Customary physical activity and physical health outcomes in later life

Behavioral Lifestyles and Survival: A Meta-Analysis

The aim of the study is to determine the association between Behavioral Lifestyles (regular physical activity, healthy diet, sleeping, and weight control) and longevity in the elderly. A search strategy was conducted in the PsycInfo, Medline, PubMed, Web of Science (WoS), and Scopus databases. The primary outcome was mortality/survival. Four variables (mean of participant's age at the baseline of the study, follow-up years of the study, gender, and year of publication) were analyzed to evaluate the role of potential moderators. Ninety-three articles, totaling more than 2,800,000 people, were included in the meta-analysis. We found that the lifestyles analyzed predict greater survival. Specifically, doing regular physical activity, engaging in leisure activities, sleeping 7-8 h a day, and staying outside the BMI ranges considered as underweight or obesity are habits that each separately has a greater probability associated with survival after a period of several years.

Daily moderate-intensity physical activities and optimism promote healthy ageing in rural northern Sweden: a cross-sectional study

The aim of our study was to explore the association between self-reported health factors and self-rated health (SRH) among an older rural population in northern Sweden and whether confounders optimistic outlook or daily moderate-intensity physical activity could moderate the association between self-reported health factors and SRH, controlling for age. The study is based on a sample (N = 1946) from the “Health on Equal Terms” Västernorrland survey 2018 aged 65–84. Prevalence and multivariate logistic regression analyses were performed. The results indicated most rural older people perceived very good or good SRH, though physical and mental health issues and impaired mobility increased with advanced age. Mental well-being exhibited a stronger association with poor SRH than physical health or impaired mobility. In addition, confounders optimistic outlook and daily moderate-intensity physical activity, separately and together could moderate the association between health factors and poor SRH. In conclusion, older people in a rural setting perceived good health, despite common physical and mental health issues. Promoting daily moderate-intensity physical activity and activities contributing to an optimistic outlook can protect against poor SRH in old age.

Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults

INTRODUCTION

Engaging in >150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity weekly is recommended for optimal health. The relationship between walking, the most common activity especially for older adults, and total mortality is not well documented.

METHODS

Data from a large U.S. prospective cohort study including 62,178 men (mean age 70.7 years) and 77,077 women (mean age 68.9 years), among whom 24,688 men and 18,933 women died during 13 years of follow-up (1999-2012), were used to compute multivariable-adjusted hazard rate ratios and 95% CIs for walking as the sole form of activity or adjusted for other moderate- or vigorous-intensity physical activity in relation to total and cause-specific mortality (data analysis 2015-2016).

RESULTS

Inactivity compared with walking only at less than recommended levels was associated with higher all-cause mortality (hazard rate ratio=1.26, 95% CI=1.21, 1.31). Meeting one to two times the recommendations through walking only was associated with lower all-cause mortality (hazard rate ratio=0.80, 95% CI=0.78, 0.83). Associations with walking adjusted for other moderate- or vigorous-intensity physical activity were similar to walking only. Walking was most strongly associated with respiratory disease mortality followed by cardiovascular disease mortality and then cancer mortality.

CONCLUSIONS

In older adults, walking below minimum recommended levels is associated with lower all-cause mortality compared with inactivity. Walking at or above physical activity recommendations is associated with even greater decreased risk. Walking is simple, free, and does not require any training, and thus is an ideal activity for most Americans, especially as they age.

Racial Differences in Eating Patterns and Food Purchasing Behaviors among Urban Older Women

OBJECTIVE

To examine differences in diet and food purchasing behaviors between Black and White older women living in urban neighborhoods.

DESIGN

Cross-sectional observational study.

SETTING

Urban neighborhoods in Washington, DC, USA.

PARTICIPANTS

Community-dwelling White and Black women of age 65 and older.

MEASUREMENTS

Participants were queried on diet via 24-hour recalls, food purchasing habits, their use of neighborhood resources and local travel patterns. Frequency and location of self-reported food purchasing and consumption were compared by race.

