Association between frailty and the combination of physical activity level and sedentary behavior in older adults.
ABSTRACT: BACKGROUND:The combined association of physical activity and sedentary behavior with adverse health factors is not yet clear in the literature. A combined analysis of physical activity level and sedentary behavior may provide evidence of the interrelation between these behavioral variables and the frailty syndrome. Thus, the aim of this study was to examine the relationship between physical activity level, sedentary behavior and frailty in older adults. METHODS:In this study, we evaluated 457 older adults (age range = 60 to 96 years old) from the Longitudinal Study of the Elderly Health of Alcobaça, Bahia. The frailty condition was defined by the presence of three or more of the following criteria: unintentional weight loss, slow walking speed measured over a 4.57 m test, a reduction of manual grip strength and exhaustion. Based upon these criteria, participants were classified as non-frail or frail. Physical activity level and time spent in sedentary behavior were assessed with the International Questionnaire of Physical Activity. Descriptive statistics were used to characterize the sample. To examine the combined association of physical activity and sedentary behavior with frailty, chi-square and Poisson regression tests were used. Statistical significance was defined as p ≤ 0.05. RESULTS:The prevalence of frailty was 8.8% (n = 40), with higher prevalence observed with increasing age. Low physical activity level combined with excessive time spent in sedentary behavior (physical activity level < 150 min/wk. and sedentary behavior ≥540 min/day) was associated with frailty, resulting in a prevalence ratio of 2.83 (95% CI, 1.23 to 6.52). CONCLUSION:Frailty is more prevalent among older adults who exhibit insufficient levels of physical activity combined with a great amount of time spent in sedentary behavior, even when adjusted for sociodemographic factors.
Project description:This paper aims to analyse whether time spent in sedentary behaviour was a discriminant criterion for frailty in older adults. This was a cross-sectional study conducted in a sample of 457 elderly individuals aged ≥60 years. Frailty was defined as the presence of three or more of the following criteria: Unintentional weight loss, low walking speed at a 4.57 m course, reduced manual grip strength, exhaustion and insufficient physical activity level. Participants were classified into two groups: Non-frail or frail. Exposure to sedentary behaviour was assessed by the time spent sitting during a typical week, according to the adapted version of the International Physical Activity Questionnaire. Descriptive (mean, frequency) and inferential statistics (Poisson regression, Pearson’s Chi-square, Receiver Operating Characteristic Curve) were used to analyse the data, comparing them to the time-related areas exposed to sedentary behaviour by gender and the presence of fragility. The prevalence of frailty was 22.1% (n = 101). The most accurate cut-off points of sitting time for predicting frailty were >495 min/day (men) or >536 min/day (women). Time spent in sedentary behaviour can be used to indicate fragility in the elderly of both sexes.
Project description:BACKGROUND:Frail older adults are heavy users of health and social care. In order to reduce the costs associated with frailty in older age groups, safe and cost-effective strategies are required that will reduce the incidence and severity of frailty. OBJECTIVE:We investigated whether self-reported intensity of physical activity (sedentary, mild, moderate or vigorous) performed at least once a week can significantly reduce trajectories of frailty in older adults who are classified as non-frail at baseline (Rockwood's Frailty Index [FI] ? 0.25). METHODS:Multi-level growth curve modelling was used to assess trajectories of frailty in 8649 non-frail adults aged 50 and over and according to baseline self-reported intensity of physical activity. Frailty was measured in five-year age cohorts based on age at baseline (50-54; 55-59; 60-64; 65-69; 70-74; 75-79; 80+) on up to 6 occasions, providing an average of 10 years of follow-up. All models were adjusted for baseline sex, education, wealth, cohabitation, smoking, and alcohol consumption. RESULTS:Compared with the sedentary reference group, mild physical activity was insufficient to significantly slow the progression of frailty, moderate physical activity reduced the progression of frailty in some age groups (particularly ages 65 and above) and vigorous activity significantly reduced the trajectory of frailty progression in all older adults. CONCLUSION:Healthy non-frail older adults require higher intensities of physical activity for continued improvement in frailty trajectories.
