Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

in Journal of Aging and Physical Activity

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Benjamin T. SchumacherHerbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, CA, USA

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John BellettiereHerbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, CA, USA

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Michael J. LaMonteDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo–SUNY, Buffalo, NY, USA

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Kelly R. EvensonDepartment of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

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Chongzhi DiPublic Health Sciences Division, The Fred Hutchinson Cancer Research Center, Seattle, WA, USA

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I-Min LeeBrigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

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David A. SleetDivision of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA

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Charles B. EatonDepartment of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, RI, USA

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Cora E. LewisDepartment of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA

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Karen L. MargolisHealthPartners Institute for Medical Education, Minneapolis, MN, USA

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Lesley F. TinkerThe Fred Hutchinson Cancer Research Center, Seattle, WA, USA

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Andrea Z. LaCroixHerbert Wertheim School of Public Health and Longevity Science, UC San Diego School of Medicine, San Diego, CA, USA

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Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

Schumacher (btschuma@health.ucsd.edu) is corresponding author.

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  • 2018 Physical Activity Guidelines Advisory Committee. (2018). 2018 Physical Activity Guidelines Advisory Committee scientific report. Washington, DC: U.S. Department of Health and Human Services. https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.pdf

    • Search Google Scholar
    • Export Citation
  • Anderson, G., Cummings, S., Freedman, L., Furberg, C., Henderson, M., Johnson, S., Kuller, L., Manson, J., Oberman, A., Prentice, R., Rossouw, J., Finnegan, L., Hiatt, R., Pottern, L., McGowan, J., Clifford, C., Caan, B., Kipnis, V., Ettinger, B., . . . Clark, A. (1998). Design of the Women’s Health Initiative clinical trial and observational study. Controlled Clinical Trials, 19(1), 61109. https://doi.org/10.1016/S0197-2456(97)00078-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Anderson, G.L., Manson, J., Wallace, R., Lund, B., Hall, D., Davis, S., Shumaker, S., Wang, C.-Y., Stein, E., & Prentice, R.L. (2003). Implementation of the Women’s Health Initiative study design. Annals of Epidemiology, 13, 517. https://doi.org/10.1016/S1047-2797(03)00043-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Araiza, P., Hewes, H., Gashetewa, C., Vella, C.A., & Burge, M.R. (2006). Efficacy of a pedometer-based physical activity program on parameters of diabetes control in type 2 diabetes mellitus. Metabolism, 55(10), 13821387. https://doi.org/10.1016/j.metabol.2006.06.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bellettiere, J., Zhang, Y., Berardi, V., Full, K.M., Kerr, J., LaMonte, M.J., Evenson, K.R., Hovell, M., LaCroix, A.Z., & Di, C. (2019). Parameterizing and validating existing algorithms for identifying out-of-bed time using hip-worn accelerometer data from older women. Physiological Measurement, 40(7), Article 75008. https://doi.org/10.1088/1361-6579/ab1c04

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bergen, G., Stevens, M.R., & Burns, E.R. (2016). Falls and fall injuries among adults aged ≥65 years — United States, 2014. Morbidity and Mortality Weekly Report, 65(37), 993998. https://doi.org/10.15585/mmwr.mm6537a2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Buchner, D.M., Rillamas-Sun, E., Di, C., LaMonte, M.J., Marshall, S.W., Hunt, J., Zhang, Y., Rosenberg, D.E., Lee, I.M., Evenson, K.R., Herring, A.H., Lewis, C.E., Stefanick, M.L., & LaCroix, A.Z. (2017). Accelerometer-measured moderate to vigorous physical activity and incidence rates of falls in older women. Journal of the American Geriatrics Society, 65(11), 24802487. https://doi.org/10.1111/jgs.14960

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Burns, E.R., Stevens, J.A., & Lee, R. (2016). The direct costs of fatal and non-fatal falls among older adults—United States. Journal of Safety Research, 58, 99103. https://doi.org/10.1016/j.jsr.2016.05.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Buuren, S., & Groothuis-Oudshoorn, K. (2011). mice: Multivariate Imputation by Chained Equations in R. Journal of Statistical Software, 45(3), 167. https://www.jstatsoft.org/v45/i03/

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cauley, J.A., Harrison, S.L., Cawthon, P.M., Ensrud, K.E., Danielson, M.E., Orwoll, E., & Mackey, D.C. (2013). Objective measures of physical activity, fractures and falls: The osteoporotic fractures in men study. Journal of the American Geriatrics Society, 61(7), 10801088. https://doi.org/10.1111/jgs.12326

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Centers for Disease Control and Prevention. (2012). Vital signs: Walking among adults—United States, 2005 and 2010. Morbidity and Mortality Weekly Report, 61(31), 595601. https://www.ncbi.nlm.nih.gov/pubmed/22874838

    • Search Google Scholar
    • Export Citation
  • Centers for Disease Control and Prevention. (2013). The state of aging and health in America 2013. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services.

