title: Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study Predictive value of the Short Physical Performance Battery following hospitalization in older patients. Effects of Mobility and Cognition on Risk of Mortality in Women in Late Life: A Prospective Study. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. The relationship between physical performance and cardiac function in an elderly Russian cohort. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. The relationship of physical performance with HIV disease and mortality Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. Mobility stress test approach to predicting frailty, disability, and mortality in high-functioning older adults. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. Physical Performance Measures as Predictors of Mortality in a Cohort of Community-dwelling Older French Women Frailty Phenotypes, Disability, and Outcomes in Adult Candidates for Lung Transplantation. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Lower limb function and 10-year survival in population aged 75 years and older.
abstract: Background : objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period . Participants : two hundred and forty older adults were r and omly recruited from 12 general practice s in urban and suburban areas of a city in the United Kingdom . Follow-up included 213 of the baseline sample . Methods : socio-demographic variables , height and weight , and self-reported diagnosed diseases were recorded at baseline . Seven-day accelerometry was used to assess total physical activity , moderate-to-vigorous activity and sedentary time . A log recorded trips from home .  Lower limb function was assessed using the Short Physical Performance Battery . Medical records were accessed on average 50 months post baseline , when new diseases and deaths were recorded . Analyses : ANOVAs were used to assess socio-demographic , physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up . Regression models were constructed to assess the prospect i ve associations between physical activity and function with mortality and new disease . Results : for every 1,000 steps walked per day , the risk of mortality was 36 % lower ( hazard ratios 0.64 , 95 % confidence interval ( CI ) 0.44–0.91 , P = 0.013 ) . Low levels of moderate-to-vigorous physical activity ( incident rate ratio ( IRR ) 1.67 , 95 % CI 1.04–2.68 , P = 0.030 ) and low frequency of trips from home ( IRR 1.41 , 95 % CI 0.98–2.05 , P = 0.045 ) were associated with diagnoses of more new diseases . Conclusion : physical activity should be supported for adults in their 70s and 80s , as it is associated with reduced risk of mortality and new disease development BACKGROUND Hospitalization represents a stressful and potentially hazardous event for older persons . We evaluated the value of the Short Physical Performance Battery ( SPPB ) in predicting rates of functional decline , rehospitalization , and death in older acutely ill patients in the year after discharge from the hospital . METHODS Prospect i ve cohort study of 87 patients aged 65 years and older who were able to walk and with a Mini-Mental State Examination score ≥ 18 and admitted to the hospital with a clinical diagnosis of congestive heart failure , pneumonia , chronic obstructive pulmonary disease , or minor stroke . Patients were evaluated with the SPPB at hospital admission , were reevaluated the day of hospital discharge , and 1 month later . Subsequently , they were followed every 3 months by telephone interviews to ascertain functional decline , new hospitalizations , and vital status . RESULTS After adjustment for potential confounders , including self-report activity of daily living and comorbidity , the SPPB score at discharge was inversely correlated with the rate of decline in activity of daily living performance over the follow-up ( p < .05 ) . In a multivariable discrete-time survival analysis , patients with poor SPPB scores at hospital discharge ( 0 - 4 ) had a greater risk of rehospitalization or death ( odds ratio : 5.38 , 95 % confidence interval : 1.82 - 15.9 ) compared with those with better SPPB scores ( 8 - 12 ) . Patients with early decline in SPPB score after discharge also had steeper increase in activity of daily living difficulty and higher risk of rehospitalization or death over the next year . CONCLUSIONS In older acutely ill patients who have been hospitalized , the SPPB provides important prognostic information . Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge BACKGROUND This study examines the effects of mobility and cognition on  mortality risk in women late in life . METHODS A prospect i ve study was conducted among 1,495 women ( mean age 87.6 years ) participating in the Study of Osteoporotic Fractures Year 20 examination ( 2006 - 2008 ) .  