Frequent and occasional physical activity in the elderly: A 12-year follow-up study of mortality

doi:10.1016/j.amepre.2004.03.011

American Journal of Preventive Medicine

Volume 27, Issue 1, July 2004, Pages 22-27

https://doi.org/10.1016/j.amepre.2004.03.011 Get rights and content

Abstract

Background

The positive health effects of physical activity are well known. However, there are few studies of the association between different levels of physical activity and all-cause mortality among elderly people.

Methods

A national random sample of 3206 women and men aged ≥65 were interviewed in 1988 and 1989 and followed until December 31, 2000, for all-cause mortality. Cox regression was used to analyze the association between five different levels of physical activity and all-cause mortality, after adjustment for gender, age, education, smoking habits, body mass index, diabetes, hypertension, and self-rated health. All analyses were conducted in 2003.

Results

For elderly people who were physically active occasionally, the risk of all-cause mortality was 28% lower than for those who were physically inactive (hazard ratio [HR]=0.72; confidence interval [CI]=0.64–0.81), after adjustment for all explanatory variables. For those who were physically active once a week, the risk of all-cause mortality was 40% lower than for those who were physically inactive (HR=0.60; CI=0.50–0.71). For those who were physically active more frequently, the reduction in all-cause mortality risk was about the same as for those who were physically active once a week. Diabetes, hypertension, and daily smoking were, as expected, significant risk factors for all-cause mortality.

Conclusions

Physical activity, even occasionally, decreases the risk of all-cause mortality among elderly people. Preventive resources among the elderly should include moderate exercise such as walking.

Introduction

Little is known about the relationship between different levels of physical activity and mortality among the elderly. Past studies of middle-aged women and men have demonstrated an association between physical activity and increased longevity.1, 2 Moreover, individual changes over time to a more sedentary lifestyle were associated with increased all-cause mortality.3 However, past research into physical activity and mortality among the elderly is sparse4, 5 and inconsistent. For example, some studies have even shown an inverse effect between no physical activity and all-cause mortality among the elderly.6, 7 An explanation for this inconsistency may be that some of the previous studies focusing on elderly people have not adjusted for self-rated health. Thus, these studies do not permit evaluation of physical inactivity that is not a result of disease processes. Moreover, the beneficial effect of vigorous versus moderate physical activity on longevity is controversial.8, 9

The purpose of this 12-year follow-up study was to analyze the association between five levels of physical activity and all-cause mortality for people aged ≥65 using a random sample representative of the entire Swedish population. The first aim of this study was to examine to what extent different levels of physical activity are associated with all-cause mortality in people aged ≥65. The second aim was to examine whether the hypothesized association between physical activity and all-cause mortality remains after adjustment for confounders such as age, educational status, smoking habits, body mass index (BMI), diabetes, hypertension, and self-rated health.

Section snippets

Methods

A simple, random sample from the Swedish Annual Level-of-Living Survey (SALLS), a national survey conducted by Statistics Sweden of the non-institutionalized population was used in this study. The sample consisted of 1792 women and 1414 men, aged ≥65, surveyed in 1988 and 1989. The sample represented 792,000 women and 616,000 men of the Swedish population aged ≥65. The participants were interviewed face-to-face by trained interviewers about their living conditions, including questions about

Results

There were 925 deaths among women and 881 deaths among men. Age-adjusted all-cause mortality rates by explanatory variables are shown in Table 1. For both men and women, the highest mortality rates were observed among those who reported low educational status, physical inactivity, current smoking, underweight, obesity, diabetes, hypertension, or poor self-rated health.

Table 2 shows age-adjusted HRs with 95% CIs for all-cause mortality by explanatory variables, separated by gender. Self-rated

Discussion

The main finding of this study is that leisure-time physical activity decreases all-cause mortality among men and women aged ≥65. Even occasional physical activity was associated with decreased mortality among the elderly. For those who were physically active about twice a week or vigorously at least twice a week the reduction in the risk of all-cause mortality was about the same as for those who were physically active once a week after adjustment for all the explanatory variables, including

Conclusions

These findings provide some evidence that all-cause mortality is reduced when elderly men and women are physically active. Even occasional physical activity seems to be of great value for longevity. Preventive resources among elderly should provide more opportunities for physical activity. For example, senior centers could offer retirees moderate exercise such as walking in groups or bicycling, and healthcare professionals should encourage elderly people to be physically active, even

Acknowledgements

This work was supported by grants from the National Institutes of Health (1 R01 HL71084-01), the Swedish Council for Working Life and Social Research (2001-2373), the Swedish Research Council (K2001-27X-11651-06C), the Knut and Alice Wallenberg Foundation, and the Stockholm County Council.

We are grateful to Sanna Sundquist, student at Foothill College, California, for technical assistance.

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Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses.
The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14–3.75) than for physical inactivity (OR 1.63, 95% CI 1.28–2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility.
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Research articleFrequent and occasional physical activity in the elderly: A 12-year follow-up study of mortality

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgements

Lancet

J Clin Epidemiol

J Chronic Dis

Am J Clin Nutr

Physical activity, all-cause mortality, and longevity of college alumni

N Engl J Med

Change in lifestyle factors and their influence on health status and all-cause mortality

Int J Epidemiol

Mortality among the elderly in the Alameda County Studybehavioral and demographic risk factors

Am J Public Health

Physical activity and coronary heart disease in middle-aged and elderly menthe Honolulu Heart Program

Am J Public Health

Risk factors for all-cause and coronary heart disease mortality in the oldest-old. The Adventist Health Study

Arch Intern Med

Physical activity and coronary heart disease risk in mendoes the duration of exercise episodes predict risk?

Circulation

Effects of walking on mortality among nonsmoking retired men

N Engl J Med

Physical activity and 23-year incidence of coronary heart disease morbidity and mortality among middle-aged men. The Honolulu Heart Program

Circulation

Survival analysis

Risk due to inactivity in physically capable older adults

Am J Public Health

Research article
Frequent and occasional physical activity in the elderly: A 12-year follow-up study of mortality