Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries

Click name to view affiliation

Lee Smith Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom

Search for other papers by Lee Smith in
Current site
Google Scholar
PubMed
Close
,
Dong Keon Yon Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine,Seoul, South Korea
Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

Search for other papers by Dong Keon Yon in
Current site
Google Scholar
PubMed
Close
,
Laurie Butler Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom

Search for other papers by Laurie Butler in
Current site
Google Scholar
PubMed
Close
,
Karel Kostev University Clinic of Marburg, Marburg, Germany

Search for other papers by Karel Kostev in
Current site
Google Scholar
PubMed
Close
,
Carol Brayne Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom

Search for other papers by Carol Brayne in
Current site
Google Scholar
PubMed
Close
,
Yvonne Barnett Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom

Search for other papers by Yvonne Barnett in
Current site
Google Scholar
PubMed
Close
,
Benjamin R. Underwood Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom

Search for other papers by Benjamin R. Underwood in
Current site
Google Scholar
PubMed
Close
,
Jae Il Shin Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea

Search for other papers by Jae Il Shin in
Current site
Google Scholar
PubMed
Close
,
Masoud Rahmati Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran

Search for other papers by Masoud Rahmati in
Current site
Google Scholar
PubMed
Close
,
Sharon A.S. Neufeld Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

Search for other papers by Sharon A.S. Neufeld in
Current site
Google Scholar
PubMed
Close
,
Anya Ragnhildstveit Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

Search for other papers by Anya Ragnhildstveit in
Current site
Google Scholar
PubMed
Close
,
Guillermo F. López Sánchez Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain

Search for other papers by Guillermo F. López Sánchez in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-9897-5273 *
, and
Ai Koyanagi Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain

Search for other papers by Ai Koyanagi in
Current site
Google Scholar
PubMed
Close
Restricted access

Background: There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown. Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations. Results: Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%). Conclusions: Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

López Sánchez (gfls@um.es) is corresponding author, https://orcid.org/0000-0002-9897-5273

Supplementary Materials

    • Supplementary Material (PDF 639 KB)
  • Collapse
  • Expand
  • 1.

    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126131. PubMed ID: 3920711

    • Search Google Scholar
    • Export Citation
  • 2.

    Yerrakalva D, Hajna S, Suhrcke M, et al. Associations between change in physical activity and sedentary time and health-related quality of life in older English adults: The EPIC-Norfolk cohort study. Health Qual Life Outcomes. 2023;21(1):7. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Musich S, Wang SS, Schaeffer JA, Kraemer S, Wicker E, Yeh CS. The association of physical activity with loneliness, social isolation, and selected psychological protective factors among older adults. Geriatr Nurs. 2022;47:8794. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Jofré-Saldía E, Villalobos-Gorigoitía Á, Giakoni-Ramirez F, Astie S, Gea-García G. El entrenamiento multicomponente en fases progresivas mejora la funcionalidad y calidad de vida en un grupo de mujeres mayores chilenas. Sport TK-Revista Euroam Ciencias del Deport. 2023;12:2.

    • Search Google Scholar
    • Export Citation
  • 5.

    Hoti F. Impact of physical activity on longevity: a review of the literature. Atena J Public Heal. 2021;3:4.

  • 6.

    Kushkestani M, Parvani M, Ghafari M, Avazpoor Z. The role of exercise and physical activity on aging-related diseases and geriatric syndromes. Sport TK-Revista Euroam Ciencias del Deport. 2022;11:401. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020. https://www.who.int/publications/i/item/9789240015128

    • Search Google Scholar
    • Export Citation
  • 8.

    World Health Organization. Physical activity. 2022. https://www.who.int/news-room/fact-sheets/detail/physical-activity

  • 9.

    Smith L, Gardner B, Fisher A, Hamer M. Patterns and correlates of physical activity behaviour over 10 years in older adults: prospective analyses from the English Longitudinal Study of Ageing. BMJ Open. 2015;5(4):423. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    World Health Organization. Multimorbidity. 2016. https://apps.who.int/iris/bitstream/handle/10665/252275/9789241511650-eng.pdf

  • 11.

    Asogwa OA, Boateng D, Marzà-Florensa A, et al. Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2022;12(1):e049133. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Delpino FM, de Lima APM, da Silva BGC, Nunes BP, Caputo EL, Bielemann RM. Physical activity and multimorbidity among community-dwelling older adults: a systematic review with meta-analysis. Am J Health Promot. 2022;36(8):13711385. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Smith L, Shin J Il, Jacob L, et al. Association between physical multimorbidity and sleep problems in 46 low-and middle-income countries. Maturitas. 2022;160:2331. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Kline CE. The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2014;8(6):375379. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Kowal P, Chatterji S, Naidoo N, et al. Data resource profile: The World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012;41(6):16391649. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Freeman EE, Roy-Gagnon MH, Samson E, et al. The global burden of visual difficulty in low, middle, and high income countries. PLoS One. 2013;8(5):e63315. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Arokiasamy P, Kowal P, Capistrant BD, et al. Chronic noncommunicable diseases in 6 low-and middle-income countries: findings from wave 1 of the World Health Organization’s study on global Ageing and adult health (SAGE). Am J Epidemiol. 2017;185(6):414428. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Garin N, Koyanagi A, Chatterji S, et al. Global multimorbidity patterns: a cross-sectional, population-based, multi-country study. Journals Gerontol Ser A Biomed Sci Med Sci. 2016;71(2):205214. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27(6):645.

