Changes in leisure time physical activity and risk of all-cause mortality in men and women: the Baltimore Longitudinal Study of Aging

Higher Levels and Intensity of Physical Activity Are Associated with Reduced Mortality among Community Dwelling Older People

Introduction. There is limited evidence on physical activity and mortality in older people. Methods. People aged 75–84 years (n = 1449) participating in a randomized trial of health screening in UK general practice were interviewed about their physical activity (PA) and were assessed for a wide range of health and social problems. Mortality data were collected over 7 years of followup. Results. Full information on PA and potential confounders was available in 946 people. Those in the highest third of duration of PA had a lower mortality, confounder-adjusted Hazard Ratio (HR) = 0.74, and 95% Confidence Interval (CI) 0.56–0.97, compared to the lowest third. Similar benefits were seen when categorized by intensity of PA, with those in the highest group having a lower mortality, confounder-adjusted HR = 0.61, and 95% CI 0.47–0.79, compared to the lowest category. Conclusions. Our results suggest the importance of providing older people with opportunities for physical activity.

Physical activity and mortality related to obesity and functional status in older adults in Spain

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.

Is there evidence for mandating electrocardiogram as part of the pre-participation examination?

The risk of sudden cardiac death may be increased up to 2.8 times in competitive athletes compared with nonathletes. The majority of sudden cardiac death cases are caused by an underlying abnormality that potentially may be identified on cardiovascular screening, depending on the specific abnormality and the content of the cardiovascular screening applied. Indeed, today, cardiac screening is universally recommended by the cardiac societies [European Society of Cardiology (ESC) and American Heart Association (AHA)] and required by the sporting bodies [Fédération Internationale de Football Association (FIFA) and Union of European Football Associations (UEFA)]. Pre-participation examination is by consensus understood to include personal history and physical examination; controversy exists regarding the usefulness and appropriateness of screening using resting 12-lead electrocardiogram (ECG), with an apparent transatlantic difference. The ESC recommends screening consisting of personal history, physical examination, and 12-lead resting ECG, whereas recommendations from the AHA includes only personal history and physical examination. There is firm scientific ground to state that the sensitivity of screening with ECG is vastly superior to, and the cost-effectiveness significantly better than, screening without ECG. Cardiac screening of elite athletes with personal history, physical examination, and ECG is cost-effective also in comparison with other well-accepted procedures of modern health care, such as dialysis and implantable cardiac defibrillators. Newly published recommendations for the interpretation of the ECG in athletes (ESC) and future studies on ECGs in athletes of different ethnicity, gender, and age may further increase the specificity of ECG in cardiac screening, refining the screening procedure and lowering the costs for additional follow-up testing. Cardiac screening without ECG is not cost-effective and may be only marginally better than no screening at all and at a considerable higher cost. The difficulties in feasibility and liability issues for recommending ECGs in some countries need to be acknowledged but must be dealt with within those countries/systems. On ethical grounds, the reasons (logistical, legal, economic) for not screening individual athletes should be clearly stated. Alas, the current evidence, as presented here, suggests that the ECG should be mandatory in pre-participation screening of athletes.

Geriatric impairments and disability: the cardiovascular health study

OBJECTIVES

To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses.

DESIGN

Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time-dependent predictors and onset of disability in activities of daily living (ADLs) and mobility.

SETTING

Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA).

PARTICIPANTS

Five thousand eight hundred eighty-eight elderly persons.

MEASUREMENTS

Data were collected annually through in-person examinations.

RESULTS

ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63-2.75), 4.25 (95% CI=3.30-5.48), and 7.87 (95% CI=6.10-10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41-2.19), 2.45 (95% CI=1.95-3.07), and 3.26 (95% CI=2.53-4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27-1.73), 2.08 (95% CI=1.77-2.45), and 3.70 (95% CI=3.09-4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76-2.40), 2.80 (95% CI=2.36-3.31), and 4.20 (95% CI=3.44-5.14), respectively.

CONCLUSION

Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.

A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality.

Impact of exercise on patients with depression and anxiety

BACKGROUND

Persons with common mental disorders are at risk of lowered physical activity.

AIMS

To investigate if patients with depressive and/or anxiety disorders can achieve a level of physical activity meeting public health recommendations, increase their physical fitness and quality of life (QoL) through participation in a physical exercise programme.

