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Physical Activity Helps the Very Old Decrease Mortality

Posted: Wednesday, September 23, 2009

No matter how old you are, increased physical activity is associated with decreased mortality and improved function, a longitudinal Israeli study found.

Among physically active participants, eight-year mortality at age 70 was 15.2%, compared with 27.2% among those who were sedentary (P<0.001), according to Jochanan Stessman, MD, and colleagues at Hadassah Hebrew University Medical Center in Jerusalem.

At age 78, eight-year mortality was 26.1% among active participants, compared with 40.8% among the sedentary (P<0.001), and at age 85, three-year mortality was 6.8% among the active compared with 24.4% of the sedentary (P<0.001).

While the effects of physical activity on survival have been explored for middle-age populations, the authors noted that little was known about the long-term health or survival effects of activity among the elderly.

The Jerusalem Longitudinal Cohort Study followed 1,861 people born in 1920 and 1921 for 18 years (17,109 person-years) to determine whether physical activity was associated with improved survival and other functional or health benefits.

At ages 70, 78 and 85, participants were asked how often they were physically active:

    * Less than four hours weekly
    * About four hours weekly
    * Regularly, such as walking at least one hour daily
    * At least twice weekly, participating in vigorous sports such as jogging or swimming

Those who reported less than four hours activity per week were classified as sedentary, and the remainder were classified as physically active.

Participants also were classified according to activity over time as being consistently active, decreasers (from active to sedentary), increasers (from sedentary to active) or consistently low.

Between ages 70 and 78, 15.2% of active participants died, compared with 27.2% of sedentary participants (P<0.001).

Between ages 78 and 85, 26.1% of active participants died, compared with 40.8% of sedentary participants (P<0.001). Between ages 85 and 88 the corresponding figures were 6.8% and 24.4% (P<0.001).

Among the physically active, adjusted hazard ratios for death were:

    * Age 70, HR 0.61 (95% CI 0.38 to 0.96)
    * Age 78, HR 0.69 (95% CI 0.48 to 0.98)
    * Age 85, HR 0.42 (95% CI 0.25 to 0.68)

Physical activity level also was associated with functional status over time. Active participants deteriorated less than sedentary participants in independent performance of activities of daily living between ages 70 and 78 years (33.3% versus 52.3%).

After adjusting for factors such as sex, body mass index, diabetes, and heart disease, physical activity level at age 70 was associated with an increased likelihood of maintaining the ability to perform activities of daily living at age 78 (adjusted OR 1.72, 95% CI 0.97 to 3.03, P=0.06).

The study "provides unique evidence" that older people can improve survival not just by continuing physical activity, but by initiating it."

"Not only was the effect of this benefit similar regardless of increasing age but the magnitude of the difference between physically active and sedentary participants actually increased with advancing age," the investigators wrote.

The finding of protection against functional decline was important, according to the investigators, because physical activity may be central in delaying the "onset of a spiral of decline" through maintenance of cardiovascular health, improved immunity, slowed sarcopenia, and suppression of chronic inflammation.

Physical activity was common among this older cohort, with 76.9% being active at age 78, which may limit generalization to less active populations, the authors wrote.
Practice Pearl:

Explain to interested patients that maintaining or introducing physical activity at any age, even in their 80s, may help improve their functioning and survival.

Source: Diabetes In Control: Stessman J, et al "Physical activity, function, and longevity among the very old" Arch Intern Med Sept 14,2009; 169: 1476-1483.

 
 
 
 
 
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