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Do or Decline? : Comparing the Effects of Physical Inactivity on Biopsychosocial Components of Successful Aging
Brad A. Meisner, Shilpa Dogra, A. Jane Logan, Joseph Baker and Patricia L. Weir J Health Psychol 2010 15: 688 DOI: 10.1177/1359105310368184 The online version of this article can be found at: http://hpq.sagepub.com/content/15/5/688

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Do or Decline?
Comparing the Effects of Physical Inactivity on Biopsychosocial Components of Successful Aging
Journal of Health Psychology Copyright 2010 SAGE Publications Los Angeles, London, New Delhi, Singapore and Washington DC www.sagepublications.com Vol 15(5) 688696 DOI: 10.1177/1359105310368184

BRA D A . M E I S N ER , S H I L PA D O GR A, A. J A N E LO G A N, & J O S E P H B A K E R
York University, Canada

Abstract
Research has shown that physical activity (PA) is associated with overall successful aging (SA), but it is unknown whether PA promotes each SA component in similar ways. This cross-sectional population-based cohort study investigates SA in adults aged 60 years+ using data from the Canadian Community Health Survey (N = 12,042). Multivariate comparisons showed that, compared to those who were PA, physical inactivity was a much stronger associate of functional limitations than either chronic disease or being socially unengaged with life. This effect was not found for moderately active participants. Findings reinforce that PA, even at moderate levels, is an efficient way of optimizing biopsychosocial health, particularly functional health, in later life.

PAT R I C I A L . WEI R
University of Windsor, Canada

ACKNOWLEDGEMENTS.

This work was supported by the Social Sciences and Humanities Research Council of Canada (SSHRC fellowship # 75220092047 to B.A.M. and grant # 862-2007-0002 to J. B. and P. L. W). The sponsor had no role in any aspect of the preparation of this article. None declared.

Keywords
I I I I I biological aging older adults physical activity preventive medicine psychosocial factors

COMPETING INTERESTS: ADDRESS.

Correspondence should be directed to: School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada. [Tel. +1 (416) 736 2100, ext. 20553; Fax +1 (416) 736 5774; email: bmeisner@yorku.ca]
BRAD MEISNER,

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MEISNER ET AL.: PHYSICAL ACTIVITY AND SUCCESSFUL AGING

THE PROPORTION of older individuals in the world is expected to increase drastically over the next few decades (Hayutin, 2007; Health Canada, 2002; US Department of State, 2007). Conceivably motivated by this demographic shift, research has enhanced our understanding of the processes of aging in virtually every field. A developing area of gerontological and geriatric research focuses on successful aging (SA), which has the central objective of discovering antecedents of age-associated susceptibility to disease and disablement as well as significant predictors of optimal health throughout life. Although criticized (e.g. Laberge, Dumas, Rail, Dallaire, & Voyer, 2003; Strawbridge, Wallhagen, & Cohen, 2002), one of the most popular models of SA was proposed by Rowe and Kahn (1987, 1998). This biopsychosocial framework suggests that SA is characterized by: (1) low probability of disease and disease-related disability; (2) high cognitive and physical functioning; and (3) active social engagement with life. Despite scrutiny, this SA model is often used in SA research not only because of the comprehensive and interdisciplinary nature of its components but also because of its focus on modifiable lifestyle-related factors. Recent research discovered that physical activity has a positive influence on overall SA as defined by Rowe and Kahn, as higher levels of physical activity were associated with increased probability of being categorized as aging successfully (Baker, Meisner, Logan, Kungl, & Weir, 2009). There is considerable evidence that physical activity promotes each component of SA in later life independently. First, the relationship between physical activity and the prevention of disease and diseaserelated disability has been well established and is particularly potent for conditions such as cardiovascular disease, type II diabetes, cancer and obesity (Warburton, Nicol, & Bredin, 2006). Second, decreases in physical and cognitive fitness are direct consequences of physical inactivity (Colcombe & Kramer, 2003; Miller, Rejeski, Reboussin, Ten Have, & Ettinger, 2000; Morey, Pieper, & Cornoni-Huntley, 1998; Yaffe, Barnes, Nevitt, Lui, & Covinsky, 2001). Last, being actively engaged with ones life has been significantly associated with physical activity as older adults who are active are more likely to be socially integrated (Colston, Harper, & Mitchener-Colston, 1995; Dogra, Meisner, & Baker, 2008). From these findings it is clear that physical activity is a promoting agent within each component of SA; however, the effects of physical activity among

SA components within the same sample of older adults is unknown. Discerning the relative contribution that physical activity has on different components of SA is particularly relevant for health promotion and preventive medical interventions. The purpose of this study was to quantify the association between physical activity and each of the three criteria of SA posited by Rowe and Kahn, which were examined in tandem.

