Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology and Population Health

The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study



The purpose of this study was to determine the joint associations of weight status and physical activity with mobility disability in older men and women.


We analyzed prospective data from 135,220 participants in the NIH-AARP Diet and Health Study between 1995–1996 and 2004–2005.


Height and weight, as well as light- and moderate-to-vigorous-intensity physical activity typical of the past 10 years (h/week) were self-reported at baseline, and body mass index (BMI: kg/m2) was categorized into normal weight (BMI 18 to <25 kg/m2); overweight (BMI 25 to <30 kg/m2); and obese (BMI ≥ 30 kg/m2). Mobility was assessed by self-report at follow-up and mobility disability was defined as reporting “unable to walk” or an “easy usual walking pace (<2 mph)”. Multivariable logistic regression determined the independent and joint associations of weight status and total physical activity with the odds of mobility disability.


Twenty-one percent of men and 37% of women reported a mobility disability at follow-up. We observed a curvilinear dose-response association between increasing categories of weight status and mobility disability within each tertile of physical activity, with the highest odds experienced by men and women with overweight (OR = 2.45; 95%CI: 2.25, 2.67 for men and OR = 2.99; 95%CI: 2.78, 3.22 for women) and obesity (OR = 3.93; 95%CI: 3.58, 4.32 for men and OR = 5.08; 95% CI: 4.65, 5.54 for women) in combination with low physical activity. Moreover, among those reporting 7 or fewer hours/week of total physical activity, being of normal body weight did not eliminate the excess odds of mobility disability.


These findings highlight the combined importance of obesity prevention and physical activity promotion to mobility in older age. Given aging demographics and the global economic burden associated with aging- and disuse-related disability, there is tremendous public health benefit to understanding how various modifiable determinants of mobility disability can interact in older age.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3


  1. Courtney-Long EA, Carroll DD, Zhang QC, Stevens AC, Griffin-Blake S, Armour BS, et al. Prevalence of Disability and Disability Type among Adults — United States, MMWR Morb Mortal Wkly Rep. 2013;64:777–83.

  2. National Center for Health Statistics. Health, United States, 2014: with special feature on adults aged 55–64. Hyattsville, MD: National Center for Health Statistics, CDC. 2015. January 2018.

  3. Brault MW. Americans with disabilities: 2010. Washington, DC: Census Bureau. Current population report P70–131. 2010. Accessed January 2018.

  4. Vincent HK, Vincent KR, Lamb KM. Obesity and mobility disability in the older adult. Obes Rev. 2010;11:568–79.

    Article  CAS  Google Scholar 

  5. Rajeski WJ, Marsh AP, Chmelo E, Rejeski JJ. Obesity, intentional weight loss and physical disability in older adults. Obes Rev. 2010;11:671–85.

    Article  Google Scholar 

  6. Marsh AP, Rejeski WJ, Espeland MA, et al. Muscle strength and BMI as predictors of major mobility disability in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P). J Gerontol Med Sci. 2011;66A:1376–83.

    Article  Google Scholar 

  7. Brach JS, VanSwearingen JM, FitzGerald SJ, Sorti KL, Kriska AM. The relationship among physical activity, obesity, and physical function in community-dwelling older women. Prev Med. 2004;39:74–80.

    Article  Google Scholar 

  8. Koster A, Patel KV, Visser M, van Eijk JTM, Kanaya AM, de Rekeneire N, et al. Joint effects of adiposity and physical activity on incident mobility limitations in older adults. J Am Geriatr Soc. 2008;56:636–43.

    Article  Google Scholar 

  9. Bruce B, Fries JF, Hubert H. Regular vigorous physical activity and disability development in healthy overweight and normal weight seniors: a 13-year study. Am J Public Health. 2008;168:284–90.

    Google Scholar 

  10. Kritchevsky SB, Lovato L, Handing EP, Blair S, Botoseneanu A, Guralnik JM, et al. Exercise’s effects on mobility disability in older adults with and without obesity: The LIFE Study Randomized Clinical Trial. Obesity. 2017;25:1199–205.

    Article  Google Scholar 

  11. Stenholm S, Koster A, Valkeinen H, Patel KV, Bandinelli S, Guralnik JM, et al. Association of physical activity history with physical function and mortality in old age. J Gerontol: Med Sci. 2016;71:496–501.

    Article  Google Scholar 

  12. Stenholm S, Ally D, Bandinelli S, Griswold ME, Koskinen S, Rantanen T, et al. The effect of obesity combined with low muscle strength on decline in mobility in older persons: results from the InCHIANTI Study. Int J Obes. 2009;33:635-–44.

    Article  CAS  Google Scholar 

  13. Schatzkin A, Subar AF, Thompson FE, et al. Design and serendipity in establishing a large cohort with wide dietary intake distributions: The National Institutes of Health-American Association of Retired Persons diet and health study. Am J Epidemiol. 2001;154:1119–25.