Mobility  ( ascertained by Short Physical Performance Battery [ SPPB ] ) was categorized as poor ( SPPB 0 - 3 , n = 312 ) , intermediate ( SPPB 4 - 9 , n = 799 ) , or good ( SPPB 10 - 12 , n = 384 ) . Cognitive status ( adjudicated based on neuropsychological tests ) was classified as normal ( n = 873 ) , mild cognitive impairment ( n = 354 ) , or dementia ( n = 268 ) . Deaths ( n = 749 ) were identified from Year 20 through July 31 , 2014 ( average follow-up 4.9 years ) . RESULTS There was not strong evidence of an interaction between mobility and cognition for prediction of mortality risk ( p interaction term .16 ) . Compared to women with good mobility , mortality risks were increased among women with intermediate mobility ( hazard ratio [ HR ] 1.26 , 95 % confidence interval [ CI ] 1.02 - 1.57 ) and those with poor mobility ( HR 1.64 , 95 % CI 1.24 - 2.16 ) after consideration of cognition and other mortality risk factors . Similarly , mortality risks were higher among women with mild cognitive impairment ( HR 1.46 , 95 % CI 1.21 - 1.76 ) and those with dementia ( HR 1.88 , 95 % CI 1.54 - 2.31 ) compared to women with normal cognition after consideration of mobility and other mortality risk factors . CONCLUSIONS Among women late in life , 5-year mortality risk was substantially increased among women with deficits in mobility even after accounting for cognition and traditional prognostic indicators . Similarly , deficits in cognition were associated with increased 5-year mortality despite consideration of mobility and conventional risk factors OBJECTIVES To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality ; hospitalization ; and the onset of disability , defined as a decline in activities of daily living ( ADLs ) , independent of muscle mass , inflammatory markers , and comorbidities . DESIGN A prospect i ve , observational , population -based follow-up study . SETTING Three well-circumscribed areas of Belgium . PARTICIPANTS Five hundred sixty participants aged 80 and older were followed for 33.5 months ( interquartile range 31.1 - 35.6 months ) . MEASUREMENTS  Grip strength , Short Physical Performance Battery ( SPPB ) score , and muscle mass  were measured at baseline ; ADLs at baseline and after 20 months ; and all-cause mortality and time to first hospitalization from inclusion onward . Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization . Logistic regression analysis was used to determine predictors of decline in ADLs . RESULTS Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score . The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization , independent of muscle mass , inflammatory markers , and comorbidity . A relationship was found between SPPB score and decline in ADLs , independent of muscle mass , inflammation , and comorbidity . CONCLUSION In people aged 80 and older , physical performance is a strong predictor of mortality , hospitalization , and disability , and muscle strength is a strong predictor of mortality and hospitalization . All of these relationships were independent of muscle mass , inflammatory markers , and comorbidity This study aims to determine the cardiac dysfunction prevalence , to investigate the relationship between the Short Physical Performance Battery ( SPPB ) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population . A r and om sample of 284 community-dwelling adults aged 65 and older were selected from a population -based register and divided into two age groups ( 65 - 74 and ≥75 ) .  The SPPB test , echocardiography and all-cause mortality were measured . The prevalence of cardiac dysfunction was 12 % in the 65 - 74 group and 23 % in the ≥75 group . The multivariate models could explain 15 % and 23 % of the SPPB score total variance for the 65 - 74 and ≥75 age groups , respectively . In the younger age group , the mean follow-up time was 2.6±0.46 years , and the adjusted hazard ratio ( HR ) for risk of mortality from cardiac dysfunction was 4.9 . In the older age group , the mean follow-up time was 2.4±0.61 years , and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality ( adjusted HR=3.4 and adjusted HR=4.2 , respectively ) . The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to , or even lower than , reported prevalences for Western countries . Furthermore , the observed correlations between echocardiographic abnormalities and SPPB scores were limited . Cardiac dysfunction was shown to be a strong mortality predictor in both age groups , and poor physical performance was identified as an independent mortality predictor in the oldest subjects We investigated the predictive value of geriatric assessment ( GA ) on