Physical capability predicts mortality in late mid-life as well as in old age: Findings from a large British cohort study.
Ontology highlight
ABSTRACT: Introduction
Low physical capability predicts mortality, perhaps by association with co-morbidity. However, few studies include participants <70years old with lower co-morbidity burdens compared to older adults. We examined relationships between usual walking speed (UWS), timed chair stands speed, grip strength, standing balance and all-cause mortality in 8477 participants aged 48-92years enrolled in the European Prospective Investigation of Cancer-Norfolk study.Methods
Participants (55.1% female) were followed up for 6.0 years (inter-quartile range 4.6, 7.5). Associations were examined using Cox proportional hazards regression by age-group (<70years versus ≥70years) and then in the whole cohort adjusted for age, sex, anthropometry, history of diabetes/stroke/myocardial infarction/cancer, smoking, alcohol intake, socioeconomic status, television viewing time and physical activity.Results
Age and sex adjusted associations were similar in younger and older participants (Pinteraction all >0.05) and those with lower physical capability had higher mortality risk. For example, in those <70years old hazard ratios (95% confidence interval) for mortality in the third, second and lowest sex-specific quartiles of UWS compared to the highest were 1.21 (0.75, 1.96), 2.11 (1.35, 3.28) and 2.91 (1.84, 4.62) and in participants ≥70years old were 1.19 (0.73, 1.95), 2.09 (1.35, 3.24) and 2.64 (1.73, 4.02) respectively. In the whole cohort, strong associations between all physical capability tests and mortality persisted after multivariable adjustment and after excluding participants with co-morbidity.Conclusions
Physical capability was independently predictive of future mortality risk with similar associations in late mid-life, when co-morbidity burden is lower, as at older age.
SUBMITTER: Keevil VL
PROVIDER: S-EPMC5701965 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:PurposeTo investigate the associations of time spent sedentary, in moderate-to-vigorous-intensity physical activity (MVPA) and physical activity energy expenditure (PAEE) with physical capability measures at age 60-64 years.MethodsTime spent sedentary and in MVPA and, PAEE were assessed using individually calibrated combined heart rate and movement sensing among 1727 participants from the MRC National Survey of Health and Development in England, Scotland and Wales as part of a detailed clinical assessment undertaken in 2006-2010. Multivariable linear regression models were used to examine the cross-sectional associations between standardised measures of each of these behavioural variables with grip strength, chair rise and timed up-&-go (TUG) speed and standing balance time.ResultsGreater time spent in MVPA was associated with higher levels of physical capability; adjusted mean differences in each capability measure per 1 standard deviation increase in MVPA time were: grip strength (0.477 kg, 95% confidence interval (CI): 0.015 to 0.939), chair rise speed (0.429 stands/min, 95% CI: 0.093 to 0.764), standing balance time (0.028 s, 95% CI: 0.003 to 0.053) and TUG speed (0.019 m/s, 95% CI: 0.011 to 0.026). In contrast, time spent sedentary was associated with lower grip strength (-0.540 kg, 95% CI: -1.013 to -0.066) and TUG speed (-0.011 m/s, 95% CI: -0.019 to -0.004). Associations for PAEE were similar to those for MVPA.ConclusionHigher levels of MVPA and overall physical activity (PAEE) are associated with greater levels of physical capability whereas time spent sedentary is associated with lower levels of capability. Future intervention studies in older adults should focus on both the promotion of physical activity and reduction in time spent sedentary.
| S-EPMC4427100 | biostudies-literature
Project description:ObjectivesTo examine associations between three commonly used objective measures of physical capability assessed at age 53 and a composite score of these measures and all cause mortality; to investigate whether being unable to perform these tests is associated with mortality.DesignCohort study.SettingMRC National Survey of Health and Development in England, Scotland, and Wales.Participants1355 men and 1411 women with data on physical capability at age 53 who were linked to the National Health Service (NHS) central register for death notification.Main outcome measureAll cause mortality between ages 53 (1999) and 66 (2012).ResultsFor each of the three measures of physical capability (grip strength, chair rise speed, and standing balance time) those participants unable to perform the test and those in the lowest performing fifth were found to have higher mortality rates than those in the highest fifth. Adjustment for baseline covariates partially attenuated associations but in fully adjusted models the main associations remained. For example, the fully adjusted hazard ratio of all cause mortality for the lowest compared with the highest fifth of a composite score of physical capability was 3.68 (95% confidence interval 2.03 to 6.68). Those people who could not perform any of the tests had considerably higher rates of death compared with those people able to perform all three tests (8.40, 4.35 to 16.23). When a series of models including different combinations of the measures were compared by using likelihood ratio tests, all three measures of physical capability were found to improve model fit, and a model including all three measures produced the highest estimate of predictive ability (Harrell's C index 0.71, 95% confidence interval 0.65 to 0.77). There was some evidence that standing balance time was more strongly associated with mortality than the other two measures.ConclusionsLower levels of physical capability at age 53 and inability to perform capability tests are associated with higher rates of mortality. Even at this relatively young age these measures identify groups of people who are less likely than others to achieve a long and healthy life.
