNI 0000 0004 1756 6246, CIBERESP (CIBER of Epidemiology and Public Health), ; Madrid, Spain

[6 ]GRID grid.482878.9, ISNI 0000 0004 0500 5302, IMDEA-Food Institute, CEI UAM+CSIC, ; Madrid, Spain

[7 ]Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, ( https://ror.org/01rxfrp27) Victoria, 3086 Australia

Article

Publisher ID: 1072

DOI: 10.1007/s11357-024-01072-9

PMC ID: 11009203

PubMed ID: 38252359

SO-VID: 54ec46b0-5d28-442d-a23f-2a6e4cf9c9ab

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 December 2023

Date accepted : 9 January 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100023561, Ministerio de Universidades;

Award ID: n. CAS21/00163

Award Recipient : Rocio Izquierdo-Gomez

Funded by: Universidad de Cadiz

Open Access :

Funding for open access publishing: Universidad de Cádiz/CBUA

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Keywords: disability,aging,survival,physical activity

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Keywords: disability, aging, survival, physical activity

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The role of physical activity in the association between disability and mortality among US older adults: a nationwide prospective cohort study

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Most cited references 27

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

The Physical Activity Guidelines for Americans

Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

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