For individual use only. Duplication or distribution prohibited by law.

Physical Activity; Older Adults

Evidence to Support Including Lifestyle LightIntensity Recommendations in Physical Activity Guidelines for Older Adults Paul D. Loprinzi, PhD; Hyo Lee, PhD; Bradley J. Cardinal, PhD Abstract Purpose. The purpose of this study was to examine the association of objectively measured lifestyle light-intensity physical activity (LLPA) and moderate-to-vigorous physical activity (MVPA) with various biological markers and chronic diseases among a nationally representative sample of U.S. older adults (65þ years). Design. A cross-sectional design was used for this study. Setting. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2003–2006. Subjects. Subjects were 1,496 older U.S. adults. Measures. Participants wore an accelerometer for at least 4 days and completed questionnaires to assess sociodemographics and chronic disease information. Blood samples were taken to assess biological markers. Analysis. Adjusted Wald tests and Poisson regression were used to examine the association of LLPA and MVPA with biological markers and chronic disease. Results. Older adults engaging in 300 min/wk of LLPA had lower observed values for body mass index, waist circumference, C-reactive protein, and insulin resistance compared to those engaging in ,300 min/wk of LLPA. Additionally, those engaging in ,300 min/wk of LLPA had a rate 1.18 times greater for having chronic disease compared to those engaging in 300 min/wk of LLPA. Conclusion. In this national sample of older U.S. adults, participation in at least 300 min/ wk of LLPA was associated with more favorable health outcomes. Future experimental studies are warranted to confirm these findings. (Am J Health Promot 2015;29[5]:277–284.) Key Words: Accelerometry, Biomarkers, Chronic Disease, Epidemiology, Exercise, National Health and Nutrition Examination Survey (NHANES). Manuscript format: research; Research purpose: modeling/relationship testing, descriptive; Study design: cross-sectional; Outcome measure: biometric; Setting: national; Health focus: physical activity, weight control; Strategy: education, behavior change; Target population age: seniors; Target population circumstances: education, race/ethnicity

PURPOSE In an effort to improve the health of U.S. adults, the U.S. Department of Health and Human Services recommends that adults of all ages (18þ years) engage in at least 150 minutes of moderate-intensity (3 to 5.9 metabolic equivalents) or 75 minutes of vigorousintensity (6þ metabolic equivalents) physical activity per week (or some combination of the two).1 Relatively few adults achieve this criterion, and the odds of doing so decrease with age. Specifically, older adults are the least active age group, with male and female older adults (aged 70þ years) engaging in 8.7 and 5.4 min/d, respectively, of objectively measured moderate-to-vigorous physical activity (MVPA; expressed as 1-minute bouts).2 Their lowactivity behavior may be a result of concerns regarding whether they are healthy enough to engage in MVPA,3 increased health worry (e.g., anxiety about getting injured from physical activity participation),4 or limited mobility from the aging process,5 among a host of other possibilities (e.g., environmental, motivational, psychosocial barriers).6,7 Age (i.e., .45 years for

Paul D. Loprinzi, PhD, is with the Center for Health Behavior Research, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, Mississippi. Hyo Lee, PhD, is with the Department of Sport and Health Sciences, Sangmyung University, Seoul, Korea. Bradley J. Cardinal, PhD, is with the College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon. Send reprint requests to Paul D. Loprinzi, PhD, Center for Health Behavior Research, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 229 Turner Center, University, MS 38677; [email protected]. This manuscript was submitted July 9, 2013; revisions were requested September 23, 2013; the manuscript was accepted for publication December 10, 2013. Copyright Ó 2015 by American Journal of Health Promotion, Inc. 0890-1171/15/$5.00 þ 0 DOI: 10.4278/ajhp.130709-QUAN-354

