Age and Ageing 1998; 27-S3: 17-23

Stability and change in levels of habitual physical activity in later life

GILLIAN K. ARMSTRONG, KEVIN MORGAN Centre for Ageing and Rehabilitation Studies, School of Health and Related Research, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, UK Address correspondence to G. K. Armstrong. Fax: (+44) I 14 271 5771; E-mail: g.k.armstrong@sheffield.ac.uk

Abstract
Objectives: to describe stability and change in levels of customary physical activity assessed in recall-based questionnaire surveys of older people conducted in 1985, 1989 and 1993Design: longitudinal study. Subjects: 1042 people originally aged 65 and over randomly sampled from general practitioner lists in Nottingham, UK. Methods: logistic and multiple regression analyses, intraclass correlation coefficients. Main outcome measures: self-reported time spent per day walking and shopping; self-reported time spent per week in other indoor, outdoor and leisure activities; frequency of performance of strength andflexibilityactivities. Results: among survivors, activity levels at baseline tended to be higher than those of their non-surviving peers. Overall, 8-year change between 1985 and 1993 was characterized by progressively declining activity levels. Nevertheless, in both trajectories and stability profiles, differences did emerge among the seven activity categories studied. At least one in four respondents increased the time they spent walking, and approximately one in three respondents increased the time they spent shopping between 1985 and 1993. Conclusions: thesefindingssuggest that, while some activity variables show levels of stability consistent with traitlike constructs, others are clearly more labile. While the present data cannot offer a definitive explanation for these differences, it seems reasonable that within each activity the influence of ability, opportunity and need interact to determine levels of participation.
Keywords: activity, ageing, exercise, leisure, longitudinal study, shopping, stability

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Introduction
The physiological benefits of regular exercise and aerobic training have now been demonstrated across the human Iifespan [1]. However, since current cohorts of elderly people show relatively low participation rates in sports and formal exercise programmes [2], the health implications of habitual or customary physical activity levels in later life have attracted particular attention [3 - 5]. While recall-based survey assessments of physical activity appear to offer a practical research tool for both cross-sectional and longitudinal research in this area, data on the reliability and stability of such measurements remain scarce [6]. Nevertheless, the research literature continues to reflect the widespread assumption that later life activity levels are trait-like (i.e. personally enduring) constructs the measurement of which allows individual's to be classified on an activeinactive continuum (e.g. [7]). For a variety of reasons, activity levels can be expected to decline with

advancing age. However, the extent to which older individuals might maintain their relative position on such a continuum remains unknown. Using 8-year data from the Nottingham Longitudinal Study of Activity and Ageing (NLSAA) [8], this paper explores these assumptions by examining temporal trends in physical activity levels among survivors of a random sample, all of whom were aged 65+ at baseline. Specifically, the analyses focus on aspects of stability and change with the aim of (i) describing stability/ change in the overall levels of activity participation among survivors of the original sample and (ii) estimating stability/change in the relative position of respondents within selected distributions of activity values.

Methods
Data were derived from the NLSAA, full details of which

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G. K. Armstrong, K. Morgan are presented elsewhere [8]. Briefly, the NLSAA is an 8year survey of activity, health and wellbeing conducted within a representative stratified sample of people originally aged 65 and over. The baseline (Tl) survey for the NLSAA was conducted between May and September 1985, during which time 1042 people (507 aged 65-74; 535 aged 75+), randomly sampled from general practitioner's lists, were interviewed in their own homes (a response rate of 80%). Subsequent analyses showed that the age, sex, and social class structure of this sample closely resembled that for England and Wales as a whole. Follow-up surveys were conducted at 4-yearly intervals in 1989 (T2) and 1993 (T3), with re-interview rates of 88% (690 interviews from 781 eligible respondents) and 73% (410 interviews from 564 eligible respondents) respectively obtained among survivors [8].
Assessment of customary physical activity (CPA)

