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com

Original article

150 minutes of vigorous physical activity per week

predicts survival and successful ageing:
a population-based 11-year longitudinal study
of 12 201 older Australian men
Osvaldo P Almeida,1,2,3 Karim M Khan,4,5,6 Graeme J Hankey,7,8 Bu B Yeap,7,9
Jonathan Golledge,10 Leon Flicker2,7,11

For numbered affiliations see ABSTRACT health resources than their inactive counterparts,3
end of article. Background Physical activity has been associated with possibly because physical activity reduces the morbid-
Correspondence to improved survival, but it is unclear whether this increase ity associated with diabetes, musculoskeletal disor-
Professor Osvaldo P Almeida, in longevity is accompanied by preserved mental and ders, cardiovascular diseases and cancer,4 as well as
School of Psychiatry & Clinical physical functioning, also known as healthy ageing. the risk of frailty.5 6 These findings suggest that a
Neurosciences (M573), We designed this study to determine whether physical physically active lifestyle contributes to increase lon-
University of Western Australia,
activity is associated with healthy ageing in later life. gevity and, potentially, ageing free of significant
35 Stirling Highway, Crawley,
Perth, WA 6009, Australia; Methods We recruited a community-representative medical morbidity. Such outcomes are akin to the
osvaldo.almeida@uwa.edu.au sample of 12 201 men aged 65–83 years and followed concept of successful or healthy ageing.
them for 10–13 years. We assessed physical activity at Healthy ageing is a multidimensional phenotype
Accepted 12 August 2013 the beginning and the end of the follow-up period. characterised by various necessary but insufficient
Published Online First
3 September 2013 Participants who reported 150 min or more of vigorous components, including preserved cognitive, affect-
physical activity per week were considered physically ive and daily function.7 A 5-year longitudinal study
active. We monitored survival during the follow-up of 601 men who had reached their 80s showed
period and, at study exit, assessed the mood, cognition that ageing free of clinically significant cognitive
and functional status of survivors. Healthy ageing was and mood disturbances was associated with higher
defined as being alive at the end of follow-up and education and physical activity, and that this associ-
having a Patient Health Questionnaire score <10, ation was independent of other sociodemographic,
Telephone Interview for Cognitive Status score >27, lifestyle and clinical measures.8 Physical activity has
and no major difficulty in any instrumental or basic also been associated with improved physical func-
activity of daily living. Cox regression and general linear tion in randomised trials of older sedentary
models were used to estimate HR of death and risk ratio people,9 which suggests that a physically active life-
(RR) of healthy ageing. Analyses were adjusted for age, style might contribute to preserve function and
education, marital status, smoking, body mass index and defer disability.10 Recent reviews have concluded
history of hypertension, diabetes, coronary heart disease that physical activity is associated with increased
and stroke. survival11 and with less cognitive decline and
Results Two thousand and fifty-eight (16.9%) impairment.12 13 Taken together, existing data indi-
participants were physically active at study entry. Active cate that physical activity may be an important
men had lower HR of death over 10–13 years than factor in enabling people to age successfully.13
physically inactive men (HR=0.74, 95% CI=0.68 to A sufficiently powered randomised controlled trial
0.81). Among survivors, completion of the follow-up would be the best way to establish with certainty that
assessment was higher in the physically active than physical activity causes older people to age success-
inactive group (risk ratio, RR=1.18, 95% CI=1.08 to fully. Although there is trial evidence to prove that
1.30). Physically active men had greater chance of physical activity improves physical and mental func-
fulfilling criteria for healthy ageing than inactive men tion, such data have arisen predominantly from
(RR=1.35, 95% CI=1.19 to 1.53). Men who were at-risk populations (such as sedentary people or older
physically active at the baseline and follow-up adults with mild cognitive impairment or depression)
assessments had the highest chance of healthy ageing and are difficult to generalise.9 12 14 Designing a trial
compared with inactive men (RR=1.59, 95% CI=1.36 of physical activity for an unselected community
to 1.86). sample of older people would be challenging because
Conclusions Sustained physical activity is associated of the high probability of contamination of the
with improved survival and healthy ageing in older men. control group and loss of power. A longitudinal study
Vigorous physical activity seems to promote healthy of a community-representative sample of older
ageing and should be encouraged when safe and people might be a more pragmatic way of ascertain-
feasible. ing whether physical activity contributes to healthy
ageing. Such a study should aim to minimise con-
founding (eg, age, education and body mass index),
To cite: Almeida OP, INTRODUCTION reverse-causality (eg, prevalent disease causing phys-
Khan KM, Hankey GJ, et al. Regular engagement in vigorous physical activity has ical inactivity) and survivorship bias (eg, outcome
Br J Sports Med 2014;48: been associated with reduced mortality in middle age data more likely to be available among those who are
220–225. and in later life.1 2 Active older people consume less healthy) to ensure that its results are valid.

