Higher levels of physical activity is associated with better walking ability and fall-related fitness of older adults during COVID-19 in China

This study analyzed the relationship of physical activity levels with walking ability and fall-related fitness in older adults in the Henan Provence, China. Physical activity levels of 288 older adults were assessed using the short form of the International Physical Activity Questionnaire. The participants were divided into low (LPAG, n = 81), moderate (MPAG, n = 106), and high physical activity groups (HPAG, n = 101). The 10-m walking test (10MWT), 3-m backward walking (3MBW), and Berg Balance Scale (BBS) were used to evaluate walking ability. Thirty seconds Sit to Stand Test (30SST), Time up and Go Test (TUGT), and figure-of-8 walk test (8WT) were evaluated for fall-related fitness. One-way ANOVA was used to detect between group differences, whilst Pearson’s correlation was used to evaluate the relationship between total physical activity level and the measured variables. Logistic regression analyses were used to compute the odds ratios (ORs) of LPAG and MPAG relative to HPAG. There were significant differences between the groups for walking ability, 10MWT (p < 0.01), 3MBW, and BBS (p < 0.01), and also for variables of fall-related fitness, TUGT (p < 0.01), and 8WT (p < 0.01). Total physical activity levels had significant correlations with all variables except 30SST. In the walking ability, OR for 10MWT was 2.42 and 2.53 times for the LPAG compared to that for HPAG by model 1 and model 2. OR for BBS was 3.24 and 3.54 times for the LPAG and 9.31 and 9.65 times for the MPAG compared to for the HPAG by model 1 and model 2. In the fall-related fitness, OR for 8WT was 14.09 and 16.76 times for the LPAG compared to that for HPAG. High levels of physical activity are positively correlated with good walking ability and fall-related fitness. Increasing physical activity levels can reduce the risks associated with impaired walking ability and fall-related fitness.

Physical activity level; Older adults; Walking; Fall; China

[1] National Bureau of Statistics. Annual data. 2020. Available at: http: //www.stats.gov.cn/english/Statisticaldata/AnnualData/(Accessed: 01 August 2022).

[2] Ma GC, Hao CQ, Shang GX. The development and enlightenment of American geriatrics and medical model. Soft Science of Health. 2014; 28: 486–488.

[3] Zhao C, Wong L, Zhu Q, Yang H. Prevalence and correlates of chronic diseases in an elderly population: a community-based survey in Haikou. PLOS ONE. 2018; 13: e0199006.

[4] Zhang J, Chaaban J. The economic cost of physical inactivity in China. Preventive Medicine. 2013; 56: 75–78.

[5] Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine. 2015; 175: 959–967.

[6] World Health Organization. China country assessment report on ageing and health. 2015. Available at: https://apps.who.int/iris/bitstream/handle/10665/194271/9789241509312_eng.pdf (Accessed: 01 August 2022).

[7] Ng SW, Howard AG, Wang HJ, Su C, Zhang B. The physical activity transition among adults in China: 1991–2011. Obesity Reviews. 2014; 15: 27–36.

[8] He J, Gu D, Wu X, Reynolds K, Duan X, Yao C, et al. Major causes of death among men and women in China. New England Journal of Medicine. 2005; 353: 1124–1134.

[9] Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020; 54: 1451–1462.

[10] Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. Gerontologist. 2016; 56: S268–S280.

[11] Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB, et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. Journal of the American Geriatrics Society. 2000; 48: 1618–1625.

[12] Xiao YL, Wang LQ, Zhang SC. Research progress on the influencing factors of fall in elderly patients in neurology. Journal of Cardiac Cerebral Perumal and Vasuclar Disease. 2017; 25: 13–17.

[13] Mahlknecht P, Kiechl S, Bloem BR, Willeit J, Scherfler C, Gasperi A, et al. Prevalence and burden of gait disorders in elderly men and women aged 60–97 years: a population-based study. PLOS ONE. 2013; 24: 8: e69627.

[14] Satoh Y, Yamada T, Shimamura R, Ohmi T. Comparison of foot kinetics and kinematics during gait initiation between young and elderly participants. The Journal of Physical Therapy Science. 2019; 31: 498–503.

