Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Regular Vigorous Physical Activity and Disability Development in Healthy Overweight and Normal-Weight Seniors: A 13-Year Study

Download as pdf or txt
Download as pdf or txt
You are on page 1of 6

 RESEARCH AND PRACTICE 

Regular Vigorous Physical Activity and Disability


Development in Healthy Overweight and Normal-Weight
Seniors: A 13-Year Study
| Bonnie Bruce, DrPH, MPH, RD, James F. Fries, MD, and Helen Hubert, PhD

The United States is experiencing a senior Objectives. We examined the relationship of regular exercise and body weight
“boom” as increasing numbers of adults are to disability among healthy seniors.
living longer and healthier than their parents. Methods. We assessed body mass index (BMI) and vigorous exercise yearly
By 2030, older adults will compose about (1989–2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4
20% of the US population.1 However, this groups: normal-weight active (BMI<25 kg/m2; exercise>60 min/wk); normal-weight
group even now poses enormous challenges inactive (exercise ≤60 min/wk); overweight active (BMI≥25 kg/m2); and overweight
to policymakers and health care providers to inactive. Disability was measured with the Health Assessment Questionnaire (0–3;
0 = no difficulty, 3 = unable to do). We used multivariable analysis of covariance to
meet their needs. Older adults are the largest
determine group differences in disability scores after adjustment for determinants
consumers of health care. Five of the 6 lead-
of disability.
ing causes of death among seniors are from
Results. The cohort was 72% men and 96% White, with a mean age of 65.2
chronic diseases1 that can be in part pre- years. After 13 years, overweight active participants had significantly less dis-
vented, delayed, or modified through lifestyle. ability than did overweight inactive (0.14 vs 0.19; P = .001) and normal-weight in-
The identification of strategies to help active (0.22; P = .03) participants. Similar differences were found between nor-
maintain health and independence as far mal-weight active (0.11) and normal-weight inactive participants (P < .001).
into the last years of life as possible is of Conclusions. Being physically active mitigated development of disability in
foremost importance to help alleviate the in- these seniors, largely independent of BMI. Public health efforts that promote
creasing public health burden. However, the physically active lifestyles among seniors may be more successful than those
sweeping national epidemic of overweight that emphasize body weight in the prevention of functional decline. (Am J Pub-
lic Health. 2008;98:1294–1299. doi:10.2105/AJPH.2007.119909)
and obesity as indicated by a body mass
index (BMI; weight in kilograms divided by
height in meters squared) of 25 kg/m2 or Physical activity confers myriad health ben- activity, obesity, and disability among aging
more in parallel with the small proportion of efits across age groups and among both nor- men21 and aging women,22 the most disability
the elderly who are sufficiently physically ac- mal-weight and overweight individuals.6,13,14 was found among inactive participants.
tive to achieve health benefits are among Participation in regular physical activity helps However, there are little longitudinal data
major pubic health concerns. More than two to moderate or prevent disability and im- evaluating the specific relationship between
thirds of seniors aged 65 to 75 years have a proves functional ability, especially among disability, body weight, and physical activity
BMI greater than 25 kg/m2, and nearly seniors. Mortality and morbidity are also posi- among older healthy men and women, and
three fourths are physically inactive.1 Being tively affected among seniors who participate more specifically those who are classed as
overweight and physically inactive are recog- in regular physical activity.15 As such, physi- overweight and who participate in regular
nized risk factors for several chronic diseases cally active older adults demonstrate higher physical activity. Brach et al.20 examined this
and are also important predictors of func- levels of physical functioning than their inac- relationship in older women in both cross-sec-
tional impairment, or disability, among older tive counterparts.10,16 tional and longitudinal studies over 17 years
adults.3–7 Healthy weight maintenance and regular of follow-up and reported less disability in
Functional limitations in turn have been participation in physical activity are important physically active overweight and obese
shown to contribute to poorer health out- goals of public health initiatives.17 In older women, although they were unable to control
comes and increased health care utiliza- adults, investigators have compared physical for baseline disability. In their 16-year study
tion.3,8,9 Nearly 40% of overweight older activity with functional status,18,19 body weight of living habits, obesity, and mortality in mid-
adults have impaired physical functioning to with functional status,3,7,8 and overweight and dle-aged and older Finnish men, Haapenen-
the extent that it limits their ability to perform obesity with physical activity11,20 and have re- Niemi et al.23 concluded that being obese was
common activities of daily living, including ported lower disability both in overweight not an independent predictor of mortality, al-
walking and reaching.10 Moreover, as weight and nonoverweight participants who were though low levels of physical activity, per-
increases, physical activity decreases, and physically active. In cross-sectional studies of ceived physical fitness, and physical function-
functional impairment increases.11,12 the association between leisure-time physical ing predicted increased risk. In a cohort of