years and a dummy variable for gender with male = 0 and female = 1 were entered into the model. Multiple and logistic regressions were also used to assess differences in Tl CPA levels between those who did, and those who did not survive to 1993. Age in years, gender, and the dummy variable died = 0 and alive in 1993 = l were entered into these models. All data were analysed using SPSS for Windows (Release 6.0) [10]. Analyses of survivors Respondents who were still alive in 1993 and with data at all three time points were classified as an elite subgroup, and used to assess stability and change in CPA levels. To assess the temporal stability of an individual's position within each activity distribution (i.e. to assess the extent to which individuals remain more, or less active than their peers), activity values were standardized (z-scores) for each survey wave. Intraclass correlation coefficients QCC) were then calculated for each activity using the 2r-score transformed values, providing an estimate of the average correlation among measurements. A one-way analysis of variance was fitted to the z-scores and the ICC (p) was calculated as:
P
=

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For the questionnaire assessment of CPA, all activities were divided into seven mutually exclusive functional categories: outdoor productive activities (e.g. gardening, house and car maintenance), indoor productive activities (e.g. housework, decorating, indoor maintenance), walking (purposeful walking outside the house or garden), shopping (i.e. continuous ambulatory behaviour associated with shopping), leisure activities (e.g. cycling, swimming), strength activities (e.g. climbing high steps, dragging heavy loads) and joint flexibility activities (e.g. reaching for high shelves, bending for low shelves). Time spent walking and shopping was scored as min per typical day [9]. Time spent in all other continuous activities was scored as min per week. For strength and flexibility activities, a total score was calculated from individual tasks, each scoring 0-4 for the following ordered categorical response: performed never; performed occasionally; performed once or twice a week; performed daily; performed several times a day. Statistical analysis To summarize the data, and allow for comparisons of results from all three survey waves, data for indoor, outdoor, leisure, walking and shopping activities were recoded into appropriate time categories. Multiple regression, adjusting for age, was used to estimate the mean differences for men and women in baseline (Tl) levels of indoor activities and strength and flexibility scores. The indoor activity variable was square root transformed before the regression analysis. Since a proportion of older people recorded 0 scores on outdoor, leisure, walking or shopping activities, binary variables (none versus some) were created and used in the logistic regressions to estimate the differences between men and women, again adjusting for age. For the multiple and logistic regression analyses, age in

subject

^subject ' ^error

Results
Indoor, outdoor and leisure activities

Levels of indoor, outdoor and leisure activities are shown in Table 1. The table is split by age group in 1985 and by gender. All 1985' are the distributions for the total baseline sample interviewed at Tl in 1985. The distributions of the elite sub-group of older people at all three time points are also shown. Gender differences Significant differences were present in the levels of indoor, outdoor and leisure activities between men and women in 1985. A higher proportion of women did more indoor activities per week than men (square root transformed: adjusted j3 = 8.77; 95% CI 7.55-10.00, P < 0.001). The reverse was true for outdoor and leisure activities. A higher proportion of women did no outdoor activities compared with men [adjusted odds ratio (OR) = 0.39; 95% CI 0.30-0.51, P<0.001[. Women were also less likely to participate in leisure activities (adjusted OR = 0.61; 95% CI 0.47-0.79, < 0.001). Stability and change Older people who were still alive in 1993 did more

18

Stability and change in levels of physical activity in later life

Table I. Time spent per week in indoor, outdoor and leisure activities by all subjects and by the elite sub-groupa

% of subjects
Men All

Women Elite 1985 1989 1993

All

Elite 1985 1989 1993

Activity/age group/ time spent (h/week) Indoor 65-74 years in 1985

0

1985

1985

^3 >3-7 >7-l4
>14

24% 27% 29% 15%

5%
216 29% 25% 24% 17%

20% 30% 26% 16% 7%

25% 26% 23% 17% 8%

27% 32% 29% 8%

4%
7% 31%

0% 7% 32%

36%
22% 283

n 75+ years in 1985

0 =3

99
19% 19%

99
23%

3% 99
29%

37% 24%
153

4% 7% 30% 37% 22% 153 2% 20% 40% 28% 10%

5%
17%

44%
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27% 7% 153 23% 20% 31% 24% 2%

