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Taking Up Physical Activity in Later Life and Healthy Ageing: The English Longitudinal Study of Ageing

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Original article

Taking up physical activity in later life and healthy


ageing: the English longitudinal study of ageing
Mark Hamer,1 Kim L Lavoie,2,3 Simon L Bacon2,4,5

▸ Online supplementary tables ABSTRACT specific health and function problems in old age,
S1 and S2 are published online Background Physical activity is associated with and has pronounced effects on strength, flexibility,
only. To view these files please
visit the journal online (http://
improved overall health in those people who survive to aerobic capacity, walking capacity, balance and
dx.doi.org/10.1136/bjsports- older ages, otherwise conceptualised as healthy ageing. mental and cognitive decline.5 6 For example, ran-
2013-092993). Previous studies have examined the effects of mid-life domised controlled trials in elderly samples have
1
Physical Activity Research physical activity on healthy ageing, but not the effects demonstrated favourable effects of exercise training
Group, Department of of taking up activity later in life. We examined the on cognitive7 and physical function.8 In addition,
Epidemiology and Public association between physical activity and healthy ageing physical activity has been associated with increased
Health, University College over 8 years of follow-up. survival in the elderly.9 10
London, London, UK
2
Montreal Behavioural
Methods Participants were 3454 initially disease-free Several epidemiological studies have previously
Medicine Centre, Hôpital du men and women (aged 63.7±8.9 years at baseline) from examined the prospective association between
Sacré-Coeur de Montréal, the English Longitudinal Study of Ageing, a prospective mid-life physical activity and healthy ageing using a
A University of Montreal study of community dwelling older adults. Self-reported multidimensional construct made up of compo-
Affiliated Hospital, Montréal, physical activity was assessed at baseline (2002–2003) nents including chronic disease, mental health,
Quebec, Canada
3
Department of Psychology, and through follow-up. Healthy ageing, assessed at physical and cognitive function.11–15 The
University of Quebec at 8 years of follow-up (2010-2011), was defined as those Cardiovascular Health Study,13 the Harvard alumni
Montreal (UQAM), Montreal, participants who survived without developing major study,14 Whitehall II study12 and Nurses’ Health
Quebec, Canada chronic disease, depressive symptoms, physical or Study11 all observed robust associations between
4
Research Center, Montreal
Heart Institute, Concordia cognitive impairment. physical activity and exceptional survival. However,
University, Montreal, Quebec, Results At follow-up, 19.3% of the sample was one of the limitations of prior studies is a failure to
Canada defined as healthy ageing. In comparison with inactive capture the effects of changes in physical activity
5
Department of Exercise participants, moderate (OR, 2.67, 95% CI 1.95 to 3.64), through follow-up. A major advantage of using
Science, Concordia University,
or vigorous activity (3.53, 2.54 to 4.89) at least once a data from cohort studies with repeated assessments
Montreal, Quebec, Canada
week was associated with healthy ageing, after is the ability to examine the effects of changes in
Correspondence to adjustment for age, sex, smoking, alcohol, marital status physical activity on health outcomes. This issue is
Dr Mark Hamer, Department of and wealth. Becoming active (multivariate adjusted, particularly relevant in older populations as there is
Epidemiology and Public 3.37, 1.67 to 6.78) or remaining active (7.68, 4.18 to limited evidence on the health effects of becoming
Health, 1-19 Torrington Place,
University College London, 14.09) was associated with healthy ageing in physically active relatively late in life.
London WC1E 6BT, UK; comparison with remaining inactive over follow-up. The aim of this study was to examine the associ-
m.hamer@ucl.ac.uk Conclusions Sustained physical activity in older age is ation between physical activity and healthy ageing
associated with improved overall health. Significant over an 8-year follow-up in the English
Received 15 August 2013
Revised 16 September 2013
health benefits were even seen among participants who Longitudinal Study of Ageing (ELSA). We specific-
Accepted 24 September 2013 became physically active relatively late in life. ally focused on the effects of physical activity
Published Online First changes through follow-up on healthy ageing.
25 November 2013

