Research article
Physical Activity and Mortality Related to Obesity and Functional Status in Older Adults in Spain

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Background

Older people who increase or maintain their physical activity have lower mortality than those who remain sedentary. This could result from a lower body weight and a better functional status that allow to be more active. However, this explanation would be unlikely if the benefits of physical activity on mortality were seen also in older people with obesity or functional limitations.

Purpose

This study examined the association between change in leisure-time physical activity (LTPA) and mortality in older adults, and whether this association varied with obesity and functional limitations.

Methods

Data were taken from a prospectively follow-up study of 2732 people representative of the Spanish population aged ≥60 years. Changes in LTPA from 2001 to 2003 were linked to all-cause mortality from 2003 to 2009. Analyses were performed in 2010 with Cox models adjusted for the main confounders, and were stratified by obesity and functional limitations.

Results

Compared with people who were continually sedentary from 2001 to 2003, those who increased their LTPA had 34% lower mortality (hazard ratio [HR]=0.66, 95% CI=0.52, 0.84), and those who were continually active had 45% lower mortality (HR=0.55; 95% CI=0.43, 0.70). These results did not vary in analyses stratified by obesity and functional limitations.

Conclusions

Increasing or maintaining LTPA is associated with greater longevity in older adults, even those with obesity or functional limitations. Given the high frequency of these disorders, the current results suggest that most older adults can benefit from an active lifestyle.

Introduction

In older adults, physical activity is associated with lower all-cause mortality.1, 2, 3, 4 Moreover, the few studies5, 6, 7, 8, 9 that have examined the impact of changes in physical activity on mortality have observed that, in comparison with people who remain sedentary, those who increase or maintain their physical activity have lower mortality.

People who are obese or have functional limitations tend to reduce their physical activity and become more sedentary.10, 11 Given that abdominal obesity and functional limitations are associated with higher levels of mortality in older people,12, 13 the lower mortality in those who increase or maintain PA5, 6, 7, 8, 9 could result from their lower body weight and better functional status which allow them to be more active. However, this explanation would be unlikely if the benefits of physical activity on mortality were seen also in older adults with obesity or functional limitations.

Several previous investigations have adjusted for BMI6, 7, 8 or functional status,5 but none have stratified the analyses by these variables. Thus, it is not known whether older adults with obesity or disability can reduce their mortality by adopting an active lifestyle. This is important for two reasons. First, if mortality were lower in the obese and the disabled who maintain or increase physical activity, this association would probably be due to physical activity itself, and not to a normal weight and good functional status, which favor the practice of physical activity. Second, because of the high frequency of obesity and functional limitations in the older adults,14, 15, 16 evidence of the benefit of physical activity could be extended to a large fraction of the elderly population. In the present study, an examination was made of the association between changes in leisure-time physical activity (LTPA) and mortality in older adults in Spain and, in particular, whether this association varied with general and abdominal obesity and with functional limitations.

Section snippets

Methods

The study methods have been reported elsewhere.17, 18 Briefly, this was a prospective cohort population-based cohort study. The cohort was established in 2001 and was followed until 2009.

In 2001, the cohort consisted of 4008 people representative of the non-institutionalized Spanish population aged ≥60 years. Information was collected in the households by personal interview and physical examination performed by trained and certified personnel.

In 2003, an attempt was made to contact the subjects

Results

From 2001 to 2003, 15.8% of the study participants remained sedentary, 26.3% increased LTPA, 9.8% decreased LTPA, and 48.1% remained active. Compared with the rest of the study population, those who remained sedentary were less frequently men, were older, had a lower educational level, and less frequently consumed tobacco and alcohol. They also had a lower frequency of chronic diseases, worse scores on the PCS of the SF-36 and on the MMSE, higher BMI and waist circumference, and a higher

Discussion

The present study shows that older adults who maintain or increase LTPA have lower mortality than those who are continually sedentary. These results are observed even in people who are very old, with obesity or with functional limitation, especially in IADL.

The current study expands knowledge in this field because it shows for the first time that maintaining or adopting an active lifestyle increases longevity even in older adults who are obese or have functional limitation. This is important

Conclusion

This study suggests that increasing or maintaining LTPA is associated with greater longevity in older adults with obesity or functional limitation. This is important because the number of older adults will continue to grow in the future16 and because of the high prevalence of being sedentary, which affects up to 26% of the subjects in the current study. And finally, given the high frequency of obesity and functional limitation, the current findings suggest that most older adults can benefit

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