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For individual use only. Duplication or distribution prohibited by law. males, .55 years for females) in and of itself is considered a contraindication for MVPA involvement.8 More palatable for older adults may be less intense forms of physical activity, such as lifestyle light-intensity physical activity (between 1.6 and 3 metabolic equivalents).9 Examples of lifestyle light-intensity physical activity include, but are not limited to, casual walking, stretching, light weight training, dancing slowly, leisurely sports (e.g., table tennis), and light yard work/housework. But, little is known about the health benefits of such forms of physical activity. Moreover, the current government guidelines do not include a recommendation for lightintensity physical activity, which may change with emerging research showing its potential beneficial effects among older adults.10 For example, Buman et al.10 showed that lightintensity physical activity was favorably associated with physical health (e.g., general health rating, body mass index [BMI]) and psychological well-being (e.g., stress, life satisfaction). This favorable association, coupled with the knowledge that older adults may be disinclined to engage in MVPA because of perceived risk of injury, suggests the need to further examine the association between light-intensity physical activity and intermediate biological health markers (e.g., insulin resistance) and chronic diseases among older adults. This aligns with phase 1 of the behavioral epidemiology framework, which is used to specify a systematic sequence of studies regarding health-related behaviors (e.g., phase 1: link between physical activity and health; phase 2: physical activity measures; phase 3: determinants of physical activity; phase 4: physical activity interventions; and phase 5: translating physical activity research into practice).11 Specifically, there is a need to establish the link between light-intensity physical activity and older adults’ health. Such research may inform future physical activity guidelines for integrating light-intensity activity recommendations for older adults. Therefore, the purpose of this study was to examine the association between objectively measured lightintensity physical activity (and MVPA) and various biological markers and

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chronic disease among a nationally representative sample of U.S. older adults.

METHODS Design Data were obtained from the 2003– 2006 National Health and Nutrition Examination Survey (NHANES), as presently these are the only NHANES cycles with objectively measured physical activity data. NHANES is an ongoing survey conducted by the Centers for Disease Control and Prevention that uses a representative sample of noninstitutionalized U.S. civilians, selected by a complex, multistage, stratified, clustered probability design. Briefly, participants were interviewed in their homes and then subsequently examined in mobile examination centers by NHANES personnel. NHANES study procedures were approved by the National Center for Health Statistics ethics review board, with informed consent obtained from all participants prior to data collection. Sample In the 2003–2006 NHANES cycles, 2,683 participants were 65 years of age or older. Of these 2,683 participants, 1,987 had complete data on the covariates. Among these, 1,496 participants had sufficient accelerometry data (i.e., 4 days of 10 or more hours of monitoring per day) to represent habitual activity patterns and constituted the analytic sample. When comparing the analytic sample (n ¼ 1,496) to those excluded because of insufficient accelerometry data, the analytic sample was younger (73.4 vs. 74.5 years; p , .001), had a lower cotinine level (30.1 vs. 42.1 ng/mL; p ¼ .04), and had a higher poverty-to-income score (2.7 vs. 2.4; p ¼ .01). Measures Measurement of Physical Activity. While attending the mobile examination center, participants were asked to wear an ActiGraph 7164 accelerometer during all activities except water-based activities and while sleeping. The accelerometer measured the frequency, intensity, and duration of physical activity by generating an activity count proportional to the measured acceler-

ation. The ActiGraph accelerometer has demonstrated evidence of reliability and validity.12 Further details about the mechanics of the ActiGraph 7164 accelerometer can be found elsewhere.13 Estimates for lifestyle light-intensity physical activity were classified as activity counts between 760 and 2020;14 activity counts greater than or equal to 2020 were classified as MVPA intensity;2 moderate and vigorous-intensity physical activity were combined because participants engaged in little vigorous-intensity physical activity (mean: 0.13 min/d: standard error ¼ .04). Estimates of physical activity were summarized in 1-minute bouts. With regard to MVPA, participants were classified as engaging 150 min/ wk or ,150 min/wk of MVPA, which is consistent with current government physical activity guidelines.1 With regard to lifestyle light-intensity physical activity, participants were classified as engaging in an a priori level of 300 min/wk or ,300 min/wk of lifestyle light-intensity physical activity. This 300-minute cut-point for lifestyle lightintensity physical activity was chosen because it is conceptually consistent with and operationally identical to the current physical activity guidelines for MVPA. That is, twice the amount of moderate-intensity physical activity is needed for similar benefits compared to time spent in vigorous-intensity physical activity (i.e., 75 minutes of vigorous intensity or 150 minutes of moderate-intensity physical activity). Notably, very few (n ¼ 4) participants engaged in 75 min/wk of vigorousintensity physical activity; therefore, results were not stratified for vigorous intensity alone. For the analyses described here, and to represent habitual physical activity patterns, only those participants with at least 4 days of 10 or more hours per day of monitoring data were included in the analyses.2 To determine the amount of time the monitor was worn, nonwear was defined by a period of 60 consecutive minutes of zero activity counts, with the allowance of 1 to 2 minutes of activity counts between 0 and 100.2 Measurement of Biological and Health Markers. Of the available NHANES