Methods Participants
Archived data from the Canadian Community Health Survey (CCHS; Cycle 2.1; refer to Statistics Canada, 2003 for detailed information), a large government-survey project, were used for this investigation. Data were collected by telephone interviews via random sampling of approximately 130,000 Canadians of all provinces and territories. This dataset is considered to be highly representative of the Canadian population with a response rate of 80 percent or higher across the country. Participants in the present study were a sub-sample of the overall dataset, as some questionnaire content was optional based on the particular needs and priorities of individual provinces. One of the variables of interest in this study (i.e. number of hours of sedentary activities) was optional content and incorporated into the surveys of Alberta, British Columbia, Manitoba and Ontario. Analyses were therefore limited to these four provinces. Respondents included in the present analyses had complete data for the variables under examination. The sample was limited to individuals 60 years of age and greater. The final sample size was 12,042 participants. From the archived dataset, items that best represented the constructs proposed by Rowe and Kahns SA model were retroactively searched for and used in the current analysis.

Measures
Successful aging component I: Low probability of disease or disease-related disability This variable was captured using the presence of chronic conditions scale, where respondents reported any clinician-diagnosed long-term illnesses expected to last, or having already lasted, six months or longer. These illnesses included respiratory diseases (asthma, chronic bronchitis, emphysema and chronic obstructive pulmonary disease), inflammatory diseases (fibromyalgia, rheumatoid
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JOURNAL OF HEALTH PSYCHOLOGY 15(5)

arthritis and osteoarthritis), cardiovascular diseases (hypertension, angina, stroke and congestive heart failure), metabolic and related diseases (diabetes, cataracts and glaucoma), cancers (general and sexspecific) and other diseases such as incontinence and back problems. Respondents stating the presence of any of these chronic conditions were classified as having disease or disease-related disability. Successful aging component II: High cognitive and physical functional capacity This component of SA was measured by whether a respondent reported requiring assistance with instrumental and general activities of daily living. These physical and cognitive activities included tasks such as preparing and eating meals, shopping for groceries and other necessities, completing light and heavy housework, personal hygiene such as washing and dressing, moving about the house and paying bills. Respondents stating an inability to perform any of these actions without assistance resulted in participants being classified as having compromised functional capacity. Successful aging component III: Active social engagement with life The last SA criterion was measured using three variables that relate to social participation. The first was the total number of hours spent in sedentary activities in an average week. These behaviors included time spent on a computer and/or the Internet, playing computer or video games, watching television or videos and reading. Accumulating fewer than 35 sedentary hours was a classification for being actively engaged with life while greater than or equal to 35 sedentary hours represented being disengaged with life (Baker et al., 2009). Second, the respondents sense of belonging to their local community was measured on a four-point Likert scale; very strong and somewhat strong responses were classified as engaged while somewhat weak and very weak were coded as disengaged. The third variable was involvement in voluntary social organizations (i.e. community centers, identity-based associations, clubs, etc.). Participants responses of an affirmed membership represented active social engagement with life while non-membership corresponded to being socially disengaged. To ensure that the social engagement with life variable was not too restrictive, two different methods of classification were used (Baker et al., 2009). First, a respondent was coded as being actively engaged in life if they accumulated fewer than or equal to 35 sedentary hours
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per week and felt a very strong or somewhat strong sense of belonging to their local community. Second, social engagement was determined when a respondent participated in fewer than or equal to 35 sedentary hours per week and reported membership in a social organization. If either one of these two criteria was met, respondents were scored as being socially engaged with life. Physical activity Involvement in physical activity was examined using the Physical Activity Index. This CCHS-derived variable categorized respondents as inactive, moderately active or active based on their average daily metabolic equivalent (MET) value. These energy expenditure values were based on the frequency and duration of each session of leisure-time physical activity, ranging from gardening to running. Physically active respondents expended greater than 3.0 kilocalories per kilogram per day (kkd), moderately active individuals expended between 1.5 and 3.0 kkd and inactive respondents expended fewer than 1.5 kkd on an average day. Covariates Based on previous research (Baker et al., 2009; Trost, Owen, Bauman, Sallis, & Brown, 2002), sex, age and total household income were included in the multivariate analyses to remove their confounding effects on the multivariate associations under investigation. Age was classified in five-year cohorts, beginning from 6064 years up to 7579 years, with a final cohort aged 80 and older. Five annual income categories were used as a measure of socioeconomic status: $0$14,999, $15,000$29,999, $30,000$49,999, $50,000$79,999 and $80,000 or more.

