Table S4. Prospective (Longitudinal) Cohort Studies Examining the Relationship Between

Table s4. Prospective (longitudinal) cohort studies examining the relationship between physical activity and functional limitations in older adults

Publication Objective Population Methods Outcomes Comments and Country Conclusions Al Snih et To examine  N=2493 Follow-up at 2, 5, Linear relationship of Hand grip al., 2004 the  Sex: men and and 7 y hand grip strength at strength is an [22] association women baseline and risk of independent between hand  Age: >65 y; Measurements: incident ADL disability predictor of ADL USA grip strength mean 73 y ADL disability – a stepwise decrease disability and 7 y  Mexican in risk with greater incidence of American in Physical activity: hand grip strength ADL disability EPESE data Hand grip strength base Risk of new ADL Cox proportional limitation in lowest hazards quartile compared to highest of hand grip strength: Men: HR 1.90, CI 1.14-3.14 Women HR 2.28, CI 1.59-3.27

Bäckmand To determine  N=1164 Follow-up 10 y Low levels of physical An increase in et al., the role of  Sex: men Age: activity in 1985 (OR physical activity 2006[19] physical 59-70 y Measurements: 4.91, CI 2.02-11.9) supports physical activity in the daily functionality  664 athletes Physical functioning increased the risk of physical and Finland (64.6 y) of daily living (heavy poor physical function psychological  500 controls house cleaning, in daily living in 1995. functioning of (62.0 y) daily living in a dressing and undressing, writing, Increased levels of cohort of  Former Finnish shopping or physical activity (OR former elite national male athletes athletes banking, travelling 0.89, CI 0.83-0.95) by public transport) between 1985-1995 protected against poor Physical activity: physical functioning Questionnaire on recreational physical The previously athletic activity; 5 MET group did not reveal index quintiles any protective effect on physical function Logistic Regression

Berk et al., To assess the  n=549 Follow-up 16 y Increase in HAQ Beneficial effect 2006[14] effect of  Sex: 73% men, scores: of exercise (at changes in 27% women Measurements: Sedentary 0.37 units; high levels), even USA exercise (and  Age: Baseline Assessment of (Indicates difficulty in when begun later other risk mean 58 y and Disability: HAQ-D1; 3 domains of daily in life, on factors) on follow-up 74 y Health Assessment function, or inability in postponement of disability or  From Questionnaire one) disability health-related comparative (HAQ) 21 questions Decreasers 0.28 units; quality of life study of scored as no Increasers 0.17 units; Re comments on in seniors who vigorous difficulty, some, (Indicates “good” end physical activity: were originally exercisers much, and inability of study scores) starting, inactive and (runners) and to perform Exercisers 0.11 units increasing, or

1 Table s4. Prospective (longitudinal) cohort studies examining the relationship between physical activity and functional limitations in older adults

Publication Objective Population Methods Outcomes Comments and Country Conclusions increased population maintaining exercise or controls Vigorous exercise of Final disability score vigorous exercise who exercised  “specialized” greater than 60 associated with particularly and sample min/wk (High) or current more than walking, cycling, decreased less than (Low) initial exercise group; or aerobics activity initial and in follow- Change in HAQ for up periods Increasers versus Sedentary (low–low) Sedentary significantly Exercise increasers more favourable with (low–high) multivariate statistical Exercise decreasers adjustment (high–low) Exercisers (high- high)

ANOVA (covariance) on adjusted change in HAQ

Boyle et al., To examine  N=1020 Average follow-up of Of the 26% who In older persons 2007 [33] association  Sex: Men and 2.6 y (annual became ADL disabled without dementia, between Women evaluations) in follow-up the physical activity USA physical  Age: mean relative risk of is associated with activity and 80.5 y Measurements: ADL disability was 7% less maintenance of risk of incident  Sample free of and IADL with scale for every additional functional status, disability dementia; of no help, help, hour of physical and reduced risk (ADL and analysis for unable to do activity (HR 0.93, CI of impairment in IADL) in those with no Assessed gait 0.88-0.98); thus, 16% ADL and IADL elderly, disability at speed to control for less disability for 2.33 th community- baseline baseline gait hr/wk (50 %ile) and dwelling 41% less for 7 hr/wk Physical activity: (90th%ile) walk for exercise, Of the 55% who gardening, became IADL calisthenics or impaired in follow-up exercise, cycle, the relative risk of swim in previous disability was 7% less two weeks; for every additional analyzed as hours hour of physical per week activity (HR 0.93, CI 0.89-0.98); thus 21% Cox proportional less for 2.8 hr/wk hazards models activity and 47% less adjusted for many for 7.5 hr/wk activity factors Also risk of mortality was 24% less with 2.3 hr/wk and 57% less with 7 hr/wk of physical activity

Publication Objective Population Methods Outcomes Comments and Country Conclusions * Buchman Outcome was Each additional hour Both physical et al., 2007 mobility decline from of physical activity activity and leg [49] 8 foot walk and 360 was associated with strength were degree turn an ~3% decrease in independent rate of mobility decline predictors of Leg strength also A higher level of leg mobility decline measured strength was in older persons associated with a slower rate of mobility decline

Brach et al., To determine  N=229 Follow-up 14 y, with Initial and 10 year Physical activity 2003 [20] the  Sex: women physical activity at physical activity (by was related to relationship of  Age: mean 74 initial, 10 and 14 y questionnaire or functional status USA physical y at follow-up objective) was a 14 years later activity to (i.e. initially ~60 Measurements: significant measured by functional y) Functional status independent predictor various methods status over a  Initial cohort questionnaire (FSQ) of gait speed at the 14 of self-report ADL long-term involved in a of ADL and IADL y follow-up function, physical randomized Physical performance or walking Performance Test The greater gait speed intervention, (PPT) of 7 items of consistency of and followed- daily activities and physical activity the up 14 y gait speed over 4 m better the functional  A very high status (PPT) and ADL functioning Physical activity and gait speed; tests group (75th to questionnaire of for trends across 90th %ile of walking for exercise physical activity levels function) and sports; and total were significant activity averaged over year; and used objective measures of monitors Grouped into met or did not meet Surgeon General recommendation; and by above and below median for objective activity counts; and from the 3 test times – always active, never active or inconsistently active