INTRODUCTION MATERIALS AND METHODS


In a growing elderly population, healthy ageing is Study sample and procedures
becoming a crucial factor to reduce the burden of ELSA is an ongoing cohort study that contains a
disease and disability and related healthcare costs.1 nationally representative sample of the English
One of the key targets recently outlined by the population living in households.16 The ELSA
European Commission’s Active and Healthy Ageing cohort consists of men and women born on or
Innovation Partnership is to achieve an increased before 29 February 1952. The sample was drawn
healthy life expectancy of 2 years by the year from households that have participated in Health
2020.2 Healthy ageing is a multidimensional Survey for England (HSE) in 1998, 1999 and 2001
phenotype and does not merely capture the (‘wave 0’). HSE recruits participants using
absence of clinical disease, but also incorporates multistage-stratified probability sampling with post-
Open Access
freedom from physical disability, plus preserved code sectors selected at the first stage and house-
Scan to access more cognitive, affective and social functioning.3 There hold addresses selected at the second stage.
free content
are limited data on modifiable midlife risk factors Interviews at baseline (wave 1; 2002–2003) were
for healthy ageing. Emerging evidence suggests that carried out with 11 391 individuals (5186 men and
regular physical activity is among the most import- 6205 women); the overall response rate was 70%
ant lifestyle factors for maintenance of good health at the household level and 67% at the individual
To cite: Hamer M, at older ages. Across developed regions of the level. Participants were re-assessed every 2 years
Lavoie KL, Bacon SL. Br J world, inactivity ranks alongside tobacco, alcohol thereafter and follow-up for healthy ageing was
Sports Med 2014;48: and obesity as a leading cause of reduced healthy made 8 years later at wave 5 (2010–2011). The
239–243. life expectancy.4 Inactivity contributes to several present analysis contained survivors at follow-up.

Hamer M, et al. Br J Sports Med 2014;48:239–243. doi:10.1136/bjsports-2013-092993 1 of 6


