Active and healthy ageing: the role of physicalactivity and sedentary behaviour

Prof Dr jannique van Uffelen

KU Leuven – University of Leuven

Department of Movement Sciences

Physical Activity, Sports and Health Research Group

Sallis JF et al. Behavioral epidemiology: a systematic framework to classify phases of research on health promotion and disease prevention.

Ann Behav Med. 2000;22(4):294-8.

Setting the scene: behavioural epidemiology

1. Establish links

between behaviour

and health

2. Develop Methods

to measure

behaviour

3. Identify factors

that influence

behaviour

4. Evaluate

interventions

5. Translate into

practice

There are more than 30 supercentenariansin the world

http://www.grg.org/SC/WorldSCRankingsList.html

The oldest – still living - person in the worldwas born in the 19th century

https://en.wikipedia.org/wiki/List_of_the_oldest_living_people

https://en.wikipedia.org/wiki/List_of_the_verified_oldest_people

Healthy ageing

“ The process of developing and maintaining the

functional ability that enables wellbeing in

older age ”

Intrinsic capacity

mental and physical capacities that a person can draw on

Environments

Physical and social environment

WHO. World Report on Ageing and Health. 2015.

WHO. World Report on Ageing and Health.2015.

WHO. Active ageing: a policy framework. 2002

0

5

10

15

20

25

F - Europe M - Europe F - Belgium M - Belgium

Healthy life yrs at age 65 Life expectancy at age 65

https://ec.europa.eu/eurostat/

Being sedentary is the same as not beingphysically active

Definitions

• Physical activity → Bodily movement, produced by the contraction of skeletal muscles, that substantially increases energy expenditure

• Exercise→ Planned structured, repetitive and purposeful, resulting in improvement/maintenance of one or more components of physical fitness

• Sedentary behaviour→ Any waking activity characterized by an energy expenditure ≤ 1.5 metabolic equivalents and a sitting or reclining posture

Caspersen CJ et al. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.

Public Health Rep. 1985;100(2):126-31.

http://www.sedentarybehaviour.org/

Every day activities

Serious exercise!

Lack of PA is in the top five leading mortality risks in the world

WHO. Global health risks - Mortality and burden of disease attributable to selected major risks. 2009.

Disease prevention / risk reduction

↓ all cause + CVD mortality

↓ CVD (incl CAD, stroke)

↓ diabetes

↓ cancer

↓ dementia

↓ risk of falls + related injuries

↓ hypertension

↓ adverse blood lipid profile

↓ weight (re)gain

Psychological

↑ QoL

↑ sleep

↓ anxiety

↓ depression

Functional status

↑ bone health

↑ physical function

↑ cognition

Regular

PA

Social

↑ confidence, mastery, self esteem

↑ social interaction

↑ community engagement

↓ isolation

↓ depressionBauman A et al. Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological

Evidence, Prevalence, and Interventions to Promote "Active Aging". Gerontologist. 2016 Apr;56 :S268-80

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition.

Washington, DC: U.S. Department of Health and Human Services; 2018..

Bangsbo et al. The Copenhagen consensus conference. Physical activity and ageing. Br J Sports Med 2018

Increasing levels of

PA is one of the most

important steps older

adults can take to

improve and maintain

their physical, social

and mental health,

and quality of life.

https://movement-pills.nowwemove.com/

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition.

Washington, DC: U.S. Department of Health and Human Services; 2018.

Aerobic activity

BalanceMuscle

strengthening

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans,

2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

GUIDELINES BELGIUM / adults

www.gezondleven.be/themas/beweging-sedentair-gedrag/bewegingsdriehoek

52,656

72,8

19,216,9

11,7

28,2 27,1

15,5

0

10

20

30

40

50

60

70

80

55-64 yrs 65-74 yrs 75+ yrs

PE

RC

EN

TA

GE

Health Enhancing PA

0

1-149

150+

Majority of older adults do no PA

https://ec.europa.eu/eurostat

Many factors influence behaviour - SEM

Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW. Correlates of physical activity: Why are some people physically active and others not?

