Are flexibility and muscle-strengthening activities associated with functional limitation?

Abstract

This retrospective cohort study examined the relationship between self-reported participation in flexibility and muscular strengthening activities and the development of functional limitation (i.e., once an individual has difficulty with or becomes unable to perform activities of daily living). Data were obtained from 1318 adults (mean age 49.5 ​± ​9.7 years; 98.7% Caucasian; 14.9% female) enrolled in the Aerobics Center Longitudinal Study from 1979 to 2004 and free of functional limitation at baseline. Mail-back health surveys were used to prospectively determine incident functional limitation. Participation in muscle-strengthening and flexibility activities was assessed via self-report. Adjusted logistic regression analyses were used to determine the odds ratios (OR) and corresponding 95% confidence intervals for developing functional limitation during follow-up based on participation in general and specific categories of flexibility (‘Stretching’, ‘Calisthenics’, or ‘Exercise Class’) and muscle-strengthening activities (‘Calisthenics’, ‘Free Weights’, ‘Weight Training Machines’, or ‘Other’). Overall, 42.6% of the sample reported incident functional limitation. After adjusting for potential confounders (e.g., age, sex, cardiometabolic risk factors), those who reported performing muscle-strengthening activities in general (n ​= ​685) were at lower risk of developing functional limitation [OR ​= ​0.79 (0.63-1.00)]. In addition, the specific flexibility activities of stretching (n ​= ​491) and calisthenics (n ​= ​122) were associated with 24% and 38% decreased odds of incident functional limitation, respectively. General muscle-strengthening, stretching, and calisthenics activities are prospectively associated with decreased risk of incident functional limitation in generally healthy, middle-aged and older adults. Thus, both public health and rehabilitation programs should highlight the importance of flexibility and muscle-strengthening activities during adulthood to help preserve functional capacity.

Keywords

Functional capacity / Quality of life / Aging / Exercise / Independence / Health

References

[[1]] S. Katz. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc, 31 (12) ( 1983), pp. 721-727, DOI: 10.1111/j.1532-5415.1983.tb03391.x

[[2]] Y. Huang, C.A. Macera, S.N. Blair, et al.. Physical fitness, physical activity, and functional limitation in adults aged 40 and older. Med Sci Sports Exerc, 30 (9) ( 1998), pp. 1430-1435, DOI: 10.1097/00005768-199809000-00013

[[3]] F. Landi, R. Liperoti, A. Russo, et al.. Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older. J Clin Epidemiol, 63 (7) ( 2010), pp. 752-759, DOI: 10.1016/j.jclinepi.2009.09.007

[[4]] M. Hirvensalo, T. Rantanen, E. Heikkinen. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. J Am Geriatr Soc, 48 (5) ( 2000), pp. 493-498, DOI: 10.1111/j.1532-5415.2000.tb04994.x

[[5]] P.A. Brill, C.A. Macera, D.R. Davis, et al.. Muscular strength and physical function. Med Sci Sports Exerc, 32 (2) ( 2000), pp. 412-416, DOI: 10.1097/00005768-200002000-00023

[[6]] C.C. Sieber. Frailty-from concept to clinical practice. Exp Gerontol, 87 ( 2017), pp. 160-167, DOI: 10.1016/j.exger.2016.05.004

[[7]] J.M. Guralnik, L.P. Fried, M.E. Salive. Disability as a public health outcome in the aging population. Annu Rev Publ Health, 17 (1) ( 1996), pp. 25-46, DOI: 10.1146/annurev.pu.17.050196.000325

[[8]] D.R. Bouchard, K.A. McGuire, L. Davidson, et al.. Cardiorespiratory fitness, obesity, and functional limitation in older adults. J Aging Phys Activ, 19 (4) ( 2011), pp. 336-346, DOI: 10.1123/japa.19.4.336

[[9]] American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. (ninth ed.), Lippincott Williams & Wilkins ( 2013)

[[10]] N.K. Fukagawa, L. Wolfson, J. Judge, et al.. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci, 50 (Special Issue) ( 1995), pp. 64-67, DOI: 10.1093/gerona/50A.Special_Issue.64

[[11]] U. Granacher, A. Gollhofer, T. Hortobágyi, et al.. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. J Sports Med, 43 (7) ( 2013), pp. 627-641, DOI: 10.1007/s40279-013-0041-1

[[12]] K.H. Cho, S.K. Bok, Y.-J. Kim, et al.. Effect of lower limb strength on falls and balance of the elderly. Ann Phys Rehabil Med, 36 (3) ( 2012), p. 386, DOI: 10.5535/arm.2012.36.3.386