overall survival ( OS ) for older adults with acute myelogenous leukemia ( AML ) . Consecutive patients ≥ 60 years with newly diagnosed AML and planned intensive chemotherapy were enrolled at a single institution . Pretreatment GA included evaluation of cognition , depression , distress , physical function ( PF ) ( self-reported and objective ly measured ) , and comorbidity . Objective PF was assessed using the Short Physical Performance Battery ( SPPB , timed 4-m walk , chair st and s , st and ing balance ) and grip strength . Cox proportional hazards models were fit for each GA measure as a predictor of OS . Among 74 patients , the mean age was 70 years , and 78.4 % had an Eastern Cooperative Oncology Group ( ECOG ) score ≤ 1 . OS was significantly shorter for participants who screened positive for impairment in cognition and objective ly measured PF . Adjusting for age , gender , ECOG score , cytogenetic risk group , myelodysplastic syndrome , and hemoglobin , impaired cognition ( Modified Mini-Mental State Exam < 77 ) and impaired objective PF ( SPPB < 9 ) were associated with worse OS . GA methods , with a focus on cognitive and PF , improve risk stratification and may inform interventions to improve outcomes for older AML patients Objective : To evaluate whether HIV infection was associated with reduced physical performance , and to examine if reduced physical performance predicted mortality in our aging cohort of HIV-infected and HIV-uninfected persons . Design : Prospect i ve , observational cohort of current and former injection drug users in the AIDS Linked to the IntraVenous Experience study in Baltimore , Maryl and , USA . Methods : The  Short Physical Performance Battery ( SPPB )  was used as an objective measure of physical performance and measured semiannually along with behavioral and demographic data . Correlates of reduced physical performance ( SPPB score ⩽10 ) were identified and the relationship between reduced physical performance , HIV infection and mortality was analyzed by Cox regression . Results : Among 12 270 person-visits contributed by 1627 participants , the median age was 51 , 30.3 % were HIV-infected and 32.6 % had an SPPB score 10 or less . In multivariable models , HIV infection was independently associated with 30 % increased odds of reduced physical performance [ odds ratio 1.30 ; 95 % confidence interval (CI):1.12–1.52 ] . Reduced physical performance predicted mortality in a dose-response manner and within all HIV disease strata . Whereas reduced physical performance alone ( hazard ratio 2.52 , 95 % CI : 1.59–4.00 ) and HIV infection alone ( hazard ratio 2.78 , 95 % CI : 1.70–4.54 ) increased mortality , HIV-infected participants with reduced physical performance had a six-fold increased mortality risk ( hazard ratio 6.03 , 95 % CI : 3.80–10.0 ) compared with HIV-uninfected participants with higher physical performance . Conclusion : HIV infection was independently associated with reduced physical performance . HIV and reduced physical performance have independent and joint effects on mortality . Physical performance measurement may be an important research and clinical tool to predict adverse outcomes among aging HIV-infected persons BACKGROUND The Short Physical Performance Battery ( SPPB ) , which includes walking , balance , and chair st and s tests , independently predicts mobility disability and activities of daily living disability . To date , however , there is no definitive evidence from r and omized controlled trials that SPPB scores can be improved . Our objective was to assess the effect of a comprehensive physical activity ( PA ) intervention on the SPPB and other physical performance measures . METHODS A total of 424 sedentary persons at risk for disability ( ages 70 - 89 years ) were r and omized to a moderate-intensity PA intervention or a successful aging ( SA ) health education intervention and were followed for an average of 1.2 years . RESULTS The mean baseline SPPB score on a scale of 0 - 12 , with 12 corresponding to highest performance , was 7.5 . At 6 and 12 months , the PA versus SA group adjusted SPPB ( + /- st and ard error ) scores were 8.7 + /- 0.1 versus 8.0 + /- 0.1 , and 8.5 + /- 0.1 versus 7.9 + /- 0.2 , respectively ( p < .001 ) . The 400-meter walking speed was also significantly improved in the PA group . The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk ( hazard ratio = 0.71 , 95 % confidence interval = 0.44 - 1.20 ) . CONCLUSIONS A structured PA intervention improved the SPPB score and other measures of physical performance . An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes , such as mobility disability OBJECTIVES To examine the validity of the Walking While Talking Test ( WWT ) , a mobility