Original article
Physical Activity and the Effect of Multimorbidity on All-Cause Mortality in Older Adults

https://doi.org/10.1016/j.mayocp.2016.12.004Get rights and content

Abstract

Objective

To examine the stratified and joint associations of physical activity (PA) and the number of chronic conditions on long-term all-cause mortality.

Patients and Methods

We used data from a cohort of 3967 individuals representative of the noninstitutionalized population 60 years and older in Spain (2000/2001). Information on self-reported PA (inactive, occasionally, monthly, weekly) and 11 chronic conditions diagnosed by a physician and reported by the study participants were recorded. Associations are summarized using hazard ratios (HRs) and Cox regression, after adjustment for covariates.

Results

At baseline, 43.2%, 37.5%, 14.4%, and 4.9% of participants had 0, 1, 2, and 3 or more chronic conditions, respectively. Mean follow-up was 8.9 years (median, 10.8 years; range, 0.02-11.28 years), with 1483 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, 2, and 3 or more chronic conditions compared with those with none were 1.26 (1.05-1.39), 1.78 (1.51-2.09), and 2.27 (1.79-2.86), respectively. Being physically active (ie, doing any PA) was associated with a mortality reduction (95% CI) of 30% (14%-43%), 33% (18%-45%), 35% (16%-50%), and 47% (18%-66%) in participants with 0, 1, 2, and 3 or more chronic conditions, respectively. Compared with those with 0 chronic conditions who were physically active, participants with 2 (HR=2.63; 95% CI, 2.09-3.31) and 3 or more (HR=3.26; 95% CI, 2.42-4.38) chronic conditions who were physically inactive had the highest mortality risk.

Conclusion

Physical activity is associated with a reduction in increased risk of death associated with multimorbidity (ie, coexistence of ≥2 chronic conditions) in older individuals.

Section snippets

Study Population and Design

We used data from the Universidad Autonoma de Madrid cohort, with a total of 4008 individuals (1739 men), representative of the noninstitutionalized population 60 years and older in Spain. The study methods have been reported in detail elsewhere.9, 10 The baseline cohort was recruited in 2000/2001 using probabilistic sampling by multistage clusters. The clusters were stratified according to region of residence and size of municipality. Census sections were then chosen randomly within each

Results

The baseline characteristics of the study participants are presented in Supplemental Table 1 (available online at http://www.mayoclinicproceedings.org). The proportion of participants with 0, 1, 2, and 3 or more chronic conditions was 43.2% (n=1715), 37.5% (n=1488), 14.4% (n=571), and 4.9% (n=193), respectively. Compared with participants having 0 chronic conditions, those who had 3 or more chronic conditions were older, had lower educational attainment, and were less frequently physically

Discussion

In this nationally representative cohort of older adults, a higher number of chronic diseases was progressively associated with increased mortality; however, being physically active was linked to a 30% to 47% lower risk of death at each level of morbidity. In fact, the effect of PA on mortality was particularly important in individuals with multimorbidity so that physically active individuals with 3 or more chronic diseases had lower mortality risk than those who were physically inactive and

Conclusion

Physical activity is associated with a reduction in increased risk of death associated with multimorbidity (ie, the coexistence of ≥2 chronic conditions) in older individuals. Future research to examine the role of PA in improving health outcomes in aging populations should focus on individuals with specific geriatric syndromes, such as frailty, disability, falls, or incontinence.

References (26)

  • D. Martinez-Gomez et al.

    Nonexercise cardiorespiratory fitness and mortality in older adults

    Med Sci Sports Exerc

    (2015)
  • D. Martínez-Gómez et al.

    Concurrent validity of the historical leisure-time physical activity question of the Spanish National Health Survey in older adults

    Rev Esp Cardiol (Engl Ed)

    (October 24, 2016)
  • P. Guallar-Castillón et al.

    Consumption of alcoholic beverages and subjective health in Spain

    J Epidemiol Community Health

    (2001)
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      Older adults who are physically active have lower rates of morbidity and mortality than older adults with sedentary behaviour.1 Physical activity is associated with 30% lower mortality rates in older adults without chronic diseases and 47% lower mortality rates in older patients with various comorbidities.2 During hospitalisation, sedentary behaviour is common, with inpatients spending long periods resting in bed, regardless of their primary reason for admission.3

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    Grant Support: This work was supported by the Ministry of Health (FIS grant 12/1166, State Secretary of R+D+I and FEDER/FSE), the Ministry of Economy, Industry and Competitiveness (R+D+I grant DEP2013-47786-R), the Ministry of Education (mobility grant JC2015-00080), the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), and the ATHLOS project (European project H2020 [project ID: 635316]).

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