    • Search Google Scholar
    • Export Citation
  • Centers for Disease Control and Prevention. (2020). WISQARS — Web-based injury statistics query and reporting system. National Center for Injury Prevention and Control. https://www.cdc.gov/injury/wisqars/index.html

    • Search Google Scholar
    • Export Citation
  • Chan, B.K., Marshall, L.M., Winters, K.M., Faulkner, K.A., Schwartz, A.V., & Orwoll, E.S. (2007). Incident fall risk and physical activity and physical performance among older men: The osteoporotic fractures in men study. American Journal of Epidemiology, 165(6), 696703. https://doi.org/10.1093/aje/kwk050

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cheng, N., Guo, Z., & Cheng, J. (2021). maczic: Mediation analysis for count and zero-inflated count data (R package version 0.2.0.). https://cran.r-project.org/package=maczic

    • Search Google Scholar
    • Export Citation
  • Choi, L., Liu, Z., Matthews, C.E., & Buchowski, M.S. (2011). Validation of accelerometer wear and nonwear time classification algorithm. Medicine & Science in Sports & Exercise, 43(2), 357364. https://doi.org/10.1249/MSS.0b013e3181ed61a3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Durrleman, S., & Simon, R. (1989). Flexible regression models with cubic splines. Statistics in Medicine, 8(5), 551561. https://doi.org/10.1002/sim.4780080504

    • Crossref
    • Search Google Scholar
    • Export Citation
  • El-Khoury, F., Cassou, B., Charles, M.A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ, 347, Article f6234. https://doi.org/10.1136/bmj.f6234

    • Search Google Scholar
    • Export Citation
  • Evenson, K.R., Wen, F., Herring, A.H., Di, C., LaMonte, M.J., Tinker, L.F., Lee, I.M., Rillamas-Sun, E., LaCroix, A.Z., & Buchner, D.M. (2015). Calibrating physical activity intensity for hip-worn accelerometry in women age 60 to 91years: The Women’s Health initiative OPACH calibration study. Preventive Medicine Reports, 2, 750756. https://doi.org/10.1016/j.pmedr.2015.08.021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Florence, C.S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693698. https://doi.org/10.1111/jgs.15304

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ganz, D.A., & Latham, N.K. (2020). Prevention of falls in community-dwelling older adults. New England Journal of Medicine, 382(8), 734743. https://doi.org/10.1056/NEJMcp1903252

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M., & Lamb, S.E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, Article CD007146. https://doi.org/10.1002/14651858.CD007146.pub3

    • Search Google Scholar
    • Export Citation
  • Giné-Garriga, M., Roqué-Fíguls, M., Coll-Planas, L., Sitjà-Rabert, M., & Salvà, A. (2014). Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 95(4), 753769.e3. https://doi.org/10.1016/j.apmr.2013.11.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Guralnik, J.M., Ferrucci, L., Pieper, C.F., Leveille, S.G., Markides, K.S., Ostir, G.V, Studenski, S., Berkman, L.F., & Wallace, R.B. (2000). Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journals of Gerontology, Series A: Biological Sciences & Medical Sciences, 55(4), M221231. https://doi.org/10.1093/gerona/55.4.m221

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Guralnik, J.M., Simonsick, E.M., Ferrucci, L., Glynn, R.J., Berkman, L.F., Blazer, D.G., Scherr, P.A., & Wallace, R.B. (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology, 49(2), M85M94. https://doi.org/10.1093/geronj/49.2.m85

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hale, W.A., Delaney, M.J., & Cable, T. (1993). Accuracy of patient recall and chart documentation of falls. Journal of the American Board of Family Medicine, 6(3), 239242. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8503294