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For individual use only. Duplication or distribution prohibited by law. data, the following biological and health markers were chosen because they have previously been shown to associate with physical activity: BMI, waist circumference, triceps skinfold, subscapular skinfold, systolic and diastolic blood pressure (average of up to four measurements), C-reactive protein, high-density lipoprotein cholesterol, fasting low-density lipoprotein cholesterol, total cholesterol, fasting triglycerides, fasting glucose, fasting insulin, cotinine (marker of active or passive smoking), homocysteine (marker of endothelial function), and blood glycohemoglobin (HbA1C). Details on the assessment of these variables can be found elsewhere.15,16 The Homeostasis Model Assessment (HOMA) was used to evaluate insulin resistance using the following formula: fasting serum insulin (lU/mL) 3 fasting plasma glucose (mmol/L)/ 22.5.17 Measurement of Covariates. Information about age, gender, and race-ethnicity were obtained from a questionnaire. As a measure of socioeconomic status, poverty-to-income ratio (PIR) was assessed, with a PIR value below 1 considered below the poverty threshold. The PIR is calculated by dividing the family income by the poverty guidelines, which is specific to the family size, year assessed, and state of residence. Serum cotinine was measured as a marker of active smoking status or environmental exposure to tobacco (i.e., passive smoking). Serum cotinine was measured by an isotope dilution–high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometry. BMI was calculated from measured weight and height (i.e., weight in kilograms divided by the square of height in meters). A comorbidity index count variable was created to classify number of comorbidities each participant had.18 The number of comorbidities were based on self-report of the following chronic diseases/ events: arthritis, coronary heart disease, heart attack, congestive heart failure, stroke, cancer, emphysema, and chronic bronchitis. Diabetes, hypertension, and chronic kidney disease were also included as comorbidities, though the presence of these comor-

American Journal of Health Promotion

bidities was not based exclusively on self-report. Diabetes was defined as a previous diagnosis of the disease (excluding gestational diabetes mellitus), taking insulin or other medications to lower blood sugar, a HbA1C of 6.5% or greater, or a fasting glucose level of 126 mg/dL or higher. Hypertension was defined as a measured systolic blood pressure 140 mm Hg, a measured diastolic blood pressure 90 mm Hg, or reported use of blood pressure– lowering medication. Lastly, chronic kidney disease was defined as a glomerular filtration rate of ,60 mL/min per 1.73 m2, which was assessed from the Chronic Kidney Disease Epidemiology equation based on specified race, sex, and creatinine level.19 Participants were considered to have a physical functional disability if they reported special assistance for walking (e.g., cane), had limitations from keeping them from working, or reported having any difficulty in the five functional disability categories (i.e., lower extremity mobility, general physical activity, activities of daily living, instrumental activities of daily living, and leisure and social activities) discussed elsewhere.20 Accelerometer wear time (i.e., number of hours the accelerometer was worn per day) and number of valid accelerometer days (i.e., 4, 5, 6, or 7 days with at least 10 h/ d) were included as covariates, as these parameters can influence activity estimates.21 Analysis All statistical analyses (STATA, version 12.0, College Station, Texas) accounted for the complex survey design used in NHANES by using survey sample weights, clustering, and primary sampling units. Recalculated sample weights for the subsamples with 4 or more days of valid accelerometer data were used to make the selected samples nationally representative. New sample weights were created for the combined NHANES cycles following analytical guidelines for the continuous NHANES.22 Mobile examination center sample weights were used for all analyses with nonfasting variables, whereas fasting sample weights were used for analyses with fasting variables. Means and standard errors were calculated for continuous variables, and

