Huang Li, Liang Zhenzhen, Chen Huajian
Faculty of Medical, Heidelberg University, Heidelberg, Germany.
Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, China.
Int J Behav Nutr Phys Act. 2025 Mar 10;22(1):31. doi: 10.1186/s12966-025-01725-8.
Frailty has become an important health problem in the middle-aged and older people population. Physical activity (PA) is a key intervention for frailty prevention and management. However, studies of the association between COVID-19 pre-pandemic PA and the worsening or improvement of frailty during the pandemic remain unclear.
This longitudinal cohort study used data from the English Longitudinal Study of Ageing (ELSA), including participants aged 50 and over. Three intensities of PA (vigorous, moderate, and mild) were categorized as less than once per week and at least once per week, respectively, based on participant self-report. The frailty index (FI) assessed the frailty status, defining frailty as FI ≥ 25. Logistic regression was applied to examine the association between PA and frailty, estimating odds ratios (OR) and 95% confidence intervals (95% CI).
Of the 4379 non-frail participants at baseline (median age 67, 54.9% female), 8.1% developed frailty during a mean follow-up of 3.5 years. Among 564 frail participants at baseline (median age 71, 66.5% female), 17.9% regained health. Compared to those engaging in PA less than once per week, participants who engaged in vigorous (OR: 0.47 [95% CI: 0.35-0.62]), moderate (OR: 0.37 [95% CI: 0.29-0.48]), or mild (OR: 0.38 [95% CI: 0.26-0.56]) PA at least once a week had a lower risk of frailty worsening. Additionally, participants who engaged in moderate (OR: 2.04 [95% CI: 1.29-3.21]) or mild (OR: 2.93 [95% CI: 1.54-5.58]) PA at least once a week had a higher likelihood of frailty improvement. Sensitivity analyses based on comprehensive PA levels confirmed these findings. Participants who maintained at least one PA per week had lower frailty worsening (Vigorous, OR: 0.20 [95%CI: 0.12-0.33]; Moderate, OR: 0.13 [95%CI: 0.09-0.19]; Mild, OR: 0.20 [95%CI: 0.11-0.38]) and higher frailty improvement rates (Moderate, OR: 3.43 [95%CI: 1.93-6.11]; Mild, OR: 4.65 [95%CI: 1.90-11.42]). In addition, individuals (Vigorous, OR: 0.35 [95%CI: 0.20-0.60]; Moderate, OR: 0.36 [95%CI: 0.22-0.56]) who transitioned from inactive to active also exhibited a lower risk of frailty.
This study emphasized the critical role of PA in preventing and improving frailty in middle-aged and older people, especially during the COVID-19 pandemic. Our study also highlighted the importance of maintaining PA habits to reduce frailty risk and promote its improvement. Also, the study indicated that individuals who transitioned from inactive to active had a lower risk of frailty. These findings enriched the understanding of the association between PA and frailty and provided valuable insights for addressing the health impact of future pandemics on middle-aged and older people.
衰弱已成为中老年人群中的一个重要健康问题。身体活动（PA）是预防和管理衰弱的关键干预措施。然而，关于新冠疫情前的身体活动与疫情期间衰弱状况恶化或改善之间关联的研究仍不明确。
这项纵向队列研究使用了英国老龄化纵向研究（ELSA）的数据，包括50岁及以上的参与者。根据参与者的自我报告，将三种强度的身体活动（剧烈、中等和轻度）分别归类为每周少于一次和每周至少一次。衰弱指数（FI）评估衰弱状况，将衰弱定义为FI≥25。应用逻辑回归分析来检验身体活动与衰弱之间的关联，估计比值比（OR）和95%置信区间（95%CI）。
在基线时4379名非衰弱参与者中（年龄中位数67岁，女性占54.9%），在平均3.5年的随访期间，8.1%的人出现了衰弱。在基线时564名衰弱参与者中（年龄中位数71岁，女性占66.5%），17.9%的人恢复了健康。与每周进行身体活动少于一次的人相比，每周至少进行一次剧烈（OR：0.47 [95%CI：0.35 - 0.62]）、中等（OR：0.37 [95%CI：0.29 - 0.48]）或轻度（OR：0.38 [95%CI：0.26 - 0.56]）身体活动的参与者衰弱恶化风险较低。此外，每周至少进行一次中等（OR：2.04 [95%CI：1.29 - 3.21]）或轻度（OR：2.93 [95%CI：1.54 - 5.58]）身体活动的参与者衰弱改善的可能性更高。基于综合身体活动水平的敏感性分析证实了这些发现。每周至少保持一种身体活动的参与者衰弱恶化风险较低（剧烈，OR：0.20 [95%CI：0.12 - 0.33]；中等，OR：0.13 [95%CI：0.09 - 0.19]；轻度，OR：0.20 [95%CI：0.11 - 0.38]），衰弱改善率更高（中等，OR：3.43 [95%CI：1.93 - 6.11]；轻度，OR：4.65 [95%CI：1.90 - 11.42]）。此外，从不活动转变为活动的个体（剧烈，OR：0.35 [95%CI：0.20 - 0.60]；中等，OR：0.36 [95%CI：0.22 - 0.56]）也表现出较低的衰弱风险。
本研究强调了身体活动在预防和改善中老年人衰弱方面的关键作用，尤其是在新冠疫情期间。我们的研究还强调了保持身体活动习惯以降低衰弱风险和促进其改善的重要性。此外，该研究表明从不活动转变为活动的个体衰弱风险较低。这些发现丰富了对身体活动与衰弱之间关联的理解，并为应对未来疫情对中老年人健康的影响提供了有价值的见解。
