Dose-Response Relationship of Physical Activity with All-Cause Mortality among Older Adults: An Umbrella Review

Noritoshi Fukushima; Hiroyuki Kikuchi; Hiroki Sato; Hiroyuki Sasai; Kosuke Kiyohara; Susumu S Sawada; Masaki Machida; Shiho Amagasa; Shigeru Inoue

doi:10.1016/j.jamda.2023.09.028

Dose-Response Relationship of Physical Activity with All-Cause Mortality among Older Adults: An Umbrella Review

J Am Med Dir Assoc. 2024 Mar;25(3):417-430. doi: 10.1016/j.jamda.2023.09.028. Epub 2023 Nov 1.

Authors

Noritoshi Fukushima¹, Hiroyuki Kikuchi¹, Hiroki Sato², Hiroyuki Sasai³, Kosuke Kiyohara⁴, Susumu S Sawada⁵, Masaki Machida¹, Shiho Amagasa⁶, Shigeru Inoue⁷

Affiliations

¹ Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan.
² Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
³ Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁴ Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
⁵ Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
⁶ Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan; Graduate School of Public Health, Teikyo University, Tokyo, Japan.
⁷ Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan. Electronic address: inoue@tokyo-med.ac.jp.

PMID: 37925162
DOI: 10.1016/j.jamda.2023.09.028

Abstract

Objectives: To examine the dose-response relationship between physical activity (PA) and all-cause and cardiovascular disease (CVD) mortality, specifically among older adults.

Design: Umbrella review.

Setting and participants: Eligible studies included systematic reviews with meta-analyses that investigated the association of aerobic PA, muscle-strengthening activity, and multicomponent PA, including exercise programs (such as aerobic, muscle strengthening, and balance training), with all-cause and CVD mortality among older adults aged ≥60 years.

Methods: We performed a literature search in PubMed, CINAHL, and the Cochrane Library for eligible studies published between January 2017 and March 2023 to update an umbrella review initially conducted by the United States 2018 PA Guidelines Advisory Committee. Studies included in the 2018 US PA and 2020 World Health Organization (WHO) Guidelines were also reviewed. In addition, meta-analyses that reported effect sizes stratified by age and recruiting older adults (aged ≥60 years) were included.

Results: Overall, 16 relevant systematic reviews (10 from our review and 6 from the US and WHO guidelines) met the inclusion criteria. All these reviews showed that 7.5 to 15.0 metabolic equivalents (METs)-hours/week (around the recommended PA levels outlined in the US and WHO guidelines) substantially reduced mortality risks among older adults (approximately 19%-30% for all-cause mortality and 25%-34% for CVD mortality). Moreover, 15.0 to 22.5 MET-hours/week, exceeding the guideline-recommended PA levels, resulted in greater reductions in mortality risks by 35% to 37% and 38% to 40%, respectively.

Conclusions and implications: PA substantially reduced all-cause and CVD mortality risks among older adults. Larger risk reductions may be achieved by engaging in PA levels higher than those recommended by the current international PA guidelines. Our findings suggest that recommending higher PA levels beyond the current guidelines may benefit older adults when developing future international PA guidelines.

Keywords: Aged; World Health Organization; guidelines; mortality; physical activity.

Publication types

Review

MeSH terms

Aged
Cardiovascular Diseases* / mortality
Exercise*
Humans
Meta-Analysis as Topic
Mortality*
Risk Reduction Behavior
Systematic Reviews as Topic