proportions were calculated for categorical variables. Mean values for the biological/ health variables were calculated across the lifestyle light-intensity group (i.e., 300 or ,300 min/wk of lifestyle lightintensity physical activity) and the MVPA group (i.e., 150 or ,150 min/ wk of MVPA). Models were computed separately for lifestyle light-intensity physical activity and MVPA. An adjusted Wald test was used to determine whether differences in the biological/ health variables occurred across the physical activity groups. To examine the association between accelerometerassessed lifestyle light-intensity physical activity, MVPA, and chronic disease, a Poisson regression analysis was employed. The outcome variable (chronic disease) of interest was a comorbidity index. A Poisson model was chosen because the comorbidity index variable was in the form of count data and was positively skewed. Incident rate ratios from the Poisson regression model reflect the rate of events for each variable in the model while holding the other variables in the model constant. The binary lifestyle light-intensity and MVPA variables served as independent variables, with covariates including age, gender, BMI, race-ethnicity, cotinine, PIR, physical functioning, accelerometer wear time, and number of valid accelerometer days. All covariates were entered into the model at the same time because there was no evidence of multicollinearity. Evidence of multicollinearity is likely to exist if there is correlation ..8 between two covariates, if the mean variance inflation factor is .6 or if the highest individual variance inflation factor is .10, or if the tolerance statistic is ,.1. For the present study, the highest correlation between two covariates was .35; the mean variance inflation factor was 1.1; the highest individual variance inflation factor was 1.3; and all individual tolerance statistics were ..7. A p  .05 denoted statistical significance for all analyses.

RESULTS Table 1 displays the weighted characteristics of the analytic sample. Table 2 shows the weighted means for the

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Table 1 Weighted Characteristics of the Analyzed Sample, NHANES 2003–2006 Mean/Proportion (Standard Error) No Comorbidities (n ¼ 102) Demographic/health variables Mean age (y) (n ¼ 1496) % Female (n ¼ 704) Mean BMI (kg/m2) (n ¼ 1496) % Obese (BMI  30 kg/m2) Mean waist circumference (cm) (n ¼ 1465) Mean triceps skinfold (mm) (n ¼ 1385) Mean subscapularis skinfold (mm) (n ¼ 1264) Ethnicity % Non-Hispanic white (n ¼ 967) % Other race (n ¼ 529) Mean comorbidities (n ¼ 1496) Mean poverty-to-income ratio (n ¼ 1496) % Physical function limitations (n ¼ 1496) Biological variables Mean systolic blood pressure (mm Hg) (n ¼ 1496) Mean C-reactive protein (mg/dL) (n ¼ 1496) Mean white blood cells (1000 cells/lL) (n ¼ 1493) Mean neutrophils (1000 cells/lL) (n ¼ 1489) Mean LDL-cholesterol (mg/dL) (n ¼ 679) Mean total cholesterol (mmol/L) (n ¼ 1496) Mean triglycerides (mg/dL) (n ¼ 694) Mean glucose (mg/dL) (n ¼ 694) Mean insulin (lU/mL) (n ¼ 691) Mean insulin resistance (n ¼ 626)* Mean cotinine (ng/mL) (n ¼ 1496) Mean HbA1C (%) (n ¼ 1491) Physical activity Mean accelerometer wear time (h/d) (n ¼ 1496) Mean valid days (d/wk) (n ¼ 1496) Mean lifestyle light-intensity physical activity (min/d) (n ¼ 1496) %  300 min/wk (n ¼ 724) % , 300 min/wk (n ¼ 772) Mean moderate-to-vigorous physical activity (min/d) % 150 min/wk (n ¼ 186) % ,150 min/wk (n ¼ 1310)

