Association between sedentary life and mortality according to body mass index in older people
Keywords:
body mass index; mortality; older adult; sedentary lifestyleAbstract
Introduction: Sedentary behavior is common among older adults and is associated with frailty, functional dependence, and increased mortality. The effect of this association may vary according to body mass index (BMI), although the available evidence in older adults remains heterogeneous.
Objective: To determine the association between sedentary behavior and mortality in older adults according to BMI categories.
Methods: A retrospective cohort observational study was conducted using data from the CEMENA Frailty Study, which included older adults treated at the Naval Medical Center of Peru between 2014 and 2020. Records with missing data were excluded. Sedentary behavior was assessed using the Physical Activity Scale for the Elderly, and mortality data were obtained from institutional records. BMI was classified into four categories. Cox regression models were used to estimate mortality risk adjusted for sociodemographic and clinical variables.
Results: A total of 45.44% of participants were classified as sedentary, and 10.59% died during follow-up. In the BMI-stratified analysis, sedentary behavior was associated with a higher risk of mortality among older adults with underweight (HR = 3.27; 95% CI: 1.30–4.58) and obesity (HR = 6.33; 95% CI: 1.03–8.70).
Conclusions: Sedentary behavior was associated with a higher risk of mortality in older adults, particularly among those with underweight or obesity according to BMI. These findings highlight the importance of interventions aimed at promoting physical activity and maintaining an adequate nutritional status in old age.
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1. Jiménez-Aguilera B, Baillet-Esquivel LE, Ávalos-Pérez F, Campos-Aragón L. Dependencia funcional y percepción de apoyo familiar en el adulto mayor [Internet]. Atención Familiar. 2023; 4:129-33. DOI: 10.1016/j.af.2016.08.002
2. Izquierdo M, Duque G, Morley JE. Physical activity guidelines for older people: knowledge gaps and future directions [Internet]. Lancet Healthy. 2021;6:e380-3. DOI: 10.1016/S2666-7568(21)00079-9
3. Instituto Nacional de Estadística e Informática. Factores de riesgo de las enfermedades crónicas no transmisibles. En: Perú: Situación de Salud de la Población Adulta Mayor, 2012 [Internet]. Lima: Instituto Nacional de Estadística e Informática; 2013. p. 93-128 [acceso: 22/09/2025]. Disponible en: https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1146/cap05.pdf
4. Rodriguez-Cuba MA, Ibarra-Abanto SJ, Parodi JF, Runzer- Colmenares FM. Sedentarismo y mortalidad en pacientes hipertensos: rol de los criterios de sarcopenia [Internet]. Rev. Fed. Arg. Cardiol. 2022 [acceso: 22/09/2025];51(1):16-22. Disponible en: https://revistafac.org.ar/ojs/index.php/revistafac/article/view/361
5. Strain T, Flaxman S, Guthold R, Semenova E, Cowan M, Riley LM, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants [Internet]. Lancet Glob Health. 2024;12(8):e1232-43. DOI: 10.1016/S2214-109X(24)00150-5
6. Pérez-Sousa MÁ, Del Pozo-Cruz J, Olivares PR, Cano-Gutiérrez CA, Izquierdo M, Ramírez-Vélez R. Role for physical fitness in the association between age and cognitive function in older adults: A mediation analysis of the SABE Colombia study [Internet]. Int J Environ Res Public Health. 2021;18(2):751. DOI: 10.3390/ijerph18020751
7. Saavedra Conde L, Ordóñez Hernández CA, Granja Escobar LC, Castro Hernández J. Percepción de la salud por adultos mayores que realizan actividad física en un parque público de Cali, Colombia. Rev. Fac. Nac. Salud Pública [Internet]. 202;39(3):e341345. DOI: 10.17533/udea.rfnsp.e341345
8. D’Amore C, Lajambe L, Bush N, Hiltz S, Laforest J, Viel I, et al. Mapping the extent of the literature and psychometric properties for the Physical Activity Scale for the Elderly (PASE) in community-dwelling older adults: a scoping review [Internet]. BMC Geriatr. 2024;24(1):761. DOI: 10.1186/s12877-024-05332-3
9. Li CY, Al Snih S, Chen NW, Markides KS, Sodhi J, Ottenbacher KJ. Validation of the modified frailty phenotype measure in older Mexican Americans [Internet]. J Am Geriatr Soc. 2020;67(11):2393–7. DOI: 10.1111/jgs.16104
10. Silveira EA, Mendonça CR, Delpino FM, Elias Souza GV, Pereira de Souza Rosa L, de Oliveira C, et al. Sedentary behavior, physical inactivity, abdominal obesity and obesity in adults and older adults: A systematic review and meta-analysis [Internet]. Clin Nutr ESPEN. 2022;50:63–73. DOI: 10.1016/j.clnesp.2022.06.001
11. Lin C-C, Li C-I, Liu C-S, Lin C-H, Lin Y-C, Yang S-Y, et al. Independent and joint effects of self-reported physical activity and sedentary behaviors on mortality in community-dwelling older persons: a prospective cohort study [Internet]. BMC Geriatr. 2024;24(1):886. DOI: 10.1186/s12877-024-05493-1
12. Jiang M, Zou Y, Xin Q, Cai Y, Wang Y, Qin X, et al. Dose-response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis [Internet]. Clin Nutr. 2019;38(4):1511–23. DOI: 10.1016/j.clnu.2018.07.021
