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Maturitas 75 (2013) 113117

Contents lists available at SciVerse ScienceDirect

Maturitas
journal homepage: www.elsevier.com/locate/maturitas

Review

Lifestyle predictors of healthy ageing in men


Marita Sdergren
Centre of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden

a r t i c l e i n f o a b s t r a c t

Article history: With ageing populations a major challenge is to maintain physical and cognitive function, quality of
Received 15 January 2013 life and independence. The literature does not only indicate important gender differences in lifestyle
Received in revised form 22 February 2013 behaviours, but also how these behaviours might affect health outcomes. The current review has a male
Accepted 25 February 2013
perspective when exploring lifestyle predictors of healthy ageing, such as physical activity and sedentary
behaviours, smoking, diet and alcohol consumption. This review shows that not only do men with healthy
lifestyles survive longer, but also with good health and disability is postponed and compressed into fewer
Keywords:
years at the end of life. It is also clear that physical activity and smoking in midlife and late adulthood
Health behaviour
Food habits
impact and predict healthy ageing in men. However, healthy ageing has no clear phenotypic denition
Physical activity and more research is needed to establish the impact on dietary and sedentary behaviours on healthy
Smoking ageing in men. Adoption of healthier lifestyles could result in postponement of age associated diseases
Older adults and/or the slowing down of the ageing process. Consequently, this allows independent living for a longer
period of time and would reduce the burden to social and health care sectors.
2013 Elsevier Ireland Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
2. Lifestyle factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1. Physical activity, exercise, and sedentary behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.1. Physical activity and physical function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.2. Physical activity and cognitive function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.3. Sedentary behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.2. Smoking and alcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
2.3. Dietary behaviours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
3.1. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

1. Introduction older populations. The major challenge, with ageing populations


is to maintain physical and cognitive functions, quality of life and
Worldwide, it is well-recognized that the population is ageing independence.
and that this will have signicant economic and social impacts [1,2]. Ageing is a continuous process, that includes loss of functional
Accompanying these increasing life expectancies is an awareness capability and changes that depend on numerous genetic, environ-
of the need to promote positive ageing and healthy lifestyles for mental, and lifestyle factors [3]. Ageing is usually viewed as being
distinct from major chronic diseases, but there are often shared
exposure factors or mechanisms, for example, oxidative processes
Correspondence address: Centre of Family Medicine, Department of Neurobio-
that cause mutations in DNA. A study by Newman et al. showed a
logy, Care Sciences and Society, Karolinska Institutet, Alfred Nobels all 12, SE-141
graded relationship between the extent of vascular disease and the
83 Huddinge, Sweden. Tel.: +46 70 7360221. likelihood of an individual maintaining good health and function
E-mail address: marita.sodergren@ki.se as they age [4]. Previous studies have also found that an increased

0378-5122/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.maturitas.2013.02.011
114 M. Sdergren / Maturitas 75 (2013) 113117