Original article

Participants gave full informed written consent to participate in Mental health


the study and ethical approval was obtained from the London Depressive symptoms were assessed using the eight-item Centre of
Multi-Centre Research Ethics Committee. Epidemiological Studies Depression (CES-D) scale. As in previous
studies, we used a score of ≥4 to define cases of elevated depres-
Physical activity assessment sive symptoms.19 The CES-D is highly validated for use in older
Self-reported physical activity was collected at baseline, and adults and displays excellent psychometric properties.20 21
included questions on the frequency of participation in vigor-
ous, moderate and light physical activities (more than once per Disability and physical function
week, once per week, one to three times per month, hardly We assessed disability based on participants’ responses to ques-
ever). Physical activity was further categorised into three groups, tions on perceived difficulties in basic (eg, difficulty dressing,
as previously described17: inactive (no moderate or vigorous including putting on shoes and socks)22 and instrumental (eg,
activity on a weekly basis); moderate activity at least once a difficulty preparing a hot meal) activities of daily living.23
week and vigorous activity at least once a week. These physical Participants with difficulties in one or more activities were con-
activity questions were repeated at wave 3 (2006–2007), thus sidered to have some degree of disability. Physical functioning
enabling us to assess changes in physical activity levels through was objectively assessed using walking speed measured over an
follow-up. A binary physical activity variable (inactive or moder- 8-foot long (2.44 m) course. Adequate physical function was
ate/vigorous activity) was created and a change in physical activ- defined as gait speed greater than 0.6 m/s, which has previously
ity over 4 years (waves 1–3) was categorised into four groups: been used as a cut-point to predict poor health and function.24
always inactive, became inactive, became active and always
active. We have recently validated the physical activity question-
Covariates
naire in 116 (61 men and 55 women) ELSA participants (aged 64.5
Baseline demographic and health-related covariates included cig-
±12.5 years) using objective accelerometry devices (Hamer M,
arette smoking (current, previous or non-smoker), current fre-
2012; unpublished data). Participants wore a GeneActiv device
quency of alcohol intake (daily, at least weekly, rarely, never),
on their wrist for seven consecutive days. The three category
marital status (married, single, divorced, widowed). Wealth was
exposure variable described above was moderately correlated
used as our measure of socioeconomic status, as this has been
with objectively assessed hours per day of moderate-vigorous
shown to best capture the material resources available to older
intensity activity (Spearman’s r=0.21, p=0.02).
adults.25 Wealth was calculated as net of debt and included the
total value of the participant’s home (excluding mortgage),
Outcome: healthy ageing
financial assets such as savings, business assets, and physical
Although there is no consensus on the definition of healthy
wealth such as artwork or jewellery.
ageing, recent working definitions have included not only
disease status but also cognitive, physical and other functions.
For the current analyses we employed previously described cri- Statistical analyses
teria11 12 for the following four domains: (1) being free from We used χ2 tests to examine differences in baseline characteris-
major chronic disease; (2) having no major impairment of cog- tics with respect to healthy ageing. Multiple logistic regressions
nitive function; (3) having no major limitation of physical func- were used to examine the association between physical activity
tions and (4) and having good mental health. Healthy ageing at baseline and healthy ageing at follow-up. In multivariate
was defined as those participants who survived without develop- models, we adjusted for several covariates in a step-wise
ing any of the above limitations. fashion: model 1 contained basic variables including age and
Disease status was measured using self-reported physician sex; model 2 contained additional baseline behavioural and
diagnosis of major chronic diseases, including cardiovascular demographic covariates, including smoking, alcohol use, marital
diseases (arrhythmia, myocardial infarction, congestive heart status and wealth quintile. Covariates were selected a priori
failure, angina, heart murmur, stroke) diabetes or high blood based on existing data linking these covariates to both physical
sugar, cancer, obstructive lung diseases (including chronic bron- activity and healthy ageing.11–15 We used a similar modelling
chitis, emphysema), Parkinson’s disease or Alzheimer disease. approach to investigate associations between change in physical
Cognitive function was assessed objectively using a battery of activity and healthy ageing. All analyses were conducted using
widely used neuropsychological tests validated through clinical– SPSS V.20.
pathological studies.18 Participants were presented with a list of
10 words that were read out by a computer at the rate of one RESULTS
word every 2 s. A total of four such lists were available and The selection of participants for the present study is summarised
these were randomly allocated by the computer. Following pres- in figure 1. Any participants with existing chronic disease at
entation of the words, participants were asked to recall as many baseline (wave 1) and wave 2 were excluded. The final analytic
words as they could (immediate recall). Participants were also sample comprised 3454 individuals (aged 63.7±8.9 years at
asked to recall these words after an interval during which they baseline, 42.5% men). Excluded participants were slightly older
completed other cognitive function tests (delayed recall). The (64.4 vs 63.7 years, p=0.002), more likely to be physically
number of correctly recalled words was used as a measure of inactive (27.7% vs 18.9%, p<0.001), and less wealthy (17.4%
memory. Verbal fluency was used as a measure of executive in top quintile vs 23.6%, p<0.001) compared with those
function. Participants were asked to name as many members of included. At baseline, participants who were defined as healthy
a specific category (in this case, animals) as they could in 1 min. agers at follow-up (19.3% of the sample) were older, more
The number of animals named was used as a measure of execu- likely to be never smokers, regular alcohol drinkers, more phys-
tive function. A global cognitive function score was calculated ically active, married and had greater wealth (table 1). In a sub-
from the sum of standardised scores on each test, as previously sample of participants (N=1953) with available clinical data
described.12 A global score of less than –1 SD from the mean from the wave 2 nurse assessment, healthy agers demonstrated
was used to define cognitive impairment. more favourable lipid profiles and glycaemic control, lower

2 of 6 Hamer M, et al. Br J Sports Med 2014;48:239–243. doi:10.1136/bjsports-2013-092993


Original article

Figure 1 A flow chart describing the


selection of participants for the present
study.