Almeida OP, et al. Br J Sports Med 2014;48:220–225. doi:10.1136/bjsports-2013-092814 1 of 6

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Original article

We examined the association between physical activity and Outcome measure: survival and healthy ageing 11 years
healthy ageing in a community-representative sample of 12 201 later (HIMS2)
older men. We collected survey data at two different time-points Outcome data were collected 9.8–12.6 years after the baseline
and used electronic administrative health records to optimise assessment (mean±SD: 11.1±0.6). All cause mortality data
the validity of our analyses. We hypothesised that, compared were retrieved from the Western Australia Data Linkage
with inactive men, participants who were physically active at the System,21 which include information about the date of death
beginning of the follow-up period would have greater chance of that we then used to calculate time to death.
being alive and free of affective, cognitive and physical func- We considered that surviving participants were ‘healthy’ if
tional impairment 10–13 years later. they showed no evidence of clinically significant symptoms of
depression, impaired cognition or daily physical function at the
follow-up assessment that was conducted in 2008–2009
METHODS (HIMS2). Men were considered free of clinically significant
Study design and setting depressive symptoms if their total score on the Patient Health
Cohort study of a community-representative sample of older Questionnaire (PHQ-9) was lower than 10.22 The presence of
men living in the Perth metropolitan area, Australia. cognitive impairment was established by a score of 27 or lower
on the Telephone Interview for Cognitive Status.23 24 Men rated
their functional limitations in grooming, eating normal food,
Participants bathing or taking a shower, dressing upper body, dressing lower
We used the electoral roll to recruit a community-representative body, getting up from a chair, walking inside the house and
sample of 12 203 men aged 65–83 years into a study of abdom- using the toilet (basic activities of daily living (ADL)),25 as well
inal aortic aneurysm, which served as the starting point for the as shopping for personal items or groceries, doing light house-
Health In Men Study (HIMS). Details about the recruitment work (eg, washing dishes and dusting), doing heavy housework,
procedure have been described elsewhere.15 Eligibility for the laundry, managing money, preparing main meals, taking medica-
current study required availability of physical activity data at the tions, using the telephone and doing leisure activities or hobbies
baseline assessment, which led to the exclusion of two partici- (instrumental activities of daily living (IADL)).26 Possible
pants and resulted in a study sample of 12 201 men. answers for each question were as follows: no difficulty, some
The study was conducted in accordance with the principles difficulty, major difficulty, unable to do without help. We consid-
expressed by the Declaration of Helsinki for Human Rights. ered that men who indicated having ‘major difficulty’ or being
The Human Research Ethics Committee of the University of ‘unable to do without help’ showed evidence of impaired func-
Western Australia approved the study protocol and all men pro- tion in the relevant area. For the purposes of this study, men
vided written informed consent to participate. who reported major difficulty or inability to perform any of the
ADL tasks were considered to have impaired ADLs, and likewise
