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Observational Study
. 2025 Jul;26(7):105620.
doi: 10.1016/j.jamda.2025.105620. Epub 2025 May 28.

Are the Recommended Levels of Moderate-to-Vigorous Aerobic Activity and Resistance Training Inversely Associated with Frailty and Mortality?

Andrea Mayo  1 , Jack Quach  2 , Myles W O'Brien  2 , Judith Godin  1 , Dustin S Kehler  3 , Derek S Kimmerly  4 , Olga Theou  5
Affiliations
Free article
Observational Study

Are the Recommended Levels of Moderate-to-Vigorous Aerobic Activity and Resistance Training Inversely Associated with Frailty and Mortality?

Andrea Mayo et al. J Am Med Dir Assoc. 2025 Jul.
Free article

Abstract

Objectives: To examine the association of meeting the moderate-to-vigorous physical activity (MVPA) and resistance training (RT) components of the physical activity guidelines with frailty and mortality and to determine if these associations vary by age and sex.

Design: Observational study.

Setting and participants: Secondary analysis of 17,716 community-dwelling individuals [46 ± 19 years (range: 20-85 years), 52.2% female] from the National Health and Nutrition Examination Survey (NHANES) (cycles 1999-2006) who had available Frailty Index, mortality, and self-reported physical activity data.

Methods: Self-reported MVPA (≥150 minutes/wk) and RT (≥2 days/wk) levels were used to divide participants into Combined (both met), MVPA Only, RT Only, or Inactive (neither met) groups. Frailty was measured with a 46-item Frailty Index (FI), and all-cause mortality was obtained using National Death Index data. Group differences were explored using analyses of variance. Associations between MVPA and/or RT with (1) frailty and (2) mortality used covariate-adjusted multiple linear regression and Cox proportional hazards models, respectively.

Results: A total of 1878 (10.6%) people were included in the Combined group, 3741 (21.1%) in the MVPA Only group, 1257 (7.1%) in the RT Only group, and 10,840 (61.2%) in the Inactive group. Older females needed to engage in MVPA to experience a beneficial effect on frailty, whereas males benefited from engaging in either or both types of activity regardless of age. Females at the lowest frailty level [hazard ratio (HR) 0.65, 95% CI 0.46-0.93] and frail males (HR 0.72, 95% CI 0.59-0.88) in the Combined group had a lower risk of mortality compared to the Inactive group.

Conclusions and implications: There is a lower association with frailty and mortality when achieving MVPA or RT guidelines alone, although sex and age differences demonstrate that MVPA is especially critical as females age.

Keywords: Frailty index; NHANES; physical activity; sex differences.

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Conflict of interest statement

Disclosure Dr Olga Theou has asserted (with Dr Kenneth Rockwood) copyright of the Pictorial Fit-Frail Scale, which is made freely available for education, research, and not-for-profit health care. Licenses for commercial use are facilitated through the Dalhousie University Office of Commercialization and Industry Engagement. No other author declares any conflicts of interest.

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