body mass index and higher blood haemoglobin levels (see of the sample remained inactive, 11.9% became inactive, 9%
online supplementary table S1). became active and 70.1% remained active (moderate or vigor-
ous activity at least once a week). Becoming active or remaining
Baseline physical activity and healthy ageing at follow-up active was associated with healthy ageing in comparison with
At follow-up, 38.4% of the sample had developed a chronic remaining inactive (table 4), and these associations persisted in
illness, 17.6% reported depressive symptoms, 32% reported dis- fully adjusted models.
ability, 19.2% had cognitive impairment and 17.7% had inad-
equate gait speed. There was a dose–response association DISCUSSION
between baseline physical activity and healthy ageing at 8 years The main findings from the present study demonstrate a dose–
follow-up, such that participants reporting participation in mod- response association between physical activity and healthy ageing
erate or vigorous activity were 3.1-fold and 4.3-fold more likely over 8 years of follow-up in an initially disease-free population.
to be healthy agers, respectively, in comparison with inactive The novel aspect of this study was in examining the impact of
participants (table 2). These effect estimates were only slightly changes in physical activity on healthy ageing, made possible by
attenuated after adjustment for standard covariates and did not repeated collection of physical activity data over follow-up.
appear to be influenced by further adjustment for biological risk Importantly, we demonstrate, for the first time, that participants
factors (see online supplementary table S2). Among the covari- who remained physically active through follow-up were most
ates, wealth and smoking predicted healthy ageing; compared likely to age successfully, although participants who took up activ-
with participants in the poorest quintile, those in the richest ity during the follow-up period were also more likely to remain
were more likely to be healthy agers (multivariate adjusted healthy compared with those who were inactive throughout. In
OR=2.81, 95% CI 1.93 to 4.10). Smokers were less likely to be fact, participants who remained active over 4 years of follow-up
healthy agers (multivariate adjusted OR=0.66, 0.48 to 0.89). were over sevenfold more likely to be healthy agers after covariate
When we examined the association between physical activity adjustment. In comparison, when using a single assessment of
and individual components of healthy ageing, all components physical activity at baseline, participants reporting vigorous activity
remained independently associated with physical activity after were just over three times more likely to be healthy agers. Thus,
mutual adjustment for one another (table 3). repeated assessment of the exposure variable improved prediction
of our outcome. Undoubtedly, controlled trials are the best test of
Change in physical activity and successful ageing causality. However, longitudinal studies of community samples
We examined associations between 4-year change in physical have several advantages in that they are more representative, and
activity and subsequent healthy ageing. Over the 4 years, 8.9% can be followed up over longer periods of time without the risk of

Hamer M, et al. Br J Sports Med 2014;48:239–243. doi:10.1136/bjsports-2013-092993 3 of 6


Original article

Table 1 Characteristics of the study population at baseline Table 3 OR (95% CI) for the association of physical activity and
(N=3454) different components of healthy ageing over 8 years follow-up
Healthy
(N=3454)
ageing Unhealthy Model 1 Model 2
(n=665) ageing (n=2789) p Value OR (95% CI) OR (95% CI)