Statistics of between group comparisons; multivariate linear regression models of past physical

Publication Objective Population Methods Outcomes Comments and Country Conclusions activity and gait speed

* Brach et To examine  N= 171 Follow-up 14 y Obesity and physical Physical activity al., 2004[45] the cross-  Sex: Women activity measures appears to be as sectional and  Age: mean Measurements: were both related to important or USA longitudinal baseline 60 y FSQ re ADL, and physical function more important associations to follow-up gait speed on 4 m status. Always active than body weight among mean 74 y walk at 14 y and never overweight in prediction obesity,  Initially were in group had least future physical physical a walking Initial and 3 follow- difficulty with ADL and function activity, and intervention up of BMI, and walked faster and physical trial Physical Activity of never active and function over a blocks walked and always overweight 17-year time sport leisure – had greatest period in calculated total ADL difficulty and community- activity per week slowest gait speed dwelling older over past year women (active 1000 Both weight and kcal/wk; 30 min physical activity were moderate on most independent days); predictors of FSQ and gait speed but when ANOVA between both entered into groups regression physical Hierarchical activity and not regression obesity was an independent predictor of physical function both FSQ and gait speed

Bruce et al., To examine  N=805 Follow-up 13 y Physically inactive had Regular physical 2008 [15] the  Sex: Men and significantly more activity relationship of women HAQ-DI – disability disability than active postpones USA regular  Age: 50-72 y; index of 8 regardless of weight disability exercise and mean 65 y categories scaled group (i.e., in both body weight to  Assessed from 0 to 3 weight groups) Preventive disability yearly approach to among a  Recruited from Physical activity: reduce functional cohort of national minutes per week of impairment healthy older runners vigorous exercise associated with adults association grouped as Active > overweight and control 60 min (mean 250- through physical sample 300 min/wk) and activity inactive < 60 min (mean ~25 min/wk)

Self-reported BMI

4 groups: normal- weight active and

Publication Objective Population Methods Outcomes Comments and Country Conclusions inactive and overweight active and inactive

Multivariate analysis and generalized estimating equations

Christensen To analyze the  N=387 Follow-up at 10, 20 Strong association Physical inactivity et al., 2006 impact of  Sex: men and and 25 y between physical is a risk factor for [28] physical women inactivity at age 70 disability among inactivity from  Age: Baseline Measurement: and disability at age old people Denmark middle age to age 50 y; Functional ability at 75, but, no effect of early old age follow-up at 75 age 75 from cumulated physical Old should be on functional y “tiredness” with six inactivity from age 50- encouraged to ability at age mobility activities 60-70 on disability at take up and 75 grouped as good age 75 when adjusting maintain physical function vs. poorer for functional ability at training function age 70 throughout the aging process Physical activity as Thus, physical cumulated activity inactivity at age 70 from age 50 to 60 to related to disability at 70 and at the 3 age 75 OR 5.07, CI separate time points 1.08-23.89; inverse from self-report 0.17, CI 0.04-0.93 grouped to mainly sedentary, slightly active, moderate activity and vigorous activity; and in this analysis grouped into mainly sedentary or mainly active

Logistic regression analysis

Clark, 1996 To examine  N=3841; 413 Follow-up at 2, 4 Each of the walking Walking 4 to 7 [46] the Blacks and and 6 y categories vs. never days/wk reduced association 3428 Whites walking 1 mile was the risk of USA between  Sex: Men and Measurements: significant in disability onset regular women Lower body predicting increased by 50-80% on all physical  Age: >70 y disability – walking lower body disability in five disability activity and  Longitudinal ¼ mile, 10 stairs; Whites but only items within the increase of Study on Aging standing 2 hr, walking 4-7 times/wk Black sample lower body crouching/kneeling, reached significance and by 50% on disability in carrying 25 lbs in Blacks; the effect of two items within older, regular exercise was the White sample community- Physical activity: not significant for

Publication Objective Population Methods Outcomes Comments and Country Conclusions dwelling Walking 1 mile or either race Blacks and more – 2X/wk, 2- Whites 3/wk, 4-7/wk For onset of specific And also regular lower body disabilities exercise routine the risk in Blacks ranged (depending on Discrete time the disability measure) hazard models from 0.17 to 0.54 and in Whites from 0.49 to 0.93 (with some non- significant)

For walking ¼ mile the odds ratios were expressed vs. never walking for 1 d/wk, 2-3 d/wk or 4-7 d/wk For Blacks 0.31, 0.29, 0.17; For Whites 0.56, 0.52, 0.49; Thus showing little gradient with walking frequency

Dunlop et To evaluate  n=5,715 Follow-up 2 y Function declined in Lack of regular al., 2005 the prevalence  Sex: Men and 13.6% of group over vigorous physical [36] of functional women Measurements: 2-y activity is a limitations in  Age: >65 y; Questionnaires potential USA older adults mean ~75 y Function defined Most prevalent risk modifiable risk with arthritis  Characteristics: based on ability to factor was lack of factor that could and the Older adults perform basic ADL regular physical reduce functional frequency of with arthritis tasks and IADL; activity (64%) decline in ADL functional from a national progression – none, and IADL in older decline over 2 probability mild, moderate, Risk of functional adults with years sample severe decline, progression to arthritis  ~20% had more severe level of limitations at Vigorous activity: functional limitation baseline over past 12 mo. OR 1.9, CI 1.5-2.4. participated 3+X/wk Inverse OR 0.53, CI in vigorous sports, 0.42-0.67 heavy housework or job of physical If all had engaged in labour regular vigorous physical activity could Multiple logistic reduce the functional regression adjusted decline by 32% odd ratios (OR) Ebrahim, et To examine  N=5717 Follow-up 12-14 y Compared to inactive Physical inactivity al., 2000 the  Sex: men Measurements: the adjusted odds of was a strong [37] relationship  Age: 40-59 y, Self-reported locomotor disability for predictor of between mean ~50 y locomotor disability occasional active and locomotor UK lifestyle and with mean at re getting outdoors, for light OR 0.7, CI disability later in other risk follow-up ~63 y walking 400 m, 0.5-0.8; for moderate life independent