9%
17% 29% 28% 17%

3%
13% 31% 28% 25%

39%
26% 10%

35%
26% 10% 0% 31

>3-7 >7-l4
>14 n

35%
19%

4%
181

6%
31

3%
31

336

96

96

96

Outdoor 65-74 years in 1985

0

^3 >3-7
>7

25% 20% 18%

10% 20% 21%

16% 15% 31%

30%

46%
29% 15% 10% 283 71% 18% 8%

37%
31% 20% 13%

33%
10%

37%
218

n 75+ years in 1985

0

48% 99 26% 26%

29% 19% 31

37% 99 39%
26% 16% 19% 31

26% 99
61% 16%

143 54%
22% 14% 10%

48% 28% 11% 13% 143

58%
27% 10%

6%
143 78% 16% 1% 4% 79

47%
20% 11% 22% 181

63%
19% 10% 8% 79

^3 >3-7
>7 n

6%
16% 31

4% 336

79

Leisure 65-74 years in 1985

0 =3 41% 24% 17% 18% 217 51% 21% 12%

35%
22% 20%

49%
19% 18% 14% 100 58% 19%

>3-7
>7

62% 23% 10%

55%
27% 12%

47%
31% 15% 8%

53%
28% 10% 8% 144

74% 19%

6%
1%

23%
100

5%
100

6%
283

n 75+ years in 1985

0

144 48% 34%

14%

144 86% 9% 3% 3%
80

39%
19% 23% 19% 31

55%
32% 10%

63%
27% 8% 2%

69%
20% 10% 1% 80

^3 >3-7
>7 n

6%
16% 31

16%
181

3%
31

5%
80

336

"Older people who are still alive in 1993, for whom data are available for all three time points.

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G. K. Armstrong, K. Morgan
Table 2. Changes between the categories (scores for strength and flexibility) of habitual physical activity over the 8-year period 1985-93 Men

% showing change in category Activity Indoor Outdoor Leisure Walking Shopping Strength Flexibility Decrease
38%

Women % showing change in category n

130 130 131 120 120 131 132

None
41%

Increase
22%

Decrease
58% 41%

None
29% 50% 47%

Increase
13% 10%

n 249 222 224

51% 49%
41% 27% 40%

43%
41%

6%
11% 25%

34% 39%
8%

44% 36%
29% 61% 67%

9%
28% 32% 31% 22%

34%
52% 32%

36% 39%
8% 11%

196
192 252

59%

9%

254

indoor activities in 1985 than those who died within the 8 year period (square root transformed: adjusted (3 = 2.11; 95% CI 0.83-3.38, P<0.001). Table 1 shows that the distribution of time spent on indoor activities by the elite sub-group of older people reduced over time in each age/gender group. At the individual level, more than 50% of women had reduced their time spent on indoor activities over the 8-year period, whilst there was no change for 41% of men (Table 2). Table 2 also shows that a further 22% of men had increased their time spent on indoor activities over the same period. The stability of an individuals position relative to others, as indicated by intraclass correlation coefficients (average correlation among two measurements on the same person) computed for z-score transformed values, for indoor activities was fair for both men and women (Table 3). Survivors in 1993 were more than twice as likely in 1985 to have spent time on outdoor activities than those who died before 1993 (adjusted OR =2.10; 95% CI 1.58-2.80, P < 0.001). Nevertheless, within the elite sub-group, the distribution of time spent on outdoor activities decreased over 8 years in each age/gender Table 3. The intraclass correlation coefficient3 of the z scores for each habitual physical activity by gender Correlation coefficient Activity Indoor Outdoor Leisure Walking Shopping Strength Flexibility
Men

