이 논문은 2018년 대한민국 교육부와 한국연구재단의 지원을 받아 수행된 연구임(NRF-2018S1A5A2A03037691).
This review aimed to evaluate the relationship between objectively measured physical activity and sedentary behavior and frailty in community-dwelling older adults.
An electronic search was undertaken using the MEDLINE® databases from January 1st 2010 to December 31st 2019. Titles, abstracts, and full texts of the studies identified by the search were scrutinized by the author to determine eligibility for an inclusion in this review.
The search identified 87 relevant articles resulted, of which eight studies from four cohorts met the inclusion requirements. Almost all the studies reported a significantly negative association between moderate-to-vigorous physical activity (MVPA) and frailty, while only one was a longitudinal study. Significant associations between sedentary time (ST) and higher severity of frailty were observed, however, the findings of associations of sedentary bouts were mixed.
Higher amounts of ST and lower amounts of MVPA were associated with a higher prevalence of frailty or worse frailty levels. Replacing ST with MVPA may offset the detrimental consequences of ST on frailty. More longitudinal studies and quantitative researches are needed to investigate the association of MVPA and ST bouts with frailty.
Population aging is accelerating worldwide, with 962 million people older than 65 years in 2017, and this number is estimated to reach 2 billion people by 2050, which has profound implications for the planning and delivery of health and social care [
Lifestyle is considered one of the main keystones in the development of frailty, and a healthy lifestyle can help older adults to manage frailty [
An electronic search was undertaken using the MEDLINE® databases from 1st January 2010 to 31st December 2019. The search employed the terms ‘frailty’ or ‘frail’ combined with the terms ‘physical activity’ or ‘sedentary behavior’, details were as follows: Physical activity [Title] or Light Physical Activity [Title] or Moderate-Vigorous Physical Activity [Title] or Bouts <10 minutes [Title] or Bouts ≥10 minutes [Title] or Sedentary behavior [Title] or Sedentary time [Title] or Sedentary bout [Title] or Sedentary break [Title], and Frailty [Title] or Frail [Title]. Titles, abstracts, and full texts of the studies identified by the search were scrutinized by the author Chen Si to determine eligibility for inclusion in the present review. Any studies providing or potentially capable of providing cross-sectional or longitudinal data regarding the association between objectively measured PA and SB and frailty in community-dwelling older adults were eligible. Studies including non-English, randomized controlled trial, review, comment, selected samples (subjects with diseases), and subjectively measured PA or SB were excluded. Moreover, when multiple studies used the same cohort, only the study with the largest sample size was included. The following data were extracted from each study: study design, author, cohort name, sample size, age, PA, and SB assessment method, frailty instrument, statistical analysis, adjustment variable, and effect estimate.
The search identified 87 relevant articles (
The characteristics of the eight included studies are summarized in
The NILS-LSA [
This is the first review to determine the associations of objectively measured PA and SB with frailty in community-dwelling older adults. The majority of studies included in this review observed higher amounts of ST and lower amounts of MVPA measured using accelerometer were associated with a higher prevalence of frailty or worse frailty levels, which confirm the findings from two previous reviews [
The authors have no conflicts of interest to declare.
Conceptualization: SC, TC, HP; Formal analysis: SC; Methodology: SC; Project administration: HP, SK; Visualization: HP; Writing - original draft: SC, TC, SK; Writing - review & editing: TC, SK, HP.
Flowchart of studies included in review.
Association of objectively measured physical activity and sedentary behavior with frailty
Reference | Exposure assessment | Frailty instrument | Statistical analysis | Adjustment variables | Effect estimates |
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Physical activity | Sedentary behavior | ||||||
Longitudinal study | |||||||
Yuki et al. (2019), NILS-LSA, n = 401, aged 65-82 years, mean follow-up period 4.2 years | Lifecorder, uniaxial accelerometer (SPA < 1.8, LPA 1.8 -3.0, MVPA ≥ 3.0 METs) | Fried Frailty Phenotype | Generalized estimating equation | Follow-up year, age, sex, body fat, education, smoking status, energy intake, comorbidity, baseline frailty status | LPA (< 40.0 vs ≥ 40.3 min/day); | N/A | |
MVPA (< 7.5 vs ≥ 7.5 min/day) |
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Cross-sectional study | |||||||
Blodgett et al. (2015), NHANES, n = 3,146, 50 years and older | ActiGraph AM-7164s, uniaxial accelerometer (SB<100, LPA 101-2,020, MVPA >2,021 counts/min) | 46 item Frailty Index | Linear regression | Age, sex, wear time, race, marital status, MVPA and ST | MVPA |
ST |
|
Del Pozo-Cruz et al. (2017), TSHA, n = 519, 65 years and older | ActiGraph, ActiTrainer 3X, triaxial accelerometer (SB<100 counts/min) | Frailty Trait Scale | Linear regression | Age, sex, comorbidity status, mental health, polypharmacy status, and wear time | N/A | ST |
|
Kehler et al. (2018), NHANES, n = 2,569, 50 years and older | ActiGraph AM-7164s, uniaxial accelerometer (SB<100, LPA 101-2,020, MVPA >2,021 counts/min) | 46 item Frailty Index | Linear regression | Age, sex, ethnicity, education, annual household income, marital status, smoking status, alcohol consumption, BMI, total sedentary time, accelerometer wear time, bouted MVPA, and ST pattern variables | MVPA in bouts <10 min |
30-min bouts of ST |
|
MVPA in bouts ≥10 min |
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Manas et al. (2018), TSHA, n = 519, 65 years and older | ActiGraph, ActiTrainer 3X, triaxial accelerometer (SB<100, LPA 101-1,951, MVPA >1,952 counts/min) | Frailty Trait Scale | Isotemporal substitution | Age, sex, educational status, polypharmacy status, SPPB, waist-tohip ratio, comorbidity status, and cognitive function | Replacing 30 min of ST with LPA; Replacing 30 min of ST with MVPA |
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Nagai et al. (2018), n = 886, 65 years and older | Actiband, wrist-worn accelerometer (SB<1.5, LPA 1.5-3, MVPA ≥3 METs) | Fried Frailty Phenotype | Isotemporal substitution | Age, sex, and education | Replacing 30 min of ST with LPA |
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Kehler et al. (2019), NHANES, n = 2,317, 50 years and older | ActiGraph AM-7164s, uniaxial accelerometer (SB<100, LPA 101-2,020, MVPA >2,021 counts/min) | 46 item Frailty Index | Linear regression | Age, ethnicity, education, annual household income, marital status, smoking status, alcohol consumption, BMI, total sedentary time, and accelerometer wear time | |||
Manas et al. (2019), TSHA, n = 749, 65 years and older | ActiGraph, ActiTrainer 3X, triaxial accelerometer (SB<100, LPA 101-1,951, MVPA >1,952 counts/min) | Frailty Trait Scale | Linear regression; Johnson-Neyman technique | Age, sex, education, income, marital status, body mass index, MVPA, and accelerometer wear time | 2 7.25 min/day of MVPA can moderate the harmful effects of ST to frailty |
NILS-LSA, National Institute for Longevity Sciences-Longitudinal Study of Aging; SPA, Slight Physical Activity; LPA, Light-intensity Physical Activity; MVPA, Moderate-to-Vigorous-intensity Physical Activity; METs, Metabolic Equivalents; NHANES, National Health and Nutrition Examination Survey; SB, Sedentary Behavior; TSHA, Toledo Study for Healthy Aging; SPPB, Short-Physical Performance Battery.