1294 | Research and Practice | Peer Reviewed | Bruce et al. American Journal of Public Health | July 2008, Vol 98, No. 7
 RESEARCH AND PRACTICE 

older adults from the Health, Aging, and Medical Research, and each participant gave from 0 (no disability) to 3 (completely dis-
Body Composition Study, Houston et al. written informed consent. abled). The HAQ-DI has been extensively
found that excess weight was linked with ob- studied and is valid and sensitive to change.25
jective measures of physical performance.4 Data Collection Assessment of physical activity. Physical ac-
Our primary objective was to examine the Self-report data were collected yearly by tivity was assessed as the number of minutes
relationship of body weight and physical ac- mail with the Stanford Health Assessment spent weekly doing vigorous exercise. Vigor-
tivity to disability in a cohort of healthy, older Questionnaire (HAQ).25 Rigorous, standard- ous exercise was defined on the questionnaire
adults over 13 years of follow-up. We hypoth- ized protocols were followed for data collec- as “vigorous exercise that will cause you to
esized that physically active overweight and tion and quality control. These included fol- sweat and your pulse, if taken, will be above
normal-weight seniors would have less dis- low-up telephone calls to nonrespondents and 120.” Activities under this definition included
ability than their less-active counterparts. review of all returned questionnaires for com- running, swimming, bicycling or using a sta-
pleteness, ambiguities, or inconsistencies, with tionary bike, aerobic dance and exercise, stair
METHODS subsequent telephone contact as needed by steppers, brisk walking, hiking or using a tread-
trained outcome assessors.25 mill, racket sports, and also periods of rapid
Participants were from a cohort of 1195 Demographic and health data. Participant walking at work and in daily activities. For
adults who were recruited between 1984 characteristics (age, gender, years of educa- convenience, we chose to use the terms “ac-
and 1991 from a national runners’ associa- tion, race/ethnicity, years of follow-up, dis- tive” and “inactive” to describe physical activ-
tion and from the local Stanford University ability, medical history, exercise, smoking sta- ity groups in this study. Participants were cate-
community to participate in a longitudinal tus, comorbid conditions, pain, and global gorized as active if they participated in vigorous
prospective study of the health effects of health status) were obtained by self-report. exercise for more than 60 minutes per week
running.24 Men and women were eligible for Racial/ethnic groups were derived from pa- or inactive if they participated in vigorous ex-
study inclusion at time of enrollment if they tient self-identification as non-Hispanic White, ercise for 60 minutes or fewer per week.
were aged 50 to 72 years, had at least a non-Hispanic African American, Asian or Pa- Assessment of body weight. Self-reported
high school diploma, and spoke English as cific Islander, American Indian/Alaskan Na- body weight was classified by BMI. Partici-
their primary language.24 There were no in- tive, Canadian Indian, Hispanic, or other. pants were categorized as either normal
clusion criteria regarding physical activity Smoking status was assessed by whether re- weight (< 25 kg/m2) or overweight (≥ 25 kg/
level. An earlier publication described the spondents were currently smoking cigarettes. m2) in accord with the National Institutes of
original cohort as being better educated and Comorbidity data were obtained by asking re- Health Clinical Guidelines on the Identifica-
having more professionals than national pop- spondents if they had ever been told by a tion, Evaluation, and Treatment of Over-
ulation samples at the time.24 Runners’ asso- physician that they had cardiovascular, pul- weight and Obesity in Adults.2 Frequency of
ciation members were also younger, in- monary, neurological, endocrinological, gas- obesity (≥ 30 kg/m2) among participants was
cluded more men, had significantly lower trointestinal, or musculoskeletal conditions, or also examined.
BMIs, and the biggest difference was the cancer. Assessment of overall health and vital-
number of miles run, compared with the ity was measured on the Health Assessment Study Groups
community controls.24 Questionnaire’s (HAQ’s) double-anchored We formed 4 study groups based on BMI
Data for this study originated in 1989, the global health visual analog scale (scored and vigorous exercise level on the 1989
first year that data for all relevant variables 0–100; 100 = very healthy). The HAQ global questionnaire, the first year that data were
were available (e.g., weight, physical activity, health scale has been validated as a “generic” available for all variables relevant to this
and disability). Participant selection was based measure of health-related quality of life.26 study, or on the respondent’s first question-
on availability of relevant data regardless of Assessment of disability. Disability was as- naire, which could have ranged from 1989 to
original group membership (i.e., whether from sessed with the Stanford HAQ Disability Index 1991. Accordingly, respondents were assigned
the runners’ group or community sample). In (HAQ-DI),25 which includes items that evalu- to normal-weight active (BMI < 25 kg/m2; ex-
addition, investigators were blinded to origi- ate fine movements of the upper extremity, ercise > 60 min/wk); normal-weight inactive
nal group membership. Participants were eli- locomotor activity of the lower extremity, and (exercise ≤ 60 min/wk); overweight (BMI ≥
gible for this study if they had at least 2 years activities that involve both upper and lower 25 kg/m2) active; or overweight inactive.
of follow-up with weight, physical activity, extremities. The HAQ-DI contains 20 items in
and disability data during the 13-year study 8 categories of functioning—rising, dressing, Statistical Analyses
period, from 1989 to 2002. Overall, two eating, walking, hygiene, reaching, gripping, The primary comparisons for analysis were
thirds (66.5%) of the participants had an av- and ability to do usual daily activities. Re- the active participants compared with the in-
erage of at least 11 years of follow-up data, sponses are made on a scale from 0 (no diffi- active participants within each weight group.
which ranged from 2 to 13 years. The study culty) to 3 (unable to do). The maximum item The HAQ-DI score was the primary depen-
protocol was approved by Stanford University’s scores in each of the 8 categories were summed, dent outcome variable. The covariates chosen
Administrative Panel on Human Subjects in then averaged, to obtain an overall HAQ-DI for the model were correlated with disability