group (Table 1). Table 2 also shows that 43% of men and 50% of women spent the same time on outdoor activities in 1993 as they did in 1985. Intraclass correlations showed only moderate stability for outdoor activities (Table 3). Again, older people still alive in 1993 were more likely in 1985 to have participated in leisure activities than those who had died within the 8-year period (adjusted OR=1.63; 95% CI 1.24-2.15, /><0.001). Table 1 also shows, however, that for the elite subgroup, participation in leisure activities decreased over time for each age/gender group. Overall, 49% of men and 44% of women reduced their participation in leisure activities from 1985 to 1993 (Table 2). The stability of an individual's position relative to others for leisure activities was lower for women (ICC = 0.25) than for men (ICC = 0.45; Table 3). Walking and shopping Gender differences In 1985, over 60% of older people in each age/gender group walked less than 30 min on a typical day (i.e. less than 3-5 h a week; Table 4). Women were less likely to walk on a typical day than men (adjusted OR = 0.65; 95% CI 0.49-0.86, P < 0 . 0 1 ) . Although a high proportion of older people did not shop in 1985, there were no statistically significant differences between men and women (adjusted OR=1.27; 95% CI 0.95-1.71,

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Women 0.27 0.58 0.25 0.18 0.16 0.56 0.48

0.31 0.50 0.45 0.45 0.17 0.49 0.39

Stability and change Older people who were alive 8 years later were no more likely to have walked on a typical day in 1985 than those who died before 1993 (adjusted OR= 1.28; 95% CI 0.96- 1.71, P= 0.09). Table 4 shows that for the elite sub-group of older people, the distribution of time spent walking decreased over the 8 years, although 35% of women aged under 75 years did no walking per

"Average correlation among two scores on the same subject.

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Stability and change in levels of physical activity in later life

day in both 1985 and 1993- Over one-third of men and women did not change their amount of time spent walking on a typical day (Table 2). A further 25% of men and 28% of women over the same period had increased their time spent walking. Across all three distributions of walking values (1985, 1989 and 1993), the relative position of men was more stable (ICC = 0.45) than that for women (ICC = 0.18, Table 3)Older people who were alive 8 years later were more likely to have reported shopping in 1985 than those who died before 1993 (adjusted OR =1.38; 95% CI 1.02-1.88, P=0.04). In the elite sub-group of older people, the proportion who did shop increased over time in each age/gender group (Table 4). Overall, 34% of men and 32% of women increased their time spent shopping (Table 2). The stability of z-score transformed values was particularly low for shopping over the three periods of measurement (Table 3). Strength and flexibility scores Gender differences Scores are shown in Table 5, with higher values indicating higher levels of strength/flexibility. Reliability coefficients for the scales were calculated as a = 0.65 and a = 0.58 for strength and flexibility respectively. There were no significant differences between the mean flexibility score for men and women

Table 4. Time spent walking and shopping per day by all subjects and by the elite sub-groupa

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% of subjects
Men All

Women Elite 1985 1989 1993

All

Elite 1985 1989 1993

Activity/age group/ time spent (min/day)