Age (years) 67.0±4.2 62.9±9.5 <0.001 Chronic disease


Men 300 (45.1) 1169 (41.9) 0.13 Inactive 1.00 (ref) 1.00
Smoking <0.001 Moderate physical activity 0.70 (0.58 to 0.84) 0.78 (0.64 to 0.95)
Never 307 (46.2) 1010 (36.2) Vigorous physical activity 0.61 (0.50 to 0.74) 0.67 (0.54 to 0.84)
Previous 301 (45.3) 1264 (45.3) p-trend <0.001 0.001
Current 57 (8.6) 515 (18.5) Depressive symptoms (CES-D>3)
Alcohol intake 0.017 Inactive 1.00 (ref) 1.00
Daily 217 (32.6) 804 (28.8) Moderate physical activity 0.51 (0.41 to 0.64) 0.67 (0.53 to 0.85)
At least once per week 220 (33.1) 891 (31.9) Vigorous physical activity 0.36 (0.27 to 0.46) 0.51 (0.39 to 0.67)
(but not daily)
p-trend <0.001 0.001
Rarely 186 (28.0) 822 (29.5)
Cognitive impairment
Never 42 (6.3) 272 (9.8)
Inactive 1.00 (ref) 1.00
Physical activity <0.001
Moderate physical activity 0.71 (0.56 to 0.90) 0.88 (0.69 to 1.13)
Inactive 55 (8.3) 598 (21.4)
Vigorous physical activity 0.49 (0.37 to 0.64) 0.64 (0.48 to 0.85)
Moderate (at least once 345 (51.9) 1347 (48.3)
p-trend <0.001 0.005
per week)
ADL/IADL
Vigorous (at least once 265 (39.8) 844 (30.3)
per week) Inactive 1.00 (ref) 1.00
Marital status 0.016 Moderate physical activity 0.43 (0.35 to 0.52) 0.57 (0.46 to 0.70)
Married 479 (72.0) 1890 (67.8) Vigorous physical activity 0.30 (0.24 to 0.37) 0.41 (0.33 to 0.52)
Single, never married 25 (3.8) 141 (5.1) p-trend <0.001 <0.001
Separated/divorced 56 (8.4) 341 (12.2) Impaired gait speed (<0.6 m/s)
Widowed 105 (15.8) 417 (15.0) Inactive 1.00 (ref) 1.00
Wealth quintile <0.001 Moderate physical activity 0.38 (0.30 to 0.49) 0.54 (0.40 to 0.72)
1 (lowest) 45 (6.8) 458 (16.4) Vigorous physical activity 0.23 (0.17 to 0.32) 0.41 (0.29 to 0.58)
2 103 (15.5) 538 (19.3) p-trend <0.001 <0.001
3 135 (20.3) 601 (21.5) Model 1; adjustment for age, sex.
4 172 (25.9) 586 (21.0) Model 2; adjustment for age, sex and mutually for all components of healthy ageing
model.
5 (highest) 210 (31.6) 606 (21.7) ADL, activities of daily living; CES-D, Centre of Epidemiological Studies Depression;
IADL, instrumental activities of daily living.
Percentages denoted in brackets.

contamination effects that is a concern in trials with extended ELSA.17 This supports the biological plausibility of our findings
follow-up. In the present study we aimed to minimise possible and further reinforces the likelihood of causality. Thus, taken
confounding by controlling for key covariables (including age, sex, together prospective observational studies of representative com-
smoking, alcohol intake, marital status and wealth as a marker of munity samples are an important approach for establishing links
social status) and reduce the risk of reverse causality by removing between physical activity and healthy ageing.
participants with prevalent disease at baseline. We also demon- The prevalence of healthy ageing in ELSA is comparable with
strated associations between healthy ageing and several biomarkers previous studies. For example, in the Nurses’ Health Study,
that have been previously associated with physical activity in 10.8% met the criteria for healthy ageing11 and 20.9% met the

Table 2 OR (95% CI) for the association of baseline physical


Table 4 OR (95% CI) for the association of physical activity change
activity and healthy ageing over 8 years follow-up (N=3454)
over wave 1–3 and healthy ageing at follow-up (N=3051)
Healthy ageing
cases Model 1 Model 2 Healthy
Total N OR (95% CI) OR (95% CI) ageing
cases Model 1 Model 2
Inactive 55/653 1.00 (ref) 1.00 Total N OR (95% CI) OR (95% CI)
Moderate physical 345/1692 3.12 (2.30 to 4.24) 2.67 (1.95 to 3.64)
Remained inactive 12/273 1.00 (ref) 1.00
activity
Became inactive 37/363 2.50 (1.27 to 4.94) 2.36 (1.19 to 4.68)
Vigorous physical 265/1109 4.35 (3.16 to 5.98) 3.53 (2.54 to 4.89)
activity Became active 34/275 3.57 (1.79 to 7.14) 3.37 (1.67 to 6.78)
p-trend <0.001 <0.001 Remained active 521/2140 9.51 (5.22 to 17.33) 7.68 (4.18 to 14.09)
p-trend <0.001 <0.001
Model 1; adjustment for age, sex.
Model 2; adjustment for age, sex, smoking (never; previous; current), alcohol (daily; at Model 1; adjustment for age, sex.
least weekly; rarely; never), marital status (married; always single; separated; Model 2; adjustment for age, sex, smoking, alcohol (daily; at least weekly; rarely;
widowed), wealth quintile. never), marital status (married; always single; separated; widowed), wealth quintile.