July 2008, Vol 98, No. 7 | American Journal of Public Health Bruce et al. | Peer Reviewed | Research and Practice | 1295
 RESEARCH AND PRACTICE 

at P < .05. These were age, gender, ethnicity TABLE 1—Baseline Participant Characteristics Among 805 Healthy US Seniors: 1989–2002
(categorized as White or non-White, because
numbers of participants in specific racial/eth- Normal Weighta Overweightb
nic groups were too small to analyze sepa- Physically Physically Physically Physically
rately), education (years), number of comor- Activec Inactived Activec Inactived
(n = 442) (n = 123) (n = 153) (n = 87)
bid conditions, and baseline HAQ-DI score.
We also tested the data for any interactions White, % 96 95 98 98
between weight and exercise at baseline. Men, % 74 53* 83 67*
Baseline differences in the HAQ-DI score Age, y, mean (SE) 64.8 (0.3) 66.6 (0.6)* 65.1 (0.5) 66.0 (0.7)
and covariates between the 2 exercise groups Education, y, mean (SE) 16.6 (0.1) 16.5 (0.2) 16.8 (0.2) 16.1 (0.3)
within each weight group were compared Follow-up, y, mean (SE) 11.5 (0.2) 10.9 (0.4) 11.2 (0.3) 10.7 (0.5)
using the χ2 and 2-tailed t tests. Comparisons Comorbid conditions, no. (SE) 0.07 (0.01) 0.15 (0.02) 0.09 (0.02) 0.14 (0.04)
at P < .05 were considered statistically signifi- Smokers, % 7 2* 9 3*
cant. Multivariable analysis of covariance with Global health scoree, mean (SE) 84.2 (0.6) 73.6 (1.7)* 79.9 (1.2) 74.2 (1.4)*
disability as the dependent variable was used HAQ-DI scoref, mean (SE) 0.07 (0.01) 0.16 (0.02)* 0.12 (0.02) 0.17 (0.03)
to determine differences among the active Exercise, min/wk, mean (SE) 302.7 (9.8) 15.7 (2.1)* 251.0 (14.2) 12.3 (2.4)*
and inactive participants and the weight BMI, kg/m2, mean (SE) 22.2 (0.8) 22.3 (0.2) 27.1 (0.2) 28.3 (0.3)*
groups after adjustment. We used generalized
Note. HAQ-DI = Stanford Health Assessment Questionnaire Disability Index; BMI = body mass index.
estimating equations, a method of parameter a
Defined as a BMI of < 25 kg/m2.
estimation analysis of longitudinal data that b
Defined as a BMI of ≥ 25 kg/m2.
c
includes repeated measures of an individual Defined as vigorous exercise for more than 60 minutes per week.
d
Defined as vigorous exercise for 60 minutes or less per week.
or cluster of individuals over time.27 Thus, e
Measured 0 to 100; 100 = very healthy.
f
changes in covariates were taken into account Measured 0 to 3; 0 = no difficulty, 3 = unable to do.
in the multivariable analyses. Analyses were *P < .05, between the active and inactive categories within weight group.
performed in a staged manner to examine the
impact of specific covariates on group differ-
ences and were conducted with SAS version Baseline values by study group are pre- than active groups (P < .05). Within each
9.1 (SAS Institute Inc, Cary, North Carolina). sented in Table 1 and show few differences weight group, the physically inactive partici-
among the groups. The study cohort was pre- pants reported statistically poorer overall
RESULTS dominantly White (96%) and well-educated health (P < .05).
(> 16 years of education). There were signifi- Although baseline disability was low in all
Our findings were based on the 805 partic- cantly more physically active men than inac- groups, it was higher in the normal-weight
ipants from the original cohort of 1195 men tive men in both weight groups (P < .05 for physically inactive participants (P < .05) com-
and women who had weight, exercise, and each weight group). The normal-weight inac- pared with their active counterparts. Baseline
disability data and met this study’s criterion tive participants were slightly older than their disability also trended higher among the over-
of having at least 2 years of follow-up during physically active counterparts (66.6 years vs weight inactive respondents compared with
the study period (1989–2002). In the cohort, 64.8 years; P < .05), and the age difference their active peers (P = .07). By design, exercise
57% (n = 460) of the participants were from between the overweight inactive and active minutes were significantly higher in active
the runners’ association group and 43% participants was similar (66.0 years vs 65.1 compared with inactive participants in both
(n = 345) were from the community sample. years; P > .05). weight groups (P < .05). Body mass index was
Participants’ characteristics mirrored that of We found a significant interaction between slightly higher in the overweight inactive ver-
the original cohort; the majority were well- weight and exercise, because as body weight sus overweight active participants (28.3 vs
educated White men. increased, exercise decreased. This was not 27.1; P < .05), but was nearly identical when
Of all participants, 70% (n = 565) had a unexpected, because research has shown that physical activity groups were compared in the
normal BMI of less than 25 kg/m2. Of normal- heavier individuals tend to exercise less.11,12 normal-weight participants (22.2 vs 22.3;
weight participants, 78% (n = 442) fell into the Years of follow-up did not differ among study P > .05).
active group (exercise > 60 min/wk), whereas groups. Comorbidities were infrequent in all Data for the staged multivariable analyses
64% (n = 153) of the overweight group was groups, indicating that this was a relatively by weight group with disability as the depen-
active. About 14% (n = 33) of the overweight healthy cohort, but were slightly higher in the dent variable are presented in Table 2. The
participants were obese (≥ 30 kg/m2), compos- inactive compared with active participants. full model included adjustment for age, gen-
ing 6% (n = 14) of the overweight active Overall, smoking prevalence was low, but in der, race/ethnicity (White vs non-White), ed-
group and 8% (n = 19) of the overweight inac- both weight groups, there was a smaller pro- ucation years, smoking status, number of co-
tive group. portion of smokers in the physically inactive morbid conditions, and baseline HAQ-DI

1296 | Research and Practice | Peer Reviewed | Bruce et al. American Journal of Public Health | July 2008, Vol 98, No. 7
 RESEARCH AND PRACTICE 

