Physical Activity and Association Between Frailty and All-Cause and Cardiovascular Mortality in Older Adults: Population-Based Prospective Cohort Study

Objectives To examine the separate and joint association between physical activity and frailty and long-term all-cause and cardiovascular disease (CVD) mortality in older adults. Design Population-based prospective cohort study. Setting Cohort representative of the noninstitutionalized Spanish population. Participants Individuals aged 60 and older (N=3,896) in 2000-01. Measurements Participants reported their physical activity using a validated instrument, and frailty was ascertained using the Fatigue, low Resistance, limitation in Ambulation, Illness and weight Loss (FRAIL) scale. Those with 0 frailty criteria were considered to be robust, with 1 or 2 criteria to be prefrail, and with 3 of more criteria to be frail. Participants were followed until 2014 to identify all-cause and CVD deaths. Associations were summarized using hazard ratios (HRs) and Cox regression after adjustment for main covariates. Results During a median 14 years of follow-up, 1,801 total deaths occurred, 672 from CVD. Compared with being robust, the multivariate hazard ratio (95% confidence interval) for all-cause mortality was 1.29 (1.14-1.45) in prefrail individuals, and 2.16 (1.82-2.58) in frail individuals (p-trend <.001). Compared with being physically inactive, being physically active was associated with a statistically significant 18% (1-32%), 28% (16-39%) and 39% (17-55%) lower all-cause mortality among robust, prefrail, and frail individuals, respectively (all p <.001). Compared with participants who were robust and physically active, those who were frail and inactive showed the highest all-cause mortality 2.45 (95%CI: 1.95-3.06); however, the hazard ratio (95% confidence interval) for all-cause mortality in frail individuals who were physically active was comparable to that in pre-frail and inactive participants: 1.70 (1.32-2.19) and 1.56 (1.34-1.82), respectively. Mortality of prefrail active participants was similar to that of robust inactive participants. Results were similar for CVD mortality. Conclusion Physical activity might partly compensate for the greater mortality risk associated with frailty in old age.