for IADLs. A secondary endpoint of interest in this study was
Study measures: exposures (HIMS1) survival by 18 April 2009, which was the last date for the
During the baseline assessment (1996–1998), men completed a follow-up assessment, according to physical activity status at
questionnaire that contained information about the date of baseline (HIMS1).
assessment, participant’s date of birth, highest level of education As changes in physical activity between baseline and the
attained, marital status and lifestyle practices. We assessed phys- follow-up assessment could conceivably confound the results of
ical activity with the following question: In a usual week do you the study, we repeated the assessment of physical activity at the
do any vigorous exercise that makes you breathe harder or puff follow-up assessment. We asked the following question: If you
and pant, such as fast walking, jogging, aerobics, vigorous swim- add up all the times you spent in each activity last week, how
ming, vigorous cycling, tennis, football, squash, etc? Men who much time did you spend all together doing more vigorous
indicated that they engaged in vigorous activity for 150 min or leisure activity or household/garden chores that make you
more per week were considered ‘physically active’.16 For con- breathe harder or puff and pant? We considered that men were
venience in this article, men who did not meet the 150 min physically active if they reported 150 min or more of vigorous
threshold will be referred to as ‘physically inactive’. This ques- activity.
tion about physical activity was derived from an Australian
survey for the prevention of cardiovascular diseases.17 Statistical analyses
We also measured smoking status and alcohol use,18 and con- Data were managed and analysed with the statistical package
sidered men who had never smoked or had quit smoking for at Stata release V. 12.1 (StataCorp, College Station, Texas, USA).
least 5 years ‘non-smokers for at least 5 years’. We chose this We used descriptive statistics (mean, SD of the mean (SD) and
timeline because currently available evidence suggests that the proportions) to summarise our data, and t tests (for age) and
health hazards associated with smoking require about 5 years of Pearson χ2 statistics (χ2) to compare the characteristics of partici-
cessation to become apparent.19 Men who consumed less than pants who were and were not physically active at the baseline
four drinks per day in a usual week were considered ‘safe assessment. We used Cox regression to estimate HR of death by
alcohol users’.20 We used standard procedures to measure parti- 18 April 2009 according to physical activity status, and adjusted
cipant’s height (to 0.5 cm) and weight (to 0.2 kg), and calcu- the results of the analyses for the effect of age, education,
lated the body mass index (BMI) in kg/m2. BMI between 18.5 marital status, smoking, alcohol use, body mass index and the
and 24.9 was considered normal. Finally, we asked participants presence of hypertension, diabetes, coronary heart disease and
the following question: Have you ever been told by a doctor history of stroke. The results were plotted using the
that you had hypertension, diabetes, heart attack/angina/heart Kaplan-Meyer survival function.
bypass surgery or angioplasty (coronary heart disease) or a Exponentiated log-linked general linear models were used to
stroke? (yes/no for each question). estimate the risk ratio (RR), and 95% CI of RR of depression,