| S-EPMC4004787 | biostudies-literature
Project description:ObjectivesOur aim was to investigate the association of epigenetic age and physical capability in later life. Having a higher epigenetic than chronological age (known as age acceleration (AA)) has been found to be associated with an increased rate of mortality. Similarly, physical capability has been proposed as a marker of ageing due to its consistent associations with mortality.SettingThe MRC National Survey of Health and Development (NSHD) cohort study.ParticipantsWe used data from 790 women from the NSHD who had DNA methylation data available.DesignEpigenetic age was calculated using buccal cell (n=790) and matched blood tissue (n=152) from 790 female NSHD participants. We investigated the association of AA at age 53 with changes in physical capability in women from ages 53 to 60-64. Regression models of change in each measure of physical capability on AA were conducted. Secondary analysis focused on the relationship between AA and smoking, alcohol, body mass index (BMI) and socioeconomic position.Outcome measuresThree objective measures of physical capability were used: grip strength, standing balance time and chair rise speed.ResultsEpigenetic age was lower than chronological age (mean 53.4) for both blood (50.3) and buccal cells (42.8). AA from blood was associated with a greater decrease in grip strength from ages 53 to 60-64 (0.42 kg decrease per year of AA, 95% CI 0.03, 0.82 kg; p=0.03, n=152), but no associations were observed with standing balance time or chair rise speed. Current smoking and lower BMI were associated with lower epigenetic age from buccal cells.ConclusionsWe found evidence that AA in blood is associated with a greater decrease in grip strength in British females aged between 53 and 60-64, but no association with standing balance time or chair rise speed was found.
| S-EPMC5695310 | biostudies-literature
Project description:Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, -7.4% (95% confidence interval (CI): -12.8, -2.8); chair rise, 2.1% (95% CI: -0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (-5.1%, 95% CI: -8.7, -1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals-for standing balance, as early as childhood.
| S-EPMC3727343 | biostudies-literature
Project description:ObjectiveThe aim of the study was to test the hypothesis that higher childhood cognitive ability is associated with reduced risk of decline in physical capability in late midlife.MethodsParticipants were 1954 men and women from the Medical Research Council National Survey of Health and Development with complete data on cognitive ability at age of 15 years and measures of grip strength and chair rise speed at ages of 53 and 60 to 64 years. Using multinomial logistic regression, associations of childhood cognitive ability with categories of change in grip strength and chair rise speed (i.e., decline, stable high, stable low, reference) were investigated. Adjustments were made for potential confounders from early life and adult mediators including health behaviors, educational level, and cognitive ability at age of 53 years.ResultsHigher childhood cognitive scores were associated with reduced risks of decline in grip strength and chair rise speed, for example, the sex-adjusted relative-risk ratio of decline (versus reference) in grip strength per 1SD increase in childhood cognitive score was 0.82 (95% confidence interval = 0.73-0.92). Higher childhood cognitive scores were also associated with reduced risk of stable low and increased likelihood of stable high chair rise speed.ConclusionsThese findings suggest that childhood cognitive ability may be related to decline in physical capability in late midlife. A number of life course pathways are implicated, including those linking childhood and adult cognitive ability. Future research aiming to identify new opportunities to prevent or minimize age-related declines in physical capability may benefit from considering the potential role of neurodevelopmental as well as neurodegenerative pathways.
