Elsevier

Preventive Medicine

Volume 72, March 2015, Pages 23-29
Preventive Medicine

The association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults

https://doi.org/10.1016/j.ypmed.2014.12.023Get rights and content

Highlights

  • Inverse dose–response relationship exists between physical activity and mortality.

  • The elderly older adults benefit from an active lifestyle in most subgroups.

  • The elderly older adults should be encouraged to be physically active at least 1–2 times/week

Abstract

Objective

To evaluate the association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults.

Methods

A study sample consisting of 77,541 community-dwelling Taipei citizens aged ≥ 65 years was selected based on data obtained from the government-sponsored Annual Geriatric Health Examination Program between 2006 and 2010. Subjects were asked how many times they had physical activity for ≥ 30 min during the past 6 months. Mortality was determined by matching cohort identifications with national death files.

Results

Compared to subjects with no physical activity, those who had 1–2 times of physical activity per week had a decreased risk of all-cause mortality [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.71–0.85). Subjects with 3–5 times of physical activity per week had a further decreased risk of all-cause mortality (HR: 0.64; 95% CI: 0.58–0.70). An inverse dose–response relationship was observed between physical activity and all-cause, cardiovascular, and cancer mortality. According to stratified analyses, physical activity was associated with a decreased risk of mortality in most subgroups.

Conclusions

Physical activity had an inverse association with all-cause, cardiovascular, and cancer mortality among older adults. Furthermore, most elderly people can benefit from an active lifestyle.

Introduction

The health benefits of physical activity, including increased longevity or postponed premature mortality, have been supported by evidences from many epidemiological studies (Bellavia et al., 2013, Moore et al., 2012, Nocon et al., 2008, Wannamethee and Shaper, 2001, Wannamethee et al., 2001). Low cardiorespiratory fitness, which is closely related to physical activity, was observed to be responsible for the highest proportion of deaths in a large longitudinal study across age groups (Stofan et al., 1998, Sui et al., 2007, Sui et al., 2013). Although the association between physical activity and mortality has been examined extensively in the past years, most of the evidence has been derived from studies involving a combination of middle-aged and elderly subjects (Arrieta and Russell, 2008, Autenrieth et al., 2011, Bellavia et al., 2013, Moore et al., 2012, Nocon et al., 2008, Oguma et al., 2002, Wen et al., 2011). Fewer studies have been conducted to focus on only the older population (Balboa-Castillo et al., 2011, Bembom et al., 2009, Knoops et al., 2004, Schooling et al., 2006, Sundquist et al., 2004, Ueshima et al., 2010). Although physical activity may result in favorable physiological changes in all age groups, the association of physical activity and mortality among the elderly remains inconsistent. Furthermore, the magnitude of benefit for postponing premature mortality is unknown. Possible adverse effects of physical activity have been reported (Maron, 2000). The benefit of exercise has been reported to be attenuated in those aged 75 years or older who are extremely active (Sherman et al., 1994). Given the aging populations worldwide, the survival of older adults would be a major concern to caregivers and can also pose a burden to public health.

Many studies have been conducted to evaluate the association of physical activity with all-cause mortality. However, the evidence regarding the association between physical activity and cardiovascular disease (CVD) and cancer mortalities remains limited. Autenrieth et al. revealed that physical activity has a protective effect on all-cause, CVD, and cancer mortalities among participants aged 25–74 years (Autenrieth et al., 2011). However, Ueshima et al. observed that physical activity among older adults had an inverse association with all-cause and CVD mortalities, but the association between physical activity and cancer mortality remains unclear (Ueshima et al., 2010). Further studies are needed to examine the possible effects of physical activity on cancer mortality among older adults.

Older population has a higher incidence of multiple chronic diseases, which consists of a heterogeneous group of risk factors for mortality. It might be appropriate to evaluate them by using subgroups of diverse clinical characteristics. Furthermore, the clinical characteristics of older adults with different physical activity levels remain an interesting topic to investigate.

In this study, we analyzed a large cohort of 77,541 elderly people who were enrolled in the Annular Geriatric Health Examinations Program using detailed information regarding demographic, lifestyle, body mass index (BMI), cognitive and mood status, blood pressure, and laboratory data. We followed-up on the participants' vital status for 5 years, which totals 254,211 person-years of observation. The objective of this study was to evaluate the association of physical activity with all-cause, CVD, and cancer mortality among older adults. Furthermore, the large sample size of 77,541 older adults allowed us to focus on older people and perform stratified analyses to investigate the associations among each clinical characteristic subgroup.

Section snippets

Study population

Data for this study were obtained from the Taipei Geriatric Health Examination Database. A cohort consisting of 77,541 participants aged ≥ 65 years, including 39,365 men and 38,176 women, was evaluated. The participants were enrolled in the annual physical examination program for older adults, which is managed by the Taipei City Government, between May 1, 2006 and December 31, 2010. Participants voluntarily took part in the physical examination program and were encouraged to participate in the

Results

The baseline characteristics of all participants are shown in Table 1. There were 77,541 participants with a mean age of 73.1 (SD = 6.6) years. The 5-year study period consisted of 254,211 person-years of observation with an average follow-up of 3.28 (SD = 1.30) years. Participants with more physical activity were likely to have the following characteristics: younger, male, married/cohabiting, higher educational level, non-smoker, drinker, normal weight, no cognitive impairment, and no depression.

Discussion

In this study, we were able to observe that the risk for all-cause, CVD, and cancer mortality among older adults decreased substantially with physical activity, as indicated by a distinct dose–response relationship and across the majority of subgroups. Healthy adults have been recommended to engage in physical activity to improve and maintain health treatment; according to one study, this recommendation may apply to older adults as well (Haskell et al., 2007). Moreover, an inverse association

Conclusion

Physical activity was observed to have an inverse association with all-cause, CVD, and cancer mortality among older adults. Furthermore, older adults can benefit from an active lifestyle; including a minimal amount of physical activity to one's daily routine (i.e., 30 min once or twice per week) may increase longevity. Preventive resources for older adults should include more opportunities for physical activity. Healthcare professionals should also encourage older adults to be physically active

Conflict of interest

The authors declare that there are no conflicts of interests.

Sponsor's role

This study was supported by the Taiwan Ministry of Education through its “Aim for the Top University Plan”, and by grants from the Department of Health of the Taipei City Government (10301-62-001), Taipei Veterans General Hospital (V103C-201), and the National Science Council Taiwan (NSC 98-2314-B-075-029). This study was based on data from the Taipei City Public Health Database, which was provided by the Department of Health of the Taipei City Government and managed by the Databank for Public

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