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Original article

cognitive impairment and impaired IADLs and ADLs at alcohol use, body mass index and prevalent hypertension, dia-
follow-up according to whether men were physically active or betes, coronary heart disease and stroke; figure 1).
not at the baseline assessment. We followed the same procedures The RR of impaired cognitive function, IADL and ADL at the
to estimate the crude and adjusted RR of being ‘healthy’ at the follow-up assessment was lower for active than inactive men
follow-up assessment according to physical activity status at (table 2), and was borderline non-significant for depression
baseline, and adjusted the analyses for the same variables (p=0.053). The RR of reaching the follow-up assessment free
described above. of mood, cognitive and functional impairments was 1.21 among
Finally, we grouped participants according to their level of the survivors (95% CI=1.08 to 1.35; adjusted for age, marital
physical activity at the baseline and follow-up assessments: phys- status, education, smoking, alcohol use, body mass index and
ically inactive at baseline and follow-up, physically inactive at prevalent hypertension, diabetes, coronary heart disease and
baseline but active at follow-up, active at baseline but physically stroke). If we consider that those who died before the follow-up
inactive at follow-up and active at both baseline and follow-up. assessment could not be healthy, the adjusted RR of completing
We then estimated the RR (and 95% CI) of being ‘healthy’ at the follow-up assessment in good health was 1.35 (95%
follow-up for each group. These analyses were adjusted for the CI=1.19 to 1.53) for those who were active (n=259/1323)
same variables described above, as well as for the following compared with those who were physically inactive (680/6646)
follow-up variables: marital and smoking status, alcohol use and at baseline. This last analysis excluded 4232 participants who
BMI group. The α was set at 5% and all statistical probability were alive but did not complete the follow-up assessment.
tests reported are two-tailed. Finally, we grouped surviving men who took part in both
assessments according to their level of self-reported physical
RESULTS activity. The results of these analyses are summarised in table 3.
Of the 12 201 men who entered the study, 2058 (16.9%) were Being physically active in at least one of the assessments
physically active. Physical activity decreased with increasing age, increased the RR of follow-up completion in good health
and active men were on average 1.1 years younger than their (RR=1.38, 95%CI=1.24 to 1.54; adjusted for age, marital
non-active counterparts (71.2±4.1 vs 72.3±4.4; t=10.68 status, education, smoking, alcohol use, body mass index and
(df=12 199), p<0.001). Table 1 summarises the demographic, prevalent hypertension, diabetes, coronary heart disease and
lifestyle and clinical characteristics of men at the baseline assess- stroke). The health benefits associated with physical activity
ment. A larger proportion of physically active than inactive men were non-significant among those who were active at baseline
reported the completion of high school education, non-risk but not at follow-up, increased by 35% among those who were
alcohol use or smoking, and BMI in the normal range. They physically inactive at baseline but active at follow-up, and was
were also less likely to report a clinical history of hypertension, nearly 60% greater for those who reported being active at both
coronary heart disease and stroke. assessments (table 3).
Eleven years later (mean: 11.1±0.6; range: 9.8–12.6) 4733
men had died, leaving a surviving sample of 7508 people. Of DISCUSSION
those, 3276 (43.6%) accepted our invitation to complete the The results of this community-based longitudinal study showed
follow-up assessment. Completion of the follow-up assessment that a lifestyle that incorporates physical activity increases by
was greater among men who were physically active than inactive 1.6-fold the chance of men aged 65–83 years remaining alive
at baseline (RR=1.18, 95%CI=1.08 to 1.30). Cox regression and free of functional or mental impairments after 10–13 years.
showed that active participants had lower hazard of death We also found that the health benefits of physical activity
during follow-up (n=582/2058) than their physically inactive appeared to be all but lost among active men who became
counterparts (n=4111/10 143): HR=0.74, 95% CI=0.68 to inactive over the following decade, whereas men who were
0.81 (adjusted for age, marital status, education, smoking, physically inactive and became active accrued the benefits of

Table 1 Demographic, lifestyle and clinical characteristics of older men at the beginning of the follow-up period according to their level of
vigorous physical activity
Physically inactive N=10 143 n (%) Physically active N=2058 n (%) Statistic p Value

Age (years)
65–69 3683 (36.3) 962 (46.7) χ2(3)=97.61 <0.001
70–74 3578 (35.3) 683 (33.2)
75–79 2234 (22.0) 336 (16.3)
80+ 648 (6.4) 77 (3.7)
High school education 3827 (37.7) 1075 (52.3) χ2(1)=149.80 <0.001
Marital status married 8231 (81.2) 1689 (82.1) χ2(1)=0.90 0.341
Non-risk alcohol use 5414 (53.4) 1209 (58.7) χ2(1)=19.88 <0.001
Non-smoker for at least 5 years 8326 (82.1) 1832 (89.0) χ2(1)=58.98 <0.001
BMI in the normal range 3035 (29.9) 695 (33.8) χ2(1)=11.77 0.001
Hypertension 3958 (40.4) 729 (37.3) χ2(1)=6.43 0.011
Diabetes 1201 (11.8) 215 (10.4) χ2(1)=3.24 0.072
Coronary heart disease 2490 (25.4) 448 (22.9) χ2(1)=5.34 0.021
Stroke 799 (8.2) 104 (5.3) χ2(1)=18.40 <0.001
We considered physically active men who reported 150 min or more of vigorous exertion during a typical week.
χ2(degrees of freedom): Pearson χ2 statistic; BMI: body mass index.

