Lung function in older humans: the contribution of body composition, physical activity and smoking

Sex Differences in Age-Related Physical Changes among Community-Dwelling Adults

The prevalence of physical functioning limitations is positively correlated with age in both men and women. However, whether the appearance of deterioration differs depending on physical function and sex remains unclear. This study aimed to clarify the modes of age-related changes in physical function and sex differences in middle-aged and older adults. This study comprised 124 (46 men and 78 women) healthy adults aged 30 years or older and examined gender differences in physical function. The results of this study showed that one-leg standing time had the highest rate of age-related decline in both men and women, followed by knee extension strength, skeletal muscle mass, the 5 m walking test, and the timed up and go test. The sex-specific points showed a high rate of decline in trunk forward bending in men and a high rate of decline in forced expiratory volume (1 s) and gradual rate of decline in the bone area ratio in women. After middle age, it is desirable to start monitoring and training balance, muscle function, and walking. Men require early intervention for flexibility, and women require early intervention for respiratory function and continued intervention for bone mineral density.

Association between Physical Activity Levels and Body Composition among Healthy Older Japanese Adults during a Snowy Winter: A Cross-Sectional Study

BACKGROUND

Despite a long average lifespan, increased life expectancy does not guarantee higher quality of life.

METHODS

To contribute in understanding some determinants of healthy life expectancies in older Japanese individuals in a snowy winter region, we investigated the indicators of health. Local residents (n = 124) in the city of Iwamizawa volunteered for health examinations from January 2016 to March 2016. We recorded activity via daily steps for 2-week periods. In addition, we measured body composition, grip strength, and assessed nutritional status.

RESULTS

Analysis of body composition and daily activity indicated that women who walked more than 4000 steps had lower fat mass and increased muscle mass. Men with >3.0 metabolic equivalents (METs) when walking had lower body fat.

CONCLUSION

For healthy older Japanese individuals in this snowy winter region, walking >4000 steps daily for women and exercise of >3.0 METs for men may indicate health-promoting activities.

Exceptional Human Longevity

Exceptional longevity represents an extreme phenotype. Current centenarians are survivors of a cohort who display delayed onset of age-related diseases and/or resistance to otherwise lethal illnesses occurring earlier in life. Characteristics of aging are heterogeneous, even among long-lived individuals. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life. Careful observations in the oldest old offer some empirical strategies that favor increased health span and life span, with implications for compression of disability, identification and implementation of lifestyle behaviors that promote independence, identification and measurement of more reliable markers associated with longevity, better guidance for appropriate health screenings, and promotion of anticipatory health discussions in the setting of more accurate prognostication. Comprehensive PubMed literature searches were performed, with an unbiased focus on mechanisms of longevity. Overall, the aggregate literature supports that the basis for exceptional longevity is multifactorial and involves disparate combinations of genes, environment, resiliency, and chance, all of which are influenced by culture and geography.

Meta-analysis across Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium provides evidence for an association of serum vitamin D with pulmonary function

The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)-pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D-pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (P race difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (P race difference=0·56). Among EA, the 25(OH)D-FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.

Associations between body composition, physical capabilities and pulmonary function in healthy older adults

BACKGROUND/OBJECTIVES

There are positive associations between pulmonary function (PF) and fat-free mass as well as muscle strength. Contrarily, negative associations were found with indirect measures of visceral adipose tissue (VAT). We aimed to differentiate between associations of body composition and PF by assessing mediating and moderating effects of physical capabilities.

SUBJECTS/METHODS

Cross-sectional data were assessed among 40 healthy, free-living elderly (20 males) aged 65.1-81.2 years (mean±s.d. age: 72.2±4.3 years; body mass index: 25.6±3.7 kg/m²). Total and regional skeletal muscle (SM), and adipose tissue (AT) were measured using whole-body magnetic resonance imaging. Muscle strength by handgrip dynamometry, physical activity (PA) by questionnaire, and physical performance by gait speed and sit-to-stand test (STS). Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁) were assessed by spirometry.

