Original Article
Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study

https://doi.org/10.1016/j.jclinepi.2006.09.010Get rights and content

Abstract

Objectives

The aims of the study were to describe the prevalence of physical activity in a sample of older adults in home care in Europe and to examine the relationship between physical activity and incident disability.

Study Design and Setting

Study population consisted of a random sample of 2,005 subjects aged 65 or older admitted to home care programs in 11 European Home Health Agencies who participated in AgeD in HOme Care project. Participants who reported spending 2 or more hours of physical activities in last 3 days were defined physically active. Disability performing activities of daily living was defined as the need of assistance in one or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting.

Results

More than 50% of participants were physically active. During a median follow-up of 12 months, 370 subjects (15%) became disabled. After adjusting for age, gender, and other possible confounding variables, active subjects were significantly less likely to become disabled compared to those reporting no or very low-intensity physical activity (OR, 0.67; 95% CI 0.53–0.84).

Conclusions

These findings support the possibility that physical activity has an independent effect on functional autonomy among frail and old people.

Introduction

Physical activity is directly correlated to improvements in mortality, morbidity, and disability. Exercise capacity and physical activity are associated with lower all-cause mortality and with lower morbidity and mortality rates from cardiovascular diseases [1], [2], [3], [4], [5]. Benefits of physical activity also include reductions in risks of stroke [6], diabetes mellitus [7], cancer [8], and osteoporosis [9].

Physical activity started in late life continues to improve the functional autonomy and to reduce mortality, having a strong effect on longevity, even when controlling for potential adverse risk factors such as smoking, hypertension, family history of hereditary diseases (i.e., cardiovascular diseases, cancer, diabetes), and obesity [10], [11]. However, the relative contribution of low and moderate intensity of habitual physical activities to reduce disability is still unclear. Indeed some authors have demonstrated that only participation in vigorous physical activity and/or high-intensity exercise program is associated with reductions in functional decline [12], [13], [14], whereas others have extended these benefits to low-moderate activities [15], [16], [17]. Nonetheless, these studies almost invariably excluded elderly patients, especially the oldest ones, and greatly underrepresented women. Moreover, these studies have screened out patients with preserved functional status, thereby limiting the generalizability of the findings. Thus, despite the epidemiological relevance of disability among older individuals, there is a paucity of data to elucidate the impact of physical activity of the more “typical” frail older subjects. Although it is well established that exercise activity protects against loss of physical function in adults, few studies have explored the effects of home-based leisure physical activity across a broad spectrum of age. In fact, most of the physical activity intervention studies focused on younger adult population. Furthermore, the best physical activity program for obtaining appropriate health benefits among older people has not yet been identified.

The aims of the study was 1) to describe the prevalence of moderate-intensity physical activity in a large European population of frail and very old people living in community and 2) to examine the relationship between physical activity and incident disability.

Section snippets

Study population

The study population consisted of a random sample of elderly patients admitted to the home care programs in 11 different European Home Health Agencies—from 2001 to 2003—who participated in the AgeD in HOme Care (AdHOC) project, under the sponsorship of the European Union [18]. The AdHOC Project aimed to identify a model of Home Care for the elderly through the analysis of the structural and organizational characteristics of Home Care Services in 11 European countries, along with the clinical

Results

Main characteristics of the study population are shown in Table 1. Patients were Caucasian, predominately female (78%) with a mean age of 82.1 ± 7.0 years. More than 60% of the individuals were aged 80 years or older. Overall, patients had a moderate impairment in cognitive performance; cognitive function was compromised in a small number of patients (less than 20% showed a CPS score more than 2, indicating moderate to severe cognitive impairment). The mean number of diseases was slightly higher

Discussion

The AdHOC study examines the recipients of community care services in 11 European countries, using information collected with the MDS-HC, a comprehensive and standardized geriatric assessment instrument. The AdHOC database is the first available resource to conduct outcome-based research in recipients of standard community care services and to identify the characteristics of recipients that can result in substantial health benefits. Using this innovative database, the present study shows that a

Acknowledgments

This study has been funded by a grant from the Fifth Framework Programme on “Quality of Life and Management of Living Resources” of the European Union.

This large and complex study required very substantial commitment from very many staff within the participating research organizations and health and social care services of each country. It would not have been possible without their collaboration in the face of many frustrations and time-consuming tasks. Their contribution is gratefully

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