Physical activity, sitting time, and mortality from inflammatory diseases in older adults

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain. Design: Prospective study. Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged =60 years was followed-up during 14.3 years. Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions). Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50-0.90) or very active (HR = 0.48, 95%CI = 0.33-0.68), independently of ST. Also, being seated ≥7 h/d vs. < 7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02-1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59-3.29) compared to those with moderate/very PA and ST < 7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance. Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of themThis work was supported by FIS grant 16/609 (Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE), MINECO R+D+I grant (DEP2013-47786-R), MECD mobility grant (JC2015-00080), the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), and the ATHLOS project (European project H2020- Project ID: 635316

A healthy lifestyle attenuates the effect of polypharmacy on total and cardiovascular mortality: a national prospective cohort study

This work examines whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We included a prospective cohort of 3,925 individuals representative of the Spanish population aged ≥60 years, who were recruited in 2000–2001 and followed up through 2014. Polypharmacy was defined as treatment with ≥5 medications. The following lifestyle behaviors were considered healthy: not smoking, eating a healthy diet, being physically active, moderate alcohol consumption, low sitting time, and adequate sleep duration. Individuals were classified into three lifestyle categories s: unfavorable (0–2), intermediate (3–4) favorable (5–6). Over a median 13.8-y follow-up, 1,822 all-cause and 675 CVD deaths occurred. Among individuals with polypharmacy, intermediate and favorable lifestyles were associated with an all-cause mortality reduction (95% confidence interval [CI]) of 47% (34–58%) and 54% (37–66%), respectively; 37% (9–56%) and 60% (33–76%) for CVD death, respectively. The theoretical adjusted hazard ratio (95%CI) associated with replacing 1 medication with 1 healthy lifestyle behavior was 0.73 (0.66–0.81) for all-cause death and 0.69 (0.59–0.82) for CVD death. The theoretical adjusted hazard ratio (95%CI) for all-cause and CVD mortality associated with simply reducing 1 medication was 0.88 (0.83–0.94) and 0.83 (0.76–0.91), respectively. Hence, adherence to a healthy lifestyle behavior can reduce mortality risk associated with polypharmacy in older adults.This work was supported by FIS grants 16/609 and 13/0288 (Instituto de Salud Carlos III, State Secretary of R + D + I and FEDER/FSE), MINECO R + D + I grant (DEP2013-47786-R), the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), and the ATHLOS project (European project H2020- Project ID:635316

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes

Background: Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes. Objective: The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults. Design: A cross-sectional design was used. Methods: The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status). Results: The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures. Limitations: The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study. Conclusion: The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal design

Physical activity and long-term survival in older men and women: A 21 year longitudinal study

The NLSAA survey was conducted in 1985 with 1,042 participants. As of 31st May 2006 (21 years from baseline), there were 919 recorded deaths (368 men and 551 women). Mortality analyses were from baseline interview to death or censorship (May 2006). Men and women were analysed separately in unadjusted models and adjusting for demographic and health-related variables. In separate unadjusted models, participation in outdoor activities, indoor productive activities, leisure activities, walking, undertaking activities requiring flexibility, and physical effort each were associated with reduced long-term mortality among both men and women. In adjusted models, participation in physical activities had no significant association with mortality risk for men. Among women, participation in outdoor activities and leisure activities remained significantly associated with long-term survival in adjusted models. Among men, the benefits of physical activities for mortality risk were explained through demographic, health, and psychosocial variables. However, participation in outdoor and leisure physical activities was beneficial for women and had a significant association with survival, even when controlling for demographic, health and psychosocial variables. Therefore, encouraging participation in specific physical activities, such as gardening, swimming, and dancing among older women may improve long-term survival

Physical Activity, Sitting Time, and Mortality From Inflammatory Diseases in Older Adults

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain.Design: Prospective study.Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged ≥60 years was followed-up during 14.3 years.Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions).Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50–0.90) or very active (HR = 0.48, 95%CI = 0.33–0.68), independently of ST. Also, being seated ≥7 h/d vs. <7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02–1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59–3.29) compared to those with moderate/very PA and ST <7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance.Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of them

