Self-reported physical activity properties and 20-year all-cause and cardiovascular mortality among community-dwelling older adults

Purpose: Physical activity was previously associated with decreased mortality. Current guidelines recommend >150 min/week or >75 min/week of moderate or high-intensity exercise to maintain a healthy lifestyle; however, exercise properties most strongly associated with low mortality among the elderly may still be explored. Methods: A total of 1210 community-dwelling older adults, from the third phase (1999-2004) of the Israel Study on Glucose Intolerance, Obesity, and Hypertension, were followed until 2016 and 2019 for cardiovascular and all-cause mortality, respectively. Physical activity properties were recorded and evaluated against all-cause and cardiovascular mortality. Results: Mean age at baseline was 73 ± 7 years, with 638 (53%) females, and 585 (48%) reported habitual exercise. When compared to sedentary individuals, multivariable Cox regressions showed a significantly lower risk for all-cause mortality among currently active individuals [hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.59-0.88, P =. 002], those engaging in light-moderate activity (HR = 0.72, 95% CI: 0.57-0.89, P =. 003), those with diverse exercise types (HR = 0.59, 95% CI: 0.44-0.80, P =. 001), more sessions/week (HR = 0.94, 95% CI: 0.92-0.97, P <. 001), those meeting current exercise recommendations (HR = 0.79, 95% CI: 0.58-0.89, P =. 03), those who engaged in walking (HR = 0.58, 95% CI: 0.45-0.76, P <. 001), and swimming (HR = 0.66, 95% CI: 0.45-0.96, P =. 03). Similar HRs were found for cardiovascular mortality, although a somewhat stronger protective association was observed for swimming (HR = 0.48, 95% CI: 0.24-0.95, P =. 04) compared to a sedentary lifestyle. Conclusion: The study further supports current exercise guidelines among the elderly. It also underscores the importance of physical activity in older individuals while prioritizing a greater number of sessions/week in addition to the total duration, and highlights specific activity features associated with lower long-term mortality among older adults. Key message: • What is already known on this topic - Physical activity was associated with a lower risk for mortality, although the specific properties and the preferred type of exercise among older adults are still debatable. • What this study adds - The study suggests the optimal activity characteristics in older adults while prioritizing activity sessions over time, light-moderate exercise over strenuous activity, diverse activity, and walking and swimming over other activities. • How this study might affect research, practice or policy - Future exercise guidelines should focus on increasing activity sessions throughout the week and not on the cumulative time to maximize the effect on mortality.