4 of 6 Hamer M, et al. Br J Sports Med 2014;48:239–243. doi:10.1136/bjsports-2013-092993


Original article

criteria in the British Whitehall II study of civil servants.12 In summary, a sustained level of physical activity in older age
Slight differences are possibly due to variations in the criteria is associated with improved overall health in participants surviv-
used for defining healthy ageing and also differences in ing over an 8-year follow-up. Moreover, significant health bene-
follow-up time. For example, previous studies11 12 have used fits were even seen among participants who became physically
longer follow-up periods of 14–16 years, with younger samples active relatively late in life. This study supports public health
at baseline. Thus, our sample may have already contained a high initiatives designed to engage older adults in physical activity,
proportion of healthy survivors at baseline. Social function is even those who are of advanced age.
included in the definition of healthy ageing although seldom
used, thus this dimension of ageing should be considered in
future studies. What are the new findings?
Several previous studies, including the Cardiovascular Health
Study,13 the Harvard Alumni Study,14 Whitehall II study12 and
Nurses’ Health Study11 have all observed strong associations ▸ Sustained physical activity was prospectively associated with
with physical activity and exceptional survival. In contrast, other improved healthy ageing (absence of disease, freedom from
studies have not observed these associations.15 The present disability, high cognitive and physical functioning, good
study is one of the first to assess associations between changes in mental health).
activity and healthy aging. A reduction in physical activity may ▸ Significant health benefits were even seen among
be one of the first indicators of the disease onset. However, in participants who became physically active relatively late in
the present study participants who became physically active life.
after baseline were more likely to be healthy than those who
remained sedentary and those who became inactive. In a recent
11-year follow-up study of older Australian men, participants
who met the physical activity recommendations at baseline and How might it impact on clinical practice in the near
follow-up were most likely to be successful agers at follow-up.26 future?
Several other cohort studies have demonstrated that an increase
in physical activity in older age is protective against all-cause
mortality.27 28 Although our assessment of physical activity
The results support public health initiatives designed to engage
change was crude, the results appear to suggest that maintaining
older adults in physical activity.
or beginning any form of regular activity is beneficial. The
mechanisms underlying these effects remain unclear. One key
mechanism may involve inflammatory pathways. Regular phys- Contributors MH had full access to the data, and takes responsibility for the
ical activity is associated with sustained levels of lower inflam- integrity and accuracy of the results. All authors contributed to the concept and
matory markers in older adults.29 In addition, low-grade design of study, drafting and critical revision of the manuscript.
inflammation has been linked to many of the components of Funding The data were made available through the UK Data Archive. The English
healthy ageing, including chronic disease,30 31 depression,32 Longitudinal Study of Ageing (ELSA) was developed by a team of researchers based
cognitive decline,33 sarcopenia and disability.34 35 at University College London, the Institute of Fiscal Studies and the National Centre
for Social Research. The funding is provided by the National Institute on Aging in
Our study has some limitations. Chronic disease was based on theUSA(grants 2RO1AG7644-01A1 and 2RO1AG017644) and a consortium of UK
self-report of physician diagnosis, though previous work has government departments co-ordinated by the Office for National Statistics.
demonstrated the validity of this measure in ELSA.36 Competing interests MH is supported by the British Heart Foundation (RE/10/
Self-reported physical activity was crudely assessed and, consist- 005/28296); KLL and SLB are supported by Chercheur boursier awards from the
ent with others,37 was modestly related to objective accelerome- Fonds de recherché du Quebec—santé (FRQS) and New Investigator Awards from
try measures. For this reason, and because self-reported physical the Canadian Institutes of Health Research (CIHR).
activity in older adults has been shown to overestimate actual Patient consent Obtained.
activity and underestimate its true effects on mortality in older Ethics approval London Multi-Centre Research Ethics Committee.
adults,10 our study may have considerably underestimated the Provenance and peer review Not commissioned; externally peer reviewed.
strength of associations between physical activity and healthy
Data sharing statement The data were made available through the UK Data
ageing. As in any observational study, residual confounding may Archive.
explain our results. However, the effect estimates were a little
Open Access This is an Open Access article distributed in accordance with the
attenuated after a range of multivariate adjustments. In a sub- Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which
sample with available clinical data we did also make adjustments permits others to distribute, remix, adapt, build upon this work non-commercially,
for other clinical covariates such as body mass index, inflamma- and license their derivative works on different terms, provided the original work is
tory markers, glucose metabolism and blood lipid levels, properly cited and the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/3.0/
although these factors may be on the causal pathway linking
physical activity with healthy ageing. The participants excluded
from our analyses were less physically active and generally of REFERENCES
1 Landefeld CS, Winker MA, Chernof B. Clinical care in the aging century—
lower social status, which could have introduced bias into the announcing ‘Care of the aging patient: from evidence to action’. JAMA
results, although the impact of resurvey non-response has been 2009;302:2703–4.
shown to have negligible effects in previous research.38 Despite 2 Lagiewka K. European innovation partnership on active and healthy ageing: triggers
these limitations, our study also has some notable strengths. of setting the headline target of 2 additional healthy life years at birth at EU
average by 2020. Arch Public Health 2012;70:23.
These include the repeated serial collection of data enabling us 3 Rowe JW, Kahn RL. Successful ageing. Gerontologist 1997;37:433–40.
to model changes in physical activity; the objective assessments 4 Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major
of several healthy ageing outcomes; the use of a large national non-communicable diseases worldwide: an analysis of burden of disease and life
sample of community-dwelling men and women. expectancy. Lancet 2012;380:219–29.