Project description:Background: Sedentary behavior has gained prominence in the literature as a risk factor for health and mortality independent of physical activity level; however, little is known about the relationship of sedentary behavior with frailty in older adults. The aim of this study was to investigate if time spent sitting can be used as a discriminator of frailty in older hospitalized persons. Methods: The study included 162 hospitalized inpatients aged ?60 years. Blood samples were taken for analyzing leukocyte counts and serum concentrations of C-reactive protein (CRP). Participants also answered a questionnaire about time spent sitting. Frailty was determined from a combination of CRP concentration and leukocyte count. Receiver operating characteristic (ROC) curves were constructed to analyse the predictive power and cut-points for time spent sitting and the presence of frailty. Results: The areas under the ROC curves indicated that time spent sitting was an independent indicator of frailty (area under curve >0.6). The cut-off points for time spent sitting as an indicator of frailty were >257 min/day for men and >330 min/day for women. Conclusions: Time spent sitting is associated with biomarkers of frailty in persons aged ?60 years, indicating a need for interventions aimed at reducing sedentary behavior in this age group.
Project description:INTRODUCTION:Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA. AIM:This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels. METHODS:Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA). RESULTS:Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home. CONCLUSIONS:Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.
Project description:The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from accelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women (p ≤ 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM (p ≤ 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men. In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.
Project description:BACKGROUND:There has been limited longitudinal assessment of the relationship between moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) with frailty, and no studies have explored the possibility of reverse causality. This study aimed to determine the potential bidirectionality of the relationship between accelerometer-assessed MVPA, SB, and frailty over time in older adults. METHODS:Participants were from the Toledo Study for Healthy Aging. We analysed 186 older people aged 67 to 90 (76.7 ± 3.9; 52.7% female participants) over a 4-year period. Time spent in SB and MVPA was assessed by accelerometry. Frailty Trait Scale was used to determine frailty levels. A cross-lagged panel model design was used to test the reciprocal relationships between MVPA/SB and frailty. RESULTS:Frailty Trait Scale score changed from 35.4 to 43.8 points between the two times (P < 0.05). We also found a reduction of 7 min/day in the time spent on MVPA (P < 0.05), and participants tended to spend more time on SB (P = 0.076). Our analyses revealed that lower levels of initial MVPA predicted higher levels of later frailty [std. ? = -0.126; confidence interval (CI) = -0.231, -0.021; P < 0.05], whereas initial spent time on SB did not predict later frailty (std. ? = -0.049; CI = -0.185, 0.087; P = 0.48). Conversely, an initial increased frailty status predicted higher levels of later SB (std. ? = 0.167; CI = 0.026, 0.307; P < 0.05) but not those of MVPA (std. ? = 0.071; CI = -0.033, 0.175; P = 0.18). CONCLUSIONS:Our observations suggest that the relationship between MVPA/SB and frailty is unidirectional: individuals who spent less time on MVPA at baseline are more likely to increase their frailty score, and individuals who are more frail are more likely to spent more time on SB at follow-up. Interventions and policies should aim to increase MVPA levels from earlier stages to promote successful aging.
Project description:Sedentary behavior is related to increased mortality risk. Whether such elevated risk can be offset by enhanced physical activity has not been examined using accelerometry data.We examined the relations of sedentary time and physical activity to mortality from any cause using accelerometry data among 1,677 women and men aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 cycle with follow-up through December 31, 2006.During an average follow-up of 34.67 months and 4,845.42 person-years, 112 deaths occurred. In multivariate Cox proportional hazard models, greater sedentary time (≥ median of 8.60 hours/day) was associated with increased risk of mortality from any cause (relative risk (RR) = 2.03; 95% confidence interval (CI) = 1.09-3.81). Low level of moderate to vigorous physical activity (< median of 6.60 minutes/day) was also related to enhanced all-cause mortality risk (RR = 3.30; 95% CI = 1.33-8.17). In combined analyses, greater time spent sedentary and low levels of moderate to vigorous physical activity predicted a substantially elevated all-cause mortality risk. As compared with the combination of a low sedentary level and a high level of moderate to vigorous physical activity, the risks of mortality from all causes were 4.38 (95% CI = 1.26-15.16) for low levels of both sedentary time and physical activity, 2.79 (95% CI = 0.77-10.12) for greater time spent sedentary and high physical activity level, and 7.79 (95% CI = 2.26-26.82) for greater time spent sedentary and low physical activity level. The interaction term between sedentary time and moderate to vigorous physical activity was not statistically significant (p = 0.508).Both high levels of sedentary time and low levels of moderate to vigorous physical activity are strong and independent predictors of early death from any cause. Whether a high physical activity level removes the increased risk of all-cause mortality related to sedentariness requires further investigation.