| S-EPMC5580377 | biostudies-literature
Project description:PurposeSedentariness has been proposed as an independent risk factor for poor health. However, few studies have considered associations of sedentary time (ST) with physical functional health independent of time spent in moderate-to-vigorous physical activity (MVPA).MethodsCommunity-based men and women (n = 8623, 48-92 yr old) in the European Prospective Investigation of Cancer-Norfolk study attended a health examination for objective measurement of physical capability, including grip strength (Smedley dynamometer (kg)), usual walking speed (UWS (cm·s(-1))), and timed chair stand speed (TCSS (stands per minute)). Of these, 4051 participants wore an accelerometer (GT1M ActiGraph) for 7 d to estimate time spent in MVPA (MVPA, ≥1952 counts per minute) and ST (ST, <100 counts per minute). Relations between physical capability outcomes and both MVPA and ST were explored using linear regression. The mutual independence of associations was also tested, and ST-MVPA interactions were explored using fractional polynomial models to account for nonlinear associations.ResultsMen in the highest compared with those in the lowest sex-specific quartile of MVPA were stronger (1.84 kg; 95% confidence interval (CI), 0.79-2.89), had faster UWS (11.7 cm·s(-1); 95% CI, 8.4-15.1) and faster TCSS (2.35 stands per minute; 95% CI, 1.11-3.59) after multivariable adjustment. Similarly, women in the highest quartile of MVPA were stronger (2.47 kg; 95% CI, 1.79-3.14) and had faster UWS (15.5 cm·s(-1); 95% CI, 12.4-18.6) and faster TCSS (3.27 stands per minute; 95% CI, 2.19-4.25). Associations persisted after further adjustment for ST. Associations between higher ST and lower physical capability were also observed, but these were attenuated after accounting for MVPA. Furthermore, no MVPA-ST interactions were observed (Pinteractions > 0.05).ConclusionsMore time spent in MVPA was associated with higher physical capability, but there were no independent ST associations.
| S-EPMC4762192 | biostudies-literature
Project description:ObjectivesEarly-life adversities (ELAs) such as child maltreatment (neglect and abuse) and socioeconomic disadvantage have been associated with adult mortality. However, evidence is sparse for specific types of ELA. We aimed to establish whether specific ELAs (ie, different types of child maltreatment and socioeconomic disadvantage) were associated independently with all-cause mortality in mid-adulthood and to examine potential intermediary pathways.DesignProspective cohort study.Setting1958 British birth cohort: a longitudinal, population-based sample of individuals born in Great Britain during a single week in March 1958.Participants9310 males and females with data on child maltreatment and mortality (44/45-58 years).Outcome measuresMortality follow-up from 2002/2003 to 2016 when participants were aged 44/45-58 years. Death was ascertained via the NHS Central Register (N=296) or cohort maintenance activities (N=16).ResultsPrevalence of ELAs ranged from 1.6% (sexual abuse) to 11% (psychological abuse). Several, but not all, ELAs were associated with increased risk of premature death, independent of covariates and other adversities; adjusted HRs were 2.64 (95% CI 1.52 to 4.59) for sexual abuse, 1.93 (95% CI 1.45 to 2.58) for socioeconomic disadvantage, 1.73 (95% CI 1.11 to 2.71) for physical abuse and 1.43 (95% CI 1.03 to 1.98) for neglect. After adjustment for covariates and other adversities, no associations with mortality were observed for psychological and witnessing abuse. Regarding potential intermediaries (including adult socioeconomic factors, behaviours, adiposity, mental health and cardiometabolic markers), most associations attenuated after accounting for adult health behaviours (particularly smoking). In addition, early-life socioeconomic disadvantage and neglect associations attenuated after accounting for adult socioeconomic factors. The association for sexual abuse and premature mortality was largely unaffected by potential intermediaries.ConclusionsAssociations with premature mortality varied by type of ELA: associations for sexual and physical abuse, neglect and socioeconomic disadvantage were independent of each other. Different types of ELAs could influence premature mortality via different pathways; this requires further research.