central distribution of fat with advancing age are associated with men participating in regular exercise programmes (both strength
chronic metabolic and cardiovascular abnormalities [5]. Chronic and aerobic training) elicited a number of favourable responses
diseases such as cardiovascular disease, diabetes, and chronic respi- that prevent functional decline. Strength training induced signif-
ratory diseases are projected by the WHO to become the leading icant changes in body strength and exibility tests, and the aerobic
causes of disability throughout the world by the year 2020 [2]. Three training improved aerobic endurance, agility and dynamic balance
modiable health risk behaviourslack of physical activity, tobacco [19]. Moreover, a combination of smoking and exercise patterns
use, and poor nutritionare responsible for much of the illness, suf- in midlife and late adulthood has been found to be a predictor
fering, and early death related to chronic diseases [1,2]. In addition, of subsequent disability. Bourke et al., found that exercising and
sedentary behaviours are emerging as an important component of refraining from cigarette smoking is associated with maintenance
the physical activity and health equation [6]. of good health in older men [20]. In addition, Vita et al. assessed
The link between physical activity and health has caused a surge cumulative disability after an average age of 67 years, and showed
in physical activity research, and the evidence is overwhelming that that the onset of disability, among non-smoking, exercising men
physical activity has a protective effect on cardiovascular health (low-risk-group) was postponed by more than ve years [21]. Both
and reduces all-cause mortality [7]. Physical activity has also the cumulative disability and disability in the one or two years before
power to attenuate the decline in appendicular lean tissue as an death were much lower in the low-risk-group than in the high-risk-
individual age and to reduce the risk of abdominal adiposity and group [21]. Similar results were found when examining lifestyle
degradation of skeletal muscles in the elderly (sarcopenia) [8]. Sev- factors associated with a life-span of 90 or more years and the main-
eral studies have reported a role for physical activity in preventing tenance of late-life function in men [22,23]. Regular exercise and
depression and in maintaining cognitive function in older adults not smoking remained signicant predictors of physical and men-
[9,10]. It is also well known that physical activity and a sedentary tal function even after controlling for cardiovascular disease risk
lifestyle have opposing effects on telomere length and thus may factors and the presence of subclinical disease [22].
slow down or accelerate or the ageing process, respectively [11]. Physical activity can inuence the decline in appendicular lean
Cigarette smoking is considered to be the number one killer tissue and reduce the risk of abdominal adiposity and sarcope-
and is the leading cause of death worldwide [1,2]. There is an nia [5]. An increase in physical activity (energy expenditure) was
adverse relationship between smoking and functional ability, and associated with an attenuation of the decline in appendicular lean
strong and consistent associations have been observed between tissue that would normally have been expected over a 10-year
sustained smoking from age 50 to 70 and reduced functional abil- period [5]. Some studies have explored the effect of physical activ-
ity at age 75, even after adjustment for physical activity [12,13]. ity on endocrine function and bone density in men. For example,
Furthermore, smoking is reported to be positively correlated with one study from Italy suggests that, in ageing men, regular mod-
alcohol consumption, and an unhealthy diet [14]. Conversely, older erate physical activity is associated with higher levels of serum
adults who exercise regularly report a lower intake of dietary fat dehydroepiandrosterone sulfate (DHEAS) and, insulin-like growth
compared to non-exercising older adults. It is clear that there are factor-I (IGF-1) and with alterations in thyroid function [24]. Also,
multiple determinants for healthy ageing, and gender differences data from a large prospective study examining midlife determi-
have been observed in various lifestyle behaviours and in how nants of future hip fractures in men showed that high levels of
these behaviours affect health outcomes [15,16]. The current short leisure-time physical activity protected against hip fracture [25].
review, therefore, takes a male perspective when exploring lifestyle However, neither the study by Ravaglia et al. nor a later exercise
predictors of healthy ageing. intervention study by Huuskonen et al. could establish a convinc-
ing relation between regular physical activity, sex hormone levels,
2. Lifestyle factors and/or bone mineral density in healthy men [24,26].