METHODS

In a non-blinded controlled study, 48 patients referred by private psychiatric clinics and private general practices were either treated in an intervention (n=27) or a control group (n=21). The intervention group took part in 20 weeks of group exercise consisting of aerobic training and non-aerobic weight-lifting. All participants were interviewed and tested at baseline, week 20 and at week 32.

RESULTS

The intervention group increased in physical activity (120 min/week) and VO(2)max (0.48 ml O(2)/min). The VO(2)max increase was maintained after a 12-week follow-up period. Findings should be conservatively interpreted because of high attrition rate.

CONCLUSIONS

Patients with anxiety and/or depressive disorders who participated in a structured, supervised exercise programme achieved in accordance with public health recommendations a higher level of physical activity and VO(2)max.

CLINICAL IMPLICATIONS

The clinical implications of the study may be a suggestion of offering physical exercise to milder and moderate severe cases of depression and anxiety.

Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort

OBJECTIVE

To examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation.

DESIGN

Population based cohort study with follow-up over 35 years.

SETTING

Municipality of Uppsala, Sweden.

PARTICIPANTS

2205 men aged 50 in 1970-3 who were re-examined at ages 60, 70, 77, and 82 years.

MAIN OUTCOME MEASURE

Total (all cause) mortality.

RESULTS

The absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity. Men who increased their physical activity level between the ages of 50 and 60 continued to have a higher mortality rate during the first five years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity). After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking).

CONCLUSIONS

Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation.

Confusion and conflict in assessing the physical activity status of middle-aged men

BACKGROUND

Physical activity (including exercise) is prescribed for health and there are various recommendations that can be used to gauge physical activity status. The objective of the current study was to determine whether twelve commonly-used physical activity recommendations similarly classified middle-aged men as sufficiently active for general health.

METHODS AND FINDINGS

We examined the commonality in the classification of physical activity status between twelve variations of physical activity recommendations for general health in ninety men aged 45-64 years. Physical activity was assessed using synchronised accelerometry and heart rate. Using different guidelines but the same raw data, the proportion of men defined as active ranged from to 11% to 98% for individual recommendations (median 73%, IQR 30% to 87%). There was very poor absolute agreement between the recommendations, with an intraclass correlation coefficient (A,1) of 0.24 (95% CI, 0.15 to 0.34). Only 8% of men met all 12 recommendations and would therefore be unanimously classified as active and only one man failed to meet every recommendation and would therefore be unanimously classified as not sufficiently active. The wide variability in physical activity classification was explained by ostensibly subtle differences between the 12 recommendations for thresholds related to activity volume (time or energy), distribution (e.g., number of days of the week), moderate intensity cut-point (e.g., 3 vs. 4 metabolic equivalents or METs), and duration (including bout length).

CONCLUSIONS

Physical activity status varies enormously depending on the physical activity recommendation that is applied and even ostensibly small differences have a major impact. Approximately nine out of every ten men in the present study could be variably described as either active or not sufficiently active. Either the effective dose or prescription that underlies each physical activity recommendation is different or each recommendation is seeking the same prescriptive outcome but with variable success.

Walking one hour or more per day prevented mortality among older persons: results from ilSIRENTE study

OBJECTIVE

Maintaining or increasing physical activity in late-middle age has been shown to be associated with a reduction in mortality. The aim of the present study was to explore the relationship between regular walking and the risk of all-cause death in a large population of frail and very old people living in community.

METHODS

We analyzed data from the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE study), a prospective cohort study that collected data on all subjects aged 80 year and older living in a mountain community. Baseline assessments of participants started in December 2003 and were completed in September 2004. All subjects were followed-up for 24 months. To the purpose of this study we selected all subjects without impairment in the activities of daily living (n=248). The main outcome measure was the relative hazard ratio of death over two years of follow-up for different levels of walking activity.

RESULTS

During a mean follow-up time of 24 months from baseline assessment, 30 subjects (12%) died. There was an uneven distribution of the risk. After adjusting for age, gender and other possible risk factors of death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and reactive C protein) subjects walking 1 h or more per day were less likely to die compared to participants walking less than 1 h per day (RR, 0.36; 95% CI 0.12-0.98).

CONCLUSIONS

Our results obtained from a representative sample of very old and frail elderly subjects expand the knowledge that high levels of walking activity are associated with better survival.