Analyses
Bivariate logistic regression techniques were used to examine relationships between the three SA components and physical activity (Model A). Multivariate regressions were estimated that included the aforementioned covariates (Model B). As it has been established that the SA components do not act independently of one another (Rowe & Kahn, 1987, 1998), it is feasible that the association between physical activity and one SA component is influenced by the other SA components. To minimize this influence, multivariate regressions for each SA component were performed while adjusting for the influence of the other two SA components (Model C). Physical activity was used as the focal exposure variable of each dichotomous

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MEISNER ET AL.: PHYSICAL ACTIVITY AND SUCCESSFUL AGING

SA component outcome. The CCHS dataset can be weighted to attain generalizability to the Canadian population; however, as the current study sample represented less than 10 percent of the overall CCHS sample, the master weights were not applied. SPSS version 16.0 was used for all statistical analyses using 95 percent confidence intervals.

Results
Table 1 reveals that many of the older respondents in this sample were inactive (54%) while fewer were moderately active (25%) and even fewer were classified as active (21%). Regarding the components of SA, only 17 percent of these older adults met the absence of disease/disability criterion, 67 percent reported no functional impairment and 69 percent reported being socially engaged with life. The bivariate (Model A) and multivariate (Models B and C) associations between physical activity and each of the components of SA are found in Table 2. Based on Model A, compared to active older participants (referent group), those who were moderately active were more likely to report having a chronic

disease (OR = 1.46, CI = 1.301.65) and a functional impairment (OR = 1.65, CI = 1.461.86) but were equally unlikely to report social disengagement in life. However, physical inactivity was significantly associated with higher odds of reporting less desirable conditions for all three SA components. Also, physical inactivity moderated the effect of functional limitations. While inactive participants reported relatively similar increased odds of having a chronic condition (OR = 1.86, CI = 1.682.07) and being socially disengaged with life (OR = 1.41, CI = 1.291.55), the effect of physical inactivity on functional limitations was pronounced (OR = 3.77, CI = 3.404.19). The odds of the inactive group reporting a functional limitation were over two times greater than the odds for the moderately active group (OR = 1.65, CI = 1.461.86). Even after adjusting for a number of confounding variables (i.e. age, sex and total household income; Model B), comparable results were found (Table 2), except the effect of moderate physical activity on social engagement with life became statistically significant. After adjusting for the variability among the SA components in Model C, all associations remained significant (Fig. 1) although with a slight attenuation

Table 1. Sample descriptive statistics (unweighted N = 12,042) Variable Physical activity Category Active Moderately active Inactive No Yes No Yes No Yes 6064 years 6569 years 7074 years 7579 years 80 years or more Male Female $0$14,999 $15,000$29,999 $30,000$49,999 $50,000$79,999 $80,000 or more N 2569 2997 6476 2006 10,036 8053 3989 3788 8254 2963 2682 2368 1990 2039 5219 6823 1875 3939 3243 1995 990 % 21.3 24.9 53.8 16.7 83.3 66.9 33.1 31.5 68.5 24.6 22.3 19.7 16.5 16.9 43.3 56.7 15.6 32.7 26.9 16.6 8.2

SA I: Chronic condition SA II: Functional impairment SA III: Social engagement Age

Sex Total household income

Note: SA: Successful aging 691

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JOURNAL OF HEALTH PSYCHOLOGY 15(5) Table 2. Odds of each SA component stratified by physical activity level SA I: Chronic condition Model Physical activity level IA MA PA IA MA PA IA MA PA OR 1.86 1.46 1.00 1.56 1.37 1.00 1.26 1.31 1.00 95% CI 1.68, 2.07 1.30, 1.65 referent 1.39, 1.76 1.19, 1.56 referent 1.11, 1.42 1.14, 1.50 referent SA II: Functionally impaired OR 3.77 1.65 1.00 2.97 1.44 1.00 2.78 1.35 1.00 95%CI 3.40, 4.19 1.46, 1.86 referent 2.64, 3.35 1.25, 1.65 referent 2.46, 3.14 1.18, 1.56 referent SA III: Socially disengaged OR 1.41* 1.09NS 1.00 1.46 1.17 1.00 1.38 1.15 1.00 95%CI 1.29, 1.55 0.98, 1.22 referent 1.32, 1.62 1.04, 1.31 referent 1.25, 1.54 1.02, 1.29 referent

