New research shows relationship between activity levels and mortality in elderly

Doing just a few minutes at a time of any level of physical activity, is linked to a lower risk of death in older men according to a new study published online in the British Journal of Sports Medicine. Providing the recommended 150 minute weekly tally of moderate physical activity is reached, total volume, rather than activity in 10 minute bouts, as current guidelines suggest, might be key, the findings indicate.

This lower level of intensity is also likely to be a better fit for older men, most of whose daily physical activity is of light intensity, say the researchers. Current exercise guidelines recommend accumulating at least 150 minutes a week of moderate to vigorous physical activity in bouts lasting 10 or more minutes. But such a pattern is not always easy for older adults to achieve, say the researchers.

To find out if other patterns of activity might still contribute to lowering the risk of death, the researchers drew on data from the British Regional Heart Study. This involved 7735 participants from 24 British towns, who were aged between 40 and 59 when the study stated in 1978-80.

In 2010-12, the 3137 survivors were invited for a check-up, which included a physical examination, and questions about their lifestyle, sleeping patterns, and whether they had ever been diagnosed with heart disease.

They were also asked to wear an accelerometer, a portable gadget that continuously tracks the volume and intensity of physical activity–during waking hours for 7 days. Their health was then tracked until death or June 2016, whichever came first.

In all, 1566 (50%) men agreed to wear the device, but after excluding those with pre-existing heart disease and those who hadn’t worn their accelerometer enough during the 7 days, the final analysis was based on 1181 men, whose average age was 78. During the monitoring period, which averaged around 5 years, 194 of the men died. The accelerometer findings indicated that total volume of physical activity, from light intensity upwards, was associated with a lower risk of death from any cause.

Each additional 30 minutes a day of light intensity activity, such as gentle gardening or taking the dog for a walk, for example, was associated with a 17 percent reduction in the risk of death. This association persisted even after taking account of potentially influential lifestyle factors, such as sedentary time.

Whilst the equivalent reduction in the risk of death was around 33 percent for each additional 30 minutes of moderate to vigorous intensity physical activity a day, the benefits of light intensity activity were large enough to mean that this too might prolong life.

And there was no evidence to suggest that clocking up moderate to vigorous activity in bouts of 10 minutes or more was better than accumulating it in shorter bouts. Sporadic bouts of activity were associated with a 41 percent lower risk of death; bouts lasting 10 or more minutes were associated with a 42 percent lower risk.

Sporadic bouts seemed easier to achieve as two thirds (66%) of the men achieved their weekly total of moderate to vigorous physical activity in this way while only 16% managed to do so in bouts of 10 or more minutes. Finally, there was no evidence to suggest that breaking up sitting time was associated with a lower risk of death.

This is an observational study so no firm conclusions can be drawn about cause and effect. And those who wore the accelerometer tended to be younger and have healthier lifestyles than those who didn’t, so this might have skewed the results, say the researchers. Nor is it clear if the findings would be equally applicable to younger age groups or older women. Nevertheless, the results could be used to refine current physical activity guidelines and make them more achievable for older adults, suggest the researchers.

Future guidance might emphasise that all physical activity, however modest, is worthwhile for extending the lifespan–something that is particularly important to recognise, given how physical activity levels tail off rapidly as people age, they point out.

“the results suggest that all activities, however modest, are beneficial. The finding that low intensity physical activity is associated with lower risk of mortality is especially important among older men, as most of their daily physical activity is of light intensity,” write the researchers.

“Furthermore, the pattern of accumulation of physical activity did not appear to alter the associations with mortality, suggesting that it would be beneficial to encourage older men to be active irrespective of bouts,” they add.

Citation: Jefferis, Barbara J., Tessa J. Parsons, Claudio Sartini, Sarah Ash, Lucy T. Lennon, Olia Papacosta, Richard W. Morris, S. Goya Wannamethee, I. -Min Lee, and Peter H. Whincup. “Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation?” British Journal of Sports Medicine, 2018. doi:10.1136/bjsports-2017-098733.

Adapted from press release by BMJ Publications.

