Higher physical fitness is associated with lower all-cause mortality
1. Higher objectively measured physical fitness was associated with progressively lower all-cause mortality across multiple fitness domains.
2. Greater balance and agility were associated with the lowest risks, followed by greater lower-body strength and cardiorespiratory fitness.
Evidence Rating Level: 2 (Good)
Study Rundown: Performance-based assessments of cardiorespiratory fitness, muscular strength, balance, and mobility have been previously linked with mortality. However, it is unclear whether these associations remain consistent across multiple fitness domains and in non-Western older populations. This study thus examined the association between objectively measured physical fitness across multiple domains and all-cause mortality in older adults in Taiwan.
This study included adults aged >65 years who completed standardized fitness assessments in Taiwan between January 11, 2015, and November 25, 2016. The four domains of physical fitness assessed were cardiorespiratory fitness, muscular strength, flexibility, and balance and agility. The primary outcome was all-cause mortality through December 31, 2022. Among the 13, 423 participants analyzed, there were 1631 deaths reported. For all individual fitness assessments, participants in the highest performance quintile had lower all-cause mortality. The lowest risk of all-cause mortality was found for balance and agility, measured by the 8-foot up-and-go test and the 1-leg stance test. Similar risks were found between lower-body strength and lower cardiorespiratory. The weakest associations with lower all-cause mortality were found for upper-body strength (30-second arm curl) and flexibility (chair sit-and-reach).
Overall, among a population of older adults in Taiwan, higher objectively measured physical fitness was associated with lower all-cause mortality across multiple fitness domains, with greater balance and agility associated with the lowest risks, followed by greater lower-body strength and cardiorespiratory fitness.
Click to read the study in JAMA Network Open
In-Depth [Cohort study]: This study included adults aged >65 years who completed standardized fitness assessments in Taiwan between January 11, 2015, and November 25, 2016. Participant data were linked to National Health Insurance records, with medical histories retrieved from January 1, 2007, through December 31, 2022. The four domains of physical fitness assessed were cardiorespiratory fitness (2-minute step test), muscular strength (30-second arm curl and chair stand tests), flexibility (back scratch and chair sit-and-reach tests), and balance and agility (1-leg stance and 8-foot up-and-go tests). Each fitness assessment was categorized into quintiles (Q), ranging from Q1 indicating the poorest performance and Q5 indicating the best performance. A composite fitness index was created by summing percentile ranks across all fitness assessments. The primary outcome was all-cause mortality. Analyses were adjusted for sociodemographic factors, lifestyle behaviors, and prevalent comorbidities. Among the 13,423 participants analyzed (mean [SD] age, 72.9 [6.1] years; 8,394 female [62.5%]), there were 1,631 (12.2%) deaths during a median (IQR) follow-up of 7.0 (6.7-7.1) years. For all individual assessments, participants in the highest performance quintile had lower all-cause mortality. The lowest risk of all-cause mortality was found for balance and agility, measured by the 8-foot up-and-go test (Q5 vs Q1: adjusted hazard ratio [AHR], 0.41 [95% CI, 0.33-0.51]) and the 1-leg stance test (AHR, 0.50 [95% CI, 0.42-0.59]). Similar risks were found between lower-body strength (chair stand: AHR, 0.55 [95% CI, 0.46-0.65]) and lower cardiorespiratory fitness (2-minute step test: AHR, 0.58 [95% CI, 0.49-0.68]). The weakest associations with lower all-cause mortality were found for upper-body strength (30-second arm curl: AHR, 0.63 [95% CI, 0.53-0.75]) and flexibility (chair sit-and-reach: AHR, 0.79 [95% CI, 0.67-0.93]). The composite fitness index showed the strongest association, with people in the highest fitness quintile having ~61% lower risk of mortality than those in the lowest quintile (AHR, 0.39 [95% CI, 0.32-0.48]). Mortality risk consistently decreased across fitness quintiles as fitness increased. Overall, among a population of older adults in Taiwan, higher objectively measured physical fitness was associated with progressively lower all-cause mortality across multiple fitness domains. Specifically, greater balance and agility were associated with the lowest risks, followed by greater lower-body strength and cardiorespiratory fitness. These findings suggest that objectively measured physical fitness may provide important prognostic information that can enhance risk stratification in older adults. Some limitations of this study include the observational design that prevents causal inference, presence of residual confounding, lack of longitudinal data changes in physical fitness, and the absence of cause-specific mortality outcomes. Future longitudinal studies should confirm study findings and address these limitations.
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