African american grandmother happy after working out
RESEARCH FEATURE

Older Women: Every Bit (of Movement) Counts


If you are a woman over 60, move more. Move often. Break those long sitting bouts. Why? Literally, every time you twist, turn, walk, or stand counts towards improving your cardiovascular health.

That’s the good-news message from two recently published studies on the cardiovascular effects of sedentary behaviors and light physical activity in older women.

The studies involved an ethnically diverse group of more than 5,500 women, nearly half of whom were over age 80, enrolled between 2012 and 2014. None had a history of heart attack or stroke. The women were part of the NHLBI-funded Objective Physical Activity and Cardiovascular Health (OPACH) study—a sub cohort of the Women’s Health Initiative. 

“I recommend to all women who, like me, are over 60, to make a conscious effort to interrupt our sitting by getting up and moving around as often as we can,” said Andrea LaCroix, Ph.D., chair of the Division of Epidemiology and director of the Women’s Health Center of Excellence at the University of California, San Diego, who led the OPACH study. “Whether it is to get the mail, do the laundry, or walk with a friend, just getting up and moving is the goal.”

According to the study, published last March in the journal JAMA Network Open, light physical activity such as gardening, strolling through a park, and folding clothes might be enough to significantly lower the risk of cardiovascular disease among women 63 and older. LaCroix and her colleagues said that this kind of activity appears to reduce the risk of cardiovascular disease events such as stroke or heart failure by up to 22 percent, and the risk of heart attack or coronary death, by as much as 42 percent.

Illustration of how sitting time can be accumulated in different patterns.
Illustration of how sitting time can be accumulated in different patterns. CREDIT: Bellettiere, John (2018): Sitting Accumulation Patterns_2108-06-06.png. Figshare. Figure.

Heart disease is the leading cause of death among American women, and older women suffer profoundly: nearly 68 percent of those between 60 and 79 have it, as do older Americans overall. Of the estimated 85.6 million adults with at least one type of cardiovascular disease, more than half are age 60 or older.

Higher levels of sitting and lower levels of light physical activity have been linked to increased blood sugar levels, high blood pressure, elevated cholesterol levels and increased mortality risk.

In the five-year prospective study, researchers followed the women to find out if higher amounts of light physical activity were associated with reduced risks of coronary heart disease or cardiovascular disease.

Across all racial and ethnic groups, the link was clear, LaCroix said.

“The higher the amount of activity, the lower the risk,” she said. “And the risk reduction showed regardless of the women’s overall health status, functional ability or even age. In other words, the association with light physical activity was apparent regardless of these other factors.”

Indeed, any amount of physical activity, no matter how light, seemed to bode well for the women’s cardiovascular health. Conversely, too much sitting and lying around seemed to spell trouble.

The second study using the OPACH cohort, published in the journal Circulation last February, found that the longer women sit or lay down during the course of a day—and the longer the individual periods of uninterrupted sitting—the greater their risk of cardiovascular diseases such as heart disease and stroke. But reducing their sedentary time by just an hour a day appears to lower the risk of cardiovascular diseases by 12 percent—and for heart disease alone, by a dramatic 26 percent, the research found.   

“Higher amounts of sedentary time and longer sedentary bouts were directly associated with cardiovascular disease,” said John Bellettiere, Ph.D., research fellow of cardiovascular disease epidemiology at the University of California, San Diego, and lead author of the study. And just as in the first study, the association showed up regardless of a woman’s overall health, physical function, and other cardiovascular risk factors, including in this case whether they also were engaging in moderate to vigorous physical activity.

Simply, “the higher the sedentary time, the greater the risk,” Bellettiere said. Therefore, “encouraging less sedentary time and shorter sedentary bouts in older women could have large public health benefits.”

At the start of the OPACH study, participants wore hip-mounted accelerometers that measured their movement 24 hours a day for seven consecutive days. Previous studies have largely relied on self-reporting questionnaires; the accelerometers, however, provided researchers more accurate measures of sedentary time overall, as well as the duration of individual bouts of sedentary time. The latter was important because it allowed researchers to study for the first time whether sitting for long uninterrupted periods throughout the day contributed to a higher risk of cardiovascular disease.

The accelerometers were also calibrated by age to distinguish between light and moderate-to-vigorous physical activity—a monitoring detail considered a major strength of the study. Self-reporting questionnaires often produce flawed results because most people, the researchers said, do not think of folding clothes or walking to the mailbox as physical activity of any kind. That means they do not capture the low intensity movements accrued in activities of daily living, LaCroix said. Even in her own study findings, she noted, “there was no correlation between the amount of self-reported light physical activity and the amount we measured with the accelerometers. Without accurate reporting, we run the risk of discounting low intensity activity associated with important heart health benefits,” she said.

Large randomized trials are needed to determine if particular interventions might increase light physical activity in older women, and what effect that would have on cardiovascular disease rates. But the OPACH authors said they encourage this group to increase their light physical activity immediately.

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