It’s never too late to Keep Moving
Physical activity is widely regarded as a key predictor of lifelong health and well-being. But does physical activity help prevent disability arising from mobility limitations in older adults? The Lifestyle Interventions and Independence for Elders (LIFEE) study addressed this question. This randomized trial enrolled participants at eight centers around the US. Participants were between 70 and 89 years of age, sedentary, and at high risk for mobility disability based on results of the Short Physical Performance Battery. Investigators randomized a sample of 1,635 sedentary men and women to either a physical activity group or a health education program group.
The physical activity intervention included walking (with a goal of 150 minutes per week) plus strength and flexibility training. Participants attended 2 center-based sessions per week and engaged in home-based activity 3-4 times per week. Persons in the health education intervention attended weekly health education workshops for 26 weeks then monthly sessions thereafter. Major mobility disability was defined as inability to walk 400 meters (1/4 mile) within 15 minutes.
Participants in the physical activity intervention averaged 104 more minutes of physical activity per week than those in the health education intervention. After an average follow-up of 2.6 years, participants in the physical activity intervention experienced significantly less major mobility disability than those in the health education intervention (30.1 percent compared to 35.5 percent). Persistent mobility disability occurred a significant 26 percent less often in the physical activity group than in the health education group. People in the physical activity intervention experienced more adverse events than those in the health education group, but the difference was not statistically significant. While the effect size was modest, increasing physical activity reduced risk of major and persistent mobility disability. Given the severe impact of mobility disability on well-being, a physical activity program for older adults would likely help maintain their quality of life.
Turning back the clock
It makes sense that people who adopt healthy lifestyle habits earlier in life would enjoy better health and well-being. But do people who adopt healthy lifestyle behaviors later in life benefit as well? Researchers from the University of South Carolina addressed this idea using data from the Atherosclerosis Risk in Communities Study. The study included data from 15,708 participants aged 45-54. Healthy lifestyle habits included eating at least 5 servings of fruits and vegetables per day, exercising at least 2.5 hours per week, maintaining a body mass index between 18.5 and 30, and not smoking. At baseline, 1,344 (8.5 percent) of the 15,708 participants engaged in all four healthy lifestyle habits. Over the next six years, 970 participants adopted all four healthy lifestyle habits and had a 40 percent lower risk of all-cause mortality and a 35 percent lower risk of a cardiovascular disease event than participants who continued with three or fewer healthy habits. Thus, people who adopt healthy lifestyle habits later in life may still enjoy improved health.
Paths to healthy aging
There’s little doubt that physical activity promotes overall health and well-being for the general population. But what about older people, especially given the rising proportion of seniors in developed countries. Do health benefits, such as healthy ageing, accrue to people who continue physical activity into their later years? Do seniors who become physically active in their later years also experience health benefits? UK researchers used data from 3,454 participants (average 63.7 years and healthy at baseline) in the English Longitudinal Study of Ageing to address both questions. Healthy ageing was defined as 1) being free of chronic diseases, 2) have no major impairment of cognitive functions, 3) having no major limitations in physical functions, and 4) having good mental health. These and other relevant factors were evaluated at baseline, 4 and 8 years later. After 8 years, only 19.3% of the sample met all four criteria for healthy ageing.
Compared to participants who were inactive at baseline, those who were moderately or vigorously active at baseline had 167 percent and 253 percent higher chances, respectively, of meeting the healthy ageing criteria 8 years later after adjusting for confounding effects. The story gets even better. Compared to participants who were inactive at baseline and remained inactive over 8 years, those who were moderately or vigorously active at baseline and who reported the moderate or strenuous physical activity 8 years later had 337 percent and 668 percent higher chances, respectively, of meeting the healthy ageing criteria after adjusting for confounding effects. Even those who were inactive at baseline but who subsequently became active had a 237 percent higher chance of healthy aging 8 years later compared to those who were inactive at baseline and 8 years later. Those who enter their seniors as active adults and who continue to be active have are far more likely to enjoy healthy aging than older couch potatoes. And it’s never too late to become physically active.
Reduce your risk of frailty
Frailty refers to multiple deficits in older persons. Deficits include slow walking pace, inability to stand up quickly and walk, weak muscle strength, poor of balance, and poor self-reported health. Frailty increases the risks of falls, cardiovascular disease, metabolic disorders, osteoporosis, and cognitive decline. Over half of persons over age 80 had frailty in a British study. From 2010 to 2035, the number of persons over 85 years of age is expected to more than double in the UK. Unfortunately, less than half of older adults get the minimum amount of daily physical activity (150 minutes per day). To make matters worse, the average amount of physical activity that older persons engage in declines as age increases. On the positive side, numerous studies show that combinations of muscle-strengthening and aerobic exercises can safely and significantly reduce the risk of frailty or delay its manifestation.
Disability scores at age 75
James Fires and colleagues at Stanford followed the progression of disability among 335 long-time runners and 214 age-matched non-runners for 16 years. Average participants’ age at baseline was 59 years. Participants were grouped as follows: 1) Sedentary (did not get 60 minutes of vigorous physical exercise per week at baseline and at 16 years), 2) Increasers (did not get 60 minutes of vigorous physical exercise per week at baseline but did so at 16 years), 3) Decreasers (got 60 minutes of vigorous physical exercise per week at baseline but not at 16 years), and 4) Exercisers (participants who got 60 minutes of vigorous physical exercise per week at baseline and at 16 years). Disability at 16 years was measured with the Health Assessment Questionnaire – Disability. Scores ranged from 0-3 with higher scores denoting greater disability.
As expected, Exercisers had low disability scores (average of 0.12) at 16 years. Perhaps unexpectedly, Increasers had the same low disability scores (0.12) at 16 years as the Exercisers. Both the Sedentary and Decreaser participants had significantly higher disability scores (0.29 and 0.20, respectively) at 16 years. Can you get 60 minutes of vigorous physical activity per week (9 minutes per day) day through swimming, cycling or running? If so you, you may live better by postponing or avoiding disability.
What to do
Ideally, you'll enter elderhood after a life with lots of physical activity. But if not, don’t give up. As the above studies show, you can ramp up your level of physical activity even if didn’t get much physical activity earlier in your life. If you do, you’ll likely reduce your risks of disability, cardiovascular disease, frailty, and premature death.