Notes: All p .001 except * p .01, NS nsig (p .05) IA: inactive participants; MA: moderately active participants; PA: physically active participants; SA: successful aging Model A: Bivariate results between SA components and physical activity Model B: Multivariate results between SA components and physical activity after controlling for age, sex and total household income Model C: Multivariate results between SA components and physical activity after controlling for age, sex, total household income and the other two SA components

in odds from Model B (Table 2). More specifically, results demonstrated that compared to active older adults, those who were moderately active were 31 percent more likely to have a chronic condition (OR = 1.31, CI = 1.141.50), 35 percent more likely to report a functional limitation (OR = 1.35, CI = 1.181.56) and 15 percent more likely to feel socially disengaged with life (OR = 1.15, CI = 1.021.29). Inactive older adults were 26 percent more likely to have a chronic condition (OR = 1.26, CI = 1.111.42), 38 percent more likely to feel disengaged with life (OR = 1.38, CI = 1.251.54) and almost three times more likely to report a functional limitation (OR = 2.78, CI = 2.463.14).

Discussion
In a sample of older Canadian adults, representative of four provinces, the present investigation revealed that decreasing levels of physical activity attenuate overall SA in later life via independent negative effects on each of the three Rowe and Kahn SA components. The most important finding in the current investigation is that effect size differences were found among SA components depending on physical activity level. Inactive participants had over two times the odds of reporting
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a functional limitation compared to reporting either a chronic condition or being socially disengaged with life. Moderately active participants had slightly increased odds of reporting any of the three components. Inactive older adults displayed a clear distinction among the components of SA such that there were equivalent odds of reporting a chronic condition and being socially disengaged with life, while the probability of reporting a functional limitation was considerably higher. The finding that physical inactivity is the strongest predictor of functional limitation is supported by studies that show functional limitation is a more proximal, direct outcome of physical inactivity (Stewart, 2003; van Heuvelen, Kempen, Ormel, & Rispens, 1998) while the association between physical inactivity and chronic disease is more distal (Dietz, 1998; Marti et al., 1989). This distal-proximal effect may explain why the odds ratios for physical inactivity and chronic disease were attenuated after adjusting for the effects of the functional limitations component (Model C). This similar attenuation effect was greater than the attenuation for the effect of physical inactivity effect on functional limitation after adjusting for chronic condition. However, the relationship between physical inactivity and being socially unengaged with life is less clear

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MEISNER ET AL.: PHYSICAL ACTIVITY AND SUCCESSFUL AGING 3.50 3.00 2.50 Odds Ratio 2.00 1.50 1.00 0.50 0.00 Chronic Condition Functionally Impaired Successful Aging Component Inactive Moderately Active Active Socially Disengaged

*
ref

*
ref

* *
ref

Figure 1. The effect that physical activity levels have on each successful aging component at the multivariate level (Model C). *p < .001.

(Mendes de Leon, Glass, & Berkman, 2003). Future research should examine the mechanisms by which physical inactivity affects the different components of SA. Physical inactivity generates a cascade of negative effects on both physical and cognitive functioning, such as reduced cardiorespiratory fitness, reduced strength and poorer body morphology (Brill, Macera, Davis, Blair, & Gordon, 2000), that mitigate general and instrumental activities of daily living (Avlund, Vass, & Hendriksen, 2003; Miller et al., 2000) and cognitive abilities in later life (Christensen et al., 1996; Larson et al., 2006). These decreases in functional abilities over time are commonly associated with increased rates of lifestyle-related disease symptoms and diagnosis (Bruce, Fries, & Hubert, 2008; Suminski, Poston, Foreyt, & St Jeor, 2008). It is likely that social engagement fits within this sequence of events; however, identifying at what point social disengagement occurs requires future research. Evidence suggests that the relationship between psychosocial behavior and physical inactivity (Chogahara, 1999), chronic disease (Mendes de Leon et al., 2003) and functioning (Dogra et al., 2008; Unger, McAvay,

Bruce, Berkman, & Seeman, 1999) is complex, dynamic and bidirectional. Another notable result of the current study was that, unlike the inactive group, the moderately active group reported relatively similar odds over all three SA components; thus, the odds of a functional impairment seen for the inactive group can be reduced by adopting even moderate levels of physical activity. This finding is supported by the growing body of research that shows older adults who perform a small amount of physical activity, even at low intensities, experience notable improvements in numerous outcomes compared to being inactive (Pescatello, Murphy, & Costanzo, 2000; Shephard, 2001). For example, older adults can attenuate the progression in functional impairment by up to 55 percent with modest levels of physical activity (Miller et al., 2000). The current study shows that compared to inactive older adults, those who performed moderate levels of physical activity were 51 percent less likely to report functional limitations. This investigation has several notable implications for preventive medical approaches. The relationship between physical inactivity and negative
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JOURNAL OF HEALTH PSYCHOLOGY 15(5)