Hamer M, et al. Br J Sports Med 2014;48:239–243. doi:10.1136/bjsports-2013-092993 5 of 6


Original article

5 Paterson DH, Warburton DE. Physical activity and functional limitations in older 24 Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA
adults: a systematic review related to Canada’s Physical Activity Guidelines. Int J 2011;305:50–8.
Behav Nutr Phys Activ 2010;7:38. 25 Banks JA, Karlsen S, Oldfield Z. Socio-economic position. In: Marmot M, Banks JA,
6 Hamer M, Chida Y. Physical activity and risk of neurodegenerative disease: a Blundell R, Lessof C, Nazroo J.eds Health, wealth and lifestyles of the older
systematic review of prospective evidence. Psychol Med 2009;39:3–11. population in England: the 2002 English Longitudinal Study of Ageing. London:
7 Lautenschlager NT, Cox KL, Flicker L, et al. Effect of physical activity on cognitive Institute of Fiscal Studies, 2003:15.
function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 26 Almeida OP, Khan KM, Hankey GJ, et al. 150 minutes of vigorous physical activity
2008;300:1027–37. per week predicts survival and successful ageing: a population based 11-year
8 Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical longitudinal study of 12201 older Australian men. Br J Sports Med 2013 Sep 3.
function in obese older adults. N Engl J Med 2011;364:1218–29. doi:10.1136/bjsports-2013-092814
9 Stessman J, Hammerman-Rozenberg R, Cohen A, et al. Physical activity, function, 27 Wannamethee SG, Shaper AG, Walker M. Changes in physical activity,
and longevity among the very old. Arch Intern Med 2009;169:1476–83. mortality, and incidence of coronary heart disease in older men. Lancet
10 Manini TM, Everhart JE, Patel KV, et al. Daily activity energy expenditure and 1998;351:1603–8.
mortality among older adults. JAMA 2006;296:171–9. 28 Byberg L, Melhus H, Gedeborg R, et al. Total mortality after changes in leisure time
11 Sun Q, Townsend MK, Okereke OI, et al. Physical activity at midlife in relation to successful physical activity in 50 year old men: 35 year follow-up of population based cohort.
survival in women at age 70 years or older. Arch Intern Med 2010;170:194–201. BMJ 2009;338:b688.
12 Sabia S, Singh-Manoux A, Hagger-Johnson G, et al. Influence of individual and 29 Hamer M, Sabia S, Batty GD, et al. Physical activity and inflammatory markers over
combined healthy behaviours on successful aging. CMAJ 2012;184:1985–92. 10 years: follow-up in men and women from the Whitehall II cohort study.
13 Newman AB, Arnold AM, Naydeck BL, et al.; Cardiovascular Health Study Research Circulation 2012;126:928–33.
Group. ‘Successful aging’: effect of subclinical cardiovascular disease. Arch Intern 30 Vasto S, Carruba G, Lio D, et al. Inflammation, ageing and cancer. Mech Ageing
Med 2003;163:2315–22. Dev 2009;130:40–5.
14 Vaillant GE, Mukamal K. Successful ageing. Am J Psychiatry 2001;158:839–47. 31 Hingorani AD, Casas JP; Interleukin-6 Receptor Mendelian Randomisation Analysis