[15] Wu T, Zhao Y. Associations between functional fitness and walking speed in older adults. Geriatric Nursing. 2021; 42: 540–543.

[16] Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. Journal of American Medical Association. 2011; 305: 50–58.

[17] Woo J, Ho SC, Yu AL. Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older. Journal of the American Geriatrics Society. 1999; 47: 1257–1260.

[18] Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA. Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist. 2006; 46: 367–376.

[19] Quach L, Galica AM, Jones RN, Procter-Gray E, Manor B, Hannan MT, et al. The Nonlinear relationship between gait speed and falls: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Journal of the American Geriatrics Society. 2011; 59: 1069–1073.

[20] Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. The Journal of Nutrition, Health & Aging. 2009; 13: 881–889.

[21] Gillespie L, Handoll H. Prevention of falls and fall-related injuries in older people. Injury Prevention. 2009; 15: 354–355.

[22] Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT. Effective exercise for the prevention of falls: a systematic review and meta-analysis. Journal of the American Geriatrics Society. 2008; 56: 2234–2243.

[23] Bembom O, van der Laan M, Haight T, Tager I. Leisure-time physical activity and all-cause mortality in an elderly cohort. Epidemiology. 2009; 20: 424–430.

[24] Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial. International Journal of Environmental Research and Public Health. 2020; 17: 3102.

[25] Muir SW, Berg K, Chesworth BM, Klar N, Speechley M. Modifiable risk factors identify people who transition from non-fallers to fallers in community-dwelling older adults: a prospective study. Physiotherapy Canada. 2010; 62: 358–367.

[26] Macfarlane DJ, Lee CC, Ho EY, Chan KL, Chan DT. Reliability and validity of the Chinese version of IPAQ (short, last 7 days). Journal of Science and Medicine in Sport. 2007; 10: 45–51.

[27] Ainsworth BE, Bassett DR Jr, Strath SJ, Swartz AM, O’Brien WL, Thompson RW, et al. Comparison of three methods for measuring the time spent in physical activity. Medicine & Science in Sports & Exercise. 2000; 32: S457–S464.

[28] Guidelines for data processing and analysis of the international physical activity questionnaire (IPAG). 2005. Available at: https://www.physio-pedia.com/images/c/c7/Quidelines_ for_interpreting_the_IPAQ.pdf (Accessed: 01 August 2022).

[29] Tomioka K, Iwamoto J, Saeki K, Okamoto N. Reliability and validity of the international physical activity questionnaire (IPAQ) in elderly adults: the Fujiwara-kyo Study. Journal of Epidemiology. 2011; 21: 459–465.

[30] Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke. 1998; 29: 1122–1128.

[31] Pohl PS, Duncan P, Perera S, Long J, Liu W, Zhou J, et al. Rate of isometric knee extension strength development and walking speed after stroke. Journal of Rehabilitation Research & Development. 2002; 39: 651–657.

[32] Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clinical Rehabilitation. 2001; 15: 415–421.

[33] Rehm-Gelin SL, Light KE, Freund JE. Reliability of timed-functional movements for clinical assessment of frail elderly population. Physical & Occupational Therapy in Geriatrics. 1997: 15: 1–19.

[34] Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Archives of Physical Medicine and Rehabilitation. 1992; 73: 1073–1080.

[35] Downs S. The berg balance scale. Journal of Physiotherapy. 2015; 61: 46.

[36] Ministry of culture, sports, and tourism. Senior fitness promotion exercise guideline. 1st edn. Korea Sports Science Institute: Seoul, Korea. 2012.

[37] Kang SJ, Ahn CH. The effects of home-based stair and normal walking exercises on lower extremity functional ability, fall risk factors, and cardiovascular health risk factors in middle-aged older women. Journal of Exercise Rehabilitation. 2019; 15: 584–591.

[38] Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991; 39: 142–148.

[39] Nightingale CJ, Mitchell SN, Butterfield SA. Validation of the timed up and go test for assessing balance variables in adults aged 65 and older. Journal of Aging and Physical Activity. 2019; 27: 230–233.