Research shows rise in global life expectancy by 2030

The study, led by scientists from Imperial College London in collaboration with the World Health Organization, analyzed long-term data on mortality and longevity trends to predict how life expectancy will change in 35 industrialized countries by 2030. Nations in the study included both high-income countries, such as the USA, Canada, UK, Germany, Australia, and emerging economies such as Poland, Mexico, and the Czech Republic. The researchers chose countries in the study as they all had reliable data on deaths since at least 1985.

Posterior distribution of projected change in life expectancy at birth from 2010 to 2030.
Posterior distribution of projected change in life expectancy at birth from 2010 to 2030.
Credit: The Lancet.

The study, published in The Lancet and funded by the UK Medical Research Council, revealed all nations in the study can expect to see an increase in life expectancy by 2030. The results also found that South Koreans may have the highest life expectancy in the world in 2030. The UK’s average life expectancy at birth for women will be 85.3 years in 2030.

Professor Ezzati, lead researcher from the School of Public Health at Imperial explained that South Korea’s high life expectancy may be due to a number of factors including good nutrition in childhood, low blood pressure, low levels of smoking, good access to healthcare, and uptake of new medical knowledge and technologies.

French women and Swiss men were predicted to have the highest life expectancies at birth in Europe in 2030, with an average life expectancy of 88.6 years for French women and nearly 84 years for Swiss men.

The results also revealed that the USA is likely to have the lowest life expectancy at birth in 2030 among high-income countries. The nation’s average life expectancy at birth of men and women in 2030 (79.5 years and 83.3 years), will be similar to that of middle-income countries like Croatia and Mexico. The research team thinks this may be due to a number of factors including a lack of universal healthcare, as well as the highest child and maternal mortality rate, homicide rate and obesity among high-income countries.

Along with the US, other countries who may see only small increases in life expectancy by 2030 included Japan, Sweden, and Greece, while Macedonia and Serbia were projected to have the lowest life expectancies at birth for women and men respectively in 2030.

The UK’s average life expectancy at birth for women will be 85.3 years in 2030. This places them at 21st in the table of 35 countries. The average life expectancy of a UK man meanwhile will be 82.5 years in 2030. This places them at 14th in the table of 35 countries.

The research also suggested the gap in life expectancy between women and men is closing. Professor Ezzati explained: “Men traditionally had unhealthier lifestyles and so shorter life expectancies. They smoked and drank more, and had more road traffic accidents and homicides. However as lifestyles become more similar between men and women, so does their longevity.”

Professor Colin Mathers, co-author from the World Health Organization explained: “The increase in average life expectancy in high-income countries is due to the over-65s living longer than ever before. In middle-income countries, the number of premature deaths – i.e. people dying in their forties and fifties, will also decline by 2030.” The team developed a new method to predict longevity, similar to the methods used for weather forecasting, which takes into account numerous different models for forecasting mortality and life expectancy.

Life expectancy is calculated by assessing the age at which people die across the whole population. For instance, if a country has high childhood mortality rate, this will make average national life expectancy much lower, as would a country in which many young people die of injuries and violence. The team developed a new method to predict longevity, similar to the methods used for weather forecasting, which takes into account numerous different models for forecasting mortality and life expectancy. All the predictions in the study come with some uncertainty range.

Professor Ezzati added that these results suggest we need to be thinking carefully about the needs of an ageing population: “The fact that we will continue to live longer means we need to think about strengthening the health and social care systems to support an ageing population with multiple health needs. This is the opposite of what is being done in the era of austerity. We also need to think about whether current pension systems will support us, or if we need to consider working into later life.”

Citation: Kontis, Vasilis, James E Bennett, Colin D Mathers, Guangquan Li, Kyle Foreman, and Majid Ezzati. 2017. “Future Life Expectancy in 35 Industrialised Countries: Projections with a Bayesian Model Ensemble.” The Lancet, February. Elsevier.
Research funding: UK Medical Research Council, US Environmental Protection Agency.
Adapted from press release by Imperial College London.