Walking* 0
5

1985

1985

65-74 years in 1985

29%

<l-30 >3O-6O >60-90

>90

33%
17% 10% 11% 205

27% 32% 16% 10% 15%

25% 28% 25% 13% 10%

31%

36%
31% 23%

35%
28% 23%

34%
20%

n 75+ years in 1985

0

93
22%

93
41%

5% 9% 93 33% 44%
7% 7% 7% 27

5% 6% 239 58%
25% 13%

6%
8% 118

25% 31% 20% 14%

35% 37%
19%

3%

9%
118

6%
118

42%
30% 15%

<l-30 >30-60 >60-90

>90 n

33%
22% 11% 11% 27

5%
7%

26% 26% 4% 4%
27

47% 33%
12%

33%
41% 18%

53%
22% 18%

4%
1% 318

5% 3%
78

6%
1% 78

4% 4%
78

165

Shopping 65-74 years in 1985

0

<l-30 >30-60
>60 n

70% 14% 8% 8% 205

62% 20% 11% 8%

54%
21% 11% 15%

52% 29% 10% 10%

56%
19% 11% 14%

93 59%
11%

93 63%
11% 7% 19% 27

93
52%

239
78% 12%

52% 19% 13% 16% 118

47%
11% 22% 20% 118

51%

26%
14% 8% 118

75+years in 1985
0

73%
12% 10%

68%
17% 8% 7%

<l-30 >3O-6O
>60 n

37%
0% 11% 27

53% 25%
7% 16%

59%
23% 12%

5% 165

26% 4%
27

6% 5%
318

74

74

5% 74

"Older people who are still alive in 1993, for whom data are available for all three time points. b Excludes shopping.

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G. K. Armstrong, K. Morgan Table 5. Strength and flexibility scores for all subjects and for the elite sub-groupa

Men
All

Women Elite 1985 1989 1993

All

Elite 1985 1989 1993

Score/age group Strength (range 0-24) 65-74 years in 1985

Median score
IQR

1985

1985

11

11

12

11

11

10

10

(8,13)
217

(9,13)
102 10

(8,12)
102

(9,14)
102 8

(8,12)
283 7

n 75+ years in 1985 Median score

IQR

(8,13) 155
8

(6,12)
155

(6,13)
155

9 (6,11)
177

(8,11)
29

9 (7,10)
29

(7,11)
29

n Flexibility (range 0-20) 65-74 years in 1985 Median score

IQR n

(4,10) 333

(6,11)
97

6 (3,9) 97

6 (1,9) 97

11

12

11

10

11

11

(8,13)
217

(10,14)
102

(7,13)
102 8

(8,12)
102 8

(8,13)
283 8

(8,13) 156 9 (7,12)

98

9 (7,12)
156 7

9 (5,11) 156
7

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75+ years in 1985 Median score

IQR

9 (6,12)
179

9 (7,12)
30

(6,10)
30

(6,11)
30

(6,11) 334

(5,9)
98

(3,9)
98

"Older people who are still alive in 1993, for whom data are available for all three time points.

(adjusted mean difference = -0.28; 95% CI -0.72 to 0.17, P = 0.22). Women had significantly lower mean strength scores than men (adjusted mean difference -0.61; 95% CI -1.10 to -0.13, /==0.01).

Discussion
Two features of later-life activity patterns are reflected in the analyses reported here. First, survivors clearly represented an elite sub-group, whose activity levels at baseline were, in general, significantly higher than those of their non-surviving peers. In addition, missing data, due mainly to cognitive impairment (n = 27) and being housebound (n = 52) reduced further the activity information available from the 410 respondents interviewed in 1993, amplifying the 'elite' characteristics of survivors described here. And second, 8-year change between 1985 and 1993 was characterized by progressively declining activity levels. In both trajectories and stability profiles, however, differences did emerge among the seven activity categories studied. Among the continuous activities, the outdoor and leisure categories showed both the highest percentage decrease, and the lowest percentage increase in participation levels for both men and women. Conversely, walking and shopping activities showed the lowest percentage decrease, and the highest percentage increase in participation over the 8 years of the study. At least one in four respondents increased the time they spent walking, and approximately one in three respondents increased the time they spent shopping between 1985 to 1993. This differential sensitivity to ageing processes probably reflects the

Stability and change

Survivors scored higher on the flexibility scale (adjusted mean difference 1.24; 95% CI 0.78-1.70, P^ 0.001) and higher on the strength scale (adjusted mean difference = 1.49; 95% CI 1.00-1.99, P^ 0.001) than those who died before 1993. Table 5 shows that for the elite sub-group, only the median flexibility for men aged under 75 years decreased across all three time points. Only 9% of men and 11% of women scored the same in 1985 and 1993 (Table 2). The stability of an individual's position within the distribution of scores relative to others for flexibility was fair to moderate (Table 3). The median strength score deceased over time for elite women, but only for men aged 75+ years (Table 5). Table 5 shows that the median score for men aged under 75 years was 11 in 1985 and 12 in 1993Overall, 52% of men had a higher strength score in 1993 than 1985, compared with 31% of women (Table 2). For the strength scale, an individual's position relative to others was moderately stable, although slightly higher for women than for men (Table 3).