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studies using a more detailed assessment of physical activity

would strengthen our confidence in the validity and generalis-
ability of the results.
In addition, our definition of ‘physically active’ was limited to
vigorous exertion, which could have contributed to misclassify
as inactive men who engaged in sufficient amounts of moderate
plus vigorous activity. In a previous study, we showed that self-
reported non-vigorous physical activity was not associated with
mental health outcomes,8 which suggested to us that a stringent
self-reported measure of sufficient activity would be required.
However, we acknowledge that a more detailed assessment of
physical activity could have yielded useful information about a
possible dose-effect for this association. Finally, we acknowledge
that our definition of ‘physically active’ was not exactly the
Figure 1 Survival of participants according to whether they were same at study entry and at follow-up. Notwithstanding this
physically active. Participants who reported being vigorously active had caveat, the stratification of the analyses for the assessment of
lower hazard of dying between the assessments than inactive men
risk allowed us to investigate both approaches to the definition
(n=582/2058 vs 4111/10 143; HR=0.74, 95% CI 0.68 to 0.81; the
analysis was adjusted for age, marital status, education, smoking, of physical activity in a way that minimises bias.
alcohol use, body mass index and prevalent hypertension, diabetes, Loss to follow-up is an important source of bias in longitu-
coronary heart disease and cerebrovascular disease). The adjusted risk dinal studies. We had valid data on 12 201 men at study entry,
ratio (RR) of physically active survivors completing the follow-up of whom 4733 died and 44% of the survivors returned for a
assessment compared with physically inactive survivors was 1.18 (95% further assessment 10–13 years later. While survivorship bias is
CI 1.08 to 1.30). inevitable in a cohort study of older people, we were able to
model both death and non-return as outcomes of the study, and
showed that physically active men were more likely than their
healthy ageing. Taken together, these results support the inactive counterparts to remain alive and return for assessment,
hypothesis that physical activity promotes healthy ageing. demonstrating that physical activity makes a significant contribu-
tion to this critical aspect of healthy ageing: to be alive and
Limitations of the study design engaged with one’s environment.
Before discussing the implications of these findings, we must Our pragmatic definition of healthy ageing took into account
consider the characteristics of the study that might have had an the functional capacity of participants, as well as their cognitive
impact on the results. We used a random electoral roll list to and affective state.7 This strategy does not take into account
recruit older men, voting being compulsory in Australia. The important social variables, such as loneliness and financial stress,
sample comprised 63% of all invitations, and previous studies so that the proportion of men ageing successfully could be
have shown that those who took part were healthier than those lower than that reported. The consequence of such a bias would
who did not.27 Such a bias could have led to the selection of a be contamination of the sample of healthy ageing individuals,
more physically active sample, although the results of other which most likely would have reduced the effect size of the
community surveys are not consistent with such an interpret- associations with physical activity. Therefore, it is possible that
ation: our men were not more physically active than other older the association between physical activity and healthy ageing
people living in Western Australia.28 The assessment of physical could be even greater than that reported in this study.
activity is another factor that warrants consideration; it was We carefully adjusted our analyses for known confounding
based on the response of participants to a simple question measures, including demographic, lifestyle and clinical variables,
designed to measure vigorous exertion that others have shown such as prevalent diabetes, hypertension, coronary heart disease
to have good face validity,29 which gives us confidence that our and stroke. Notwithstanding the merit of our approach to the
findings reflect the level of physical activity of older men in the analyses, the possibility of residual confounding by unmeasured
community. Nonetheless, replication of our findings by other prognostic factors cannot be entirely dismissed. It is possible

Table 2 Clinical outcomes of older men according to their level of physical activity
Physically inactive Physically active
N=2535 N=741
Clinical outcomes at the follow-up assessment n (%) n (%) Risk ratio* 95% CI

Depression 168 (7.6) 36 (5.4) 0.71 0.50 to 1.01

Cognitive impairment 730 (33.0) 190 (28.4) 0.86 0.75 to 0.98
Impaired IADL 1460 (57.6) 349 (47.1) 0.82 0.75 to 0.89
Impaired ADL 958 (37.8) 220 (29.7) 0.79 0.70 to 0.89
No mood, cognitive or functional impairment* 680 (26.8) 259 (34.9) 1.30 1.16 to 1.47
Outcomes were collected 11 years after the assessment of physical activity.
We considered physically active men who reported 150 min or more of vigorous exertion during a typical week.
*Risk ratio of the outcome of men who are physically active relative to their insufficiently active counterparts.
†Risk ratio=1.21 (95% CI 1.08 to 1.35) after adjustment for age, education, marital status, smoking, alcohol use, body mass, hypertension, diabetes, coronary heart disease and
cerebrovascular disease at the time of entry into the study.
IADL, instrumental activities of daily living; ADL, activities of daily living.