Publication Objective Population Methods Outcomes Comments and Country Conclusions factors in men (52-73 y) climbing stairs, and and moderately- of the presence aged 40-59 y others vigorous OR 0.4, CI of diagnosed at baseline Physical activity of 0.3-0.5 disease and locomotor regular walking or disability 12- cycling, recreational 14 years later, activity and sporting and disability activity and frequency to give activity score; six groups from non- to vigorous and 2 groups with physically active being moderately active or more

Logistic regression

* Wanna- To examine N=5075 Follow-up ~ 16 y Physical activity of Taking up methee et predictors of Sex: Men Measurements: moderately vigorous physical activity al., 2005 the onset (and  Age: as above Self-reported or vigorous reduced even in later life [21] recovery) from with follow-up 4 disability in getting the odds associated was associated mobility more years outdoors, walking with onset of mobility with reduced UK limitation and (age 56-77 y) 400 m and climbing limitation OR 0.66, CI onset of mobility the stairs 0.50-0.87, but was limitation in older association Physical activity marginally non- age, and physical between assessed as above significant after activity may lifestyle and also adjustment for chronic promote recovery changes in categorized by disease from mobility later life and change between 12 Taking up physical limitation mobility status and 16 y follow-up; activity in later life was stable inactive, associated with a became inactive, reduced onset of became active and mobility limitation, with remained active mobility limitation in those who became Logistic regression active having OR 0.35, CI 0.22-0.56 In those with mobility limitation in the first follow- up, light or moderate levels of physical activity were associated with increased odds of recovery

Ferrucci et To determine  N=8604 Follow-up 6 y, In both men and Physical activity al., 1999 the effects of  Sex: Men and annually women each in the older [47] smoking and women increment of physical population physical  Age: > 65 y; Measurements: activity was prolongs active USA activity on mean ~ 74 y Self-report ability for associated with a life, decreases

Publication Objective Population Methods Outcomes Comments and Country Conclusions active life  EPESE study ADL (need help or lower risk of dying, a the percentage of expectancy data inability to perform = substantially lower risk remaining life and disabled No disability at disability) of new disability, and that is spent in life baseline a higher probability of disability and for expectancy Physical Activity in functional recovery a given age at walking gardening In never smokers, death is and vigorous compared with low associated with a exercise with active, in moderate shorter period of composite score and high active disability categorized as low increase in active life (bottom quartile) expectancy was 3.3 moderate (two and 5.1 years in men middle quartiles) and 3.5 and 5.7 years and high (upper in women; there was quartile little difference across Also smokers physical activity classed as “ever” or groups in disabled life “never” expectancy In ever smokers, Markov models fit to compared with low the data active, in moderate and high active increase in active life expectancy was 1.0 and 3.4 years in men and 1.5 and 4.2 years in women; moderate and high showed a greater active life expectancy There was an effect of compression of morbidity, i.e., physical activity reduces the duration of disabled life by approximately 1 to 2 y

Giampaoli et To verify if  N=141 Follow-up 4 y Reduced hand grip Poor hand grip al., 1999 hand grip  Sex: Men Measurement: strength predicted strength is a [23] performance  Age: 71-91 y; Disability in ADL, disability in men 77 y predictor of in older men is mean ~ 76 y IADL or mobility and older disability in older Finland, a predictor of  No disability in Physical activity: people Italy, disability ADL, IADL, or Hand grip strength Netherlands mobility at baseline Logistic regression analysis

Haight et al., To examine  n=1,655 (males Four surveys over 6 New physical High aerobic 2005 [38] the effects of 708, females years limitations occurred in levels (> 35 leisure time 947) 16% of women and MET.min/day

Publication Objective Population Methods Outcomes Comments and Country Conclusions USA physical  Sex: Men and Self-reported 9% of men exceeding activity (LTPA) women physical functional Physical activity recommendation and body  Age: >55 y limitation based on decreased new s) of physical composition (median 70 y); 10 questions physical limitation activity appeared on transitions with 6-y follow- (namely moving/lifting, to reduce the risk in physical up Measurements of but not for walking) by: of future functioning in  Characteristics: LTPA: Avg. weekly Men 36.8% (CI 0.0- functional the elderly; Healthy and participation over 92.2%); functional limitation; population community past 12mo. in 22 limitation OR 0.63, CI “conditional” on based cohort dwelling elderly activities; 0.00-0.92 the level of in 1993-1994 Continuous variable Women 52.7% (CI functioning (Mets.min/day) 13.5-91.9%); and established early Categories: 1. None delayed onset of in the 2. Insufficient 3. functional limitation; disablement >22.3 - <35 functional limitation process by lean- (minimum OR 0.47, CI 0.14-0.92 mass:fat-mass recommended for ratio brisk walking) 4. Also, a lower risk >35 – exercised at of functional high aerobic levels decline in those Body composition – who increased pa bioelectrical over time impedance (lean- mass:fat-mass ratio)

MSMs) marginal structural models, stochastic

* Tager et Functional limitation Leisure time al., 2004 with a 0.5 unit physical activity [106] increment in relative exerts its USA muscle mass was OR beneficial effect 0.56, CI 0.46-0.67 in through females and OR 0.77, reductions in fat CI 0.65-0.92 in male mass relative to lean body mass