The MEDLINE and EMBASE databases were reviewed for


2.1.2. Physical activity and cognitive function
English-language publications concerning lifestyle predictors of
Dementia and depression are among the most prevalent and dis-
healthy ageing, such as physical activity and sedentary behaviours,
abling psychiatric disorders of later life, and physical activity is an
smoking, diet, and alcohol consumption. Of the studies found, 20
important protective factor against cognitive decline [27]. A large-
included a signicant number of men and were deemed suitable
scale prospective cohort study from Canada showed a signicant
for the current analysis (Table 1).
protective effect of regular physical activity on the risk of cognitive
impairment and dementia in women [28]. A trend of decreased
2.1. Physical activity, exercise, and sedentary behaviour
risk of cognitive decline with increased physical activity was also
observed in men but not of statistical signicance [28]. On the other
A comprehensive review on exercise and longevity, published in
hand, a cross-sectional study of older men (65 years and older)
this journal last year by Gremeaux et al., established that exercise
showed that the likelihood of reporting high levels of psychologi-
has the power to partially reverse the effects of the ageing process
cal distress decreased with increasing weekly sessions of physical
on physiological functions and to preserve remaining functional
activity, regardless of their level of functional limitation [29].
levels in both elderly men and elderly women [17]. The current
review is built on that work and, focuses on associations between
physical activity, and physical and cognitive function in elderly 2.1.3. Sedentary behaviour
men. Recent studies have examined whether there is an association
between sedentary behaviour and healthy ageing that is, inde-
2.1.1. Physical activity and physical function pendent of physical activity levels. Novel ndings suggest that
Several studies provide encouraging evidence that disability a sedentary lifestyle is associated with reduced mitochondrial
prior to death is not an inevitable part of a mans life but may be pre- function and that this is an important determinant of ageing in
vented by physical activity. For example, Leveille et al. showed that skeletal muscles and the development of sarcopenia in the elderly
physical activity (reported as walking, gardening, and exercising) [30]. Using a large database of middle-aged and older men, Dogra
was a key factor in predicting a non-disabled 65-year-old mans et al. found evidence for a dose-dependent relationship between
chances of surviving to age 80 and then being non-disabled prior sedentary behaviour and successful ageing that was, independent
to death [18]. Also, Lobo et al. showed that institutionalized elderly of physical activity levels [31]. Thus, sedentary behaviour and
M. Sdergren / Maturitas 75 (2013) 113117 115

Table 1
Summary of included studies examining healthy ageing in men (n = 20).

Author Year Country Study name N Age (y) Study design Indicator of healthy
ageing

Hughes et al. 2004 US 54 Mean age, 60.4 at Prospective cohort (+) physical activity
[5] baseline study (10 years)
Leveille et al. 1999 US Established 1097 65 or older at baseline Prospective cohort (+) physical activity
[18] Populations for study (10 years)
Epidemiologic Studies
of Elderly
Lobo et al. [19] 2011 Portugal 185 6692 at baseline Randomized control (+) exercise
trial (1 year)
Burke et al. [20] 2001 US Cardiovascular Health 1299 65 or older at baseline Prospective cohort (+) exercise
Study study (7 years) () smoking
Vita et al. [21] 1998 US 1741 Mean age, 43.0 at Prospective cohort (+) exercise
baseline study (32 years) () smoking
Yates et al. [22] 2008 US Physicians Health 2357 Mean age, 72.0 at Prospective cohort (+) exercise
Study baseline study (16 years) () smoking
(0) alcohol intake
Willcox et al. 2006 US Honolulu Heart 5820 4568 at baseline Prospective cohort () smoking
[23] Program/Honolulu Asia study (40 years)
Aging Study
Ravaglia et al. 2001 Italy 96 Mean age, 62.7 Retrospective cohort (+) physical activity
[24] study (10 years)
Trimpou et al. 2010 Sweden Multifactor Primary 7495 4656 at baseline Prospective cohort (+) physical activity
[25] Prevention Study study (30 years) () smoking
Huuskonen 2002 Finland 140 5362 at baseline Randomized control (0) physical activity
et al. [26] trial (4 years)
Almeida et al. 2006 Australia 601 80 at follow up Prospective cohort (+) physical activity
[27] study (4.8 years) () fat intake
(0) alcohol intake
Laurin et al. 2001 Canada Canadian Study of 4615 65 or older at baseline Prospective cohort (0) physical activity
[28] Health and Aging (40% men) study (5 years)
George et al. 2011 Australia New South Wales 45 17,689 65 or older Cross-sectional study (+) physical activity
[29] and up study
Safdar et al. 2010 US 20 5075 Cross-sectional study (+) physical activity
[30] () sedentary
behaviour
Dogra and 2012 Canada The Healthy Aging 19,538 45 or older Cross-sectional study (+) physical activity
Stathokostas cycle of the Canadian (45% men) () sedentary
[31] Community Health behaviour
Survey
Izumotani et al. 2003 Japan 686 4059 Cross-sectional study () smoking
[32] (0) exercise
(0) alcohol intake
(0) calcium intake
Wardle et al. 2000 UK 1040 Mean age, 51.5 Cross-sectional study (+) fruit and vegetables
[33] (43.8% men) () fat intake
McKeown et al. 2010 US Framingham Heart 2834 3283 Cross-sectional study (+) whole-grain
[34] Study (50.6% men) () rened-grain
Hu et al. [35] 2000 US Health Professionals 44,875 4075 at baseline Prospective cohort (+) prudent diet
Follow-up Study study (8 years) () western diet
Shatenstein 2004 Canada 1990 Enqu te qu b coise 460 5574 Cross-sectional study (+) diet quality
et al. [36] sur la nutrition (47% men)