1 Comorbidity (n ¼ 1394)

71.6 51.0 26.0 12.5 94.2 17.2 17.6

(70.3–73.0) (36.3–65.7) (24.9–27.1) (4.2–20.8) (91.1–97.3) (14.9–19.5) (16.0–19.2)

74.0 55.8 28.1 30.4 100.4 19.6 19.5

(73.5–74.4) (53.3–58.4) (27.8–28.5) (26.9–33.9) (99.4–101.4) (19.1–20.1) (19.0–20.0)

74.2 25.7 0 2.6 44.7

(62.7–85.7) (14.2–37.2)

84.6 15.3 2.7 2.7 67.6

(80.6–88.5) (11.4–19.3) (2.6–2.9) (2.5–2.9) (65.4–69.8)

122.0 0.29 6.7 4.0 130.4 5.6 105.6 99.5 6.1 1.7 25.4 5.4 14.2 6.5 66.3 69.4 30.5 16.0 24.9 75.0

(2.2–2.9) (32.4–56.9) (119.6–124.3) (0.22–0.36) (6.4–7.1) (3.6–4.3) (117.8–142.9) (5.2–5.9) (92.2–119.1) (95.4–103.6) (4.6–7.6) (1.2–2.1) (10.7–40.1) (5.4–5.5) (13.8–14.5) (6.3–6.7) (55.0–77.6) (57.4–81.4) (18.5–42.5) (11.8–20.1) (11.9–37.8) (62.1–88.0)

137.7 0.43 7.2 4.2 113.9 5.1 157.3 111.3 11.3 3.3 30.0 5.7 13.9 6.3 50.7 47.1 52.8 8.7 12.0 87.9

(136.3–139.1) (0.38–0.48) (7.0–7.4) (4.2–4.3) (109.8–118.0) (5.0–5.2) (147.8–166.8) (108.7–113.9) (10.5–12.2) (3.0–3.6) (23.3–36.7) (5.7–5.8) (13.8–14.0) (6.2–6.4) (46.9–54.5) (42.7–51.5) (48.4–57.2) (7.5–9.9) (9.5–14.6) (85.3–90.4)

NHANES indicates National Health and Nutrition Examination Survey; BMI, body mass index; LDL, low-density lipoprotein; and HbA1C, glycosylated hemoglobin. * Measured using the homeostasis model assessment (HOMA).17

biological/health variables among those participating above and below 150 min/wk of MVPA. Similarly, results are shown for the biological/health variables for those participating above and below 300 min/wk of lifestyle lightintensity physical activity. With regard to lifestyle light-intensity physical activity, participants engaging in 300 min/wk of lifestyle light-intensity physical activity, compared to ,300 min/wk, had more favorable values for BMI, systolic blood pressure, waist circumference, triceps skinfold, C-re-

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active protein, white blood cells, neutrophils, glucose, insulin, insulin resistance, and HbA1C. With regard to MVPA, participants engaging in 150 min/wk of MVPA, compared to ,150 min/wk of MVPA, had more favorable values for BMI, waist circumference, triceps skinfold, subscapular skinfold, white blood cells, neutrophils, insulin, insulin resistance, and HbA1C. Cholesterol and triglycerides were not associated with light-intensity physical activity or MVPA.

The adjusted multivariate Poisson regression analyses showed that only lifestyle light-intensity physical activity was associated with comorbidity index (Table 3). Those engaging in ,300 min/wk of lifestyle light-intensity physical activity, compared to those engaging in 300 min/wk, while holding all other variables constant in the model, are expected to have a rate 1.18 times greater for having chronic disease. In the adjusted model, results for the covariates demonstrated that older age, higher BMI, being a non-

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Table 2 Weighted Mean (95% CI) Biological/Health Variables Across Activity Status, NHANES 2003–2006† Light-Intensity Physical Activity 300 min/wk