Publication Objective Population Methods Outcomes Comments and Country Conclusions Haveman- To investigate N=480 Follow-up 10 y Inactivity increased Being physically Nies et al., the effect of Sex: men and Measurements: ADL the risk of active delayed 2003 [29] healthy women and degree of dependence in men onset of (also lifestyle Age: 70-75 y difficulty with OR 1.9, 90% CI 0.9- functional reviewed in behaviours functional 3.9 and women OR dependence in Haveman- (including independence 2.6, CI 1.4-4.9 older participants Nies et al., physical defined as no (Inverse OR men aged 70-75 y 2003 [107], activity) on difficulty or difficulty 0.53, 90% CI 0.26- Age and self-rated in performing only 1 1.11; women OR 0.38, Ageing) health and self-care activity CI 0.20-0.71) self-care Physical activity by Europe ability i.e., questionnaire two functional groups: low tertile independence inactive group vs. in older adults intermediate and high activity tertiles

Logistic regression

Hirvansalo To study N=1109 Follow-up 8 y Odds for dependency Among people et al., 2000 physical Sex: Men and (with adjustment for with impaired [35] activity and women Grouped into: confounders including mobility physical the interaction Age: 65-84 y Mobile-active, physical exercise activity was Finland of physical Evergreen mobile-sedentary, earlier in life): associated with activity and Project subjects Impaired- active, Impaired-sedentary lower risks mobility independently Impaired- sedentary men OR 5.21, CI whereas the risk impairment as living at baseline 1.44-18.70 women OR did not differ predictors of 2.92, CI 1.52-5.60 according to dependence compared to Mobile- activity level (and mortality) active groups; among those with However risk of intact mobility dependence did not Mobility impaired differ significantly people may be between Mobile-active able to prevent and mobile sedentary; further disability men OR 1.10, CI 0.27- by physical 4.55 or inverse OR exercise 0.91 (0.22-3.70) and women OR 0.85, CI 0.45-1.59 or inverse OR 1.17, CI 0.63-2.22; And also did not differ for impaired active groups

Huang et al., To examine N=4670; N=577 Follow-up mean, 5.5 An inverse gradient The results 1998 [25] the age 60+ y y (significant linear support a association Sex: Men and trend) of prevalence of protective effect USA between Women Measurements: functional limitation of physical physical Age:40 y at Initial medical with fitness and fitness and fitness, baseline (but assessment and activity categories was physical activity physical analysis also functional status by found for men and on functional

Publication Objective Population Methods Outcomes Comments and Country Conclusions activity, and done on the 60+ mail survey follow- women in every age limitation among the prevalence y group of n=577) up; functional status group older adults of functional was for daily and for men 60+ y for limitation household activities those of low moderate of moderate and high fitness intensity and of prevalence of strenuous intensity functional limitation was 24%, 9% 7%; and Fitness: treadmill for women 46%, 26% test; low 18%; (bottom20%; and for activity of moderate next 40%; sedentary, moderate high, top 40%) and active in men 14%, 15% 9%; and Physical activity – in women 31%,29%,22% past 3 months Across entire age particularly range, logistic models: walking/running, a lower prevalence of work-outs; functional limitation sedentary – no than low fit (controlling regular activity; for other factors) for moderate; some men high (OR 0.3, CI participation, less 0.2-0.6) and than 10 miles per moderately (OR 0.4, week; active, equal CI0.2-0.6) fit, and for to more than 10 mi women high (OR 0.3, per week CI 0.2-0.5) and moderately fit (OR 0.5, Logistic regression CI 0.3-0.7); similar models association for physical activity men (OR 0.7 and 0.5) and women (0.7 and 0.7) and physical limitation was significant in men but not women

Koster et al., To examine N=2982 Follow-up with semi- Low physical activity High adiposity 2008 [40] the joint Sex: Men and annual assessments was associated with and low physical associations women over 6.5 y greater risk of mobility activity both USA of physical Age: 70-79 y limitation in all groups predicted the activity and Health, Aging Measurements: (men and women, onset of mobility adiposity and Body Mobility limitation of Black and White) with limitation in older measures with Composition reported difficulty consistent significant persons incident (Health ABC) walking ¼ mile or 10 differences comparing mobility study stairs the high to low activity limitation in Initially well- with HR ~1.5 or Black and functioning Physical activity slightly higher; inverse White older from questionnaire HR 0.67. adults of past 7 days all For the combined activities and effects of any of the duration and adiposity measures intensity coded to and physical activity in

Publication Objective Population Methods Outcomes Comments and Country Conclusions derive summed each adiposity group overall activity incidence rates of score; low (bottom mobility limitation were quartile), medium higher in the low (middle two physical activity quartiles), high groups and incident (highest quartile) mobility limitation was Adiposity from BMI, predicted more total % body fat, strongly with high waist circumference adiposity and low physical activity than Cox proportional when analyzed hazards separately; in general the HR was >2 (inverse 0.5) for low physical activity across different adiposity groups

* Koster et To examine As above In non-obese risk for Underscores the al., 2007 the incident mobility importance of a [108] association limitation in low and healthy lifestyle, between medium physical particularly incident activity groups physical activity mobility (compared with high) for maintaining limitation and HR 1.78, CI 1.45-2.18 function, lifestyle and HR 1.29 CI 1.07- although a factors 1.54 (Inverse: HR healthy lifestyle including 0.56, CI 0.46-0.69 and did not overcome physical HR 0.78, CI 0.65-0.93) the effect of activity in In obese risk for obesity in older obese and incident mobility adults non-obese limitation only older adults significant in low physical activity groups (compared with high) HR 1.44, CI 1.08-1.92 (inverse: HR 0.69, CI 0.52-0.93)

Lang et al., To assess N=8,702 (US) 6 yr follow-up In all weight Excess body 2007 [39] association and 1507 categories higher weight is a risk between (England) Measurements: levels of physical factor for USA and physical Sex: Men and Self-reported BMI activity were impaired physical England activity and women and physical activity associated with lower function in subsequent Age: 50 to 69 y; (past 12 months) risks of mobility middle-aged and physical mean age 60 y US: participated in impairment older, however... functioning in and 58 y with 6-y vigorous physical At BMI 20-25 relative Physical activity middle-aged follow-up activity or exercise 3 risk of incident mobility (of >30 min of adults across Characteristics: times/wk or more difficulty for “vigorous vigorous 3 a range of BMI free of disability England: heavy group” vs. less active times/wk) in

Publication Objective Population Methods Outcomes Comments and Country Conclusions categories at baseline housework, OR 0.56, CI 0.40-0.78; middle-aged is gardening, manual for BMI > 30 OR 0.59, protective of labour, brisk CI 0.45-0.76 impaired physical walking, sports – functioning 6-y summary of days later in subjects per week for 30 min of all weight or longer – category categories 3 times/wk or more.