Physical activity, frailty and physical function, and Mortality in older adults

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Formación de Profesorado y Educación, Departamento de Educación Física, Deporte y Motricidad Humana. Fecha de Lectura: 24-06-2021El incremento de la esperanza de vida se ve reflejado en un progresivo y rápido envejecimiento de la población. La Organización Mundial de la Salud promueve que todos los países desarrollen estrategias que fomenten el envejecimiento activo de su población. Sin embargo, la mayor parte de la población de esta edad no cumple con las recomendaciones mínimas de actividad física. Un objetivo propuesto para esta tesis doctoral fue examinar la asociación entre actividad física y mortalidad según el nivel de fragilidad y función física de adultos mayores. Además, también examinamos las asociaciones de la actividad física diaria medida de forma objetiva con los niveles de fragilidad y función física en los adultos mayores. El primer objetivo se desarrolló en un estudio prospectivo que incluyó 4008 participantes de 60 o más años, representativos de la población española no institucionalizada. La actividad física fue autoreportada, la fragilidad se determinó mediante la escala FRAIL, la función física se evaluó con la dimensión física del cuestionario SF-36, y se siguió a los participantes durante una media de 14 años. Los análisis se realizaron con regresión de Cox y se ajustaron para los principales factores de confusión. El segundo objetivo incluyó 436 participantes de 65 o más años. El tiempo en las actividades físicas diarias se evaluó mediante el dispositivo multi-sensor IDEEA, la fragilidad se determinó con la escala de Fried, y la función física mediante la dimensión física del cuestionario SF-12. Se examinaron las asociaciones independientes de las actividades diarias con la fragilidad y la función física mediante modelos de regresión lineal ajustados por posibles factores de confusión, y mediante modelos de sustitución isotemporal. Los principales resultados de esta tesis doctoral sugieren que (i) ser físicamente activo se asocia con una menor mortalidad total y por enfermedad cardiovascular entre las personas pre-frágiles y frágiles, y en aquellos participantes con una mala función física y (ii) la actividad física moderada-vigorosa, medida de forma objetiva, en los adultos mayores, se asoció con mejores niveles de fragilidad y función física, y el reemplazo de conductas sedentarias por actividad física ligera, también podría producir mejoras en ambas variables. Estos resultados ponen de manifiesto que la actividad física sería esencial para atenuar no solo un mayor riesgo de mortalidad asociado a la fragilidad y a una deteriorada función física, sino también el proceso de envejecimiento que provoca más fragilidad y el deterioro en la función física

Interday reliability of the IDEEA activity monitor for measuring movement and nonmovement behaviors in older adults

The interday reliability of the Intelligent Device for Energy Expenditure and Activity (IDEEA) has not been studied to date. The study purpose was to examine the interday variability and reliability on two consecutive days collected with the IDEEA, as well as to predict the number of days needed to provide a reliable estimate of several movement (walking and climbing stairs) and nonmovement (lying, reclining, and sitting) behaviors and standing in older adults. The sample included 126 older adults (74 women) who wore the IDEEA for 48 hr. Results showed low variability between the 2 days, and the reliability was from moderate (intraclass coefficient correlation = .34) to high (.80) in most of movement and nonmovement behaviors analyzed. The Bland-Altman plots showed high-moderate agreement between days, and the Spearman-Brown formula estimated that 1.2 and 9.1 days of monitoring with the IDEEA are needed to achieve intraclass coefficient correlations ≥ .70 in older adults for sitting and climbing stairs, respectively.Peer reviewe

24-h movement and nonmovement behaviors in older adults. The IMPACT65+ study

[Introduction]: The aims of this study were: (i) to provide a detailed description of movement and nonmovement behaviors objectively assessed over the complete 24-h period in a sample of older adults, and (ii) to analyze differences in these behaviors by sex, age, educational level, body mass index, self-rated health, and chronic conditions.[Methods]: The sample comprised 607 high-functioning community-dwelling older adults (383 women), 65 to 92 yr, who participated in the IMPACT65+ study. Movement and nonmovement behaviors were assessed by the Intelligent Device for Energy Expenditure and Activity, which provide estimates on both temporal and spatial gait parameters, and identify specific functional activities on the basis of acceleration and position information.[Results]: The final sample with valid data was 432 older adults (284 women). Around 30.7% of daily time was engaged in sedentary behavior (SB), whereas 33.5% and 35.8% was represented by physical activity (PA) and sleep, respectively. Sitting passive was the most prevalent SB (vs lying and reclining), whereas most light PA was by standing (vs active sitting and walking at <2.5 mph). Time spent walking at ≥2.5 mph was the major contributor to moderate-to-vigorous PA. No differences were found in sleep time by sociodemographic or health-related characteristics, but there were relevant differences in sedentary and PA behaviors.[Conclusions]: This study offers a detailed description of the distribution of SB, PA, and sleep in elderly across the 24-h spectrum. The results could be used to focus the strategies aimed to improve health in the old age.Peer reviewe

Cognitive frailty and mortality in a national cohort of older adults: the role of physical activity

[Objective]: To examine the association between cognitive frailty and long-term all-cause mortality and the stratified and combined associations of physical activity and cognitive frailty with long-term all-cause mortality in a population-based cohort of older adults from Spain.[Patients and Methods]: A representative cohort of 3677 noninstitutionalized individuals from Spain aged 60 years or older was recruited between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014. Information on self-reported physical activity and cognitive frailty status were collected at baseline. Analyses were performed with Cox regression after adjustment for confounders.[Results]: The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths. The hazard ratio (HR) for all-cause mortality among participants with cognitive frailty compared with robust participants was 1.69 (95% CI, 1.43-2.01). Being active was associated with a mortality reduction of 36% (95% CI, 21%-47%) in cognitively frail individuals. Compared with those who were robust and active, participants with cognitive frailty who were inactive had the highest mortality risk (HR, 2.13; 95% CI, 1.73-2.61), which was equivalent to being 6.8 (95% CI, 5.33-7.99) years older.[Conclusion]: Cognitive frailty was more markedly associated with increased mortality in inactive older adults, and being active reduced the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve survival among cognitively frail older adults.This work was supported in part by the Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE (FIS grants 12/1166 and 16/609), MINECO R+D+I grant DEP2013-47786-R, the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), the ATHLOS project (European project H2020-Project ID: 635316), a grant from the Alicia Koplowitz Foundation (I.E.-C.), an FPI grant from Autonomous University of Madrid (S.H.-F.), and a ‘Ramon y Cajal’ contract (RYC-2016-20546) (D.M.-G.).Peer reviewe