Variable 2

Body mass index (kg/m ) Systolic blood pressure (mm Hg) Waist circumference (cm) Triceps skinfold (mm) Subscapular skinfold (mm) C-reactive protein (mg/dL) White blood cells (1000 cells/lL) Neutrophils (1000 cells/lL) Total cholesterol (mmol/L) LDL cholesterol (mg/dL) Triglycerides (mg/dL) Glucose (mg/dL) Insulin (lU/mL) Insulin resistance‡ HbA1C (%)

27.5 134.2 98.8 18.6 19.4 0.32 6.91 4.05 5.22 118.7 147.1 107.3 9.6 2.7 5.65

(27.0–28.1)** (132.1–136.4)*** (97.3–100.3)** (17.7–19.6)** (18.5–20.2) (0.28–0.37)*** (6.66–7.17)** (3.96–4.14)*** (5.12–5.32) (112.9–124.5) (137.8–15634) (103.5–111.1)* (8.3–10.8)** (2.3–3.0)*** (5.59–5.72)***

,300 min/wk 28.5 139.2 101.2 20.2 19.4 0.51 7.49 4.45 5.15 111.5 160.9 113.5 12.3 3.7 5.88

(28.0–28.9) (137.5–140.8) (100.2–102.3) (19.4–21.0) (18.8–19.9) (0.43–0.58) (7.17–7.81) (4.31–4.59) (5.03–5.26) (106.2–116.7) (144.5–177.2) (109.8–117.3) (11.2–13.4) (3.3–4.0) (5.81–5.96)

Moderate-to-Vigorous Physical Activity 150 min/wk 25.9 133.7 94.8 16.9 18.3 0.34 6.47 3.83 5.31 121.3 140.7 108.7 6.5 2.1 5.57

(25.1–26.7)*** (129.9–137.4) (92.4–97.1)*** (15.5–18.4)*** (17.0–19.6)* (0.19–0.49) (6.13–6.81)*** (3.52–4.14)** (5.11–5.50) (111.6–131.7) (113.2–168.3) (101.5–115.9) (5.3–7.6)*** (1.7–2.5)*** (5.49–5.64)***

,150 min/wk 28.3 137.2 100.8 19.8 19.6 0.43 7.32 4.32 5.16 113.8 156.6 111.0 11.7 3.4 5.80

(27.9–28.7) (135.7–138.8) (99.9–101.8) (19.2–20.4) (19.0–20.1) (0.38–0.48) (7.13–7.50) (4.24–4.40) (5.09–5.23) (109.3–118.3) (147.9–165.3) (108.2–113.7) (10.8–12.6) (3.1–3.7) (5.74–5.87)

CI indicates confidence interval; NHANES, National Health and Nutrition Examination Survey; LDL, low-density lipoprotein; and HbA1C, glycosylated hemoglobin. † Bold indicates statistical significance (p  0.05). ‡ Measured using the homeostasis model assessment (HOMA).17 * p , 0.05. ** p , 0.01. *** p , 0.001.

white, lower poverty score, and having functional limitations were all independently associated with having chronic disease.

DISCUSSION The main finding of the present study was that older U.S. adults who engaged in 300 min/wk of lightintensity physical activity compared to those engaging in ,300 min/wk tended to have more favorable biological markers and had fewer chronic diseases. Several health parameters, such as cholesterol and triglycerides, were not associated with physical activity, which is in contrast to other studies23; however, these studies only demonstrated a modest effect. Overall, our encouraging findings, which will require confirmation from experimental studies, suggest that physical activity guidelines and public health messages, particularly for older adults, should be refined to include light-intensity recommendations along with the promotion of MVPA. Presently, the physical activity guidelines do not include a recom-

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mendation for light-intensity physical activity, with adults (of all ages) encouraged to engage in at least 150 min/wk of moderate-intensity physical activity or 75 min/wk of vigorousintensity physical activity, or some combination of the two intensities.1 At present, less than 8% of older adults (i.e., 60 years) achieve this level of physical activity,2 which is likely a result of a variety of factors, possibly including age-induced limitations (e.g., health status, mobility issues, or perceived risk of injury) for engaging in higher intensity physical activity.4 In terms of palatability, nearly half of the sample (48.4%) engaged in more than 300 min/wk of light-intensity physical activity. The traditional exercise prescription focuses on frequency, intensity, and time; however, regularity is also important. Encouraging greater regularity of physical activity by incorporating light-intensity activities may have broad personal and public health implications. Emerging research supports the present findings (i.e., the beneficial effects of light-intensity physical activity). In 2007, and using data from the