13. Tarp J, Rossen J, Ekelund U, Dohrn I. Joint associations of physical activity and sedentary time with body mass index: A prospective study of mortality risk [Internet]. Scand J Med Sci Sports 2023;33:693-700. DOI: 10.1111/sms.14297
14. Magalhães L, Silva D, Araújo M, RN LI, Almeida Filho N. Sedentarism and Metabolic Syndrome: Broadening the measurement of sedentarism [Internet]. Archives of Community Medicine and Public Health 2019;20:069–76. DOI: 10.17352/2455-5479.000057
15. Runzer FM, Parodi JF. CEMENA Frailty Study [dataset]. Figshare; 2020. DOI: 10.6084/m9.figshare.13059011.v2
16. Rothman MD, Leo‐Summers L, Gill TM. Prognostic Significance of Potential Frailty Criteria [Internet]. J Am Geriatr Soc 2008;56:2211-6. DOI: 10.1111/j.1532-5415.2008.02008.x
17. Centers for Disease Control and Prevention (CDC). Body mass index: considerations for practitioners [Internet]. Atlanta: CDC; 2011. [acceso: 22/09/2025]. Disponible en: https://stacks.cdc.gov/view/cdc/25368
18. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis [Internet]. 2019;48:601-601. DOI: 10.1093/ageing/afy169
19. Gupta S, Yadav R, Malhotra A. Assessment of physical disability using Barthel index among elderly of rural areas of district Jhansi (U.P), India [Internet]. J Family Med Prim Care. 2016;5:853. DOI: 10.4103/2249-4863.201178
20. Ríos Guarango PA, Yaulema Brito LP, Rodríguez Cevallos M de los Ángeles. Actividad física, estado nutricional y calidad de vida en adultos mayores de áreas rurales [Internet]. Rev. cuba. med. mil. 2022 [acceso: 22/09/2025];51(4):e02202132. Disponible en: https://revmedmilitar.sld.cu/index.php/mil/article/view/2132
21. Bulló M, Garcia-Aloy M, Martínez-González MA, Corella D, Fernández-Ballart JD, Fiol M, et al. Association between a healthy lifestyle and general obesity and abdominal obesity in an elderly population at high cardiovascular risk [Internet]. Prev Med (Baltim) 2011;53:155-61. DOI: 10.1016/j.ypmed.2011.06.008
22. Nordahl H, Lange T, Osler M, Diderichsen F, Andersen I, Prescott E, et al. Education and Cause-specific Mortality: the mediating role of differential exposure and vulnerability to behavioral risk factors [Internet]. Epidemiology. 2014;25:389-96. DOI: 10.1097/EDE.0000000000000080
23. Zhang Y, Liu X. Effects of physical activity and sedentary behaviors on cardiovascular disease and the risk of all-cause mortality in overweight or obese middle-aged and older adults [Internet]. Front Public Health. 2024; 12:1302783. DOI: 10.3389/fpubh.2024.1302783
24. Huang Q-M, Shen D, Gao J, Chen H, Xie J-H, Yan H-Y, et al. Association of weight change with all-cause and cause-specific mortality: an age-stratified analysis [Internet]. BMC Med. 2024;22(1):438. DOI: 10.1186/s12916-024-03665-9
25. Zhang J, Schutte R, Pierscionek B. Association of weight change with cardiovascular events and all-cause mortality in obese participants with cardiovascular disease: a prospective cohort study [Internet]. Heart. 2025; 111(10):454–61. DOI: 10.1136/heartjnl-2024-324383
26. Rezende LFM, Ahmadi M, Ferrari G, Del Pozo Cruz B, Lee I-M, Ekelund U, et al. Device-measured sedentary time and intensity-specific physical activity in relation to all-cause and cardiovascular disease mortality: the UK Biobank cohort study [Internet]. Int J Behav Nutr Phys Act. 2024; 21(1):68. DOI: 10.1186/s12966-024-01615-5
27. Zhang K, Qi J, Zuo P, Yin P, Liu Y, Liu J, et al. The mortality trends of falls among the elderly adults in the mainland of China, 2013—2020: A population-based study through the National Disease Surveillance Points system [Internet]. Lancet Reg Health West Pac. 2022; 19:100336. DOI: 10.1016/j.lanwpc.2021.100336
28. Yuan Y, Lin S, Lin W, Huang F, Zhu P. Modifiable predictive factors and all-cause mortality in the non-hospitalized elderly population: An umbrella review of meta-analyses [Internet]. Exp Gerontol 2022; 163:111792. DOI: 10.1016/j.exger.2022.111792
29. Gong L, He D, Huang D, Wu Z, Shi Y, Liang Z. Clinical profile analysis and nomogram for predicting in-hospital mortality among elderly severe community-acquired pneumonia patients with comorbid cardiovascular disease: a retrospective cohort study [Internet]. BMC Pulm Med. 2022; 22:312. DOI: 10.1186/s12890-022-02113-9
30. Fermín‐Martínez CA, Márquez‐Salinas A, Guerra EC, Zavala‐Romero L, Antonio‐Villa NE, Fernández‐Chirino L, et al. AnthropoAge, a novel approach to integrate body composition into the estimation of biological age [Internet]. Aging Cell. 2023; 22:e13756. DOI: 10.1111/acel.13756
31. Kawakami Y, Hamano J. Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study. BMC Geriatr [Internet]. 2022; 22(1):85. DOI: 10.1186/s12877-022-02778-1
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Copyright (c) 2026 Nasheyra Esteban-Marín, Nicolle Felipe-Malasquez, Alvaro M. Ñaña-Cordova, Neyling D. Aguilar-Anaya, Jose F. Parodi, Fernando M. Runzer-Colmenares
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