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Table 3 Risk of being healthy after 11 years according to whether men were physically active at the baseline and the follow-up assessments
Not healthy Healthy
N=2337 N=939
n (%) n (%) Adjusted risk ratio* 95% CI

Inactive at baseline and follow-up 1390 (59.5) 421 (44.8) 1 Reference

Inactive at baseline, active at follow-up 465 (19.9) 259 (27.6) 1.35 1.17 to 1.54
Active at baseline, inactive at follow-up 305 (13.0) 119 (12.7) 1.07 0.90 to 1.30
Active at baseline and follow-up 177 (7.6) 140 (14.9) 1.59 1.36 to 1.86
We considered physically active men who reported 150 min or more of vigorous exertion during a typical week.
Note: ‘Healthy’ indicates that participants showed no evidence of clinically significant depressive symptoms or cognitive impairment at the follow-up assessment, nor did they show
evidence of impairment in basic or instrumental activities of daily living. These analyses excluded participants who were not available for follow-up.
*The analyses were adjusted for age, education, marital status, smoking, alcohol use, body mass, hypertension, diabetes, coronary heart disease and cerebrovascular disease at the time
of entry into the study, as well as for marital status, smoking, alcohol use and body mass at the follow-up assessment.

that the association between physical activity and healthy ageing opportunistic interventions of physical activity for those at risk,
could also be due to reverse causality. In this case, people would although these interventions are likely to affect only a selected
be physically active because they are healthy. The prospective group of older people, possibly the most frail in our community.
design of the study and the statistical adjustment for prevalent In conclusion, physical activity increases 10-year to 13-year
morbidities minimises this possibility, as does the evidence that survival free of functional or mental impairment in later life. As
people who were physically inactive at baseline but became communities worldwide experience a demographic transition
active at follow-up increased their chance of healthy ageing. towards older age, the number of people disabled by ill health
Indeed, the chance of healthy ageing was highest among those will continue to increase.44 Our findings indicate that physical
who were active at both assessments, which seems consistent activity could play a key role in ensuring that we add healthy
with a causal effect of physical activity. life and not only years to our ageing population.
Finally, we acknowledge that our results are restricted to men
and that we cannot be certain they would be equally applicable
to women, although data from other sources suggest that there
What are the key findings?
are no reasons to believe they should not.1 4