Lancet. 2012;380:258-271.

Starting PA at older age does not result in health benefits

• n= 3,454

• Followed for 8 yrs (2002/2003 – 2010/2011)

• 63.7 ± 8.9 years at baseline

• PA = self reported, based on frequency vig, mod, light. • Inactive = no mod/vig on weekly basis• Moderate = at least 1/wk mod• Vigorous = at least 1/wk vig

• Which group had the best health 8 years later?

Hamer M, et al. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. Br J Sports Med 2014;48:239–243

* Adjusted for age, sex, and components of healthy ageing.

Hamer M, et al. Br J Sports Med 2014;48:239–243

1

0,9

0,6

1

0,8

0,7

1

0,7

0,5

1

0,6

0,4

0

0,2

0,4

0,6

0,8

1

1,2

Inactive Moderate activity Vigorous activity

Cognitive impairment

Chronic disease

Depressive symptoms

Physical functionOdds r

atio*

1

2,4

3,4

7,7

0

1

2

3

4

5

6

7

8

9

Remainedinactive

Became inactive Became active Remained active

Od

ds r

atio

*

* Adjusted for age, sex, marital status, wealth, smoking, alcohol intake.

Hamer M, et al. Br J Sports Med 2014;48:239–243

1

2,4

3,4

7,7

0

1

2

3

4

5

6

7

8

9

Remainedinactive

Became inactive Became active Remained active

4.4% 10.2% 12.4% 24.3%

Od

ds r

atio

*

* Adjusted for age, sex, marital status, wealth, smoking, alcohol intake.

Hamer M, et al. Br J Sports Med 2014;48:239–243

Older adults have to meet the PA guidelines for health benefits

• n= 7,646 women, born 1921-1926

• Surveys 2002, 2005, 2008

• 76-81 years at baseline

• PA = self reporte minutes of walking, moderate and vigorous PA in last week

• MET.min/week

• 7 categories

• Dose response association of PA and walking with QoL?

Heesch KC, van Uffelen et al. Dose-response relationships between physical activity, walking and health-related quality of life in mid-age and older

women. Journal of Epidemiology & Community Health. 201:66;670-677.

SF

-36

Ph

ysic

al

co

mp

on

en

tscale

(β

)

Concurrent

Prospective

●: Total PA○: Walking

SF

-36 P

hysic

al

fun

cti

on

ing

(β

)

Concurrent

Prospective

●: Total PA○: Walking

SF

-36 M

en

tal co

mp

on

en

t scale

(β

)

Concurrent

Prospective

●: Total PA○: Walking

SF

-36 V

itali

ty (β

) Concurrent

Prospective

●: Total PA○: Walking

In women in their 80s:

• Strong concurrent relationships→ physical and mental HRQoL

• Moderate-strong prospective relationships → physical HRQoL

• Most HRQoL gain with participation in up to sufficient levels

• Similar benefits for walking as for total leisure time PA

Health is the most important motivator for PA as people age

• People in their 60s • Health related factors more important than social factors• Gender differences:

• Shift towards social factors as people age

• Habit! Enjoyment!

What motivates older people to do PA?

Health Health/looks Social

improving appearance, losing weight spending time with others, meeting

friends

Van Uffelen et al. Gender differences in physical activity motivators and context preferences: a population-based study in people in their sixties.

BMC Public Health. 2017 Jul 4;17(1):624. doi: 10.1186/s12889-017-4540-0

Zubala A et al. Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PLoS One. 2017:

10;12(7):e0180902.

Take home messages

• PA has health benefits up to high age, even at levels below PA guidelines

• Benefits can be obtained from a simple activity like walking

• There is a need for multilevel interventions, targeting personal, interpersonal, environmental and policy factors, to encourage people to remain or become active as they age

• Doing something is better than doing

nothing

• You are never too old to start

• Have fun!

Thank you

KU Leuven

Department of Movement Sciences

Physical Activity, Sports and Health

Research Group

Jannique.vanuffelen@kuleuven.be