[40] Hess RJ, Brach JS, Piva SR, VanSwearingen JM. Walking skill can be assessed in older adults: validity of the figure-of-8 walk test. Physical Therapy. 2010; 90: 89–99.

[41] Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, et al. Association of social frailty with both cognitive and physical deficits among older people. Journal of the American Medical Directors Association. 2017; 18: 603–607.

[42] Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. The Canadian Journal of Public Health. 1992; 83: S7–S11.

[43] Peters TM, Moore SC, Xiang YB, Yang G, Shu XO, Ekelund U, et al. Accelerometer-measured physical activity in Chinese adults. American Journal of Preventive Medicine. 2010; 38: 583–591.

[44] Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. Journal of the American Medical Directors Association. 2013; 14: 392–397.

[45] Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clinical Interventions in Aging. 2014; 9: 433–441.

[46] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Cardiovascular health study collaborative research group. frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A Biological Sciences and Medical Sciences. 2001; 56: M146–M156.

[47] Hoogendijk EO, van Kan GA, Guyonnet S, Vellas B, Cesari M. Components of the frailty phenotype in relation to the frailty index: results from the Toulouse frailty platform. Journal of the American Medical Directors Association. 2015; 16: 855–859.

[48] Sutorius FL, Hoogendijk EO, Prins BA, van Hout HP. Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy. BMC Family Practice. 2016; 17: 102.

[49] Quan M, Xun P, Chen C, Wen J, Wang Y, Wang R, et al. Walking pace and the risk of cognitive decline and dementia in elderly populations: a meta-analysis of prospective cohort studies. The Journals of Gerontology Series A Biological Sciences and Medical Sciences. 2017; 72: 266–270.

[50] Fitzpatrick AL, Buchanan CK, Nahin RL, Dekosky ST, Atkinson HH, Carlson MC, et al. Associations of gait speed and other measures of physical function with cognition in a healthy cohort of elderly persons. The Journals of Gerontology Series A Biological Sciences and Medical Sciences. 2007; 62: 1244–1251.

[51] Perera S, Patel KV, Rosano C, Rubin SM, Satterfield S, Harris T, Ensrud K, et al. Speed predicts incident disability: a pooled analysis. The Journals of Gerontology Series A Biological Sciences and Medical Sciences. 2016; 71: 63–71.

[52] Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. Journal of Aging and Physical Activity. 2015; 23: 314–322.

[53] Fritz S, Lusardi M. White paper: “walking speed: the sixth vital sign”. Journal of Geriatric Physical Therapy. 2009; 32: 46–49.

[54] Logan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A, et al. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. British Medical Journal. 2021; 375: e066991.

[55] Duck AA, Stewart MW, Robinson JC. Physical activity and postural balance in rural community dwelling older adults. Applied Nursing Research. 2019; 48: 1–7.

[56] Kamińska MS, Brodowski J, Karakiewicz B. Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression. International Journal of Environmental Research and Public Health. 2015; 12: 3406–3416.

[57] Toraman A, Yildirim NU. The falling risk and physical fitness in older people. Archive of Gerontology and Geriatrics Research. 2010; 51: 222–226.

[58] Moreira NB, Rodacki ALF, Pereira G, Bento PCB. Does functional capacity, fall risk awareness and physical activity level predict falls in older adults in different age groups? Archive of Gerontology and Geriatrics Research. 2018; 77: 57–63.

[59] Tofthagen C, Visovsky C, Berry DL. Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research. Oncology Nursing Forum. 2012; 39: E416–E424.

[60] Dewolf AH, Meurisse GM, Schepens B, Willems PA. Effect of walking speed on the intersegmental coordination of lower-limb segments in elderly adults. Gait & Posture. 2019; 70: 156–161.

[61] Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010; 21: 658–668.

[62] Jefferis BJ, Iliffe S, Kendrick D, Kerse N, Trost S, Lennon LT, et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC Geriatrics. 2014; 14: 114.

[63] Zhu W, Chi A, Sun Y. Physical activity among older Chinese adults living in urban and rural areas: a review. Journal of Sport and Health Science. 2016; 5: 281–286.