stress test , to predict frailty , disability , and death in high-functioning older adults . DESIGN Prospect i ve cohort study . SETTING Community sample . PARTICIPANTS Six hundred thirty-one community-residing adults aged 70 and older participating in the Einstein Aging Study ( mean follow-up 32 months ) . High-functioning status at baseline was defined as absence of disability and dementia and normal walking speeds . MEASUREMENTS Hazard ratios ( HRs ) for frailty , disability , and all-cause mortality . Frailty was defined as presence of three out of the following five attributes : weight loss , weakness , exhaustion , low physical activity , and slow gait . The predictive validity of the WWT was also compared with that of the Short Physical Performance Battery ( SPPB ) for study outcomes . RESULTS Two hundred eighteen participants developed frailty  , 88 developed disability , and 49 died . Each 10-cm/s decrease in WWT speed was associated with greater risk of frailty ( HR = 1.12 , 95 % confidence interval ( CI ) = 1.06 - 1.18 ) , disability ( HR = 1.13 , 95 % CI = 1.03 - 1.23 ) , and mortality ( HR = 1.13 , 95 % CI = 1.01 - 1.27 ) . Most associations remained robust even after accounting for potential confounders and gait speed . Comparisons of HRs and model fit suggest that the WWT may better predict frailty whereas SPPB may better predict disability . CONCLUSION Mobility stress tests such as the WWT are robust predictors of risk of frailty , disability , and mortality in high-functioning older adults BACKGROUND This study examines , in initially nondisabled older persons , the impact of reduced lower extremity performance on subsequent hospitalizations . METHODS A 4-year prospect i ve cohort study was conducted among 3381 persons , aged 71 years and older , who initially reported no disability . At baseline , lower extremity performance was measured by an assessment of st and ing balance , a timed 2.4-m walk , and a timed test of rising from a chair five times .  Data on subsequent hospital admissions and discharge diagnoses over 4 years were obtained from the Medicare data base . RESULTS During the follow-up period , nondisabled persons with poor lower extremity performance spent significantly more days in the hospital ( 17.7 days ) than those with intermediate and high performance ( 11.6 and 9.7 days , respectively ) . Poor lower extremity performance in nondisabled persons significantly predicted subsequent hospitalization over 4 years ( relative risk for hospitalization in those with poor vs high performance : 1.78 ; 95 % confidence interval , 1.45 - 2.17 ) . This increased hospitalization risk could not be explained by several indicators of baseline health status . Increased hospitalization risks were especially found for geriatric conditions , such as dementia , decubitus ulcer , hip fractures , other fractures , pneumonia , dehydration , and acute infections . CONCLUSIONS Even in persons who are currently nondisabled , a simple measure of lower extremity performance is predictive of subsequent hospitalization , especially for geriatric conditions This prospect i ve cohort study evaluate the predictive value of physical performance measures for mortality in older French women , in particular those with a high health status . The subjects were 7,250 community-dwelling non-disabled French women aged 75 years or older , enrolled in the Epidémiologie de l’ostéoporose ( EPIDOS ) study .  The short physical performance battery ( SPPB ) , including walking speed , repeated chair st and s , and balance tests , was administered and h and grip strength was measured . Anthropometric measurements , physical function , cognitive performance , sensory status , smoking , medical history , medication use , subjective self- assessment of health status , and physical activity level were assessed at the baseline visit . During a mean follow-up of 3.8 years , 754 ( 10.4 % ) participants died . Complementary analysis was performed on the 2,157 non-disabled healthiest participants ( no disease at baseline ) . The SPPB and h and grip strength distinguished a gradient of risk for mortality from a low to high functional spectrum . Risk of death was 2.04-fold higher in poor ( SPPB 0–6 ) than in good ( SPPB 10–12 ) performers and 1.56-fold higher in participants with lower tertile grip strength . Walking speed alone also distinguished a gradient of mortality risk . After adjustment for confounders , low SPPB , grip strength score and slow walking speed remained significantly associated with death . In the non-disabled healthiest women , no physical performance measure predicted death . In community-dwelling elderly French women , physical performance measures significantly and independently