RESULTS

Positive associations between height-standardized FVC (FVCI) as well as FEV₁ (FEVI), and SM (r=0.435-0.520, P<0.05) were found; subcutaneous AT (SAT) and FVCI correlated negatively (r=-0.374; P<0.05). HGS and PA correlated positively with FEVI (r=0.456-0.608, P<0.05), HGS also with FVCI (r=0.595, P<0.05). Stepwise multiple regression using FVCI and FEVI as dependent variables, and total/thoracic SM, VAT, SAT, HGS, PA and physical performance as independent variables showed that (i) only HGS entered the regression for predicting FVCI (R²=0.351; standard error of estimation (SEE)=0.32 l), and (ii) HGS and PA explained 50% of FEVI (SEE=0.23 l). HGS mediated the relationship between SM and PF; the STS moderated the relationship between SM and FVCI.

CONCLUSIONS

In healthy elderly, PF is positively associated with SM; physical capabilities mediate and moderate these relationships.

Inspiratory muscle performance in endurance-trained elderly males during incremental exercise

The aim of this study was to compare the inspiratory muscle performance during an incremental exercise of twelve fit old endurance-trained athletes (OT) with that of fit young athletes (YT) and healthy age-matched controls (OC). The tension-time index (TT0.1) was determined according to the equation TT0.1=P0.1/PImax×ti/ttot, where P0.1 is the mouth occlusion pressure, PImax the maximal inspiratory pressure and ti/ttot the duty cycle. For a given VCO2, OT group displayed P0.1, P0.1/PImax ratio, TT0.1 and effective impedance of the respiratory muscle values which were lower than OC group and higher than YT group. At maximal exercise, P0.1/PImax ratio and TT0.1 was still lower in the OT group than OC group and higher than YT group. This study showed lower inspiratory muscle performance attested by a higher (TT0.1) during exercise in the OT group than YT group, but appeared to be less marked in elderly men having performed lifelong endurance training compared with sedentary elderly subjects.

Associations between muscle strength, spirometric pulmonary function and mobility in healthy older adults

Pathological obstruction in lungs leads to severe decreases in muscle strength and mobility in patients suffering from chronic obstructive pulmonary disease. The purpose of this study was to investigate the interdependency between muscle strength, spirometric pulmonary functions and mobility outcomes in healthy older men and women, where skeletal muscle and pulmonary function decline without interference of overt disease. A total of 135 69- to 81-year-old participants were recruited into the cross-sectional study, which was performed as a part of European study MyoAge. Full, partial and no mediation models were constructed to assess the interdependency between muscle strength (handgrip strength, knee extension torque, lower extremity muscle power), spirometric pulmonary function (FVC, FEV1 and FEF50) and mobility (6-min walk and Timed Up and Go tests). The models were adjusted for age, sex, total fat mass, body height and site of enrolment. Partial mediation models, indicating both direct and pulmonary function mediated associations between muscle strength and mobility, fitted best to the data. Greater handgrip strength was significantly associated with higher FVC, FEV1 and FEF50 (p < 0.05). Greater muscle power was significantly associated with better performance in mobility tests. Results suggest that decline in mobility with aging may be caused by decreases in both muscle strength and power but also mediated through decreases in spirometric pulmonary function. Future longitudinal studies are warranted to better understand how loss of function and mass of the respiratory muscles will affect pulmonary function among older people and how these changes are linked to mobility decline.

Self-reported physical activity and lung function two months after cardiac surgery--a prospective cohort study

BACKGROUND

Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

METHODS

Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

RESULTS

The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 ± 11% of preoperative value vs. 91 ± 9%; p = 0.03), inspiratory capacity (94 ± 14% vs. 88 ± 19%; p = 0.008), and total lung capacity (96 ± 11% vs. 90 ± 11%; p = 0.01).