Project description:To examine associations between objective measures of activity level and mortality risk in older men.Prospective cohort study.Six U.S. sites.Men aged 71 and older followed an average of 4.5 years (N = 2,918).Time awake spent in sedentary behavior (metabolic equivalent (MET) level ?1.50), light activity (MET level 1.51-2.99), and at least moderate activity (MET level ?3.00) measured using an activity monitor worn for 5 days or longer and expressed as quartiles. Deaths were confirmed with death certificates; cause of death was adjudicated by review of certificates and records.During follow-up, 409 (14%) men died. After multivariable adjustment, comparing Q4 with Q1, more time spent in sedentary behavior (Q4 vs Q1, hazard ratio (HR) = 1.51, 95% confidence interval (CI) = 1.10-2.08), less time spent in light activity (Q1 vs Q4, HR = 1.54, 95% CI = 1.06-2.24), and less time spent in at least moderate activity (Q1 vs Q4, HR = 1.56, 95% CI = 1.09-2.25) were similarly associated with greater mortality risk primarily due to higher risks of cardiovascular and noncardiovascular, noncancer death. The association between time spent in sedentary behavior and mortality varied according to time spent at higher activity level. More time spent in sedentary behavior was associated with greater risk of death in men spending 1.2 (median) h/d or more in at least moderate activity (Q4 vs Q1, HR = 2.09, 95% CI = 1.26-3.49) but not in those spending less time (Q4 vs Q1, HR = 1.02, 95% CI = 0.62-1.66) (P = .005 for interaction).In older men exceeding current guidelines on physical activity, more time spent in sedentary behavior is associated with greater mortality risk.
Project description:BACKGROUND:Whether physical activity can reduce cognitive frailty-a relatively new "compound" phenotype proposed in 2013-and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect. METHODS:We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70-89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline. RESULTS:After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction?=?0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction?=?0.835, 0.536, 0.934, and 0.458, respectively). CONCLUSIONS:A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging. TRIAL REGISTRATION:Clinicaltrials.gov, NCT01072500.
Project description:Background:Frailty associated with aging increases the risk of falls, disability, and death. We investigated gender-associated factors for frailty. Methods:Data of 3,079 geriatric subjects were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 database. After excluding 1,126 subjects with missing data on frailty, medical history and survival, data of 1,953 patients were analyzed. Main endpoints were frailty prevalence, mortality rates and causes of death. Results:Frailty prevalence was 5.4% in males, 8.8% in females. Significant risk factors for geriatric frailty in males were being widowed/divorced/separated, low daily total calorie intake, physical inactivity, sleeping >9 h, smoking and hospitalization history; and in females were obesity, physical inactivity, sleeping <6 h, family history of diabetes and heart attack, and hospitalization history. Frail subjects had higher mortality rates (22.5% male; 8.5% female) than pre-frail (8.7% male; 6.4% female) and non-frail (5.4% male; 2.5% female). Main causes of death were heart diseases (41%) and chronic lower respiratory diseases (23.0%) in males and nephritis/nephrosis (32.3%) and chronic lower respiratory diseases (17.6%) in females. Discussion:Factors associated with frailty differ by gender, with higher frailty prevalence in females and higher mortality in males. Gender-associated factors for frailty identified in this study may be useful in evaluating frailty and guiding development of public health measures for prevention. Key Message:Common predictive factors for frailty among older adults of both genders, including more frequent previous hospitalizations, physical inactivity, and certain gender-associated factors for frailty, are consistent with results of other NHANES studies in which self-reported higher levels of illness and sedentary behavior were directly associated with frailty.