Physical Performance Battery, modified: balance, chair stands (timed), grip strength; and self- report mobility impairment (difficulty walking several blocks, or flights of stairs)

Logistic regression modeling

Leveille et To estimate  N = 1097 (from Average follow-up Physical activity was Physical activity al., 1999 the prevalence EPESE) time 6 y related to probability was a key factor [26] of having no  Sex: men and of survival to age 80 predicting non- disability in the women Measurements: or 85 y disability before USA year prior to  Age: >65 y, Disability by Not being disabled death with a death in very mean ~ 80 y; questionnaire of before death: men, twofold likelihood old age and to who died after needing help or most active were 58% of dying without examine the age 85 y in unable to perform vs. least active 43%; disability in the factors women and any of six ADL tasks women 41% and 22% most physically (including age 80 y in Self-rated health Combined probability active versus physical men with no and chronic of survival to old age sedentary. activity) prior disability conditions by self- and dying without Evidence that associated within 15 report disability from age 65 disability prior to with this months y: death may be outcome Physical activity: Men, most active 37% prevented by Low, moderate, or vs. least active 15%; moderate (the high based on women, most active high group summed frequency 29%, least active 10% mainly reported of walking, Higher levels of walking and gardening and physical activity nearly gardening, not vigorous exercise doubled the likelihood vigorous of being free from ADL exercise) Multivariate logistic disability prior to death physical activity regression modeling OR 1.86, CI 1.24-2.79 (intermediate level of physical activity not significant compared to low activity) Inverse OR 0.53, CI 0.36-0.80

Publication Objective Population Methods Outcomes Comments and Country Conclusions

Østbye et To analyze the  N= 7845 Follow-up at Exercise at baseline There was a al., 2002 effect of  Sex: men and intervals for 5 to 6 y showed a protective strong dose- [27] modifiable risk women benefit against response factors  Age: aged 50- Measurements: subsequent relationship USA (including 60 y (Health Disability in work or dependence in ADL in between amount exercise) on and Retirement ADL, and in AHEAD a straight-line fashion; of exercise and ill-health, Study HRS) also used IADL; compared to all the outcomes including  [And 5037 Impaired mobility – sedentary, light considered and disability and aged 60-70 y walking up one flight exercise group half as heavy exercise impaired (Asset and of stairs, walk likely to be dependent had a stronger mobility Health several blocks in one ADL, OR 0.53, effect than Dynamics CI 0.43-0.66 and for moderate among the Physical activity – moderate exercise OR exercise Oldest Old number of times per 0.44, CI 0.36-0.52 and survey week participate in vigorous exercise OR AHEAD) – not light physical activity 0.22, CI 0.22-0.36 in physical and in vigorous And the physical activity physical exercise; activity level showed a analysis] overall classed as protective benefit sedentary, light, against Disability: vs. moderate, vigorous sedentary, light exercise OR 0.51, CI No “exercise” 0.40-0.64, moderate measure in AHEAD OR 0.46, CI 0.37-0.55 and heavy OR 0.25, Multivariate logistic CI 0.19-0.33 regression and And linear protective models benefit in stair ability and ability to walk blocks

Paterson et To describe  n=373 (at Baseline and 8 y At follow-up, of the Lower cardio- al., 2004 [5] those factors follow-up follow-up 279 participants 43 respiratory that were n=279) Measurements: were identified as fitness was a Canada determinants  Sex: Men and 8 y follow-up 20 min being dependent significant of becoming women telephone interview Baseline age, determinant of dependent at  Age: 55-86 y, Dependence – if presence of disease, becoming the 8 y follow- mean ~ 70 y they resided in a and VO2max increased dependent in an up  Characteristics: chronic facility, odds of becoming 8-y follow-up; Ambulatory nursing home, dependent above – having and senior home with Lower VO2max average independent care facility, increased the odds of cardiorespiratory required a dependence, OR 0.86 fitness in older wheelchair, or CI 0.74-0.99 for a age related to a walker, or home- difference of 1 50% greater care >1 time/wk ml/kg.min in VO2max reduction in risk i.e., 14% lower of becoming Body size, presence occurrence of dependent over of chronic disease, dependence per unit an 8-y period VO2max, strength, higher VO2max compared to low flexibility, walking fit group

Publication Objective Population Methods Outcomes Comments and Country Conclusions pace, leisure time Among these physical activity older adults (Minnesota Leisure- physical activity Time Physical- score was not Activity (LTPA) related to questionnaire) subsequent dependence/inde Modeling and pendence multivariate analysis, multiple logistic regression

Rantanen et To determine  N=3218 Follow-up 25 y A clear gradient of Hand grip al., 1999 whether hand  Sex: Men increasing risk for all strength predicts [24] grip strength  Age: 45-68 y Measurements: functional limitations functional measured (mean 54 y) Functional limitation and disability limitations and USA during midlife with 25 y of walking speed outcomes according to disability 25 predicts old follow-up to below 0.4 m/s, or weaker baseline hand years later in an age functional age 71-93 y inability to rise from grip strength tertiles initially healthy limitations and  Japanese- chair e.g., for walking speed cohort of men disability in American, in And Self-reported below 0.4 m/s risk aged 45 to 68 initially health Honolulu Asia disability in tasks compared to highest Good muscle men Aging study like lifting, walking grip strength group, in strength in midlife and stairs as well as lowest third OR 2.87, may protect ADL CI 1.76-4.67; or people for old inverse OR 0.35, CI age disability by Physical activity: 0.21-0.57 providing a Hand grip strength and self-care disability greater safety grouped by tertiles usually 2 times greater margin above the (i.e., OR 2+ or inverse threshold of Logistic regression OR 0.5) in lowest disability models versus highest grip tertile