TABLE 2—Adjusted HAQ-DI Scores for Staged Multivariable Analysis of Covariance for the highest levels of disability. Overweight ac-
Differences Between Physical Activity Groups Within Each Weight Group Among 805 US tive participants had significantly less disabil-
Seniors: 1989–2002 ity than their normal-weight inactive counter-
parts (0.14 vs 0.22; P < .001). Normal-weight
Normal Weighta Overweightb active participants had the lowest disability,
Physically Physically Physically Physically which was significantly different from the
Activec Inactived Activec Inactived other groups, except for their overweight
(n = 442), Mean (SE) (n = 123), Mean (SE) (n = 153), Mean (SE) (n = 87), Mean (SE)
peers.
Age only 0.09 (0.01) 0.28** (0.03) 0.16 (0.02) 0.26** (0.02)
Age + gender 0.12 (0.01) 0.28** (0.03) 0.20 (0.02) 0.28** (0.02) DISCUSSION
Age + race/ethnicitye 0.09 (0.02) 0.25** (0.03) 0.16 (0.02) 0.25** (0.03)
Age + education 0.09 (0.02) 0.25** (0.03) 0.16 (0.02) 0.25** (0.03) Results from this longitudinal study of
Age + smoking 0.07 (0.03) 0.24** (0.04) 0.15 (0.03) 0.24** (0.04) healthy seniors with 13 years of observation
Age + number of comorbid conditions 0.08 (0.03) 0.24** (0.04) 0.15 (0.03) 0.24** (0.04) support the hypothesis that being physically
Age + baseline HAQ-DI score 0.11 (0.03) 0.22** (0.03) 0.14 (0.03) 0.19* (0.03) active helps mitigate development of disabil-
ity, largely independent of weight status. We
Note. HAQ-DI = Stanford Health Assessment Questionnaire Disability Index. Having a disability was the reference variable.
a
Defined as a body mass index (BMI) of < 25 kg/m2. found significantly less disability among both
b
Defined as a BMI of ≥ 25 kg/m2. the overweight active and normal-weight ac-
c
Defined as vigorous exercise for more than 60 minutes per week. tive participants compared with their inactive
d
Defined as vigorous exercise for 60 minutes or less per week.
e
White vs non-White. counterparts, which is consistent with previ-
*P = .001; **P < .001, between active and inactive categories within weight group. ous research by our group28 as well as with
Brach et al.’s longitudinal analysis of older
women.20
These findings likewise contribute to the
score. After adjustment, the physically inac- Figure 1 presents adjusted data by both body of evidence documenting that regular
tive participants had significantly more dis- weight and physical activity group showing physical activity postpones disability, and that
ability than the active participants regardless the differences among groups. Physically inac- seniors who are physically active report supe-
of weight group. tive participants in both weight groups had rior physical functioning compared with those
who do little or no physical activity.19,29,30
They further suggest that physical activity is
an important factor and may be a more com-
pelling component than body weight in miti-
gating development of disability in older
adults.31–33 There are also plausible biological
factors supporting these findings, which dem-
onstrate that physically active overweight
adults have improved physical indicators of
health status, such as muscle strength and
bone density, which contribute to better func-
tional ability.14,15,30 In addition, data support
lower risks of morbidity and mortality, such
as cardiovascular disease and diabetes, in this
population.6,30

Strengths and Limitations


The strengths of our study included the ad-
vantage of having been able to study a cohort
of healthy aging seniors with initial low levels
of disability, rather than a subset of seniors
Note. HAQ-DI = Stanford Health Assessment Questionnaire Disability Index; BMI = body mass index. Normal weight was defined
as a BMI of less than 25 kg/m2; overweight was defined as a BMI of 25 kg/m2 or more. Data were adjusted for age, gender, who were frail or ill, in whom initial disability
race/ethnicity (White vs non-White), education, smoking status, comorbidities, and baseline disability. Active (exercise > 60 may have been a confounding factor.3,34 Ours
min/wk), Inactive (exercise ≤ 60 min/wk).
is also one of the few longitudinal studies that
FIGURE 1—Selected adjusted mean (SE) disability scores, by weight and activity group. has examined these factors and used functional

