Elsevier

Preventive Medicine

Volume 112, July 2018, Pages 23-30
Preventive Medicine

Association between exercise type and the decline in instrumental activities of daily living in community-dwelling older women: A 4-year prospective study

https://doi.org/10.1016/j.ypmed.2018.03.019Get rights and content

Highlights

  • Exercise was associated with a delay in IADL decline.

  • Especially, calisthenics was associated with a delay in IADL decline.

  • Calisthenics was the exercise type in which most participants engaged.

Abstract

Exercise can delay the decline of instrumental activities of daily living (IADL), although it remains unclear which specific exercise types are associated with such a delay. This 4-year prospective cohort study in Japan aimed to identify the longitudinal associations between exercise types and the onset of IADL decline in older women. Between 2008 and 2012, 1082 community-dwelling older women aged ≥75 years participated in this study. Participations in 16 exercise types based on a face-to-face interview at baseline were used as independent variables. The primary study outcome was a decline in IADL as assessed using the instrumental self-maintenance subscale of the Tokyo Metropolitan Institute of Gerontology index of competence. An IADL decline was defined as a decrease of ≥1 point over the 4-year follow-up period and was used as the dependent variable. Adjusted odds ratios (ORs) and 95% confident intervals (CIs) for IADL decline based on participation or non-participation in each exercise type were obtained using logistic regression analyses. An IADL decline was observed in 151 participants (13.9%) over the 4-year follow-up period. After adjustment for potential confounders, participation in calisthenics had a significantly lower OR (0.62; 95% CI 0.42–0.90) for IADL decline. There were no significant associations between other specific exercise types and IADL decline. In conclusion, participation in calisthenics was significantly and independently associated with delayed IADL decline in older women aged ≥75 years. Thus, calisthenics may be a useful exercise to slow IADL decline in this age group.

Introduction

Functional capacity is the ability of older adults to independently perform basic activities of daily living (BADL) and instrumental activities of daily living (IADL) (Lawton and Brody, 1969). BADL comprise basic physical tasks, such as bathing, dressing, and eating (Katz et al., 1963). On the other hand, IADL involve more complex activities, such as cooking, cleaning, using public transportation, and taking medicines (Lawton and Brody, 1969). A decline in IADL is a possible predictor for the future onset of BADL decline and death among older adults (Koyano et al., 1989) because IADL represent a higher level of functionality than BADL (Spector et al., 1987). Therefore, it is imperative to identify the factors associated with IADL decline in community-dwelling older adults.

Several factors are known to be associated with IADL decline: age, hospitalization, grip strength (Ishizaki et al., 2000), chronic disease (Fujiwara et al., 2003b), walking ability, self-rated health, cognitive function (Fujiwara et al., 2008), depression, alcohol consumption (Wang et al., 2002), and exercise (Boyle et al., 2007). Because exercise can prevent the onset of cardiovascular disease (Soares-Miranda et al., 2016), depression (Strawbridge et al., 2002), and mobility limitation (Pahor et al., 2014), it represents a potential modifiable factor for delaying IADL decline in older adults. Accordingly, previous prospective studies have found a significant and independent association between exercise and a slower onset of IADL decline (Boyle et al., 2007; Wang et al., 2002). A systematic review also demonstrated that higher levels of physical activity, including exercise, were significantly associated with delayed onset of IADL and BADL disabilities (Paterson and Warburton, 2010). However, in older women, this association has not been demonstrated (Stessman et al., 2002). Compared with older men, IADL decline has been reported to occur more frequently in older women (Murtagh and Hubert, 2004).

Additionally, the effects of specific exercise types on IADL decline are unclear. Some studies have focused on exercise's effects on health benefits. These studies have reported significant associations between specific modes of physical activities and health outcomes in adults: household activities were associated with a decreased risk of falling (Peeters et al., 2010); domestic work and cycling were associated with a decreased risk of coronary heart disease (Koolhaas et al., 2016); cycling contributed most to the beneficial effects on quality-of-life in older adults (Koolhaas et al., 2017); and cycling, swimming, racquet sports, and aerobics were associated with a significant reduction in all-cause mortality (Oja et al., 2017). However, the association between specific exercise types and IADL decline in older adults has not been previously reported to date.

The purpose of this study was to identify the association between participation in exercise, specific exercise types, and declines in IADL in community-dwelling older women.

Section snippets

Study design

This was 4-year prospective observational cohort study.

Setting

A baseline survey was conducted at the Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan, between October and November 2008. The primary purposes of this cohort study were 1) to identify factors related to the inability to perform activities of daily living in older women aged ≥75 years, and 2) to develop a novel comprehensive geriatric health examination to promote independence among community-dwelling older adults. A

Outcome data

An IADL decline was observed in 151 participants (13.9%) during the 4-year follow-up. The distribution of IADL changes was as follows: 26 participants (2.4%) with −5 points, 15 participants (1.4%) with −4 points, 19 participants (1.8%) with −3 points, 39 participants (3.6%) with −2 points, 52 participants (4.8%) with −1 point, 918 participants (84.8%) with 0 points (unchanged), 12 participants (1.1%) with +1 point, and 1 participant (0.1%) with +2 points.

Baseline characteristics

Table 1 shows the comparisons of

Discussion

To the best of our knowledge, this study is the first to prospectively identify associations between specific exercise types and IADL decline in older women. After adjusting for potential confounders, participation in exercise and calisthenics remained significantly associated with slower onset of IADL decline. These results suggest that exercise—particularly calisthenics—plays a role in reducing the risk of IADL decline among older women.

In this study, participation in exercise was associated

Conclusions

Participation in exercise, especially in calisthenics, was significantly associated with a delay in IADL decline among older women aged ≥75 years, even after adjusting for potential confounders. Thus, these activities may be useful for maintaining functional capacity. To demonstrate the potential of calisthenics in preventing IADL decline and maintaining functional capacity in older women, a more robust clinical trial is needed.

Acknowledgments

We are grateful to the participants and the staff members of the Tokyo Metropolitan Institute of Gerontology. We also would like to thank THF Co., Ltd. (Tsukuba, Japan) for scholarship donations.

Conflicts of interest

None.

Funding

This work was supported by Grants-in-Aid for Scientific Research ([B] 22300243, 26282201) to Hunkyung Kim by the Japan Society for the Promotion of Scientific and scholarship donations (no number) to Yosuke Osuka by THF Co., Ltd. (Tsukuba, Japan). These funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

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