The association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults
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
References (34)
- et al.
Effects of leisure and non-leisure physical activity on mortality in U.S. adults over two decades
Ann. Epidemiol.
(2008) - et al.
Physical activity and mortality related to obesity and functional status in older adults in Spain
Am. J. Prev. Med.
(2011) - et al.
Influence of habitual physical activity on body composition, fat distribution and metabolic variables in early postmenopausal women receiving hormonal therapy
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2010) - et al.
Does exercise reduce mortality rates in the elderly? Experience from the Framingham Heart Study
Am. Heart J.
(1994) - et al.
Frequent and occasional physical activity in the elderly: a 12-year follow-up study of mortality
Am. J. Prev. Med.
(2004) - et al.
Physical activity and mortality risk in the Japanese elderly: a cohort study
Am. J. Prev. Med.
(2010) - et al.
Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study
Lancet
(2011) - et al.
Cognitive impairment assessed at annual geriatric health examinations predicts mortality among the elderly
Prev. Med.
(2014) - et al.
Association between domains of physical activity and all-cause, cardiovascular and cancer mortality
Eur. J. Epidemiol.
(2011) - et al.
Physical activity and mortality in a prospective cohort of middle-aged and elderly men — a time perspective
Int. J. Behav. Nutr. Phys. Act.
(2013)
Leisure-time physical activity and all-cause mortality in an elderly cohort
Epidemiology
Physical activity and incidence of diabetes: the Honolulu Heart Program
Am. J. Epidemiol.
Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group
Ann. Intern. Med.
Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association
Med. Sci. Sports Exerc.
Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project
JAMA
The five-item Brief-Symptom Rating Scale as a suicide ideation screening instrument for psychiatric inpatients and community residents
BMC Psychiatry
Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland health and activity survey
J. Epidemiol. Community Health
Cited by (39)
Leisure-time physical activity and mortality risk in type 2 diabetes: A nationwide cohort study
2022, Diabetes and MetabolismThe association between mental health, social support and physical health outcomes among older female cancer survivors
2022, Journal of Geriatric OncologyThe environment as a determinant of successful aging or frailty
2020, Mechanisms of Ageing and DevelopmentPhysical Exercise
2019, Encyclopedia of Biomedical Gerontology: Volume 1-3Albumin levels and cause-specific mortality in community-dwelling older adults
2018, Preventive Medicine