Implications of Physical Activity and Health Measures in Older Men

By Jacquelyn Scott
Wednesday, February 2, 2022

Based on the Osteoporotic Fractures in Men Study, higher physical activity is associated with an increase in functional strength and mobility in older men, as well as decreased risk of hospitalization. Evidence suggests incorporating physical activity into primary care.

As it reaches its 20-year mark, the Osteoporotic Fractures in Men (MrOS) Study reveals higher levels of physical activity are associated with greater strength and mobility in older men.

Marcia Stefanick, Ph.D., Professor of Medicine, Obstetrics and Gynecology, and Epidemiology and Population Health at Stanford University School of Medicine and the Stanford site’s principal investigator for the MrOS, saw three distinct patterns of declining physical activity and functional independence. These three patterns include a low-, moderate- and high-activity group, and the patterns correlated with changes in grip strength, walking speed and leg power.

Physical Activity as It Pertains to Functional Performance

The MrOS started in 2000 and recruited 5,994 older men to study multiple health measures, such as grip strength, walking speed and leg power, among many others. The free online database now houses an extensive bank of data from which researchers can draw correlations.

Among the data collected, Dr. Stefanick and a team of researchers discovered that functional performance declined on average across all of the subjects as they aged, but performance declined the most in participants with the least physical activity. Their study, “Physical Activity Trajectories and Associated Changes in Physical Performance in Older Men: The MrOS Study,” reviewed MrOS data on gait speed, grip strength and timed chair stand.

According to their research, men with the highest physical activity lost 0.328 feet per second, 8.356 pounds and 0.38 seconds, respectively, whereas men with the lowest physical activity lost 0.525 feet per second, 10.648 pounds and 0.53 seconds, respectively. The losses took place across seven years in men ages 65 and older at the beginning of the study.

Gait speed is considered a reliable measure of overall health. Poor grip strength was recently more heavily associated with higher mortality rates — both all-cause and cardiovascular­ — than systolic blood pressure and as a predicator of falling versus not-falling in older men. Therefore, researchers concluded that the higher rate of loss of speed and grip strength in the low physical activity group is clinically significant.

Likewise, in “The Association Between Objectively Measured Physical Activity and Subsequent Health Care Utilization in Older Men,” Dr. Stefanick and researchers used the MrOS database to connect daily step count with hospital stays. They found a correlation between higher daily step count and lower odds of hospitalization and shorter duration of stay.

“Daily step count is an easily determined measure of physical activity that may be useful in assessment of future health care burden in older men,” according to Dr. Stefanick and co-authors. “Given that lower physical activity is associated with a broad spectrum of adverse health outcomes, it is likely that lower levels of objectively measured physical activity are associated with increased risk of hospitalization and subsequent use of postacute care.”

In fact, their research shows that each increase in standard deviation is independently associated with a 34% decrease in hospitalization odds.

­In this study, one standard deviation equals 3,092 steps.

Incorporating Physical Activity in Primary Care Practice

Low physical activity is a clinically significant predicator of limited functional independence, chronic disease and hospitalization. Primary care provider influence could be a strong influence in a patient’s decision to begin an exercise program or increase his activity level. Therefore, primary care providers might consider more formal incorporation of physical activity into their practice space.

While some providers may offer their older male patients the advice to exercise more, an “exercise prescription” might be more helpful. In practice, this could take the form of reviewing physical activity recommendations and including specific options for exercise based on the individual patient. Physical activity levels could be recorded in patients’ files in an effort to monitor patient progress over time, and if patients do not show indications of functional improvement, providers could consider referrals to physical therapy or resources that encourage physical activity, such as community-based programs or fitness centers.

Dr. CrossFit?

In what may be an extreme example of incorporating physical fitness into primary care medicine, CrossFit is stepping into the primary care space with their CrossFit Precision Care. Branded as a primary care service built by the CrossFit community, Precision Care hopes to provide a personalized, data-driven approach to the world of telehealth. The new service claims to cover all aspects of health, including sleep, physical activity, nutrition and more.

Doctors will be CrossFit-trained and provide a patient care plan based on genes, biomarkers and health metrics. Precision Care is telehealth-only but also offers in-person referrals if clients need specialist or follow-up care. Doctors for referral are not necessarily associated with CrossFit. Currently, the service is not covered by insurance and only available in certain states.