July 2008, Vol 98, No. 7 | American Journal of Public Health Bruce et al. | Peer Reviewed | Research and Practice | 1297
 RESEARCH AND PRACTICE 

status as the primary outcome variable. More- participating in regular physical activity would help delay onset of disability or improve func-
over, we had access to comprehensive annual differ substantially for other groups of seniors, tional status can be developed. It may be
data and used a longitudinal study design that because these results are consistent with an more attainable for overweight individuals to
enabled the assessment of disability progres- increasing evidence base that supports im- become physically active than to lose body
sion over 13 years. Use of repeated-measures proved functional status in diverse cohorts of weight and sustain that reduction. Shifting
analyses27 that took into account intrapartici- physically active older adults, including some public health efforts to focus on preven-
pant correlations over time helped to improve women,19 Blacks,33 and Asians.35,32 tive approaches to reduce functional impair-
the estimation of model parameters and to Although self-selection by study partici- ment associated with overweight through
control for temporal changes in covariates pants may affect the strength of the associa- physical activity rather than to emphasize
that could affect the outcome, including age, tion and cannot be ruled out completely, all body weight issues may be a more viable
gender, ethnicity, race, smoking, and comor- participants from the original cohort were in- strategy.
bidities. In addition, because we controlled cluded in this study based solely on the avail-
for baseline disability, we could infer with ability of data relevant to this investigation.
About the Authors
some confidence that these results were inde- We had no knowledge of original group At the time of the research, the authors were with the Divi-
pendent of initial functional status. membership or other variables of interest. sion of Immunology & Rheumatology, Department of Med-
Thus, there is no reason to expect that the icine, Stanford University, Palo Alto, CA.
Despite these strengths, there are factors
Requests for reprints should be sent to Bonnie Bruce,
that limit the generalizability of our findings. data would be systematically affected by re- DrPH, MPH, RD, Senior Research Scientist, Division of
These include the homogeneous nature of the cruitment source. In addition, validation stud- Immunology & Rheumatology, Stanford University Depart-
ies of reporting bias of physical function in ment of Medicine, 1000 Welch Rd, Suite 203, Palo Alto,
cohort, which was predominantly well-edu-
CA 94304 (e-mail: bbruce@stanford.edu).
cated White men. As such, this cohort may this cohort have shown no intergroup differ- This article was accepted November 21, 2007.
not represent a broader range of apparently ences in self-report.24 Despite these factors,
healthy seniors who may have different or this cohort may have been distinctive in char- Contributors
less-healthy lifestyles. These findings may not acteristics not captured in analyses, but that B. Bruce originated the study, conducted analyses, and
participated in development and revision of the article.
be applicable to aging seniors such as women, may be in some way linked with exercise,
J. F. Fries and H. Hubert assisted with the study and par-
other ethnic groups, the less-educated, the weight, and disability in aging. ticipated in analyses and article development and final-
morbidly obese, heavy smokers, seniors who All the same, these findings should be in- ization. All authors helped to conceptualize ideas, inter-
pret findings, and review and revise drafts of the article.
are ill or frail, or to octogenarians or older- terpreted with caution. They should not be
aged individuals. We also based physical ac- construed to imply that if people are over-
tivity levels on the amount of vigorous activ- weight and are physically active then they do
Human Participant Protection
The study protocol was approved by Stanford Univer-
ity compared with other studies that have not need to be at a relatively healthy weight. sity’s Administrative Panel on Human Subjects in Med-
used less-vigorous kinds of activity such as Obesity is one of the nation’s most prevalent ical Research, and each participant gave written in-
formed consent.
walking.20 Data on moderate or light activities epidemics of modern times and is among the
were not collected in earlier years of this most compelling current public health con-
References
study, thus the impact of less-vigorous activity cerns. Regular physical activity in and of itself 1. Older Americans 2004: Key Indicators of Well-
could not be assessed. Consequently, whether is one of the principal means by which en- Being. Washington, DC: Federal Interagency Forum on
the same results would accrue for the casually ergy balance can be enhanced to promote a Aging-Related Statistics; 2004.

