Dose-Response Relationship of Physical Activity with All-Cause Mortality among Older Adults: An Umbrella Review

Objectives: To examine the dose -response relationship between physical activity (PA) and all -cause and cardiovascular disease (CVD) mortality, specifically among older adults. Design: Umbrella review. Setting and Participants: Eligible studies included systematic reviews with meta -analyses that investigated the association of aerobic PA, muscle -strengthening activity, and multicomponent PA, including exercise programs (such as aerobic, muscle strengthening, and balance training), with all -cause and CVD mortality among older adults aged >= 60 years. Methods: We performed a literature search in PubMed, CINAHL, and the Cochrane Library for eligible studies published between January 2017 and March 2023 to update an umbrella review initially conducted by the United States 2018 PA Guidelines Advisory Committee. Studies included in the 2018 US PA and 2020 World Health Organization (WHO) Guidelines were also reviewed. In addition, meta -analyses that reported effect sizes stratified by age and recruiting older adults (aged >= 60 years) were included. Results: Overall, 16 relevant systematic reviews (10 from our review and 6 from the US and WHO guidelines) met the inclusion criteria. All these reviews showed that 7.5 to 15.0 metabolic equivalents (METs)-hours/week (around the recommended PA levels outlined in the US and WHO guidelines) substantially reduced mortality risks among older adults (approximately 19%-30% for all -cause mortality and 25%-34% for CVD mortality). Moreover, 15.0 to 22.5 MET-hours/week, exceeding the guidelinerecommended PA levels, resulted in greater reductions in mortality risks by 35% to 37% and 38% to 40%, respectively. Conclusions and Implications: PA substantially reduced all -cause and CVD mortality risks among older adults. Larger risk reductions may be achieved by engaging in PA levels higher than those recommended by the current international PA guidelines. Our findings suggest that recommending higher PA levels beyond the current guidelines may benefit older adults when developing future international PA guidelines. (c) 2023 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post -Acute and Long -Term Care Medicine. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).