15 Willcox BJ, He Q, Chen R, et al. Midlife risk factors and healthy survival in men. (IL6R MR) Consortium. The interleukin-6 receptor as a target for prevention of
JAMA 2006;296:2343–50. coronary heart disease: a Mendelian randomisation analysis. Lancet
16 ELSA user guide and documentation. UK Data Archive. http://www.data-archive.ac. 2012;379:1214–24.
uk/findingData/snDescription.asp?sn=5050 (accessed 21 Aug 2008). 32 Dantzer R, O’Connor JC, Freund GG, et al. From inflammation to sickness and
17 Hamer M, Molloy GJ, de Oliveira C, et al. Leisure time physical activity, risk of depression: when the immune system subjugates the brain. Nat Rev Neurosci
depressive symptoms, and inflammatory mediators: the English Longitudinal Study 2008;9:46–56.
of Ageing. Psychoneuroendocrinology 2009;34:1050–5. 33 Rafnsson SB, Deary IJ, Smith FB, et al. Cognitive decline and markers of
18 Wilson RS, Leurgans SE, Boyle PA, et al. Neurodegenerative basis of age-related inflammation and hemostasis: the Edinburgh Artery Study. J Am Geriatr Soc
cognitive decline. Neurology 2010;75:1070–8. 2007;55:700–7.
19 Steffick DE. Documentation of affective functioning measures in the Health and 34 Hamer M, Molloy GJ. Association of C-reactive protein and muscle strength in the
Retirement Study (HRS/AHEAD Documentation. Report DR-005). Ann Arbor, MI: English Longitudinal Study of Ageing. Age (Dordr) 2009;31:171–7.
Survey Research Center, University of Michigan, US. 2000. http://hrsonline.isr.umich. 35 Brinkley TE, Leng X, Miller ME, et al. Chronic inflammation is associated with low
edu/docs/userg/dr-005.pdf physical function in older adults across multiple comorbidities. J Gerontol A Biol Sci
20 Irwin M. Screening for depression in the older adult. Arch Intern Med Med Sci 2009;64:455–61.
1999;159:1701–4. 36 Pierce MB, Zaninotto P, Steel N, et al. Undiagnosed diabetes-data from the English
21 Van de Velde S, Levecque K, Bracke P. Measurement equivalence of the CES-D 8 in longitudinal study of ageing. Diabet Med 2009;26:679–85.
the general population in Belgium: a gender perspective. Arch Public Health 37 Hamer M, Kivimaki M, Steptoe A. Longitudinal patterns in physical activity and
2009;67:15–29. sedentary behaviour from mid-life to early old age: a sub-study of the Whitehall II
22 Katz S, Downs TD, Cash HR, et al. Progress in development of the index of ADL. cohort. J Epidemiol Community Health 2012;66:1110–15.
Gerontologist 1970;10:20–30. 38 Batty GD, Gale CR. Impact of resurvey non-response on the associations between
23 Lawton MP, Brody EM. Assessment of older people: self-maintaining and baseline risk factors and cardiovascular disease mortality: prospective cohort study.
instrumental activities of daily living. Gerontologist 1969;9:179–86. J Epidemiol Community Health 2009;63:952–5.

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