RESULTS

In 2014 and 2015, 49 White and 44 Black older women were enrolled in the study. Compared to Whites, Blacks reported lower daily caloric intake (mean (SD) 1314 (404) vs. 1529 (448), p=0.02), with a higher percent of calories from protein and fat 1.8 (7.0), p=0.03), and a slightly higher polyunsaturated to saturated fat ratio (p=0.05). Blacks had substantially lower alternate healthy eating index (AHEI) (33.5 (10.2) vs. 43.9 (10.8) of 80 possible points, p<0.001), daily intake (grams) of total fiber (15.3 (8.1) vs. 22.9 (8.5), p<0.001), insoluble fiber (10.8 (6.9) vs. 15.9 (6.5), p<0.001), and soluble fiber (4.5 (2.0) vs. 6.9 (2.8), p<0.001). Blacks had lower intake of micronutrients, alcohol and caffeine. Blacks shopped for groceries less often (4.4 (3.0) vs. 6.2 (3.0) monthly; p=0.006) and spent a longer time traveling to stores (15.8 (9.1) vs. 11.5 (7.2) minutes per trip, p=0.02). A lower percent of Blacks walked to stores (14% vs. 40%, p=0.003) and a higher percent of Blacks rode in a car with someone else (33% vs. 6%, p<0.001).

CONCLUSIONS

In an urban setting, food consumption and purchasing behaviors differed substantially between older Black and White women, which should be further investigated and considered to promote healthy eating in older populations.

Is leisure beneficial for older Korean immigrants? An interpretative phenomenological analysis

Leisure is an important quality of life factor for older Korean immigrants. The purpose of this study was to explore leisure benefits associated with health among older Korean immigrants. A total of 18 individuals participated in the study. Using interpretative phenomenological analysis (IPA), three themes emerged from participants' personal statements and experiences: (a) experiencing psychological benefits, (b) strengthening social connections, and (c) coping with acculturative stress. The findings indicate that leisure provided a context in which older Korean immigrants created an emotional and social support system that helped them to experience psychological and social benefits. This research suggested that older Korean immigrants used leisure as a coping mechanism that results in health and well-being.

Body Mass, Smoking, and Overall and Cause-Specific Mortality Among Older U.S. Adults

The authors examine the relationships between body mass, smoking, and overall and cause-specific mortality among U.S. adults aged 60 and older, using data from the National Health Interview Survey linked to the Multiple Cause of Death file and Cox proportional hazard models. The authors find that, compared to those who are normal weight, obese individuals have higher risks of overall, circulatory disease, and diabetes mortality. Furthermore, smoking status suppresses the relationships between obesity and overall, circulatory disease, and cancer mortality, and interacts with lowbody weight to increase mortality risks. Finally, underweight individuals initially face increased risks of death over the follow-up period, although over time their mortality risks diminish to those of normal-weight individuals, likely due to the presence of unobserved illness. Researchers and health practitioners must account for smoking status, body mass, and specific causes of death to understand and improve the health of our increasingly obese elderly population.

A comparison of subjective and objective measures of physical activity from the Newcastle 85+ study

Background: Little is known about physical activity (PA) in the very old, the fastest growing age group in the population. We aimed to examine the convergent validity of subjective and objective measures of PA in adults aged over 85 years.

Methods: A total of 484 participants aged 87–89 years recruited to the Newcastle 85+ study completed a purpose-designed physical activity questionnaire (PAQ), which categorised participants as mildly active, moderately active and very active. Out of them, 337 participants wore a triaxial, raw accelerometer on the right wrist over a 5–7-day period to obtain objective measures of rest/activity, PA intensity and PA type. Data from subjective and objective measurement methods were compared.

Results: Self-reported PA was significantly associated with objective measures of the daily sedentary time, low-intensity PA and activity type classified as sedentary, activities of daily living and walking. Objective measures of PA were significantly different when low, moderate and high self-reported PA categories were compared (all P < 0.001).

Conclusion: The Newcastle 85+ PAQ demonstrated convergent validity with objective measures of PA. Our findings suggest that this PAQ can be used in the very old to rank individuals according to their level of total PA.

Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship

BACKGROUND AND OBJECTIVE

Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA).

DATA SOURCES

We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible.

STUDY APPRAISAL AND SYNTHESIS METHODS

Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling.

RESULTS

Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose-response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval.

CONCLUSIONS AND IMPLICATIONS

The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities.

REVIEW REGISTRATION

The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266.

Depressive symptoms, social support, and walking among Hispanic older adults

OBJECTIVE

Depressive symptoms and physical inactivity are health risks among minority older adults. This study examined whether social support moderated the relationship of depressive symptoms to walking behavior among 217 community-dwelling, Hispanic older adults.

METHOD

Cross-sectional analyses were used to test whether different forms of social support interacted with depressive symptoms to affect both likelihood and amount of walking.

