Frailty Phenotype Prevalence in Community-Dwelling Older Adults According to Physical Activity Assessment Method

Figures & data

Figure 1 Flow-chart of recruitment process.

Table 1 Detailed Description of the Models Used to Determine Low Physical Activity

Instruments and Outcomes		Definition of Low Physical Activity
Physical activity instrument	Outcome (unit)	Cut-point model^a	Cut-point	Study population or other description	References
MLTPAQ 18-item version	METmin/week≈ kcal/week	A (primary phenotype)	♀: <270 kcal/week ♂: <383 kcal/week	Cardiovascular Health Study	Fried et al^Citation7
	h/week	C	♀/♂: <150 min/week in MVPA	Global recommendation for older adults (≥65 years)	World Health Organization^Citation18
MLTPAQ 6-item version	kcal/week	B	♀: 105 kcal/week ♂: 148 kcal/week	Women’s Health and Aging Studies	Eckel et al^Citation19
		C	See above	–	–
GPAQ 50+	(METh/week) kcal/week (weighted)	A	See above	–	–
	h/week	C	See above	–	–
IPAQ	kcal/week (weighted)	A	See above	–	–
	METmin/week	B	♀/♂: 600 METmin/week	Questionnaire-specific	IPAQ Research Committee^Citation20
	PA category: low, moderate, high activity	C	See above	Part of the study: Nutritional status, risk behaviors and health conditions of the elderly people of Lafaiete Coutinho, Bahia	Reis Júnior et al^Citation21
PASE	PASE score (0 to ~400 points)	B1	♀: ≤27.5 points ♂: ≤30.0 points	Hispanic Established Populations for the Epidemiologic Studies of the Elderly	Al Snih et al;^Citation22 Graham et al^Citation23
		B2	♀/♂: <89.6 points	Osteoporotic Fractures in Men Study	Cawthon et al;^Citation24  Wu et al^Citation25
7D-PAR	PAEE: kcal/week (weighted)	A	See above	–	–
	h/week	C	See above	–	–
Physical Activity Monitor (Actigraph Accelerometer)	kcal/week	A	See above	–	–
	kcal/kg/day	B	♀: ≤7.1 kcal/kg/day ♂: ≤6.2 kcal/kg/day	Sasaguri Genkimon Study	Chen et al^Citation26
	MVPA (≥1952 cpm) (Freedson et al)^Citation27	C1	See above	–	–
	MVPA (≥1041cpm) (Copeland and Esliger)^Citation28	C2	See above	–	–
	Step counts	B	♀/♂: ≤5000 steps/day	Healthy Aging and Intellectual Disability Study	Bastiaanse et al^Citation29
	Step counts	C	♀/♂: <7000 steps/day	–	Tudor-Locke et al^Citation30

Notes: Grey shading highlights phenotype models that have already been used in the literature. This refers to the specific combination of an assessment method (eg questionnaire) and cut-points used in the studies. The other phenotype models were newly created. ^aCut-point models: A: Fried’s values. B: Specific values. C: MVPA recommendations.

Abbreviations: 7D-PAR, Seven Day Physical Activity Recall; cpm, counts per minute; GPAQ 50+, German Physical Activity Questionnaire 50+; IPAQ, International Physical Activity Questionnaire; MLTPAQ, Minnesota Leisure Time Physical Activity Questionnaire; MVPA, moderate to vigorous physical activity; PAEE, physical activity energy expenditure; PASE, Physical Activity Scale for the Elderly.

Table 2 Characteristics for the Total Study Sample and for Subgroups of the Primary Phenotype

Variable	Total Sample (n=47)	Non-Frail (n=23)	Pre-Frail (n=15)	Frail (n=9)	Statistics
Sex, female	66%	61%	80%	56%	χ^2(2)=2.02, P=0.365^a
Age [in years]; M ± SD	74 ± 6	71 ± 5	76 ± 5	75 ± 6	χ^2(2)=7.68, P=0.022^b
BMI [kg/m^2]; M ± SD	28.6 ± 4.9	27.2 ± 3.6	29.6 ± 5.8	30.5 ± 5.6	F(2, 44)=2.03, P=0.144^c
Walking aid					χ^2(6)=24.37, P<0.001^a
No walking aid	77%	100%	67%	33%
Rollator	17%	0%	20%	56%
Walking stick	4%	0%	13%	0%
Crutches	2%	0%	0%	11%
Living situation					χ^2(2)=2.67, P=0.264^a
On their own	51%	39%	60%	67%
With partner/others	49%	61%	40%	33%
Education entrance qualification	(n=1 missing)	(n=1 missing)			χ^2(2)=2.55,P=0.863^a
Lower	59%	50%	67%	67%
Middle	15%	18%	13%	11%
Higher	26%	32%	20%	22%
Habitual gait speed [m/s]; M ± SD	0.86 ± 0.26 (n=2 missing)	1.06 ± 0.19	0.73 ± 0.12	0.55 ± 0.15	χ^2(2)=30.96, P<0.001^b
Frailty Index; M ± SD	0.195 ± 0.109	0.112 ± 0.044	0.237 ± 0.059	0.335 ± 0.110	F(2, 44)=42.67, P<0.001^c
Grip strength [kg]; M ± SD	27 ± 11	32 ± 10	26 ± 11	18 ± 7	F(2, 44)=6.61, P=0.003^c
Number of prescribed medications per day; M ± SD	4 ± 3 (n=1 missing)	2 ± 1 (n=1 missing)	6 ± 4	4 ± 2	F(2, 43)=13.58, P<0.001^c