or lightly exercising senior is unknown. Use of healthy weight.36 2. [No authors listed.] Executive summary of the
clinical guidelines on the identification, evaluation, and
BMI to classify individuals also may have in- treatment of overweight and obesity in adults. Arch In-
fluenced the findings because BMI is not an Conclusions tern Med. 1998;158:1855–1867.
entirely accurate measure of body composi- With life expectancy increasing, delaying 3. Jenkins KR. Obesity’s effects on the onset of func-
tion and may result in misclassification of cer- or preventing physical disability in the elderly tional impairment among older adults. Gerontologist.
2004;44:206–216.
tain groups, such as the elderly.2 In this study, is a key global issue, although many questions
4. Houston DK, Ding J, Nicklas BJ, et al. The associa-
higher BMI among exercising individuals may have yet to be answered about the best and tion between weight history and physical performance
have been associated with greater muscle most appropriate strategies for achieving this in the Health, Aging and Body Composition study. Int J
mass, whereas the same BMI among inactive goal. The rapidly growing numbers of Obes (Lond). 2007;31:1680–1687.

individuals may have been associated with seniors,1 the escalating epidemic of over- 5. Villareal DT, Apovian CM, Kushner RF, Klein S.
Obesity in older adults: technical review and position
greater adiposity. weight and obesity,37 the established relation- statement of the American Society for Nutrition and
On the other hand, the cohort’s homogene- ship between excess body weight and disabil- NAASO, The Obesity Society. Obes Res. 2005;13:
ity may favor these findings by limiting the ity,8,11 and the lack of consistently effective 1849–1863.

number of potential factors that could con- interventions for long-term weight loss2 indi- 6. Blair SN, Brodney S. Effects of physical inactivity
and obesity on morbidity and mortality: current evi-
found results, such as education and access to cate that modifiable risk factors need to be dence and research issues. Med Sci Sports Exerc. 1999;
health care. Also, there are no compelling rea- identified to inform public health and clinical 31(suppl 11):S646–S662.
sons to presume that benefits accrued from recommendations so that interventions to 7. Jensen GL, Friedmann JM. Obesity is associated

1298 | Research and Practice | Peer Reviewed | Bruce et al. American Journal of Public Health | July 2008, Vol 98, No. 7
 RESEARCH AND PRACTICE 