RESULTS

Analyses showed a significant interaction between depressive symptoms and instrumental support related to the likelihood of walking and a marginally significant interaction between depressive symptoms and instrumental social support related to the amount of walking. Depressive symptoms were associated with a lower likelihood and lower amount of walking among participants receiving high levels of instrumental social support (e.g., help with chores) but not low instrumental support. Emotional and informational support did not moderate the depression to walking relationship.

CONCLUSION

Receiving too much instrumental support was related to sedentary behavior among depressed older adults.

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.

Modernising social care services for older people: scoping the United Kingdom evidence base

In common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.

Physical activity assessment and health outcomes in old age: how valid are dose–response relationships in epidemiologic studies?

In this systematic review the validity of the dose–response relationships between physical activity (PA) and energy expenditure (EE) on defined health outcomes (cardio- and cerebrovascular morbidity and mortality, cancer) for the elderly is questioned. Medline, Cochrane, and EMBASE databases were reviewed for epidemiological longitudinal studies in populations aged 60+ for the years 1985–2007. Although most of the 18 identified studies generally demonstrated an inverse dose–response relationship between PA and EE level with morbidity and mortality, the range of dose–responses was remarkably broad. The nature of the dose–response relationship remained unclear. PA questionnaires - even those constructed for the elderly - do not cover the extremely diverse aspects of age-specific PA behavior and modes of muscular activity. Only non-age-specific tables had been used to estimate the EE in the elderly. Direct measurements of EE were limited. The results have implications for the interpretation of the dose–response relationships between PA and EE on defined health outcomes in old age.

Identification of Risk Factors for 15-Year Mortality Among Community-Dwelling Older People Using Cox Regression and a Genetic Algorithm

BACKGROUND

Previous research has identified various risk factors for mortality in older people, but has considered a limited number of the variables available for analysis. The aim of this study was to use a genetic algorithm combined with Cox regression (CoRGA) to examine all the variables to identify risk factors for 15-year mortality.

METHODS

Data were obtained from a nationally representative sample of 1,042 community-dwelling people aged 65+. Data on cognitive impairment, physical health, physical activity, psychological well-being, social engagement, and physical capability resulted in 460 independent variables for analysis. Outcome was time from 1985 interview to death or censorship on February 29, 2000. CoRGA was used to selected combinations of 1, 2, 4, 8, 12, and 16 variables as potential risk factors for 15-year mortality.

RESULTS

CoRGA selected age in all six models; variables relating to handgrip strength were selected in five models; variables relating to reported chest pain were selected in four models; and pain in joints causing difficulty in carrying bags and self-rated activity compared to peers were both selected in three models. Other variables selected by CoRGA included time since last visited the dentist and optician, use of hypnotic drugs, and number of prescribed drugs being taken.

CONCLUSIONS

CoRGA confirmed current risk factors for long-term mortality among older people and identified new risk factors. Age was confirmed as the most important predictor of mortality in older people. Handgrip strength is an important marker of frailty in predicting mortality. Self-rated activity is an important predictor of long-term mortality.

A gender-based dynamic multidimensional longitudinal analysis of resilience and mortality in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS)

The objective was to examine gender differences and similarities in health, function, familial and non-familial social networks; longitudinal resilience in those factors; and their association with risk of mortality in Israeli men and women aged 75-94. We used the Cross-Sectional and Longitudinal Aging Study (CALAS), a stratified random sample of 960 Israeli Jews aged 75-94, drawn on January 1, 1989 from National Population Registry, stratified by gender, age (75-79, 80-84, 85-89, 90-94), and place of birth (Europe/America, Middle East/North Africa, Israel), interviewed twice (Wave 1, 1989-1992; Wave 2, 1993-1995); Wave 1 values and longitudinal resilience predicted the 1999 mortality risk for those alive at both waves. Gender differences and similarities were found at Wave 1 in longitudinal resilience and in risk factors for mortality, partially supporting a gender paradox. Men were more physically active, had better cognition, gave more help to children, relied less on paid caretakers, and attended synagogue more than women, factors associated with better health and functioning. Women had poorer health and functional status and more help from children. More physical activity, synagogue attendance, and resilience in activities of daily living (ADL) were associated with lower risk of mortality for both genders. Women's risk of mortality was reduced by smoking reduction and higher cognitive vitality, and men's by emotional support and solitary leisure activity. Both men and women were resilient, yet there were differences. Gender-neutral mortality reduction programs would include physical activity, religious services, maintenance and improvement of ADL, and engaging in solitary leisure activities; for women, smoking cessation and cognitively challenging activities; and for men, maintaining or increasing emotional ties.