CONCLUSIONS

An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

Relationship between ventilatory function and age in master athletes and a sedentary reference population

Ageing is accompanied with a decline in respiratory function. It is hypothesised that this may be attenuated by high physical activity levels. We performed spirometry in master athletes (71 women; 84 men; 35-86 years) and sedentary people (39 women; 45 men; 24-82 years), and calculated the predicted lung age (PLA). The negative associations of age with forced expiratory volume in 1 s (FEV1; 34 mL·year(-1)) and other ventilatory parameters were similar in controls and master athletes. FEV1pred was 9 % higher (P < 0.005) and PLA 15 % lower (P = 0.013) in athletes than controls. There were no significant differences between endurance and power athletes and sedentary people in maximal inspiratory and expiratory pressure. Neither age-graded performance nor weekly training hours were significantly related to lung age. Life-long exercise does not appear to attenuate the age-related decrease in ventilatory function. The better respiratory function in master athletes than age-matched sedentary people might be due to self-selection and attrition bias.

Secular trends in lung function and its relation to survival in Swedish 75 year olds 1976-2006

BACKGROUND

several studies have found that lung function correlates with survival in older people. We examined secular trends in lung function and its relation to survival in Swedish 75 year olds.

METHOD

representative samples from the general population in Gothenburg, Sweden, were examined at the age of 75 in 1976-77 (n = 743) and 2005-06 (n = 765) with comprehensive somatic and psychiatric examinations. Lung function was measured as peak expiratory flow (PEF).

RESULTS

the mean PEF was higher in 75 year olds examined 2005-06 compared with those examined 1976-77 both among women (339 versus 307 l/min; P < 0.001) and men (490 versus 400 l/min, P < 0.001). The birth cohort effect was still significant after adjusting for a number of confounders. PEF correlated with survival between age 75 and 78 years among those examined in 1976-77 both in women (OR per 10 l/min increase in PEF = 1.112, 95% CI: 1.047-1.182) and in men (OR = 1.040, 95% CI: 1.015-1.066), but not in those examined 2005-06 (women: OR = 1.071, 95% CI: 0.965-1.188; men: OR = 1.000, 95% CI: 0.957-1.046).

CONCLUSION

we found better lung function in the later-born cohort of 75 year olds, which was only partially explained by changes in smoking, height and weight, physical activity, socio-economic/educational factors and pulmonary/cardiovascular morbidity. The association between better lung function and short-term survival was strong in 1976-77, but had disappeared in 2005-06. More studies are needed to elucidate the role of lung function for long-term survival and identify other factors that explain the secular trends in lung function.

The effect of body composition on pulmonary function

Background

The pulmonary function test is the most basic test method to diagnosis lung disease. The purpose of this study was to research the correlation of the body mass index (BMI), the fat percentage of the body mass (fat%), the muscle mass, the fat-free mass (FFM) and the fat-free mass index (FFMI), waist-hip ratio (WHR), on the forced expiratory volume curve.

Methods

Between March and April 2009, a total of 291 subjects were enrolled. There were 152 men and 139 female (mean age, 46.3±9.92 years), and they were measured for the following: forced vital capacity (FVC), forced expiratory volume at 1 second (FEV₁), and forced expiratory flow during the middle half of the FVC (FEF_25-75) from the forced expiratory volume curve by the spirometry, and the body composition by the bioelectrical impedance method. Correlation and a multiple linear regression, between the body composition and pulmonary function, were used.

Results

BMI and fat% had no correlation with FVC, FEV₁ in male, but FFMI showed a positive correlation. In contrast, BMI and fat% had correlation with FVC, FEV₁ in female, but FFMI showed no correlation. Both male and female, FVC and FEV₁ had a negative correlation with WHR (male, FVC r=-0.327, FEV₁ r=-0.36; p<0.05; female, FVC r=-0.175, FEV₁ r=-0.213; p<0.05). In a multiple linear regression of considering the body composition of the total group, FVC explained FFM, BMI, and FFMI in order (r²=0.579, 0.657, 0.663). FEV₁ was explained only fat% (r²=0.011), and FEF_25-75 was explained muscle mass, FFMI, FFM (r²=0.126, 0.138, 0.148).

Conclusion

The BMI, fat%, muscle mass, FFM, FFMI, WHR have significant association with pulmonary function but r² (adjusted coefficient of determination) were not high enough for explaining lung function.

