Critique date: Wed, 02/04/2004 - 3:34pm
Article Citation
Citation:
Brach J, FitzGerald S, Newman A et al . Physical Activity and Functional Status in Community-Dwelling Older Women: A 14-Year Prospective Study. Arch Intern Med. 2003;163:2565-2571.
Clinical Bottom Lines
Over 14 years, women who were not physically active (> 1000 kcal/wk) had more ADL impairment, slower gait speed and poorer physical performance test scores than those who were either constantly or even inconsistently active, even after omitting those women whose physical activity was limited by health.
The more consistent the physical activity (measured twice, 10 years apart), the better the function.
After adjusting for age, chronic conditions, and activity limited by health, physical activity measures from 1985 predicted gait speed in 1999.
Methods
Patient Population:
14-year prospective follow-up of women who had participated in an RCT of a walking intervention on measures of bone in postmenopausal women from 1982-1985.
229 community-dwelling females (current mean age 74.2; 81.3% satisfied with health; 22.9% with ADL difficulty; 45.8% with either IADL or ADL difficulty).
Significant Exclusions:
HRT, physical limitations that would prevent walking, less than one year post-menopausal, younger than 50 years or older than 65 years in 1982.
Intervention/Exposure:
1)Women were divided into more or less active groups using 2 methods. By physical activity report, more active were those who did 30 minutes of moderate physical activity on most days of the week. By LSI counts, more active were those above the median. 2) Consistency of physical activity was classified as never active (<1000 kcal/wk in 1985 and 1995), always active (>1000 kcal/wk in 1985 and 1995) and inconsistently active (1000 kcal/wk in either 1985 or 1995, but not in the other year).
Outcome Measures:
Self-report and performance-based measures of physical activity (1985, 1995, and 1999) and functional status in 1999. Physical activity was reported using a modified version of the Paffenbarger questionnaire. Physical activity was measured using the large-scale integrated (LSI) monitor (1985) and a pedometer (Yamax Digi Walker) in 1999. Functional status was measured using the Functional Status Questionnaire (FSQ) to determine if there were any difficulty with the basic or instrumental ADLs, the 7-item Physical Performance Test (PPT) and measurement of gait speed using an instrumental walkway.
Participant Follow-up:
82% for self-report or questionnaire data; 75% for performance-based data.
Conclusion
Results:
Measures of physical activity in 1985 independently predicted gait speed in 1999, after controlling for age, chronic conditions, and activity limited by health
Women who remained consistently active over a ten-year period had a better functional status than did those who were relatively inactive or inconsistently active.
Function of the 171 participants with complete data from both 1985 and 1995
Â
N (%)
ADL impairment+ *
Gait speed**
Physical Performance Test Score ***
Always active
45 (26.3%)
17 (37.8%)
1.17 m/s
24.9
Inconsistently active
60 (35.1%)
24 (40%)
1.15 m/s
24.5
Always inactive
66 (38.6%)
39 (59.1%)
1.03Â m/s
23.8
+ impairment in any ADL or IADL * P=0.02;** P=0.002;*** P=0.04
Concerns Regarding Methodology, Applicability to Older Adults, etc.:
This is the first study to assess functional status as it relates to physical activity over an extended period of time. Because functional status was not specifically measured at the end of the original RCT in 1985, an exact comparison to the functional status in 1999 cannot be performed. However, the investigators did control for possible confounding factors such as age, chronic conditions, and activities limited by health in the final analysis. Importantly, the women were relatively homogeneous- healthy, upper socioeconomic, white, with physical functioning better than 90% of community-dwelling older adults at baseline. Additional studies are needed to assess the effects in a more diverse group of people.
The large loss to follow-up was primarily due to death (20) and illness (8).
Funding Source and Role:
National Institute on Aging, National Institutes of Health, Foundation for Physical Therapy, Geriatrics Section of the American Physical Therapy Association
Created By:
Audrey Chun, MD, Mount Sinai School of Medicine
This is a review of the validity of a single study; the ‘bottom lines’ do not reflect comparison with the rest of the literature on this subject.