Factors associated with physical activity among older people--a population-based study

BACKGROUND

Regular physical activity improves survival and functional ability, and can improve quality of life. Few studies have examined factors associated with physical activity in older adults at a population level. This study examines factors associated with physical activity in the New South Wales (NSW) older population.

METHODS

Data from a random survey of 8881 community-dwelling people aged 65+ years were examined. We used Cox's regression to analyze the influence of demographic, health, and social factors on physical activity. 'Adequate' physical activity was defined as at least 30 min of walking, moderate or vigorous activity on at least 5 days in the last week. Reported barriers to physical activity were also examined.

RESULTS

Adequate physical activity was independently associated with sex (male), younger age, ability to travel independently, better physical functioning, lower psychological distress, rural residence, not having diabetes, adequate fruit and vegetable intake, and speaking a language other than English at home. No independent associations were found for good long distance eyesight, being a caregiver, living alone, age left school, employment status, fear of falling, or perception of neighborhood safety. Health problems were frequently reported barriers to physical activity.

CONCLUSIONS

About half of older adults report adequate physical activity. These results will inform strategies to promote physical activity among older people.

Benefits of exercise for community-dwelling older adults

This focused review highlights the benefits of exercise and physical activity for community-dwelling older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the benefits of physical activity and exercise for older adults with regard to morbidity, mortality, and disability. It discusses the appropriate preexercise screening and evaluation procedures for older adults contemplating exercise. Last, it reviews the current literature on the benefits of varying modes of exercise to modify the most prevalent chronic medical conditions of late life, including arthritis, heart disease, diabetes, stroke, pulmonary disease, and osteoporosis.

OVERALL ARTICLE OBJECTIVE

To summarize the current knowledge regarding the therapeutic benefits of exercise for community-dwelling older adults.

Physical activity decreases cardiovascular disease risk in women: review and meta-analysis

OBJECTIVE

To review and quantify the dose-response relationship of physical activity (PA) in initially healthy women on cardiovascular disease (CVD) outcomes, especially coronary heart disease (CHD) and stroke, and to assess the minimum amount of PA to reduce CVD risk.

DATA SOURCES

Studies on PA and CVD were searched in MEDLINE (January 1966-March 2003) with additional manual searches.

DATA SELECTION

Studies were included if they (1) provided data on women; (2) assessed PA (exposure) as either a continuous variable or a categorical variable with three or more levels, and CVD (outcome); and (3) provided information on relative risks (RRs) and 95% confidence intervals.

DATA EXTRACTION

Studies were reviewed, abstracted, and rated for quality by each author.

DATA SYNTHESIS

Thirty articles met the inclusion criteria. When studies were combined according to relative PA levels, the RRs showed a dose-response relationship for CHD (RR=1 [reference], 0.78, 0.53, 0.61, respectively; p for trend was <0.0001 for studies with four PA levels, n =5); for stroke (RR=1 [reference], 0.73, 0.68, p for trend was <0.0001 for studies with three PA levels, n =7); and for overall CVD (RR=1 [reference], 0.82, 0.78, p for trend was <0.0001 for studies with three PA levels, n =6). When studies were combined by absolute walking amount, even 1 hour/week walk was associated with reduced risk of CVD outcome.

CONCLUSIONS

Physical activity was associated with reduced risk of CVD among women in a dose-response fashion. Inactive women would benefit by even slightly increasing their PA (e.g., walking 1 hour per week or possibly less) and even more from additional PA.

Comparing health status with healthy habits in elderly assisted-living residents

There is a growing number of older adults in America. Assisted-living facilities have become a more prevalent residence for this increasing population. In the study described in this article, a secondary data analysis was completed using residents of several LifeTrust America, Inc.,'s assisted-living facilities across the Southeastern United States. There were 1,079 residents who completed the Healthy Generation Survey. Residents were asked whether they currently, previously, or had never had certain health conditions. They also responded to various questions about their current participation in healthy habits, such as using cigarette or tobacco products, moderate alcohol consumption, eating breakfast, eating healthy snacks, getting 7-8 hours of sleep each night, drinking the daily recommended amount of water, and participating in regular physical exercise. The research question asked if there was a relationship between current healthy habits and physical health. The study found that individuals with more current physical health conditions also reported greater participation in healthy habits. This could lead to the conclusion that after individuals acquired certain physical health conditions, they began to participate in more healthy habits. Also of significance was the finding that participation in physical exercise and recreational activity related to greater participation in all other healthy habits.