outcomes supports the campaign against sedentary behavior, particularly in older populations. Given that over half of this sample was inactive and that these inactive participants were almost three times more likely to report functional limitations, promotion of physically active lifestyles in later life is clearly warranted. While it has been established that physical activity attenuates risk associated with lifestyle-related disability and diseases (Bruce et al., 2008; Colcombe & Kramer, 2003; Miller et al., 2000; Morey et al., 1998; Warburton et al., 2006; Yaffe et al., 2001), this study suggests that public health and clinical interventions that promote physical activity in later life can also attenuate the risk of social disengagement. Health-related behavioral interventions should consider the interdisciplinary benefits of physical activity.

Limitations
The CCHS contains self-reported, cross-sectional data and is therefore prone to subjective biases and bidirectional relationships that cannot be quantified. As well, the sample used for the current analyses comprised of only 10 percent of the overall CCHS sample, representing only four provinces. Thus, the current findings may not be generalizable to the overall Canadian population. This limitation should be considered and remedied in future population-based work. Furthermore, the CCHS did not require respondents to specify the intensity level of their physical activities. As a result, the physical activity classifications adopted are conservative as they correspond to the low intensity value of each activity. Also, information on forms of physical activity besides leisure-time PA (e.g. occupational physical activity) were absent from these analyses. However, given the age range of the sample, it is expected that the majority of the sample was retired and therefore mostly engaging in leisuretime physical activity only. Additionally, in order to authenticate and expand upon the current findings, future research should investigate these constructs using validated measures that capture the breadth of each SA component. For instance, although the second SA component encompasses both physical and cognitive functioning, the preponderance of the items in the CCHS related to physical functioning rather than cognitive functioning. It could be contended that the measure used for functional capacity did not entirely capture cognitive functioning in this
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sample (e.g. non-verbal memory, inductive reasoning, visual spatial abilities, language and conceptualizing skills; Rowe & Kahn, 1997). With this notion in mind, future research should investigate cognitive factors as predictors of SA together with physical factors, and their interaction, at different points across the life span as components of SA as their effects are dynamic (Weir, Meisner, & Baker, this issue). This will allow an evaluation of overall functional capabilities as they relate to physical factors, cognitive factors or a combination of both. Additionally, the classification of functional capacity was measured by the inability to perform any one of a number of IADL or ADLs. This definition does not take into consideration the degree to which a participant is able to perform overall IADL and ADLs. The same could be said for the chronic disease component such that a participant was classified as having disease or disease-related disability whether they reported one or multiple chronic conditions. Future work should consider the relative burden of functional capacity and/or chronic disease as it pertains to SA and its effects. Additionally, the social engagement variable used may represent both social and solitary productive activities (Menec, 2003) as it could be argued that a number of the activities that were classified as sedentary may involve some level of social engagement and imply engagement with others. The complexities of each SA component should be considered in future work.

Conclusion
Using a large dataset of older adults, this investigation has shown that physical activity influences each component of SA, such that greater levels of physical inactivity were associated with an increased likelihood of reporting disease and disablement, low functional capacities and being socially unengaged with life. This study supports the notion that physical activity involvement is a significant associate of SA by means of reduced age-associated susceptibilities of decline. More specifically, physical activity is independent from these SA indicators; however, it is to say that physical activity has a stronger effect on functional decline than either chronic disease and disablement or being socially unengaged with life. These effects were independent of age, sex, total household income and the relative contributions of the remaining two

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MEISNER ET AL.: PHYSICAL ACTIVITY AND SUCCESSFUL AGING

SA criteria. Therefore, the robust association found between inactivity and reporting functional limitation was not influenced by co-morbid chronic disease states or being socially disengaged with life.

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Author biographies
BRAD A. MEISNER is a Doctoral Candidate of Health Psychology and Behavioral Science at York University in the School of Kinesiology and Health Science. SHILPA DOGRA recently completed her PhD at York University. She is a Certified Exercise Physiologist conducting research in the area of exercise and chronic disease. A. JANE LOGAN is a Doctoral Candidate at York University. Her research examines the role masters athletes play in informing models of aging. JOSEPH BAKER is an Associate Professor of Lifespan Development in the School of Kinesiology and Health Science at York University, Toronto, Canada. PATRICIA L. WEIR is an Associate Professor in the Department of Kinesiology at the University of Windsor, Windsor, Canada.

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