    • Search Google Scholar
    • Export Citation
  • Hall, K.S., Hyde, E.T., Bassett, D.R., Carlson, S.A., Carnethon, M.R., Ekelund, U., Evenson, K.R., Galuska, D.A., Kraus, W.E., Lee, I.M., Matthews, C.E., Omura, J.D., Paluch, A.E., Thomas, W.I., & Fulton, J.E. (2020). Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 78. https://doi.org/10.1186/s12966-020-00978-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hannan, M.T., Gagnon, M.M., Aneja, J., Jones, R.N., Cupples, L.A., Lipsitz, L.A., Samelson, E.J., Leveille, S.G., & Kiel, D.P. (2010). Optimizing the tracking of falls in studies of older participants: Comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. American Journal of Epidemiology, 171(9), 10311036. https://doi.org/10.1093/aje/kwq024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Heesch, K.C., Byles, J.E., & Brown, W.J. (2008). Prospective association between physical activity and falls in community-dwelling older women. Journal of Epidemiology and Community Health, 62(5), 421426. https://doi.org/10.1136/jech.2007.064147

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Houry, D., Florence, C., Baldwin, G., Stevens, J., & McClure, R. (2016). The CDC Injury Center’s response to the growing public health problem of falls among older adults. American Journal of Lifestyle Medicine, 10(1), 7477. https://doi.org/10.1177/1559827615600137

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Iinattiniemi, S., Jokelainen, J., & Luukinen, H. (2008). Exercise and risk of injurious fall in home-dwelling elderly. International Journal of Circumpolar Health, 67(2–3), 235244. https://doi.org/10.3402/ijch.v67i2-3.18279

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jefferis, B.J., Merom, D., Sartini, C., Wannamethee, S.G., Ash, S., Lennon, L.T., Iliffe, S., Kendrick, D., & Whincup, P.H. (2015). Physical activity and falls in older men: The critical role of mobility limitations. Medicine & Science in Sports & Exercise, 47(10), 21192128. https://doi.org/10.1249/MSS.0000000000000635

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kannus, P., Niemi, S., Parkkari, J., Palvanen, M., & Sievänen, H. (2007). Alarming rise in fall-induced severe head injuries among elderly people. Injury, 38(1), 8183. https://doi.org/10.1016/j.injury.2006.08.027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Keadle, S.K., Shiroma, E.J., Kamada, M., Matthews, C.E., Harris, T.B., & Lee, I.-M. (2017). Reproducibility of accelerometer-assessed physical activity and sedentary time. American Journal of Preventive Medicine, 52(4), 541548. https://doi.org/10.1016/j.amepre.2016.11.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Klenk, J., Kerse, N., Rapp, K., Nikolaus, T., Becker, C., Rothenbacher, D., Peter, R., Denkinger, M.D., & ActiFE Study Group. (2015). Physical activity and different concepts of fall risk estimation in older people—Results of the ActiFE-Ulm study. PLoS One, 10(6), Article e0129098. https://doi.org/10.1371/journal.pone.0129098

    • Crossref
    • Search Google Scholar
    • Export Citation
  • LaCroix, A.Z., Rillamas-Sun, E., Buchner, D., Evenson, K.R., Di, C., Lee, I.M., Marshall, S., LaMonte, M.J., Hunt, J., Tinker, L.F., Stefanick, M., Lewis, C.E., Bellettiere, J., & Herring, A.H. (2017). The objective physical activity and cardiovascular disease health in older women (OPACH) study. BMC Public Health, 17(1), 192. https://doi.org/10.1186/s12889-017-4065-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lawton, B.A., Rose, S.B., Elley, C.R., Dowell, A.C., Fenton, A., & Moyes, S.A. (2008). Exercise on prescription for women aged 40-74 recruited through primary care: Two year randomised controlled trial. BMJ, 337, Article a2509. https://doi.org/10.1136/bmj.a2509

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lee, I.M., Shiroma, E.J., Kamada, M., Bassett, D.R., Matthews, C.E., & Buring, J.E. (2019). Association of step volume and intensity with all-cause mortality in older women. JAMA, 179(8), 11051112. https://doi.org/10.1001/jamainternmed.2019.0899

    • Search Google Scholar
    • Export Citation
  • Medical Advisory Secretariat. (2008). Prevention of falls and fall-related injuries in community-dwelling seniors: An evidence-based analysis. Ontario Health Technology Assessment Series, 8(2), 178. https://www.ncbi.nlm.nih.gov/pubmed/23074507