    Article  CAS  Google Scholar 

  14. Gierach GL, Chang SC, Brinton LA, et al. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2009;124:2139–47.

    Article  CAS  Google Scholar 

  15. Howard RA, Freedman DM, Park Y, et al. Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2008;19:939-–53.

    Article  Google Scholar 

  16. Arem H, Pfeiffer RM, Engels EA, Alfano CM, Hollenbeck A, Park Y, Matthews CE. Pre- and post-diagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health–AARP Diet and Health Study. J Clin Oncol. 2014;33:180-–8.

    Article  Google Scholar 

  17. Wray LA, Blaum CS. Explaining the role of sex on disability: a population-based study. Gerontologist. 2001;41:499-–510.

    Article  CAS  Google Scholar 

  18. Reynolds SL, SaitoY, Crimmons EM. The impact of obesity on active life expectancy in older American men and women. Gerontologist. 2005;45:438–44.

    Article  Google Scholar 

  19. Friedmann JM, Elasy T, Jensen GL. The relationship between body mass index and self-reported functional limitation among older adults: a gender difference. J Am Geriatr Soc. 2001;44:206–16.

    Google Scholar 

  20. Ferraro KF, Booth TL. Age, body mass index, and functional illness. J Gerontol B Psychol Sci Soc Sci. 1999;54:S339-–S348.

    Article  CAS  Google Scholar 

  21. Al Snih S, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med. 2007;167:774–80.

    Article  Google Scholar 

  22. Mendes de Leon CF, Hansberry MR, Bienias JL, Morris MC, Evans DA. Relative weight and mobility: a longitudinal study in a biracial population of older adults. Ann Epidemiol. 2006;16:770–6.

    Article  Google Scholar 

  23. Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc. 1994;42:368-–73.

    Article  CAS  Google Scholar 

  24. Chen H, Guo X. Obesity and functional disability in elderly Americans. J Am Geriatr Soc. 2008;56:689-–94.

    Article  Google Scholar 

  25. Jensen GL, Friedmann JM. Obesity is associated with functional decline in community-dwelling rural older persons. J Am Geriatr Soc. 2002;50:918-–23.

    Article  Google Scholar 

  26. Jensen GL, Silver HJ, Roy MA, Callahan E, Still C, Dupont W. Obesity is a risk factor for reporting homebound status among community-dwelling older persons. Obesity. 2006;14:509-–17.

    Article  Google Scholar 

  27. Zoico E, DiFrancesco V, Mazzali G, Zivelonghi A, Volpato S, Bortolani A, et al. High baseline values of fat mass, independently of appendicular skeletal mass, predict 2-year onset of disability in elderly subjects at the high end of the functional spectrum. Aging Clin Exp Res. 2007;19:154-–9.

    Article  Google Scholar 

  28. Rejeski WJ, Ip EH, Marsh AP, Zhang Q, Miller ME. Obesity influences translational states of disability in older adults with knee pain. Arch Phys Med Rehabil. 2008;89:2102-–7.

    Article  Google Scholar 

  29. Stenholm S, Sainio P, Rantanen T, Koskinen S, Jula A, Heliovaara M, et al. High body mass index and physical impaiments as predictors of walking limitation 22 years later in adult Finns. Int J Obes. 2007;62:859–65.

    Google Scholar 

  30. Fielding RA, Guralnik JM, King AC, Pahor, M, McDermott MM, Tudor-Locke C, et al. Dose of physical activity, physical functioning, and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial. PLoS ONE. 2017;12:e0182155.

    Article  Google Scholar 

  31. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol. 2003;30:167-–78.

    PubMed  Google Scholar 

  32. Kyulo NL1, Knutsen SF, Tonstad S. et al. Validation of recall of body weight over a 26-year period in cohort members of the Adventist Health Study 2. Ann Epidemiol. 2012;22:744–6.

    Article  Google Scholar 

  33. Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000;71:S1-–14.

    Article  CAS  Google Scholar 

  34. McGrae McDermott M, Liu K, Guralnik JM, Martin GJ, Criqui MH, Greenland P. Measurement of walking endurance and walking velocity with questionnaire: validation of the walking impairment questionnaire in men and women with peripheral arterial disease. J Vasc Surg. 1998;28:1072–81.

    Article  Google Scholar 

  35. DiPietro L, Jin Y, Talegawkar S, Matthews CE. The joint associations of sedentary time and physical activity on mobility disability in older people. The NIH-AARP Diet and Health Study. J Gerontol A Biol Sci Med Sci. 2017;73:532–8.

    Article  Google Scholar 

Download references


All persons who contributed significantly to this manuscript have been listed as authors. We are grateful to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. This work was supported, in part, by the Intramural Research Program of the US National Institutes of Health, National Cancer Institute.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Loretta DiPietro.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DiPietro, L., Jin, Y., Talegawkar, S. et al. The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study. Int J Obes 43, 1830–1838 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links