Current global health metrics

(Washington) Improvements in sanitation, immunizations, indoor air quality, and nutrition have enabled children in poor countries to live longer over the past 25 years, according to a new scientific analysis of more than 300 diseases and injuries in 195 countries and territories.

However, such progress is threatened by increasing numbers of people suffering serious health challenges related to obesity, high blood sugar, and alcohol and drug abuse.

These and other significant health findings are being published in a dedicated issue of The Lancet as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The study draws on the work of more than 1,800 collaborators in over 120 countries.

“Development drives, but does not solely determine health,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, the coordinating center for the GBD enterprise. “We see countries that have improved far faster than can be explained by income, education, or fertility. And we also continue to see countries – including the United States – that are far less healthy than they should be given their resources.”

Globally, life expectancy increased from about 62 years to nearly 72 from 1980 to 2015, with several nations in sub-Saharan Africa rebounding from high death rates due to HIV/AIDS. Child deaths are falling fast, as are illnesses related to infectious diseases. But each country has its own specific challenges and improvements, from fewer suicides in France, to lower death rates on Nigerian roadways, to a reduction in asthma-related deaths in Indonesia.

The report was released at an event co-sponsored by IHME, The Lancet, and the World Bank in Washington, DC. The study was established in 1990 with support from the World Bank. This year researchers analyzed each country using the new Socio-demographic Index metric, examining rates of education, fertility, and income. This new categorization goes beyond the historical classifications of “developed” versus “developing” countries or economic divisions based on income alone.

The six papers provide in-depth analyses of causes of death, maternal mortality, deaths of children under age 5, overall disease burden and life expectancy, years lived with disability, and the risk factors that lead to health loss.

In much of the world, giving birth is safer for mothers and newborns than it has been over the past 25 years. The number of maternal deaths globally dropped by roughly 29% since 1990, and the ratio of maternal deaths fell 30%, from 282 per 100,000 live births in 1990 to 196 in 2015.

However, 24 countries still have what population health experts consider high rates of maternal mortality, more than 400 deaths per 100,000. These include Central African Republic (1,074 deaths per 100,000), Afghanistan (789 per 100,000), and Sierra Leone (696 per 100,000).

Such levels of maternal deaths underscore the need for reproductive health improvements in those three nations and other countries that are far behind the United Nations’ goal to have fewer than 70 deaths per 100,000 live births by 2030. Areas for improvement include increased access to family planning, better routine reproductive health care, and improved data collection systems.
 The study’s other findings include:

  • Death rates fell notably between 1990 and 2015. And that trend has been particular strong over the past decade. Between 2005 and 2015, death rates from HIV/AIDS decreased 42%, malaria 43%, preterm birth complications 30%, and maternal disorders 29%.
  • Globally, 5.8 million children under age 5 died in 2015, representing a 52% decline in the number of under-5 deaths since 1990. Neonatal deaths fell at a slower pace since 1990, decreasing 42% to 2.6 million; stillbirths declined 47% to 2.1 million.
  • Three out of every 10 people globally suffer from tooth decay, while approximately two of every 10 have trouble with tension headaches, anemia, and hearing loss. Other top nonfatal causes of health loss include migraines, vision impairment, genital herpes, and parasitic worms.
  • Much of people’s health is determined by risk factors, some of which are within one’s control. Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each fell more than 25%. However, exposure to several occupational risks, high body mass index, and drug use increased more than 25% over the same period.

Other risk factors are exacerbated by poor diet, lack of exercise, and smoking, and lead to a significant health burden. High systolic blood pressure was the top risk factor in 2015, contributing to over 9% of global health loss, followed by smoking (6.3%), high blood sugar (6.1%), and high body mass index (5%).

“Many nations face significant health challenges despite the benefits of income, education, and low birth rates, while other countries farther behind in terms of development are seeing strong progress,” said Dr. Charles Shey Wiysonge, a GBD collaborator from South Africa who serves as a Professor of Clinical Epidemiology at the Faculty of Medicine and Health Sciences, Stellenbosch University, in Cape Town. “Policymakers in all nations – from Afghanistan to Zimbabwe – can use this study to align spending to target the things that will make their communities healthier faster.”

Adapted from press release by IHME