Susceptibility of the aging lung to environmental injury

With an ever-increasing number of elderly individuals in the world, a better understanding of the issues associated with aging and the environment is needed. The respiratory system is one of the primary interfaces between the body and the external environment. An expanding number of studies suggest that the aging pulmonary system (>65 years) is at increased risk for adverse health effects from environmental insult, such as by air pollutants, infection, and climate change. However, the mechanism(s) for increased susceptibility in this subpopulation are not well understood. In this review, we provide a limited but comprehensive overview of how the lung ages, examples of environmental exposures associated with injury to the aging lung, and potential mechanisms underlying the increased vulnerability of the aging lung to injury from environmental factors.

Relationship of body composition and C-reactive protein with pulmonary function

OBJECTIVES

It has been observed that restrictive pulmonary function is associated with obesity and C-reactive protein (CRP), an indicator for systemic inflammation. However, the interrelationship among body composition, CRP, and restrictive pulmonary function has been poorly understood. This study focused on the combined effects of body composition and CRP on restrictive pulmonary function.

METHODS

We performed a cross-sectional study to examine the association of body composition and CRP with restrictive pulmonary function in 12,787 subjects (7083 men, 5704 women; ages 20-75 yr). We evaluated body composition and CRP as a categorical variable (non-obesity, percentage body fat 75 percentile; low-inflammation, CRP 75 percentile) and constructed 4 groups, which were non-overlapping (reference, inflammatory, obese, obese and inflammatory). The odds ratios (ORs) and 95% confidence intervals (CIs) for restrictive pulmonary function were calculated across all 4 groups.

RESULTS

The adjusted ORs (95% CIs) for restrictive pulmonary function according to the 4 groups were 1.00(reference), 1.19(0.93-1.52), 2.01(1.53-2.64) and 3.51(2.60-4.74) in men and 1.00 (reference), 1.26 (0.96-1.69), 1.02 (0.58-1.81), and 3.32 (2.09-5.27) in women after adjusting for confounding variables. Interaction was found between the body fat percentage and CRP in women only (P < 0.05).

CONCLUSIONS

In summary, the coexistence of high fat accumulation and systemic subclinical inflammation is associated with restrictive pulmonary function.

Relationship between body composition and lung function in elderly men and women

INTRODUCTION

The purpose of this study was to evaluate the relationship between body composition parameters and lung functions including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), FEV(1):VC ratio, and FEV(1):FVC ratio in elderly men and women.

METHODS

The study was a cross-sectional evaluation of 99 healthy men and women (aged 60-88 years). Anthropometric and body composition parameters (including fat mass [FM], fat-free mass [FFM] and percentage body fat [%BF]) were evaluated using the skinfold method, and lung function was examined using spirometry.

RESULTS

Data analysis showed %BF, body FM and body mass index (BMI) of women to be significantly higher than men. Also, their body FFM was significantly less than men (P<0.05). Lung volume (P<0.01) and lung capacity values (P<0.05) (VC, FVC, FEV(1), FEV(1):VC, FEV(1):FVC) of women were significantly less than men. There was a positive significant relationship between the FFM versus FVC and FEV(1) values of women and men. A negative significant relationship was demonstrated between body FM, BMI and FVC of all subjects.

CONCLUSION

This investigation showed that women aged between 60 and 88 years had a lower lung capacity compared to men of the same age. Older women were found to have a higher body fat ratio than men, and it was found that increasing %BF and BMI had a negative effect on lung functions in both sexes.

Longitudinal changes in physical functional performance among the oldest old: insight from a study of Swedish twins

AIMS AND METHODS

The primary purpose was to characterize mean and individual-level patterns of change in physical functional performance over eight years (2 year intervals) in a community dwelling sample of Swedish twins (579 men and women aged 79-96 years at baseline).

