Exercise adherence and 10-year mortality in chronically ill older adults

Abstract

Objectives: To compare mortality of adherents and nonadherents of an exercise program.

Design: Prospective intervention study.

Setting: Supervised geriatric fitness program called Gerofit.

Participants: One hundred thirty-five adults aged 65 and older who enrolled in Gerofit between January 1, 1990, and November 30, 1999. All participants had a baseline medical screen and exercise test. They were classified as adherent (n = 70) if they participated in Gerofit for more than 47 sessions or nonadherent (n = 65) if they did not complete 47 sessions within the first 6-month period.

Intervention: Program participation was voluntary and consisted of aerobic, strength, flexibility, and balance exercises. The program met three times week for 90 minutes.

Measurements: All-cause mortality.

Results: Twenty-six deaths occurred within the 10-year follow-up period. Using proportional hazards, time to death was not related to adherence group. However, in multivariate analyses controlling for age, sex, race, baseline risk/health status, history of heart disease, cancer, diabetes mellitus, and baseline smoking status, there was significant group-by-time interaction (P =.004), indicating a crossover in mortality risk. The initial survival benefit observed in nonadherers changed over time, resulting in a long-term protective survival effect on mortality for the adherent group (hazard rate = 0.75, 95% confidence interval = 0.61-0.91 for the interaction term).

Conclusions: Older adults with chronic diseases experience a long-term beneficial mortality effect from participation in exercise programs. Physicians should strongly encourage their patients, including those with comorbidities, to maintain a regular exercise program.