Physical activity (PA) and the disablement process: A 14-year follow-up study of older non-disabled women and men

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Abstract

Few studies have explored the associations of reported PA (RPA) with the processes underlying the development of disability. The present study was performed to explore RPA among older persons and its association with onset of functional dependence and mortality. Among a probability sample of 1782 community-living persons, aged 75–83 years, we evaluated the 1021 who reported no disability in basic activities of daily living. Participants were followed for a median of 8.34 years in public registers to determine onset of disability and mortality. RPA predicted mortality in older women (HR = 1.77, 95%CI = 1.42–2.19) and men (HR = 1.65, 95%CI = 1.27–2.14) over long time intervals. The effect of RPA persisted among permanently disabled older women, after adjusting for age, baseline vulnerability and grade of disability. Low RPA was independently associated with risk of incident disability (HR = 1.56, 95%CI = 1.10–2.23) in men. Among older women, the association between RPA and incidence of disability was attenuated in analyses that controlled for baseline mobility function. Thus, the association between physical activity and mortality reflected processes different from those underlying a simple relation between physical activity, disability and mortality. Physical activity was an ubiquitous predictor of longevity, but only for women.

Introduction

Maintaining or increasing physical activity and exercise are widely promoted as effective means to prolong life and to enhance health and physical and mental functioning of older persons. Several studies have demonstrated a link between physical activity and premature mortality and prevention of coronary heart disease, hypertension, colon cancer, and diabetes (Keysor, 2003). A substantial amount of evidence shows that exercise increases muscle strength and aerobic capacity and reduces functional limitations (Latham et al., 2003). It is less clear, however, whether physical activity or exercise prevents or postpone onset of disability (Keysor, 2003). Furthermore, RPA is reported to positively influence both cognitive performance and disability in older adults (Stuck et al., 1999, Popa et al., 2009). Some authors have found that only participation in vigorous physical activity or a high-intensity exercise program is associated with reductions in mortality risk (Lee et al., 1995). Others have extended these benefits to moderate activities such as walking and bicycling (Paffenbarger et al., 1993, Van Den Brink et al., 2005). However, only few studies have explored the associations of late-life moderate-intensity physical activity with the processes underlying the development of functional dependence (Carriere et al., 2005).

Despite increasing evidence that disability is associated with increased mortality and leads to additional adverse outcomes, such as hospitalization, use of formal and informal home care services, and nursing home placement, little is understood about how the early transition from a state of health and independence to one of increasing vulnerability, dependence, and death happens. It has been postulated that the risk of mortality in old age is attributable to a combination of predisposing factors that either make one vulnerable (e.g., cognitive impairment, comorbidity, and functional limitations) or strong (e.g., physical activity) (Fried et al., 2004). Intervening illness or disability was suggested to act as precipitants (Gill et al., 2007). In the current study we set out to test this model of mortality through an evaluation of whether the association between late-life moderate-intensity RPA, persistent disability (PD) and mortality holds over long time intervals within a community sample of older non-disabled people. If late-life moderate-intensity physical activity is associated with longevity over long intervals independent of the occurrence of PD this will support the view that RPA is a ubiquitous predictor of longevity, with implications for the prevention and management of the disablement process among older people.

Section snippets

Study design and participants

This study used data from the Brønshøj-Husum Study, a prospective population-based study of functional ability and dementia among all community dwelling elderly women (1147) and men (635) born between 1913 and 1918 and living in a district of Copenhagen on January 1st, 1994. The assembly of the cohort, which was carried out between March 1994 and December 1996, has been described in detail elsewhere (Schultz-Larsen et al., 2007a). A total of 593 elderly residents did not participate in the

Results

Elderly women and men spent a mean of 48.0 ± 39.1 and 56.2 ± 44.8, minutes per day walking and/or bicycling, respectively. Approximately 18% of the women and approximately 12% of the men participated in a variety of exercise intensities at least 1 h per week. Approximately 36% of both genders walked or rode a bicycle less than 30 min per day and did not participate in exercise.

Among the 584 participants categorized as incident persistent disabled during the follow-up period 104 women and 53 men

Discussion

In this mortality analysis on respondents in a community sample of older non-disabled people aged 75–83 years, we found that late-life moderate-intensity RPA was associated with decreased risk of overall mortality over long intervals. The findings suggest that walking or riding a bicycle more than 30 min per day exerts an important influence on mortality in both older women and men, independently of age and baseline vulnerability. We also found that the effect of RPA persisted among permanently

Conclusion

The association found between measures of physical activity and mortality reflects processes different from those underlying a simple relation between physical activity, PD and mortality. Our results expand the knowledge that late-life moderate RPA can substantially benefit even frail and disabled older women and men over long time intervals. Regular leisure activities, such as walking and riding a bicycle seem to be enough to confer considerable benefits on not only proximal but also distal

Conflict of interest statement

None.

Acknowledgements

We thank Karen Leimand for assistance with data collection. This work was supported by the Danish Ministry of Social Affairs, The Copenhagen Care and Health Administration, and VELUX FONDEN of 1981.

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