| S-EPMC8461284 | biostudies-literature
Project description:OBJECTIVES:To investigate longitudinal associations between polypharmacy and cognitive and physical capability and to determine whether these associations differ with cumulative exposure to polypharmacy. DESIGN:Prospective birth cohort study. SETTING:England, Scotland, and Wales. PARTICIPANTS:An eligible sample of men and women from the Medical Research Council National Survey of Health and Development with medication data at age 69 (N=2,122, 79%). MEASUREMENTS:Cognitive capability was assessed using a word learning test, visual search speed task, and the Addenbrooke's Cognitive Examination, Third Edition (ACE-III). Physical capability was measured using chair rise speed, standing balance time, walking speed, and grip strength. RESULTS:Polypharmacy (5-8 prescribed medications) was present in 18.2% of participants at age 69 and excessive polypharmacy (?9 prescribed medications) in 4.7%. Both were associated with poorer cognitive and physical capability in models adjusted for sex, education, and disease burden. Stronger associations were found for excessive polypharmacy (e.g., difference in mean ACE-III scores comparing polypharmacy=-2.0, 95% CI=-2.8 to -1.1 and excessive polypharmacy=-2.9, 95% CI=-4.4 to -1.4 with no polypharmacy). Participants with polypharmacy at age 60 to 64 and at age 69 showed stronger Negative associations with cognitive and physical capability were stronger still in participants with polypharmacy at both age 60 to 64 and at age 69 (e.g. difference in mean chair rise speed, comparing polypharmacy with no polypharmacy at both ages=-3.9, 95% CI=-5.2 to -2.6 and at age 60-64 only=-2.5, 95% CI=-4.1 to -0.9). CONCLUSION:Polypharmacy at age 60 to 64 and age 69 was associated with poorer physical and cognitive capability, even after adjusting for disease burden. Stronger negative associations were seen in participants with longstanding polypharmacy, suggesting a cumulative, dose-dependent relationship (where dose is the number of prescribed medications). Future research aiming to improve cognitive and physical capability should consider interventions to reduce the duration and level of polypharmacy at younger ages, in addition to optimizing disease control with appropriate medications.
| S-EPMC6001617 | biostudies-literature
Project description:Introductionobservational studies do not always find positive associations between physical activity and muscle strength despite intervention studies consistently showing that exercise improves strength in older adults. In previous analyses of the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, there was no evidence of an association between leisure time physical activity (LTPA) across adulthood and grip strength at age 53. This study tested the hypothesis that cumulative benefits of LTPA across mid-life on grip strength will have emerged by age 60-64.Methodsdata from the MRC NSHD were used to investigate the associations between LTPA at ages 36, 43, 53 and 60-64 and grip strength at 60-64. Linear regression models were constructed to examine the effect of activity at each age separately and as a cumulative score, including adjustment for potential confounders and testing of life course hypotheses.Resultsthere were complete longitudinal data available for 1,645 participants. There was evidence of a cumulative effect of LTPA across mid-life on grip strength at 60-64. Compared with the third of participants who reported the least LTPA participation across the four time points, those in the top third had on average 2.11 kg (95% CI: 0.88, 3.35) stronger grip after adjustments.Conclusionsincreased levels of LTPA across mid-life were associated with stronger grip at age 60-64, in both men and women. As these associations have emerged since age 53, it suggests that LTPA across adulthood may prevent decline in grip strength in early old age.
| S-EPMC3809720 | biostudies-literature
Project description:BackgroundMarried people have lower rates of mortality and report better physical and mental health at older ages, compared to their unmarried counterparts. However, there is limited evidence on the association between marriage and physical capability, the ability to carry out the tasks of daily living, which is predictive of future mortality and social care use. We investigate the association between marital status and physical capability at mid to later life in England and the United States.MethodsWe examine the association between marriage and physical capability at mid to later life in England and the USA using two performance-based measures of physical capability: grip strength and walking speed. Multiple linear regression was carried out on Wave 4 (2008) of the English Longitudinal Study of Ageing (ELSA) and Waves 8 and 9 (2006 and 2008) of the US Health and Retirement Study (HRS).ResultsIn age adjusted models married men and women had better physical capability than their unmarried counterparts. Much of the marriage advantage was explained by the greater wealth of married people. However, remarried men were found to have stronger grip strength and widowed and never married men had a slower walking speed than men in their first marriage, which was not explained by wealth, demographic and socioeconomic characteristics, health behaviours, chronic disease or depressive symptoms. There were no differences in the association between England and the USA.ConclusionsMarriage may be an important factor in maintaining physical capability in both England and the USA, particularly because of the greater wealth which married people have accrued by the time they reach older ages. The grip strength advantage for remarried men may be due to unobserved selective factors into remarriage.
| S-EPMC6343866 | biostudies-literature