Schroll et To highlight  n=307 Baseline and 5 y 24% died, 12% did not Mobility al., 1997 easily survivors follow-up participate in follow-up dependence was [30] measured (baseline Stability was related to related to low factors that n=405) Measures: ability to mount stairs, physical activity Denmark are relevant to  Sex: men and Questionnaires/scal walking speed, mood at baseline prevention women es, Decline, stability and physical activity A dose response and  Age: or improvement in Mortality was relationship of postponement baseline75 y; mobility function independently related declining muscle of disability follow-up 80 y measures of to PA (RR 0.45) mass to To describe 5  Characteristics: “tiredness” and increase and muscle functional yr outcome Data from the dependency. strength in women limitations was regarding Nordic (RR 0.65/N/kg observed in men death and Research on Multiple logistic increase) and women at functional Aging (NORA) regression, chi- Follow-up dependency the age of 75 y disability at study square in men was related to as well as the age 75-80 y low PA at baseline age of 80 y as well as (RR=4.142) and in

Publication Objective Population Methods Outcomes Comments and Country Conclusions individual women (RR=4.32); changes in (Inverse ~ 0.25) muscle 34% of population strength, decreased their PA at physical follow-up performance in simple function tests and self- reported physical activity and relate risk markers to 5 year outcome

* Schroll The N at age 50 y = Follow-up of 10, 20, Functional abilities in In relation to review of importance of 802; at age 60 y 30 and 35 y old age were closely cardiovascular papers from physical = 666; at age 70 associated with diseases and this study activity for y =537; at age 80 Measurements: ADL previous physical mortality these 2003 [109] functional y= 213; at age 85 in 16 activities activity i.e., in those data point toward ability in old y (home visit data including 6 related who declined a threshold level age only) = 243 from to mobility and rated approximately 24% of approximately “1914 cohort as to tiredness and were physically active 20min/day or 2-3 data” help needed whereas in those who hr/wk; and in old Sex: Men and remained stable or age this level of Women Physical activity: improved ~76% were physical activity Age: Baseline 50 During the last year active may secure an y with follow-up rated as sedentary Compared to independent life to age 80 y and to light (less than 2 physically active risk 85 y hr/wk; light (walking of mobility The majority of cycling gardening) dependence at age 80 the population 2-4 hr/wk; light more was 4.1 in sedentary was physically than 4 hr/wk (brisk, men and 4.3 in active over the fast, heavy, sports; sedentary women; entire life course highly vigorous Inverse ~ 0.25 more than 4 h/wk

Cardiorespiratory fitness measures at 50-60 and 70-80

Stessman et To determine  n=287 Follow-up 7 y Independence in ADL Subjects al., 2002 the prevalence  Sex: Men and remained high as did remained active [41] of women Home based self-reliance in IADL in and independent independence  Age: baseline interviews and men at age 77 y Israel and ease to 70 y, follow-up examinations Ease of performance Exercise at least perform ADL 77 y Questionnaires on in ADL was 4x/w at age 70 y and IADL and  Characteristics: ADL and IADL independently related preserved ease to measure Healthy and (scale – with ease, to exercise at age 70 y of performance the effect of sedentary some difficulty, Females OR 8.5, CI (prevalence of regular considerable 2.0-36.2; Males OR independent

Publication Objective Population Methods Outcomes Comments and Country Conclusions exercise at difficulty), and 4.3, CI 1.1-17.1); function in ADL, age 70 y on voluntary exercise Together OR 4.3, CI IADL) at age 77 y dependence 1.8-10.6; Inverse OR and ease of Physical activity: 0.23 (0.09-0.56) performance 7 exercise at least 4 Ease of performance years later times/wk in IADL correlated to exercise for males OR Logistic regression 3.7, CI 1.1-12.2, but not for women OR 2.0, CI 0.6-6.3 and together OR 2.3, CI 1.1-5.1; Inverse OR 0.43 (0.20-0.91)

Strawbridge To determine  N=356 Follow-up 6 y Physical activity, Walking (often) et al., 1996 6-y predictors  Sex: men and namely often walks for for exercise was [42] of successful women Measurements: exercise, was a prospectively aging  Age: 65-95 y; Successful aging – predictor of successful associated with USA mean 77 y self-reported, having aging after adjusting successful aging no difficult on any of for other variables with 13 activity/mobility an OR 0.57, CI 0.35- measures and little 1.00; inverse of 1.77 or no difficulty on 5 CI 1.00-3.12 physical performance tasks

Physical activity: reported often walk for exercise

Multiple logistic regression

Takkinen et To examine  n=198 Follow-up: 8 y Physical activity had a Physical activity al., 2001 longitudinally  Sex: Men and positive effect on had a positive [110] the predictive women (72%) Measures: meaning in life and effect on both value of  Age: ~75 y with Questionnaires/scal self-related health and meaning in life Finland physical follow up at es: self-reported functioning and self-related activity for a age 83 y health and health and sense of  Characteristics: functional functioning meaning in life Participants of capacity; 5-point Physical activity and for self- the Evergreen Likert-type scale also had an related health Project indirect effect on and (1997,1998) Physical activity in 6 self-related functioning categories and health and duration per session functioning through meaning Correlation, GLS, in life Structural Equation Modeling

Unger et al., To investigate  N=5014 Follow-up 6 y Physical activity was Study found

