Physical activity trajectories, mortality, hospitalization, and disability in the Toledo Study of Healthy Aging

Abstract

Background Physical activity (PA) is a recognized contributor to healthy aging. However, the majority of studies exploring its associations with adverse outcomes in cohorts of older adults use single‐time PA estimates, which do not consider its dynamic nature. The aim of the present study is to explore the presence of different PA trajectories in the Toledo Study of Healthy Aging and their association with adverse outcomes. Our hypothesis is that prospectively maintaining or increasing PA is associated with a reduced risk of adverse outcomes. Methods We used data from 1679 participants enrolled in the Toledo Study of Healthy Aging. Trajectories based on the Physical Activity Scale for the Elderly were identified using group‐based trajectory modelling. Cox and logistic regression were used to investigate associations between PA trajectories and mortality and hospitalization, and incident and worsening disability, respectively. Mortality was ascertained by linkage to the Spanish National Death Index; disability was evaluated through the Katz Index; and hospitalization was defined as the first admission to Toledo Hospital. Models were adjusted by age, sex, smoking, Charlson Index, education, cognitive impairment, polypharmacy, and Katz Index at Wave 2. Results We found four PA‐decreasing and one PA‐increasing trajectories: high PA‐consistent ( n = 566), moderate PA‐mildly decreasing ( n = 392), low PA‐increasing ( n = 237), moderate PA‐consistent ( n = 191), and low PA‐decreasing ( n = 293). Belonging to the high PA‐consistent trajectory group was associated with reduced risks of mortality as compared with the low PA‐decreasing group [hazard ratio (HR) 1.68; 95% confidence interval (CI) = 1.21–2.31] and hospitalization compared with the low PA‐increasing and low PA‐decreasing trajectory groups (HR 1.24; 95% CI = 1.004–1.54 and HR 1.25; 95% CI = 1.01–1.55, respectively) and with lower rates of incident [odds ratio (OR) 3.14; 95% CI = 1.59–6.19] and worsening disability (OR 2.16; 95% CI = 1.35–3.45) in relation to the low PA‐decreasing trajectory group and at follow‐up. Increasing PA during late life (low PA‐increasing group) was associated with lower incident disability rates (OR 0.38; 95% CI = 0.19–0.82) compared with decreasing PA (low PA‐decreasing group), despite similar baseline PA. Conclusions Our results suggest that sustaining higher PA levels during aging might lead to healthy aging, characterized by a reduction in adverse outcomes. Our study supports the need for enhancing PA participation among older populations, with the goal of reducing personal and economic burden in a worldwide aging population.

Physical Activity Trajectories among Persons of Turkish Descent Living in Germany—A Cohort Study

“…Similar trajectories (always sedentary, fast declining, stable moderate, and always active) were reported in a study from the U.S. among a sample of older women aged 70–79 years, however, the authors found no increasing trajectory which was explained with the high age of the study participants [ 41 ]. Most studies describe three to four trajectories or patterns [ 19 , 26 , 41 ], and less often more are reported, as in a European study conducted in Spain with more than 1600 participants, reporting very diversified patterns (high PA—consistent, moderate PA—mildly decreasing, low PA—increasing, moderate PA—consistent, and low PA—decreasing) [ 12 ].…”

“…In later life, PA can prevent cognitive decline and improve physical functioning [ 7 , 8 , 9 , 10 ]. Among the elderly, activities of daily living can longer be maintained when engaging in regular PA [ 11 , 12 ]. Finally, the beneficial effects might delay premature mortality and increase one’s lifespan [ 6 , 13 , 14 ].…”

Association between physical-activity trajectories and cognitive decline in adults 50 years of age or older

“…Recent studies have attempted to address this gap by considering the evolution of PA over time. [16][17][18][19][20][21][22][23][24][25] However, most of those studies were based on conventional methods to identify groups with different PA trajectories, which typically use clinical or empirical cut-points. [16][17][18][19][20][21] To reduce the reliance on these cut-points, data-driven approaches such as growth mixture modelling have been proposed.…”

“…22,28 Using this approach, studies have shown PA trajectories in older adults 29,30 were associated with multiple health outcomes including disability, cardiovascular diseases, and all-cause mortality. [22][23][24][25]31 However, the associations of PA trajectories with CP and is unknown.…”

Physical activity and exercise in the context of SARS-Cov-2: A perspective from geroscience field

“…Geroscience is a recent field of investigations in the broad gerontology discipline, born from the hypothesis that by manipulating biological aging it is possible to prevent or delay the onset of chronic conditions, as well as their severity ( Sierra and Kohanski, 2017 ; Sierra, 2016a , b ; Kennedy et al, 2014 ). Physical activity (PA) and exercise are considered powerful behaviors for reducing the risk of developing a myriad of chronic diseases ( de Souto Barreto et al, 2017 ; Lee et al, 2012 ; Nyberg et al, 2020 ; Moore et al, 2016 ; Kivimäki et al, 2019 ) and to slow down the age-related progression of the disabling cascade, such as frailty ( Abe et al, 2020 ), functional limitations and disability ( GBD 2017 Risk Factor Collaborators, 2018 ; Sanchez-Sanchez et al, 2020 ; Tak et al, 2013 ), and early mortality ( GBD 2017 Risk Factor Collaborators, 2018 ; Saint-Maurice et al, 2020 ). Since PA and exercise benefit so distinct diseases, such as cancer ( Moore et al, 2016 ), Alzheimer’s and related diseases ( Kivimäki et al, 2019 ), heart conditions ( Colpani et al, 2018 ), they can be seen as one of the best interventions for healthy aging from both epidemiological ( Lin et al, 2020 ) and gerosciences perspectives ( Ferrucci et al, 2016 ; Rebelo-Marques et al, 2018 ).…”