Mobility difficulties and physical activity as predictors of mortality andloss of independence in the community-living older population

OBJECTIVE: In older people, mobility impairments and physical inactivity ar e risk factors for further disability and death. We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality. DESIGN: A population-based, prospective study. The data were collected in s tructured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project. PARTICIPANTS: Subjects were 1109 independently living, at baseline 65- to 8 4-year-old people in the city of Jyvaskyla, in central Finland. METHODS: Participants were ranked into four groups: (1) Intact mobility and physically active (Mobile-Active), (2) Intact mobility and sedentary (Mobi le-Sedentary), (3) Impaired mobility and physically active (Impaired-Active ), and (4) Impaired mobility and sedentary (Impaired-Sedentary). The confou nders adjusted for in the models included age, marital status, education, c hronic conditions, smoking, and physical exercise earlier in life. RESULTS: In men and women, the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups th an the risk of death in Mobile-Active groups. However, the risk of death di d not differ between Mobile-Active and Mobile-Sedentary groups. The odds ra tio for dependency (95% confidence interval) in Impaired-Sedentary men was 5.21 (1.44-18.70) and in Impaired-Sedentary women was 2.92 (1.52-5.60) comp ared to Mobile-Active groups. The risk of dependence did not differ signifi cantly between Mobile-Active, Mobile-Sedentary, and Impaired-Active groups. CONCLUSIONS: Mobility impairments predicted mortality and dependence. Howev er, among people with impaired mobility, physical activity was associated w ith lower risks, whereas the risk did not differ according to activity leve l among those with intact mobility. Despite of their overall greater risk, mobility-impaired people may be able to prevent further disability and mort ality by physical exercise.