Australian Diabetes, Obesity, and Lifestyle (AusDiab) study, Healy et al.24 were the first to demonstrate an inverse association between objectively measured light-intensity physical activity and glucose among adults (mean age: 53.4 years). In 2008 in the AusDiab study,25 they further reported an inverse association between objectively measured light-intensity physical activity and waist circumference and clustered metabolic risk. In 2010, Gando et al.26 showed that light-intensity physical activity was inversely associated with arterial stiffness in older adults. Also in 2010, and in addition to biological markers, light-intensity physical activity was shown to favorably associate with self-rated physical health in older adults.10 In 2011, Camhi et al.27 reported an inverse association between objectively measured lightintensity physical activity and triglycerides, cholesterol, waist circumference, and metabolic syndrome among adults in the general population. In 2011, similar beneficial effects of light-intensity physical activity were reported for middle-age men28 and postmenopausal women.29 In 2013, and in a sample

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Table 3 Multivariable Poisson Regression Association Between Activity Status (Independent Variable) and Comorbidity Index (Dependent Count Variable), NHANES 2003–2006 (n ¼ 1496) Incident Rate Ratio (95% CI) for Comorbidity Index Variable Physical activity Lifestyle light-intensity physical activity ,300 min/wk of LPA vs. 300 min/wk of LPA MVPA ,150 min/wk of MVPA vs. 150 min/wk of MVPA Covariates Age, 1 y older Gender Female vs. male Body mass index, 1 kg/m2 higher Race-ethnicity Other vs. non-Hispanic white Cotinine, 1 ng/mL higher Poverty-to-income ratio, 1 unit higher Physical functioning No limitations vs. some limitations Accelerometer wear time, 1 h higher Valid days 5 days vs. 4 days 6 days vs. 4 days 7 days vs. 4 days

Unadjusted

p

Adjusted*

p

1.35 (1.24–1.47)

,0.001

1.18 (1.09–1.27)

,0.001

1.36 (1.13–1.63)

0.002

1.08 (0.91–1.28)

0.37

1.01 (1.00–1.02)

0.001

1.01 (1.00–1.02)

0.04

1.01 (0.92–1.11) 1.02 (1.01–1.03)

0.81 ,0.001

0.94 (0.87–1.03) 1.01 (1.00–1.02)

0.21 ,0.001

0.88 (0.78–0.99) 0.99 (0.99–1.00) 0.95 (0.92–0.97)

0.04 0.61 0.001

0.89 (0.80–0.99) 0.99 (0.99–1.00) 0.97 (0.94–0.99)

0.04 0.71 0.02

0.69 (0.65–0.74) 0.94 (0.92–0.97)

,0.001 ,0.001

0.79 (0.72–0.87) 0.98 (0.96–1.00)

,0.001 0.23

1.01 (0.81–1.26) 0.87 (0.70–1.07) 0.78 (0.64–0.96)

0.90 0.19 0.02

1.06 (0.87–1.29) 0.96 (0.79–1.17) 0.92 (0.76–1.10)

0.51 0.72 0.37

NHANES indicates National Health and Nutrition Examination Survey; CI, confidence interval; LPA, light-intensity physical activity; and MVPA, moderate-to-vigorous intensity physical activity. * One model was computed, with both lifestyle light-intensity and MVPA included in the model.