with functional decline in community-dwelling rural nants of all-cause and cardiovascular disease mortal-
older persons. J Am Geriatr Soc. 2002;50:918–923. ity—16 y follow-up of middle-aged and elderly men
and women. Int J Obes Relat Metab Disord. 2000;24:
8. Ferraro KF, Su YP, Gretebeck RJ, Black DR, Bady-
1465–1474.
lak SF. Body mass index and disability in adulthood: a
20-year panel study. Am J Public Health. 2002;92: 24. Lane NE, Bloch DA, Wood PD, Fries JF. Aging,
834–840. long-distance running, and the development of muscu-
9. Jenkins KR. Body-weight change and physical loskeletal disability. A controlled study. Am J Med.
functioning among young old adults. J Aging Health. 1987;82:772–780.
2004;16:248–266. 25. Bruce B, Fries JF. The Stanford Health Assess-
10. Centers for Disease Control and Prevention. Prev- ment Questionnaire: a review of its history, issues,
alence of physical inactivity during leisure time among progress, and documentation. J Rheumatol. 2003;30:
overweight persons—Behavioral Risk Factor Surveil- 167–178.
lance System, 1994. MMWR Morb Mortal Wkly Rep. 26. Fries JF, Ramey DR. “Arthritis specific” global
1996;45:185–188. health analog scales assess “generic” health related
11. Goya Wannamethee S, Gerald Shaper A, Whin- quality-of-life in patients with rheumatoid arthritis. J
cup PH, Walker M. Overweight and obesity and the Rheumatol. 1997;24:1697–1702.
burden of disease and disability in elderly men. Int J
27. Liang KY, Zeger SL. Longitudinal data analysis
Obes Relat Metab Disord. 2004;28:1374–1382.
using generalized linear models. Biometrika. 1986;73:
12. Apovian CM, Frey CM, Wood GC, Rogers JZ, Still 13–22.
CD, Jensen GL. Body mass index and physical function
28. Wang BW, Ramey DR, Schettler JD, Hubert HB,
in older women. Obes Res. 2002;10:740–747.
Fries JF. Postponed development of disability in elderly
13. Lee CD, Blair SN, Jackson AS. Cardiorespiratory runners: a 13-year longitudinal study. Arch Intern Med.
fitness, body composition, and all-cause and cardiovas- 2002;162:2285–2294.
cular disease mortality in men. Am J Clin Nutr. 1999;
69:373–380. 29. Stewart KJ, Turner KL, Bacher AC, et al. Are fit-
ness, activity, and fatness associated with health-related
14. Stevens J, Cai J, Evenson KR, Thomas R. Fitness quality of life and mood in older persons? J Cardiopulm
and fatness as predictors of mortality from all causes Rehabil. 2003;23:115–121.
and from cardiovascular disease in men and women in
the lipid research clinics study. Am J Epidemiol. 2002; 30. Bean JF, Vora A, Frontera WR. Benefits of exer-
156:832–841. cise for community-dwelling older adults. Arch Phys
Med Rehabil. 2004;85(7 suppl 3):S31–S42; quiz
15. [No authors listed.] American College of Sports S43–S44.
Medicine Position Stand. Exercise and physical activity