Physical inactivity, excess adiposity and premature mortality

The purpose of this report is to review the evidence that physical inactivity and excess adiposity are related to an increased risk of all-cause mortality, and to better identify the independent contributions of each to all-cause mortality rates. A variance-based method of meta-analysis was used to summarize the relationships from available studies. The summary relative risk of all-cause mortality for physical activity from the 55 analyses (31 studies) that included an index of adiposity as a covariate was 0.80 [95% confidence interval (CI) 0.78-0.821, whereas it was 0.82 [95% CI 0.80-0.84] for the 44 analyses (26 studies) that did not include an index of adiposity. Thus, physically active individuals have a lower risk of mortality by comparison to physically inactive peers, independent of level of adiposity. The summary relative risk of all-cause mortality for an elevated body mass index (BMI) from the 25 analyses (13 studies) that included physical activity as a covariate was 1.23 [95% CI 1.18-1.29], and it was 1.24 [95% CI 1.21-1.28] for the 81 analyses (36 studies) that did not include physical activity as a covariate. Studies that used a measure of adiposity other than the BMI show similar relationships with mortality, and stratified analyses indicate that both physical inactivity and adiposity are important determinants of mortality risk.

Daytime activity and risk factors for late-life insomnia

Laboratory evidence linking exercise with improved sleep quality raises the possibility that the lower levels of physical activity characteristic of older age groups may contribute to late-life insomnia. While support for this hypothesis appears to come from epidemiological surveys, few such studies have distinguished satisfactorily between social and physical activities which differ widely in terms of energy cost and theoretical significance. The present analyses were, therefore, designed to assess the independent influence of physical and social activity levels on the prevalence and natural history of late-life insomnia. Survivors from a nationally representative UK sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). Detailed assessments of physical and social activities, mental and physical health status, and sleep quality were made at each survey wave. Logistic regression models, adjusted for age, sex and health status, were used to assess relationships between activity levels and the prevalence, remission/persistence, and incidence of late-life insomnia. Lower physical health, depressed mood and lower physical (but not social) activity levels consistently emerged as significant risk factors for prevalent, persistent and incident insomnia. Age was unrelated to insomnia variables in all the cross-sectional models, but did emerge as a significant risk for cumulative 4-8-year insomnia incidence. These findings suggest that, independent of those activities more closely associated with social engagement, higher levels of customary physical activity per se appear to be protective against incident and chronic late-life insomnia.

Differences between older men and women in the self-rated health-mortality relationship

PURPOSE

The aims of this study were to examine differences between older men and women: (a) in the ability of self-rated health to predict mortality, (b) in the effect of different follow-up periods on the self-rated health mortality relationship, and (c) in the relative importance of self-rated health and self-rated change in health in predicting mortality.

DESIGN AND METHODS

By using data from the Nottingham Longitudinal Study of Activity and Ageing, the author assessed relationships between self-rated health and self-rated change in health and 4- and 12-year mortality in separate unadjusted and adjusted Cox proportional hazards regression models in men and women.

RESULTS

The differences between men and women in the hazard ratios for poor self-rated health were not significant, although there were differences in the explanatory factors. The relationship between self-rated health and short-term and long-term mortality was explained by age and health among men. The relationship between self-rated health and short-term mortality was explained by age, physical and mental health, and physical activity among women. The relationship between self-rated health and long-term mortality was explained by age, physical health, and physical activity among women. The relationship between self-rated change in health and short-term mortality was explained by age among men and women. The relationship between self-rated change in health and long-term mortality was explained by age and physical health among men and women. Social engagement was an independent predictor of short- and long-term mortality among men and women in this study.

IMPLICATIONS

The finding that low self-rated health was not an independent predictor of mortality among men or women, contrary to many, but not all, previous studies, may be related to differences in study design and/or across cultures. Further research investigating relationships between self-rated health and mortality and potential explanatory variables should analyze men and women separately and should consider the length of follow-up period. The benefits of individual physical and social activities in reducing mortality merit further investigation.

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study

OBJECTIVES

To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later.

DESIGN

Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation.

SETTING

Home-based interviews and examinations in Jerusalem.

PARTICIPANTS

Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase.