RESULTS

Mixed linear models revealed linear rates of decline for handgrip strength (grip) and time to complete five chair stands, and accelerating decline for peak expiratory flow rate (PEFR) for both sexes. Significant random effects were found for intercept and time for grip and PEFR tests, indicating differences between participants initially and over time. Individual differences in chair-stand performance were significant for initial status only. Age at baseline was predictive of initial status in grip, PEFR and chair performance (women only), but not rate of change. Measures of body size at baseline were predictive of individual variation in initial grip (height), PEFR (weight in men, height in women), and chair performance (height), but had less consistent associations with changes in test performance over time. In the deceased sub-sample (85% of participants), having been further from death was related to less steep declines in grip, but not PEFR or chair performance. Twins from the same pair were related in initial status (twin level variance ~30-70%), but they were not generally related in rate of change.

CONCLUSIONS

These results indicate that changes in physical functional performance in an elderly, community-dwelling population vary across individuals in a testand sex-dependent manner. Constitutional variables (age, sex, body size) are predictive of baseline performance, but explain little variance in change over time. Initial status and rate of change in grip strength had the strongest association with proximity from death, indicating that while PEFR and repeated chair stand time are useful tests to assess function, grip strength appears to be a particularly useful biomarker in the oldest-old.

Aging, sex differences, and oxidative stress in human respiratory and limb muscles

Oxidative stress is involved in the sarcopenia of aging muscles. On the grounds that ventilatory muscles are permanently active, and their activity may even increase with aging, we hypothesized that the levels of oxidative stress would probably be increased in the external intercostals of elderly healthy individuals. We conducted a case-control study in which reactive carbonyl groups, malondialdehyde-protein adducts, 3-nitrotyrosine immunoreactivity, Mn-superoxide dismutase (Mn-SOD), and catalase were detected using immunoblotting in external intercostals and quadriceps (open muscle biopsies) obtained from 12 healthy elderly and 12 young individuals of both sexes. In elderly subjects, reactive carbonyls, malondialdehyde-protein adducts, 3-nitrotyrosine, Mn-SOD, and catalase were significantly greater in the external intercostals than in the young controls. A post hoc analysis, in which men and women from both groups were analyzed separately, revealed that the external intercostals of elderly women, but not those of elderly men, showed significantly increased levels of reactive carbonyls, malondialdehyde-protein adducts, 3-nitrotyrosine, and Mn-SOD compared to those of control females. This study suggests that differences in muscle activity might explain the differential pattern of oxidative stress observed in human respiratory and limb muscles with aging as well as the likely existence of a sex-related regulation of this phenomenon in these muscles.

Body fat distribution, body composition, and respiratory function in elderly men

BACKGROUND

Most population studies have reported weak or nonsignificant associations between body mass index (BMI; in kg/m2) and lung function.

OBJECTIVE

This study focused on the distinct effects of fat distribution and body composition on lung function and examined these relations in elderly men.

DESIGN

The study was a cross-sectional evaluation of 2744 men aged 60-79 y who were free of cardiovascular disease and cancer and were drawn from general practices in 24 British towns. Anthropometric and body-composition [including fat mass (FM), fat-free mass (FFM), and percentage body fat (%BF) evaluated with bioelectric impedance] measurements were made, and lung function was examined by using spirometry.

RESULTS

Height-standardized forced expiratory volume in 1 s (FEV1) was diminished only in lean (BMI < 22.5) and obese (BMI > or = 30) men, but forced vital capacity (FVC) tended to decrease with increasing BMI (P < 0.01). All other measures of adiposity [ie, waist circumference (WC), waist-hip ratio (WHR), FM, and %BF] were significantly and inversely related to FEV1 and FVC after adjustment for confounders, including age and cigarette smoking (all: P < 0.05). This was seen both in nonobese (BMI < 30) and obese men. FFM was positively associated with FEV1 (P = 0.03) and to a lesser extent with FVC. Higher BMI and FFM were both associated with reduced odds of a low FEV1-FVC ratio (ie, <70%).

CONCLUSION

Total body fat and central adiposity are inversely associated with lung function, but increased FFM reflecting increases in muscle mass is associated with increased lung function and lower odds of low FEV1:FVC in the elderly.