    • Search Google Scholar
    • Export Citation
  • Murtagh, E.M., Murphy, M.H., & Boone-Heinonen, J. (2010). Walking: The first steps in cardiovascular disease prevention. Current Opinion in Cardiology, 25(5), 490496. https://doi.org/10.1097/HCO.0b013e32833ce972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Peel, N.M., McClure, R.J., & Hendrikz, J.K. (2006). Health-protective behaviours and risk of fall-related hip fractures: A population-based case-control study. Age and Ageing, 35(5), 491497. https://doi.org/10.1093/ageing/afl056

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Richardson, C.R., Newton, T.L., Abraham, J.J., Sen, A., Jimbo, M., & Swartz, A.M. (2008). A meta-analysis of pedometer-based walking interventions and weight loss. Annals of Family Medicine, 6(1), 6977. https://doi.org/10.1370/afm.761

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rillamas-Sun, E., Buchner, D.M., Di, C., Evenson, K.R., & LaCroix, A.Z. (2015). Development and application of an automated algorithm to identify a window of consecutive days of accelerometer wear for large-scale studies. BMC Research Notes, 8, 270. https://doi.org/10.1186/s13104-015-1229-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rillamas-Sun, E., LaCroix, A.Z., Bell, C.L., Ryckman, K., Ockene, J.K., & Wallace, R.B. (2016). The impact of multimorbidity and coronary disease comorbidity on physical function in women aged 80 years and older: The women’s health initiative. The Journals of Gerontology, Series A: Biological Sciences & Medical Sciences, 71(Suppl. 1), S5461. https://doi.org/10.1093/gerona/glv059

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Saint-Maurice, P.F., Sampson, J.N., Keadle, S.K., Willis, E.A., Troiano, R.P., & Matthews, C.E. (2020). Reproducibility of accelerometer and posture-derived measures of physical activity. Medicine & Science in Sports & Exercise, 52(4), 876. https://journals.lww.com/acsm-msse/Fulltext/2020/04000/Reproducibility_of_Accelerometer_and.13.aspx

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sherrington, C., Michaleff, Z.A., Fairhall, N., Paul, S.S., Tiedemann, A., Whitney, J., Cumming, R.G., Herbert, R.D., Close, J.C.T., & Lord, S.R. (2017). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 17501758. https://doi.org/10.1136/bjsports-2016-096547

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tudor-Locke, C., Craig, C.L., Aoyagi, Y., Bell, R.C., Croteau, K.A., De Bourdeaudhuij, I., Ewald, B., Gardner, A.W., Hatano, Y., Lutes, L.D., Matsudo, S.M., Ramirez-Marrero, F.A., Rogers, L.Q., Rowe, D.A., Schmidt, M.D., Tully, M.A., & Blair, S.N. (2011). How many steps/day are enough? For older adults and special populations. International Journal of Behavioral Nutrition and Physical Activity, 8, 80. https://doi.org/10.1186/1479-5868-8-80

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Veronese, N., Bolzetta, F., Toffanello, E.D., Zambon, S., De Rui, M., Perissinotto, E., Coin, A., Corti, M.C., Baggio, G., Crepaldi, G., Sergi, G., & Manzato, E. (2014). Association between short physical performance battery and falls in older people: The Progetto Veneto Anziani study. Rejuvenation Research, 17(3), 276284. https://doi.org/10.1089/rej.2013.1491

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wert, D.M., Talkowski, J.B., Brach, J., & VanSwearingen, J. (2010). Characteristics of walking, activity, fear of falling, and falls in community-dwelling older adults by residence. Journal of Geriatric Physical Therapy, 33(1), 4145. https://www.ncbi.nlm.nih.gov/pubmed/20503733

    • Search Google Scholar
    • Export Citation
  • Willett, W., & Stampfer, M.J. (1986). Total energy intake: Implications for epidemiologic analyses. American Journal of Epidemiology, 124(1), 1727. https://doi.org/10.1093/oxfordjournals.aje.a114366

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zhao, R., Feng, F., & Wang, X. (2017). Exercise interventions and prevention of fall-related fractures in older people: A meta-analysis of randomized controlled trials. International Journal of Epidemiology, 46(1), 149161. https://doi.org/10.1093/ije/dyw142

    • Search Google Scholar
    • Export Citation
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