for older adults. Med Sci Sports Exerc. 1998;30: 31. LaCroix AZ, Guralnik JM, Berkman LF, Wallace
992–1008. RB, Satterfield S. Maintaining mobility in late life. II.
Smoking, alcohol consumption, physical activity, and
16. Spirduso WW, Cronin DL. Exercise dose-response
body mass index. Am J Epidemiol. 1993;137:
effects on quality of life and independent living in
858–869.
older adults. Med Sci Sports Exerc. 2001;33(6
suppl):S598–S608; discussion S609–S610. 32. Simonsick EM, Lafferty ME, Phillips CL, et al.
Risk due to inactivity in physically capable older adults.
17. Healthy People 2010: Understanding and Improving
Am J Public Health. 1993;83:1443–1450.
Health. 2nd ed. Washington DC: Dept of Health and
Human Services; 2000. 33. Clark DO. The effect of walking on lower body
18. Miller ME, Rejeski WJ, Reboussin BA, Ten Have disability among older blacks and whites. Am J Public
TR, Ettinger WH. Physical activity, functional limita- Health. 1996;86:57–61.
tions, and disability in older adults. J Am Geriatr Soc. 34. Hamerman D. Toward an understanding of frailty.
2000;48:1264–1272. Ann Intern Med. 1999;130:945–950.
19. Huang Y, Macera CA, Blair SN, Brill PA, Kohl 35. Wu SC, Leu SY, Li CY. Incidence of and predic-
HW III, Kronenfeld JJ. Physical fitness, physical activity, tors for chronic disability in activities of daily living
and functional limitation in adults aged 40 and older. among older people in Taiwan. J Am Geriatr Soc. 1999;
Med Sci Sports Exerc. 1998;30:1430–1435. 47:1082–1086.
20. Brach JS, VanSwearingen JM, FitzGerald SJ, Storti 36. Brooks GA, Butte NF, Rand WM, Flatt JP, Ca-
KL, Kriska AM. The relationship among physical activ- ballero B. Chronicle of the Institute of Medicine physi-
ity, obesity, and physical function in community- cal activity recommendation: how a physical activity
dwelling older women. Prev Med. 2004;39:74–80. recommendation came to be among dietary recom-
21. Di Francesco V, Zamboni M, Zoico E, et al. Rela- mendations. Am J Clin Nutr. 2004;79:921S–930S.
tionships between leisure-time physical activity, obesity
37. Centers for Disease Control and Prevention. State-
and disability in elderly men. Aging Clin Exp Res.
specific prevalence of obesity among adults—United
2005;17:201–206.
States, 2005. MMWR Morb Mortal Wkly Rep. 2006;
22. Sulander T, Martelin T, Rahkonen O, Nissinen A, 55:985–988.
Uutela A. Associations of functional ability with health-
related behavior and body mass index among the el-
derly. Arch Gerontol Geriatr. 2005;40:185–199.
23. Haapanen-Niemi N, Miilunpalo S, Pasanen M,
Vuori I, Oja P, Malmberg J. Body mass index, physical
inactivity and low level of physical fitness as determi-

July 2008, Vol 98, No. 7 | American Journal of Public Health Bruce et al. | Peer Reviewed | Research and Practice | 1299

You might also like