predicted mortality . Increased risk of death was partly explained by baseline health status and was absent in the healthiest elderly RATIONALE Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation . OBJECTIVES To examine the construct and predictive validity of frailty phenotypes in lung transplant c and i date s. METHODS In a multicenter prospect i ve cohort , we measured frailty with the Fried Frailty Phenotype ( FFP ) and Short Physical Performance Battery ( SPPB ) . We evaluated construct validity through comparisons with conceptually related factors . In a nested case-control study of frail and nonfrail subjects , we measured serum IL-6 , tumor necrosis factor receptor 1 , insulin-like growth factor I , and leptin . We estimated the association between frailty and disability using the Lung Transplant Valued Life Activities disability scale . We estimated the association between frailty and risk of delisting or death before transplant using multivariate logistic and Cox models , respectively . MEASUREMENTS AND MAIN RESULTS Of 395 subjects , 354 completed FFP assessment s and 262 completed SPPB assessment s ; 28 % were frail by FFP ( 95 % confidence interval [ CI ] , 24 - 33 % ) and 10 % based on the SPPB ( 95 % CI , 7 - 14 % ) . By either measure , frailty correlated more strongly with exercise capacity and grip strength than with lung function . Frail subjects tended to have higher plasma IL-6 and tumor necrosis factor receptor 1 and lower insulin-like growth factor I and leptin . Frailty by either measure was associated with greater disability . After adjusting for age , sex , diagnosis , and transplant center , both FFP and SPPB were associated with increased risk of delisting or death before lung transplant . For every 1-point worsening in score , hazard ratios were 1.30 ( 95 % CI , 1.01 - 1.67 ) for FFP and 1.53 ( 95 % CI , 1.19 - 1.59 ) for SPPB . CONCLUSIONS Frailty is prevalent among lung transplant c and i date s and is independently associated with greater disability and an increased risk of delisting or death IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 BACKGROUND Scientific societies recommend assessing lower limb function in usual clinical practice . The Short Physical Performance Battery ( SPPB ) is one of the most vali date d tools to assess this , but its capacity to predict long-term mortality in very old population attending primary care has not been studied . OBJECTIVE To assess the ability of the SPPB to predict 10-year survival in individuals aged 75 and over . METHODS Prospect i ve cohort study with a 10-year follow-up . A representative sample of people aged 75 years or older without severe dependence ( Barthel Index > 20 ) treated at a Spanish primary care centre ( n = 315 ) . Baseline evaluation included  geriatric assessment  with most well-known death predictors . The three SPPB subtasks ( st and ing balance , walking speed and chair st and tests ) were administered . Kaplan-Meier curves and Cox proportional hazard models were calculated for all-cause mortality . RESULTS Mean age was 81.9 years ( 60.6 % female ) . Ten-year survival of elders with SPPB score < 7 and ≥7 was 0.23 and 0.37 ( P < 0.001 ) , respectively . This difference remained statistically significant in the Cox model adjusted by age , gender , number of drugs prescribed , cognitive status , body mass index and visual sharpness ( adjusted hazard ratio = 1.37 ; 95 % confidence interval : 1.01 - 1.86 ) . Also , walking speed and chair st and subtasks were both individual-independent predictors of 10-year survival . CONCLUSIONS Our findings indicate that SPPB is an independent predictor of long-term survival . The chair st and subtask could be a predictor as useful as the full performance battery , becoming a good alternative for primary care where the burden of performing all three subtasks could be excessive
target: The association between poor performance on SPPB and all-cause mortality remained highly consistent independent of follow-up length , subsets of participants , geographic area , and age of the population .
  Conclusions An SPPB score lower than 10 is predictive of all-cause mortality .
  The systematic implementation of the SPPB in clinical practice setting s may provide useful prognostic information about the risk of all-cause mortality .
background: Background The Short Physical Performance Battery ( SPPB ) is a well-established tool to assess lower extremity physical performance status .
  Its predictive ability for all-cause mortality has been sparsely reported , but with conflicting results in different subsets of participants .
  The aim of this study was to perform a meta- analysis investigating the relationship between SPPB score and all-cause mortality  .