of 483 middle-aged Japanese adults, Kim et al.30 showed that objectively measured light-intensity physical activity was inversely associated with the risk of metabolic syndrome. Also in 2013, Gando et al.31 reported that objectively measured light-intensity physical activity was inversely associated with insulin resistance in elderly Japanese women. Additionally, Loprinzi and Pariser32 reported in 2013 that light-intensity physical activity was inversely associated with several biological markers among adults with diabetes. The present findings, coupled with other recent findings, highlight favorable associations between light-intensity physical activity and health, independent of MVPA. In 2012, Manns et al.33 discussed a ‘‘whole-of-day’’ approach to physical activity promotion. This approach, more commonly referred to as ‘‘lifestyle physical activity,’’34 advocates not only for increasing MVPA, but also for increasing lifestyle activity, i.e., the ‘‘nonexercise’’ part of the activity continuum.33 Promotion of light-intensity

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physical activity over higher intensity levels may be more feasible and practical among older populations given age-associated mobility issues with older adults.35 It is encouraging that the present findings demonstrate an association between light-intensity physical activity and various health parameters among a sample where the majority of participants had some physical functioning limitations. Additionally, lightintensity physical activity may be a more attractive intensity level for older adults given the comorbid illnesses (e.g., cardiovascular disease) associated with aging and the possible contraindications of participating in higher intensity levels.36 With the need to promote MVPA and light-intensity physical activity in the older adult population, it is important to make note of the relative aspect of physical activity intensity, particularly among older adults with mobility and morbidity issues. For example, slow walking, typically categorized as a light-intensity activity, may

be considered moderate or greater intensity for someone recently suffering from a stroke or someone with neurological impairment. Further demonstrating the complexity of assessing and promoting physical activity in older adults, some medications (e.g., beta blockers) or devices (e.g., pacemakers) common in older adults may influence perceptions of intensity. Accelerometry is a great method for assessing walking behavior, which is one of the most common physical activity of older adults,37 and it helps to overcome many of the limitations associated with self-report methodology (e.g., recall and social desirability); however, future studies integrating a combined methodological approach (e.g., accelerometry plus ventilation assessment) among older adults are warranted for feasibility and accuracy assessment. Pioneering work by Freedson and her research team is starting to show promise for such a multi-sensor physical activity measurement system.38

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For individual use only. Duplication or distribution prohibited by law. The main limitation of the present study includes the cross-sectional design, which does not allow inferences regarding causation to be rendered; therefore, future experimental and prospective work examining the effects of lifestyle light-intensity physical activity on health outcomes in older adults, in particular, are needed. Despite this, major strengths of the present study include using an objective measure of physical activity, establishing that 300 or more minutes of lifestyle light-intensity physical activity is associated with numerous health outcomes in older adults, and using a national sample of U.S. older adults. In summary, our findings show that older adults who met physical activity guidelines (150 min/wk of MVPA), compared to those not meeting guidelines, had more favorable values for BMI, waist circumference, triceps skinfold, subscapular skinfold, white blood cells, neutrophils, insulin, insulin resistance, and HbA1C. Additionally, adults engaging in 300 min/wk of lightintensity physical activity, compared to those engaging in ,300 min/wk, had

SO WHAT? Implications for Health Promotion Practitioners and Researchers What is already known on this topic? Although mostly shown in the general population, emerging research demonstrates that light-intensity physical activity is associated with positive health outcomes. What does this article add? Lifestyle light-intensity physical activity, specifically 300 min/wk, was associated with more favorable health biomarker levels, including fewer chronic diseases, among older U.S. adults. What are the implications for health promotion practice or research? Our observed association between lifestyle light-intensity physical activity and health, coupled with the fact that older adults engage in very little MVPA, underscores the importance of promoting light-intensity physical activity among older adults. If confirmed by prospective and/or experimental studies, then future physical activity guidelines should include light-intensity recommendations for older adults.

American Journal of Health Promotion

more favorable values for BMI, systolic blood pressure, waist circumference, triceps skinfold, C-reactive protein, white blood cells, neutrophils, glucose, insulin, insulin resistance, and HbA1C, and had fewer chronic diseases. References

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Evidence to support including lifestyle light-intensity recommendations in physical activity guidelines for older adults.

The purpose of this study was to examine the association of objectively measured lifestyle light-intensity physical activity (LLPA) and moderate-to-vi...
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