Article | Published:

Epidemiology and Population Health

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

International Journal of Obesity (2018) | Download Citation

Abstract

Background/Objectives

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.

Subjects/Methods

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

Methods

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.

Results

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.

Conclusions

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.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Additional information

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

References

  1. 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. 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. http://www.cdc.gov/nchs/data/hus/hus14.pdf.Accessed January 2018.

  3. 3.

    Brault MW. Americans with disabilities: 2010. Washington, DC: Census Bureau. Current population report P70–131. 2010. http://www.census.gov/prod/2012pubs/p70-131.pdf. Accessed January 2018.

  4. 4.

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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 17.

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

  18. 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.

  19. 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.

  20. 20.

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

  21. 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.

  22. 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.

  23. 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.

  24. 24.

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

  25. 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.

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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.

  32. 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.

  33. 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.

  34. 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.

  35. 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.

Download references

Acknowledgements

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

Affiliations

  1. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

    • Loretta DiPietro
    • , Yichen Jin
    •  & Sameera Talegawkar
  2. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    • Charles E. Matthews

Authors

  1. Search for Loretta DiPietro in:

  2. Search for Yichen Jin in:

  3. Search for Sameera Talegawkar in:

  4. Search for Charles E. Matthews in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Loretta DiPietro.

Supplementary information

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/s41366-018-0294-8