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Stability and change in levels of physical activity in later life interaction of a number of factors, particularly ability, opportunity and need. Thus, while declining health and physical capacity may directly influence the ability to be active, the death of a spouse may directly affect opportunities for leisure activities, or the need (particularly among men; see Table 1) to perform indoor housework activities. These differential influences may also underlie the varying degrees of stability found within the z-score distributions of the activity categories. Outdoor, strength, flexibility and (for men) walking and leisure all showed moderate levels of stability as indexed by the intraclass correlation coefficients (Table 3). Thus, while absolute levels of participation in these activities decreased, relative positions within the distribution were moderately related over time. However, relatively low levels of stability were present for indoor, shopping and (for women) walking and leisure activities. Indeed shopping, which on theoretical grounds would be greatly influenced by need and opportunity, showed the lowest levels of stability of any activity. Overall, then, these findings strongly suggest that while some activity variables show levels of stability consistent with trait-like constructs, others are clearly more labile. While the present data cannot offer a definitive explanation for these differences, it seems reasonable that within each activity the influence of ability, opportunity and need interact to determine levels of participation. Consequently, while some activities (e.g. outdoor activities) may represent enduring features of lifestyle others (e.g. shopping) may reflect more the changing circumstances and personal transitions of later life. Finally, further evidence for the validity of the CPA assessments (see [11]) is provided by the overall pattern of results reported here, which is consistent with known age and gender influences on habitual activity [12]. Thus, the older cohort showed the highest levels of non-participation in all activities; men were more likely to engage in outdoor, leisure, walking and strength activities; and women showed substantially higher levels of participation in indoor activities. References
1. Fentem PH, Turnbull NB, Bassey EJ. Benefits of Exercise: the Evidence. Manchester: University of Manchester Press, 1990. 2. Allied Dunbar National Fitness Survey: main findings. London: Allied Dunbar (in association with the Health Education Authority and the Sports Council), 1992. 3- Ruuskanen JM, Ruoppila I. Physical activity and psychological well-being among people aged 65 to 84 years. Age Ageing 1995; 24: 292-6. 4. Ruigomez A, Alonso J, Anto JM. Relationship of health behaviours to five-year mortality in an elderly cohort. Age Ageing 1995; 24:113-9. 5. LaCroix AZ, Leveille SG, Hecht JA, Grothaus LC, Wagner EH. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J Am Geriatr Soc 1996; 44: 113-20.
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6. Smith GD, Morris JN. Assessment of physical activity, and physical fitness, in population surveys. J Epidemiol Comm Health 1992; 26:89-91. 7. Schroll M, Avlund K, Davidsen M. Predictors of five-year functional ability in a longitudinal survey of men and women aged 75-80. The 1914 population in Glostrup, Denmark. Aging Clin Exp Res 1997; 9: 1-12. 8. Morgan K. The Nottingham Longitudinal Study of Activity and Ageing: a methodological overview. Age Ageing 1998; 27 (suppl. 3): 5-11. 9. Dallosso HM, Morgan K, Bassey EJ, Ebrahim SBJ, Fentem PH, Arie THD. Levels of customary physical activity among the old and the very old living at home. J Epidemiol Comm Health 1988; 42: 121-7. 10. Norusis MJ. SPSS for Windows: Professional Statistics, Release 6.0. Chicago: SPSS Inc, 1993. 11. Morgan K, Dallosso H, Bassey EJ, Ebrahim S, Fentem PH, Arie THD. Customary physical activity, psychological wellbeing, and successful ageing. Ageing Soc 1991; 11: 399-415. 12. Bennett K. Gender and longitudinal change in physical activities in later life. Age Ageing 1998; 27 (suppl. 3): 2428.

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