  • 20.

    Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009;6(6):790804. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    World Health Organization. Global recommendations on physical activity for health. 2010. https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

    • Search Google Scholar
    • Export Citation
  • 22.

    Calderón‐Larrañaga A, Vetrano DL, Ferrucci L, et al. Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways. J Intern Med. 2019;285(3):255271. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Vassilaki M, Aakre JA, Cha RH, et al. Multimorbidity and risk of mild cognitive impairment. J Am Geriatr Soc. 2015;63(9):17831790. doi:

  • 24.

    Buracchio T, Dodge HH, Howieson D, Wasserman D, Kaye J. The trajectory of gait speed preceding mild cognitive impairment. Arch Neurol. 2010;67(8):980986. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Smith L, Shin J, Butler L, et al. Physical multimorbidity and depression: a mediation analysis of influential factors among 34,129 adults aged ≥50 years from low‐ and middle‐income countries. Depress Anxiety. 2022;39(5):376386. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Elfving B, Andersson T, Grooten WJ. Low levels of physical activity in back pain patients are associated with high levels of fear‐avoidance beliefs and pain catastrophizing. Physiother Res Int. 2007;12(1):1424. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Stubbs B, Vancampfort D, Firth J, et al. Relationship between sedentary behavior and depression: a mediation analysis of influential factors across the lifespan among 42,469 people in low-and middle-income countries. J Affect Disord. 2018;229:231238. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Koyanagi A, Moneta MV, Garin N, et al. The association between obesity and severe disability among adults aged 50 or over in nine high-income, middle-income and low-income countries: a cross-sectional study. BMJ Open. 2015;5(4):e007313. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Ma R, Romano E, Vancampfort D, Firth J, Stubbs B, Koyanagi A. Physical Multimorbidity and social participation in adult aged 65 years and older from six low-and middle-income countries. Journals Gerontol Ser B. 2021;76(7):14521462. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Vancampfort D, Koyanagi A, Ward PB, et al. Chronic physical conditions, multimorbidity and physical activity across 46 low-and middle-income countries. Int J Behav Nutr Phys Act. 2017;14:113.

    • Search Google Scholar
    • Export Citation
  • 31.

    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557560. doi:

  • 32.

    Karlson KB, Holm A, Breen R. Comparing regression coefficients between same-sample nested models using logit and probit: a new method. Sociol Methodol. 2012;42(1):286313. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Koyanagi A, Lara E, Stubbs B, et al. Chronic physical conditions, multimorbidity, and mild cognitive impairment in low‐and middle‐income countries. J Am Geriatr Soc. 2018;66(4):721727. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Koyanagi A, Garin N, Olaya B, et al. Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study. PLoS One. 2014;9(12):e114742. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Shin KC. Physical activity in chronic obstructive pulmonary disease: clinical impact and risk factors. Korean J Intern Med. 2018;33(1):75. doi:

  • 36.

    Smith L, Timmis MA, Pardhan S, Latham K, Johnstone J, Hamer M. Physical inactivity in relation to self-rated eyesight: cross-sectional analysis from the English longitudinal study of ageing. BMJ open Ophthalmol. 2017;1(1):46. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Hutton B, Feine J, Morais J. Is there an association between edentulism and nutritional state? J-Can Dent Assoc. 2002;68(3):182187.

  • 38.

    Kramer CS, Groenendijk I, Beers S, Wijnen HH, Van de Rest O, De Groot LC. The association between malnutrition and physical performance in older adults: a systematic review and meta-analysis of observational studies. Curr Dev Nutr. 2022;6(4):nzac007. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Fini NA, Bernhardt J, Said CM, Billinger SA. How to address physical activity participation after stroke in research and clinical practice. Stroke. 2021;52(6):e274e277. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Trott M, Smith L. What are the associations between extroversion, enjoyment, and wellness in group vs non-group physical activity? A pilot study. Atena J Sport Sci. 2019;1:3.

    • Search Google Scholar
    • Export Citation
  • 41.

    Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skou ST. Benefits and harms of exercise therapy in people with multimorbidity: a systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev. 2020;63:101166. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Salmoirago‐Blotcher E, Wayne PM, Dunsiger S, et al. Tai chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc. 2017;6(10):e006603. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Brenes GA, Sohl S, Wells RE, Befus D, Campos CL, Danhauer SC. The effects of yoga on patients with mild cognitive impairment and dementia: a scoping review. Am J Geriatr Psychiatry. 2019;27(2):188197. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Groessl EJ, Maiya M, Schmalzl L, Wing D, Jeste DV. Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial. BMC Geriatr. 2018;18(1):988. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Bridges L, Sharma M. The efficacy of yoga as a form of treatment for depression. J Evid Based Complementary Altern Med. 2017;22(4):10171028. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Schmid AA, Fruhauf CA, Sharp JL, Van Puymbroeck M, Bair MJ, Portz JD. Yoga for people with chronic pain in a community-based setting: a feasibility and pilot RCT. J Evid-Based Integr Med. 2019;24:763. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1246 1246 172
Full Text Views 48 48 4
PDF Downloads 64 64 6