Publication Objective Population Methods Outcomes Comments and Country Conclusions 1997 [31] the impact of  Sex: Men and associated with lower physical activity social women Measurements: levels of impairment and social USA interactions  Age: 70+ y; Physical functioning and slower functional interactions exert and physical baseline mean – ability to perform decline over the 6-y independent activity on the 76 y ADL, IADL period protective effects trajectory of  Part of (analyzed as Most of the individual on maintenance decline in Longitudinal number of physical activity items of functional physical Study of Aging impairments) (compared to peers, independence functioning of (LSOA) compared to previous, older adults Physical activity; frequency of walking over a 6-year five self-reported one mile) were period items, including associated with lower frequency of walking initial levels of – standardized to a disability and slower physical activity functional decline scale

Individual growth curve analysis

Van Den To investigate  N=560 Follow-up 10 y Highest tertile of total A physically Brink et al., the  Sex: Men physical activity had active lifestyle 2005 [34] relationship  Age: 70-89 y, Measurements: lower risk of disability was inversely between mean ~75 y Disability severity vs. lowest tertile; OR related to Netherlands duration and  Disability at (none, mild, severe) 0.46, CI 0.26-0.84; disability, and to Finland, Italy intensity of baseline in ADL, IADL and and also middle tertile prevent disability physical excluded mobility vs. lowest OR 0.55, CI duration of activity and  Active group - 0.30 -0.99 physical activity disability 10 even lowest Physical activity in Physical activity seems to be years later group had 40 walking, cycling, duration OR 0.42, CI more important min per day in gardening; duration 0.23-0.78; whereas pa than intensity walking, and a mean intensity not Duration of 100 cycling, intensity index associated with min per day was gardening (code) summing all disability recommended activities with greater duration having Logistic regression ceiling effect model

Visser et al., To investigate  n=3,075 initially Baseline and 4.5 Over 4.5 y, 34.3% of Exercise and an 2005 [48] the (n=2987 year follow-up males and 47.4% active lifestyle association participants) females developed including walking USA between  Sex: Men and Measurements: mobility limitations protect against different types women Incidence of Inactive had twice the mobility loss of physical  Age: 70-79 y mobility limitation in risk of incident mobility Physical inactivity activity  Characteristics: 400 m walk or climb limitation than doubles the risk behaviour and Black and 10 steps exercisers (HR 2.08, of future mobility incident White elders CI 1.60-2.70 for males limitation in those mobility enrolled in the Questionnaire on and HR 1.98, CI 1.51- meeting Surgeon limitation Health Aging PA previous 7 days, 2.60 for females); General and Body kcal/week; aerobic, Inverse OR males recommendation. Composition weight training; 0.48, CI 0.30-0.63 Older persons

Publication Objective Population Methods Outcomes Comments and Country Conclusions (Health ABC) medium and high females 0.51, CI 0.38- who had a study intensity; walking for 0.66 relatively active  Only well- exercise Life-style active had lifestyle or who functioning Physical Activity intermediate risk (HR walked regularly (no initial 400 m Groups: men 1.47, CI 1.17- had a lower risk walking or 10 Exercisers: >1,000 1.85; HR women 1.44, than those who stair step kcal/wk of exercise CI 1.12-1.84); Inverse were inactive limitation) activity (20-30 min OR males 0.70, CI Walk 1 hr 15 min moderate on most 0.54-0.85 females briskly or 1 hr 40 days) 0.73, CI 0.57-0.93 min moderate to Life-style active: For the life-style active expend 400 <1,000 kcal/wk with and the inactive kcal/week lowers >2,719 kcal/wk of absence of walking risk of incident total physical activity conferred an mobility limitation Inactive: <1,000 additional risk of in those who do kcal/wk with <2,719 mobility limitation (did not participate in kcal/wk of total not walk HR men moderate to high physical activity 1.72, CI 1.40-2.12; HR intensity activities To assess the effect women 1.54, CI 1.28- of walking with or 1.84 versus > 400kcal without other per week walkers; exercise activity: Inverse OR men 0.58, Frequent walkers CI 0.47-0.71; OR 400 kcal/wk; women 0.65, CI 0.54- Occasional walkers 0.78 <400 kcal/wk; Never walkers

-Thigh muscle area and attenuation; Lean tissue mass; Isokinetic knee extensor strength

ANOVA, Log rank, Cox proportional hazard models

Wang et al., To identify  n=2,581 Follow-up 3.4 y Exercise of 3X/wk or The study 2002 [43] factors  Sex: Men and more (and moderate identified not only associated women Measurements: alcohol use) were risk factors USA with functional  Age: >65; ADL; IADL associated with better associated with change and mean ~ 75 PPF (performance- functional outcomes functional decline investigate  Characteristics: based physical and decreased rates but also inter-actions Participants function) 4 tests of functional decline interactions among selected from (walking speed, rise (less ADL, IADL among these selected Group Health from a chair, grip difficulty, better PPF) factors potential risk Cooperative strength, standing Interactions were seen factors balance) between exercise and Initially ~20% coronary heart difficulty in Physical activity disease (CHD), ADL or IADL questionnaire (worse functional Unusually classed as regular outcome with CHD

Publication Objective Population Methods Outcomes Comments and Country Conclusions active - 70% exerciser with 3X/wk was mitigated among of sample did or more of 15 exercisers) regular activities: walking, exercise hiking cycling aerobic, exercise, etc.