MEASUREMENTS

Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise.

RESULTS

Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1).

CONCLUSIONS

Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.

Physical activity and all cause mortality in women: a review of the evidence

A computer assisted literature search was performed (Medline, 1966-2000) to examine the association of physical activity with all cause mortality in women. It was concluded that, by adhering to current guidelines for physical activity and expending about 4200 kJ of energy a week, women can postpone mortality. The magnitude of benefit experienced by women is similar to that seen in men.

Long-term impact of preventive proactivity on quality of life of the old-old

OBJECTIVE

This research explored the long-term benefits of engaging in proactive health promotion efforts among old-old residents of Sunbelt retirement communities to empirically test components of the Preventive and Corrective Proactivity (PCP) Model of Successful Aging. Specifically, we examined the contributions of exercise, tobacco use, moderate alcohol use, and annual medical checkups to multidimensional quality of life indicators of physical health, psychological well-being, and mortality.

METHOD

Data were obtained from a longitudinal study of adaptation to aging. Annual in-home interviews were conducted with 1000 older adults over a 9-year period. Whether health promotion behaviors at baseline predicted quality of life outcomes 8 years later was examined, controlling for the baseline outcome, sociodemographic variables, and, as an additional test, baseline health conditions.

RESULTS

Exercise was predictive of fewer IADL limitations and greater longevity, positive affect, and meaning in life 8 years later. Avoiding tobacco was predictive of longevity. Before controlling for health conditions, exercise predicted decreased risk of basic activities of daily living limitations and having more goals; moderate alcohol use predicted longevity; annual health checkup predicted more IADL limitations; and having once smoked predicted having more IADL limitations and negative affect.

CONCLUSIONS

Among the old-old, exercise had long-term and multifaceted benefits over an 8-year period. Tobacco avoidance also contributed to long-term positive outcomes. These results lend support to the long-term preventive value of health-promoting proactivity spontaneously engaged in by old-old persons proposed in the framework of the PCP model.

Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results

PURPOSE OF THE PAPER: The purpose of this article is to review the literature on physical activity and its relationship to cardiovascular risk factors and mortality in older adults, in an effort to clarify the specific benefits and optimal level of physical activity for cardiovascular health in the older adult population.

BACKGROUND/RATIONALE

Despite physical activity being recognized as an important factor in the quality of life of older adults, there is a lack of clarity about the optimal level of physical activity that results in positive cardiovascular health benefits.

DESIGN/METHODS

An integrative review of the literature using the MEDLINE and CINAHL databases from 1990 through August 2000 was conducted identifying articles related to physical activity and cardiac risk factors, cardiovascular health, or mortality in the older adult.

RESULTS/FINDINGS

Forty-four research articles were reviewed. The intervention studies generally provided support for positive cardiovascular changes with exercise, but the results were inconsistent, sample sizes were small, and the outcomes, interventions, and measures of physical activity differed between studies. There was wide variation in the method of measurement of physical activity in the studies. Studies showed an increase in mortality in those who had a sedentary lifestyle compared to those who were more physically active. Results were mixed related to plasma lipids levels. Three studies showed a positive effect of physical activity on blood pressure (BP), while three studies showed no relationship. Each of the studies that evaluated the relationship between physical activity and pulse rate showed a decreased rate with increased physical activity.

CONCLUSIONS

The quantity and type of physical activity that should be recommended to bring about positive effects on cardiovascular health and mortality is unclear. There is support, however, that an active lifestyle decreases mortality. There is conflicting evidence to support positive effects of physical activity on cardiac risk factors. Further research is needed with larger sample sizes, better control of extraneous variables, and using measurements of physical activity that have undergone adequate psychometric testing.

On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events

BACKGROUND

Little research has been done on the uniqueness of risk profiles for depression and anxiety in late life.

AIMS

Delineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design.

METHOD

Self-report data on depression and anxiety were collected from community-dwelling older respondents (> or = 55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n=1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events.

RESULTS

After 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive.

CONCLUSIONS

Depression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.

Physical activity and nutrition in older adults

Physical activity and nutrient intake are important determinants of health throughout life. Many of the alterations in physiological structure and function that occur with age may result from disuse and disability as well as from diets deficient in energy, protein or other specific nutrients. Although a healthy diet can provide significant health benefits, diet alone, is not sufficient to provide optimal health, nor protect us from the hazards of sedentary habits. Nor is physical activity alone. The ideal combines sufficient exercise and a healthy diet.