Notes: ^aChi-square tests for proportions, ^bKruskal–Wallis test for not normally distributed interval-based data, ^cANOVA for normally distributed interval-based data.

Table 3 Physical Activity Data for the Total Study Sample and for Subgroups of the Primary Phenotype

Variable	Total Sample (n=47)	Non-Frail (n=23)	Pre-Frail (n=15)	Frail (n=9)	Statistics
Accelerometer wear time [h/day]	13.9 ± 2.0	14.0 ± 1.8	14.0 ± 1.5	13.1 ± 3.0	χ^2(2)=0.55, P=0.759^a
Physical activity instrument
MLTPAQ [kcal/week ≈ METmin/week]	2688 ± 1640	3106 ± 1202	2459 ± 1917	2000 ± 1979	F(2, 44)=1.74, P=0.188^b
MLTPAQ 6-item [kcal/week]	2353 ± 1547	2583 ± 1357	2230± 1576	1970 ± 2002	F(2, 44)=0.57, P=0.572^b
IPAQ [METmin/week]	2281 ± 1930	3029 ± 1614	2110 ± 2299	653 ± 606	F(2, 44)=6.09, P=0.005^b
7D-PAR: TEE [kcal/kg/day]	36.3 ± 3.2	37.7 ± 3.1	36.0 ± 2.8	33.0 ± 1.9	F(2, 44)=9.30, P<0.001^b
7D-PAR: weighted PAEE [kcal/week]	8664 ± 2216	8808 ± 2265	9005 ± 2103	7727 ± 2266	χ^2(2)=3.12, P=0.211^a
PASE [Score] Median [IQR]	85.0 [60.4]	112.0 [60.2]	67.1 [37.6]	39.0 [43.8]	χ^2(2)=18.29, P<0.001^a
GPAQ 50+ [METmin/week]	5214 ± 3065	6199 ± 2658	4860 ± 3617	3287 ± 2122	F(2, 44)=3.38, P=0.043^b
Accelerometer [kcal/week]	1962 ± 1239	2586 ± 1148	1712 ± 1150	784 ± 296	F(2, 44)=10.21, P<0.001^b
Accelerometer [steps/day]	4864 ± 3236	6347 ± 24	4464 ± 3769	1739 ± 808	F(2, 44)=9.10, P<0.001^b
Time spent in MVPA [min/week]
GPAQ 50+	669 ± 574	873 ± 509	591 ± 653	280 ± 365	F(2, 44)=4.17, P=0.022^b
MLTPAQ	769 ± 509	827 ± 361	776 ± 646	613 ± 600	F(2, 44)=0.56, P=0.573^b
MLTPAQ 6-item	675 ± 457	719 ± 406	650 ± 456	603 ± 608	F(2, 44)=0.24, P=0.792^b
IPAQ	602 ± 553	742 ± 447	633 ± 731	192 ± 163	F(2, 44)=3.60, P=0.036^b
7D-PAR	532 ± 448	683 ± 410	540 ± 475	131 ± 227	F(2,44)=5.97, P=0.005^b
Accelerometer – Freedson	169 ± 182	252 ± 158	129 ± 210	26 ± 14	F(2, 44)=6.88, P=0.003^b
Accelerometer – Copeland & Esliger	957 ± 531	1093 ± 323	1017 ± 747	509 ± 268	F(2, 44)=4.72, P=0.014^b
Sedentary Time [h/day]
IPAQ	6.0 ± 2.4	5.7 ± 1.4	5.5 ± 2.2	7.7 ± 4.1	F(2, 44)=2.83, P=0.070^b
PASE	5.6 ± 2.5	4.9 ± 1.8	5.5 ± 2.6	7.5± 2.9	F(2, 44)=4.13, P=0.023^b
Accelerometer (Percentage of wear time)	9.9 ± 2.9 (73.1% ± 8.6%) (n=1 missing)	9.7 ± 1.8 (69.9% ± 7.9%) (n=1 missing)	9.9 ± 3.3 (74.4% ± 9.4%)	10.3 ± 2.8 (78.6% ± 6.0%)	F(2, 43)=0.16, P=0.850^b (χ^2(2)=7.15, P=0.028^a)

Notes: All values are means ± standard deviations, unless indicated otherwise. ^aKruskal–Wallis test for not normally distributed interval-based data, ^bANOVA for normally-distributed interval-based data.