Linear regression, General Estimating Equation

Wang et al., Identify the  N=370 runners’ Follow-up, 13 y Significant difference Running and 2002 [16] benefits of club and 249 in progression of other aerobic aerobic controls Measurements: disability (HAQ exercise in older USA exercise,  Age 59 y at Health Assessment scores) seen between protect against running, on baseline Questionnaire study groups disability and disability and  Sex: Men and disability score; Reaching a disability early mortality mortality in women degree of difficulty score of 0.075 was and are elderly in 8 daily activities postponed by 8.7 y (CI associated with persons and 5.5 -13.7 y) in runners prolongation of a to examine Runners averaged vs. controls disability-free life whether about 4 hr/wk plus 1 morbidity can hr vigorous be exercise; controls compressed about 90 min of by regular vigorous exercise exercise/wk; also grouped as ever runners vs. never runners

Linear mixed models to compute postponement in disability

* To compare  N=284 runners; 21 y follow-up Runners had a Vigorous Chakravarty disability and 156 controls significantly lower risk exercise et al., 2008 mortality  Sex: men and Measurements: of HAQ-DI score of (running) at [17] outcomes women HAQ-DI scores 0.5: HR 0.62, CI 0.46- middle and older between  Age: baseline 0.84 ages is USA cohorts of 57 y; follow-up Physical activity: associated with runners and 78 y runners versus Runners had survival reduced disability control Controls 1-2 controls benefit HR 0.61, CI in later life and a subjects h/wk vigorous 0.45-0.82 notable survival initially aged exercise; advantage 50 to 72 y runners 5 hr/wk (same sample as Wang et al., 2002)

Wanna- Examine  N=5075 12 to 16 y follow-up Inverse relationship Maintaining

Publication Objective Population Methods Outcomes Comments and Country Conclusions methee et association  Sex: men between physical physical activity al., 2005 between Age 40 to 59 y Measurements: activity and mobility in later live may [21] lifestyle with follow up Mobility limitation – limitation showed a improve recovery changes in at 52 to 73 y reported difficulty in trend after adjustment from mobility UK later life (mean 62 y) going out, taking for chronic disease limitation (including and 56 to 77 y stairs, walking 400 (OR of moderately Promotion of light physical (mean 66 y) yards (also vigorous to none 0.77, or moderate activity) and examined recovery CI 0.58-1.03). physical activity mobility status from mobility Maintaining or taking program (limitation) limitation) up physical activity (walking, was associated with gardening) Physical activity less mobility limitation; score in walking or became active vs. cycling, recreational stable OR 0.43, CI activity and vigorous 0.26-0.71 and sports – 4 groups becoming inactive stable inactive, showed highest odds became inactive, of having mobility became active, limitation remained active Recovery from mobility limitation was Logistic regression increased with physical activity of light and moderate degree Moderate compared to none OR 2.57 (CI 1.31-5.02) Men who remained active were more likely to recover from mobility limitation, OR 3.26 (CI 1.92-5.52)

Ward et al., To examine  N=746:Runner Follow-up 5 to 7 y Runners averaged 5 The level of 1995 [18] the s =454; Non- hr of vigorous physical disability development runners =292 Yearly self-report exercise/wk vs. non- was generally USA of physical  Age 50 to 85 y: follow-up runners who averaged low. Physical disability in Runners 58.0 y Participants 1.5 hr at baseline. disability, once persons older (83% men); classified as runners 71% of runners were present, was than age 50 y Non-runners or non-runners at still active runners at persistent among who regularly 62.3 y (54% study entry end (average both runners and participated in men) decrease of 47 min) non-runners vigorous  Sex: Men and Physical disability 7% of non-runners Presence of exercise women measured with began running during arthritis was  Runners were HAQ-D1 follow-up time greatest risk members of 49% of runners factor for runners Questionnaire reported some disability in both association measured prior physical disability groups physical activity (average index 0.2) levels, current during the study exercise activity, period vs. 77% in non- Intensity=min of runners (average vigorous exercise index 0.26)

Publication Objective Population Methods Outcomes Comments and Country Conclusions per week Identified risk factors for disability among runners were presence of arthritis symptoms, older age, greater BMI, strenuous work related activity, and use of greater number of medications

Wu et al., To estimate  N=1321 Follow-up 3 y, with Risk of chronic ADL Lack of routine 1999 [32] the incidence  Sex: men and annual evaluations disability was exercise is a of chronic ADL women inversely associated significant Taiwan disability and  Age: 65+ y; Measurements: with routine exercise, predictor of ADL its predictors mean ~70 y Self-report on ADL RR=0.52, CI 0.39-0.68 disability in older including  Not ADL (this association with adults leisure-time disabled at Physical Activity: ADL disability was not physical baseline non-active found for non-active activity recreational recreation) activities and “exercises” (folk dancing, hiking jogging walking at least 2X/wk)

Cox Proportional hazard regression models

Young et al., To examine  n=3640 Baseline (1988) and For healthy subjects Engaging in 1995 [44] the  Sex: Men 3-5 year post those who were highly physical activity association of  Age: >70 y active initially were is predictive of a USA self-reported  Characteristics: Measurements: more likely to have high level of physical Japanese- Timed walks, optimal function for physical activity with American older Balance, Strength, basic ADL OR 2.3, functioning in performance men Flexibility, CI=1.1-4.9; Inverse older men with based and participation in Performance OR 0.43, CI 0.20-0.91 and without self-reported The Honolulu scores, ADL self- home management chronic disease. physical Heart Program reported physical skills (OR 1.5, CI=1.1- In subjects with functioning with and function 2.1; Inverse OR 0.67, chronic disease measured 3 to without chronic CI 0.48-0.91)) and participation in at 5 years later disease Physical activity physical endurance least moderate levels: Self-reported type tasks OR 1.7, CI PA may be physical activity to 1.2-2.4, Inverse 0.59, sufficient to estimate METs: CI 0.42-0.83 than low maintain optimal Low, Medium, High active subjects physical functioning Multiple logistic regression, ANCOVA

ADL – Activities of Daily Living; ANOVA (ANCOVA) – Analysis of variance (covariance); BMI – Body Mass Index; CI – 95% confidence interval; EPESE - Established Populations for the Epidemiologic Study of the Elderly; FSQ – Functional Status Questionnaire (of ADL and IADL); HAQ-DI – Health Assessment Questionnaire – Disability Index; HR – Hazard ratio; IADL – Instrumental Activities of Daily Living; OR – Odds Ratio; LTPA – Leisure Time Physical Activity; MET – Resting metabolic equivalent; PPT – Physical Performance Test; RR – Relative Risk; %ile – percentile.

* Indicates second report from the same study/data base with different variables, analysis or period of follow-up. These were considered as supplementary reports not counted as “separate” studies.