Note: (+) positively associated, () negatively associated, (0) no association with healthy ageing found.

physical activity may be independent risk factors for poor health 2.3. Dietary behaviours
among ageing men [31].
In general, older men tend to have unhealthier diets, i.e. less
2.2. Smoking and alcohol consumption fruit and vegetables, and higher fat intake, than their female coun-
terparts [33]. Older men also tend to have a higher intake of rened
Besides the studies mentioned above that show the health ben- grains compared to older women [34]. McKeown et al. examined
ets for a combination of exercising and non-smoking in men, if intake of rened- or whole-grains were associated with smok-
smoking is also an independent factor for healthy ageing in men ing and alcohol consumption and found that the rates, for smoking
[23]. For example, Trimpou et al. reported an increased risk of hip and alcohol consumption were similar among older men regard-
fractures in men who smoked [25]. A study from Japan that eval- less of whether they consumed more rened grains or more whole
uated risk factors for osteoporosis in middle-aged men found that grains [34]. Hu et al. found a increase risk of coronary heart diseases
smoking accelerates the reduction of bone density with age [32]. with a Western dietary pattern, characterized by high intake of
The same study found that calcium intake, exercise, and alcohol red meat, rened grains, sugar and high-fat dairy products [35]. A
consumption were not signicant determinants of a mans bone prospective cohort study examined dietary factors associated with
mineral density as he ages [32]. In fact, none of the studies in this successful mental ageing in Australian men older than the age of 80
review that included the consumption of alcohol found any associ- [27]. Of those dietary intake assessed (consumption of meat, sh,
ation between alcohol consumption and physical or mental health full-cream milk, and amount of salt added to meals) only consump-
outcomes among ageing men [22,27,32]. tion of full-cream milk was inversely related to successful mental
116 M. Sdergren / Maturitas 75 (2013) 113117

health ageing and preservation of cognitive function. The authors 3.1. Conclusion
of that study suggest that consumption of full-cream milk could
be associated with lower socioeconomic status and a type of diet Lifestyle behaviours greatly impact and predict how well men
that is poor in essential nutrients such as calcium, iron, magnesium, age, but healthy ageing has no clear phenotypic denition. Adop-
folate, and vitamin C. Consumption of full-cream milk might also tion of healthier lifestyles could result in postponement of age
alter lipid concentrations and may increase the risk of cognitive associated diseases and/or the slowing down of the ageing process.
impairment in later life [27]. However, older men tend to report a Consequently, this allows independent living for a longer period of
lower intake of dairy products than older women [34,35]. Shaten- time and would reduce the burden to social and health care sectors.
stein et al. used a diet quality score to examine determinants of diet
quality and diversity in older Canadian men [36]. They found that Competing interest
breakfast consumption and eating commercially-prepared meals
were positively associated with diet quality, whereas eating fewer There are no competing interests to declare.
than three meals daily and the use of dietary supplements were
both found to be negative predictors of diet quality [36]. Funding

No funding.
3. Discussion

Provenance and peer review


This review shows that not only do men with healthy lifestyles
survive longer, but they also do so in good health and tend to suffer
Commissioned and externally peer reviewed.
disabilities later and over the course of fewer years at the end of
life. It is also clear that healthy ageing in later life can be predicted
by lifestyle factors assessed in midlife and late adulthood. Acknowledgement
It is difcult to compare the studies due to their varying designs,
sample sizes, and methods, so the estimated effects of these lifestyle The author was supported by Signhild Engkvists Foundation,
factors might, therefore, show signicant variation from one study Sweden.
to another. However, it is obvious that engaging in regular physi-
cal activity and refraining from smoking is essential to preventing References
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