Abbreviations: 7D-PAR, Seven Day Physical Activity Recall; GPAQ 50+, German Physical Activity Questionnaire 50+; IPAQ, International Physical Activity Questionnaire; MLTPAQ, Minnesota Leisure Time Physical Activity Questionnaire; MVPA, moderate to vigorous physical activity; PAEE, physical activity energy expenditure; PASE, Physical Activity Scale for the Elderly; TEE, total energy expenditure.

Table 4 Frailty Phenotype Prevalence According to the Assessment and Definition of Low Physical Activity

Measurement of LPA Item		Positive LPA Criterion		Frail		Pre-Frail		Non-Frail
Physical Activity Instrument	Cut-Point Model^a	n	%	n	%	n	%	n	%
Frailty Index	NA	NA	NA	16	34.0%	24	51.1%	7	14.9%
MLTPAQ	A	4	8.5%	9	19.1%	15	31.9%	23	48.9%
	C	5	10.6%	9	19,1%	15	31,9%	23	48.9%
MLTPAQ 6-item	B	2	4.3%	9	19.1%	15	31.9%	23	48.9%
	C	5	10.6%	9	19.1%	15	31.9%	23	48.9%
GPAQ 50+	A	0	0%	7	14.9%	17	36.2%	23	48.9%
	C	10	21.3%	11	23.4%	14	29.8%	22	46.8%
IPAQ	A	8	17.0%	11	23.4%	13	27.7%	23	48.9%
	B	18	38.3%	11	23.4%	19	40.4%	17	36.2%
	C	14	29.8%	11	23.4%	18	38.3%	18	38.3%
PASE	B1	3	6.4%	8	17.0%	16	34.0%	23	48.9%
	B2	26	55.3%	14	29.8%	16	34.0%	17	36.2%
7D-PAR	A	0	0%	7	14.9%	17	36.2%	23	48.9%
	C	14	29.8%	11	23.4%	16	34.0%	20	42.6%
Accelerometer	A	0	0%	7	14.9%	17	36.2%	23	48.9%
	B	40	85.1%	13	27.7%	31	66.0%	3	6.4%
	C1	30	63.8%	14	29.8%	18	38.3%	15	31.9%
	C2	0	0%	7	14.9%	17	36.2%	23	48.9%
Step ounts Accelerometer	B	27	57.4%	14	29.8%	17	36.2%	16	34.0%
	C	37	78.7%	15	31.9%	24	51.1%	8	17.0%

Notes: Grey shading highlights phenotype models that have already been used in the literature. This refers to the specific combination of an assessment method (eg questionnaire) and a cut-point. ^aCut-point models: A: Fried’s values, B: specific values of the respective study/questionnaire, C: MVPA recommendations.

Abbreviations: 7D-PAR, Seven Day Physical Activity Recall; GPAQ 50+, German Physical Activity Questionnaire 50+; IPAQ, International Physical Activity Questionnaire; LPA, low physical activity; MLTPAQ, Minnesota Leisure Time Physical Activity Questionnaire; MVPA, moderate to vigorous physical activity; NA, not applicable; PASE, Physical Activity Scale for the Elderly.

Figure 2 Frailty prevalence according to the assessment and definition of the low physical activity criterion.

Notes: Cut-point models: (A): Fried’s values. (B): specific values. (C): MVPA recommendation.
Abbreviations: Accel, Accelerometer; CI, confidence interval; GPAQ 50+, German Physical Activity Questionnaire 50+; IPAQ, International Physical Activity Questionnaire; MLTPAQ, Minnesota Leisure Time Physical Activity Questionnaire; MVPA, moderate to vigorous physical activity; PASE, Physical Activity Scale for the Elderly; 7D-PAR, Seven Day Physical Activity Recall.

Table 5 Analysis of Positive Items of the Frailty Phenotype

Positive Frailty Phenotype Items (n)	%	n
0	48.9	23
1	19.1	9
2	17.0	8
3	12.8	6
4	2.1	1

Notes: Number of positive frailty phenotype items present (not including the low physical activity criterion).

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