▸ Men aged 65–83 years who are physically active (>150 min/
Interpretation of findings week of vigorous physical activity) are more likely than their
After considering the potential caveats of our study, it seems rea- counterparts to live an additional 10–13 years.
sonable to ask the question: How does physical activity prolong ▸ Older men who are physically active have greater chance
life and maintain physical and mental function? There is robust than their counterparts of surviving 10–13 years free of
observational and trial evidence to support the fact that physical cognitive and functional impairment, as well as of
activity decreases the incidence of type 2 diabetes mellitus and depression.
cardiovascular events, which are common diseases of older ▸ Older men who were active and became inactive lost some
age.30 Physical activity has also been associated with reduced of the health benefits associated with physical activity.
blood pressure and risk of hypertension,31 32 improved lipid Those who reported <150 min/week of vigorous physical
profile,33 increased survival and function in people with coron- activity and subsequently became active gained health
ary heart disease,34 decreased risk of stroke35 and of some types benefits, whereas those who remained physically active
of cancer,36 as well as decreased risk of cognitive decline,37 benefited the most: 60% increased chance of healthy
dementia38 and depression.39–41 Our study design prevented us ageing.
from directly exploring mechanisms that could plausibly explain
how physical activity promotes healthy ageing. However, the
follow-up of men for an extended period of time, the use of a
robust definition of healthy ageing that encompassed both phys- How might these results affect clinical practice in the
ical function and mental health and our ability to adjust the stat- near future?
istical analyses for known confounding factors adds credence to
the validity of our results and those of others.13
Given that the association between physical activity and ▸ Health promotion messages should remind older adults that
healthy ageing seems to be valid and physiologically plausible, it is never too late to become active and to enjoy the health
the remaining challenge is to enhance physical activity participa- benefits associated with physical activity.
tion among older people living in the community. Three broad ▸ Whenever feasible, clinicians should encourage physical
areas should be considered. The first is the creation of environ- activity to promote greater longevity and healthy ageing.
ments that are conducive to safe and regular activity: older
people have lower risk of depression if they live in more walk-
able neighbourhoods,42 particularly those that offer access to
safe paths and green areas.43 The second is the education of Author affiliations
1
those at risk through campaigns and the promotion of events School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth,
Australia
that encourage physical activity, although the effectiveness of 2
WA Centre for Health & Ageing, Centre for Medical Research, University of Western
such approach has not been tested yet. Third, health profes- Australia, Perth, Australia
3
sionals must be trained and equipped to implement Department of Psychiatry, Royal Perth Hospital, Perth, Australia

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4
Department of Family Practice, University of British Columbia, Vancouver, Canada 18 Almeida OP, Norman PE, Van Bockxmeer FM, et al. CRP 1846G>A polymorphism
5
Aspetar: Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar increases risk of frailty. Maturitas 2012;71:261–6.
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Centre for Hip Health & Mobility, Vancouver Hospital, Vancouver, Canada 19 Wannamethee SG, Shaper AG, Whincup PH, et al. Smoking cessation and the risk
7
School of Medicine and Pharmacology, University of Western Australia, Perth, of stroke in middle-aged men. JAMA 1995;274:155–60.
Australia 20 NHMRC. Australian Guidelines to reduce health risks from drinking alcohol.
8
Department of Neurology, Royal Perth Hospital, Perth, Australia Australia: Commonwealth of Australia, 2009.
9
Department of Endocrinology, Fremantle Hospital, Fremantle, Australia 21 Holman CD, Bass AJ, Rosman DL, et al. A decade of data linkage in Western
10
Queensland Research Centre for Peripheral Vascular Disease, School of Medicine Australia: strategic design, applications and benefits of the WA data linkage system.
and Dentistry, James Cook University, Townsville, Australia Aust Health Rev 2008;32:766–77.
11
Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia 22 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity
measure. J Gen Intern Med 2001;16:606–13.
Contributors OPA conceived and designed the experiments. OPA, GJH and LF 23 Barber M, Stott DJ. Validity of the Telephone Interview for Cognitive Status (TICS) in
performed the experiments. OPA analysed the data. OPA and KMK drafted the post-stroke subjects. Int J Geriatr Psychiatry 2004;19:75–9.
manuscript. All authors reviewed the manuscript for important intellectual content 24 Seo EH, Lee DY, Kim SG, et al. Validity of the telephone interview for cognitive
and approved its submission for publication. status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and
dementia screening. Arch Gerontol Geriatr 2011;52:e26–30.
Funding National Health and Medical Research Council of Australia, project grant
25 Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The Index of
numbers 279408, 379600, 403963, 513823 and 634492.
Adl: a standardized measure of biological and psychosocial function. JAMA
Competing interests None. 1963;185:914–19.
Ethics approval Human Research Ethics Committee, University of Western 26 Lawton MP, Brody EM. Assessment of older people: self-maintaining and
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150 minutes of vigorous physical activity

per week predicts survival and successful
ageing: a population-based 11-year
longitudinal study of 12 201 older
Australian men
Osvaldo P Almeida, Karim M Khan, Graeme J Hankey, et al.

Br J Sports Med 2014 48: 220-225 originally published online

September 3, 2013
doi: 10.1136/bjsports-2013-092814

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