[[13]] M.E. Nelson, W.J. Rejeski, S.N. Blair, et al.. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116 (9) ( 2007), p. 1094, DOI: 10.1161/CIRCULATIONAHA.107.185650

[[14]] L. Dipietro, W.W. Campbell, D.M. Buchner, et al.. Physical activity, injurious falls, and physical function in aging: an umbrella review. Med Sci Sports Exerc, 51 (6) ( 2019), p. 1303, DOI: 10.1249/MSS.0000000000001942

[[15]] M.B. King, R.H. Whipple, C.A. Gruman, et al.. The Performance Enhancement Project: improving physical performance in older persons. Arch Phys Med Rehabil, 83 (8) ( 2002), pp. 1060-1069, DOI: 10.1053/apmr.2002.33653

[[16]] A. Ozcan, H. Donat, N. Gelecek, et al.. The relationship between risk factors for falling and the quality of life in older adults. BMC Publ Health, 5 (1) ( 2005), p. 1, DOI: 10.1186/1471-2458-5-90

[[17]] E.J.M.-L. Emilio, F. Hita-Contreras, P.M. Jiménez-Lara, et al.. The association of flexibility, balance, and lumbar strength with balance ability: risk of falls in older adults. J Sci Med Sport, 13 (2) ( 2014), p. 349

[[18]] G.J. Holland, K. Tanaka, R. Shigematsu, et al.. Flexibility and physical functions of older adults: a review. J Aging Phys Activ, 10 (2) ( 2002), pp. 169-206, DOI: 10.1123/japa.10.2.169

[[19]] N.N. Hairi, R.G. Cumming, V. Naganathan, et al.. Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project. J Am Geriatr Soc, 58 (11) ( 2010), pp. 2055-2062, DOI: 10.1111/j.1532-5415.2010.03145

[[20]] M.D. Peterson, M.R. Rhea, A. Sen, et al.. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev, 9 (3) ( 2010), pp. 226-237, DOI: 10.1016/j.arr.2010.03.004

[[21]] B. Roshanravan, K.V. Patel, L.F. Fried, et al.. Association of muscle endurance, fatigability, and strength with functional limitation and mortality in the health aging and body composition study. J Gerontol A Biol Sci Med Sci, 72 (2) ( 2017), pp. 284-291, DOI: 10.1093/gerona/glw210

[[22]] S.N. Blair, H.W. Kohl, R.S. Paffenbarger, et al.. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA, 262 (17) ( 1989), pp. 2395-2401, DOI: 10.1001/jama.1989.03430170057028

[[23]] B.E. Ainsworth, W.L. Haskell, M.C. Whitt, et al.. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc, 32 (9 Suppl) ( 2000), pp. S498-S504, DOI: 10.1097/00005768-200009001-00009

[[24]] D. Lee, X. Sui, F. Ortega, et al.. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med, 45 (6) ( 2011), pp. 504-510, DOI: 10.1136/bjsm.2009.066209

[[25]] A.L. Maslow, A.E. Price, X. Sui, et al.. Fitness and adiposity as predictors of functional limitation in adults. J Phys Activ Health, 8 (1) ( 2011), pp. 18-26, DOI: 10.1123/jpah.8.1.18

[[26]] D.H. Paterson, D.E. Warburton.Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines. Int J Behav Nutr Phys Activ, 7 (1) ( 2010), p. 1, DOI: 10.1186/1479-5868-7-38

[[27]] Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report.2018. US Department of Health and Human Services, Washington, DC ( 2018)

[[28]] M.-L. Bird, K. Hill, M. Ball, et al.. Effects of resistance-and flexibility-exercise interventions on balance and related measures in older adults. J Aging Phys Activ, 17 (4) ( 2009), pp. 444-454, DOI: 10.1123/japa.17.4.444

[[29]] A. Shumway-Cook, M. Baldwin, N.L. Polissar, et al.. Predicting the probability for falls in community-dwelling older adults. Phys Ther, 77 (8) ( 1997), pp. 812-819, DOI: 10.1093/ptj/80.9.896

[[30]] J.T. Elam, M.J. Graney, T. Beaver, et al.. Comparison of subjective ratings of function with observed functional ability of frail older persons. Am J Publ Health, 81 (9) ( 1991), pp. 1127-1130, DOI: 10.2105/AJPH.81.9.1127

[[31]] C.L. Himes. Obesity, disease, and functional limitation in later life. Demography, 37 (1) ( 2000), pp. 73-82, DOI: 10.2307/2648097

We thank the Cooper Clinic physicians and technicians for collecting the data and the staff at the Cooper Institute for data entry and data management.