Examining Physical Wellness as the Fundamental Element for Achieving Holistic Well-Being in Older Persons: Review of Literature and Practical Application in Daily Life

Figures & data

Table 1 Keywords Literature Search

Database	Search Terms (Number of Hits)
PubMed	Physical wellness and older persons (4657); physical activity and older persons (3041); nutrition and older persons (1920); sleep and older persons (771)
Google Scholar	Physical wellness and older persons (21,000); physical activity and older persons (17,000); nutrition and older persons (17,800); sleep and older persons (21,800)
EBSCO Information Services	Physical wellness and older persons (1969); physical activity and older persons (1500); nutrition and older persons (385); sleep and older persons (490)

Table 2 Summarizes the Study Findings Correlating Physical Activity and Healthy Aging

Study	Methodology and Type of the Studies	Number of Subjects	Examined Results
Physical activity as a preventative factor for frailty; Peterson et al^Citation29	The Health ABC study followed participants for 5 years, defining frailty based on gait speed and chair rise ability, and explored the impact of physical activity on incident frailty and transition to severe frailty. (Longitudinal, prospective cohort study)	2964	Participation in self-selected exercise activities is independently associated with delaying the onset and the progression of frailty.
(SHARP-P) Study; Legault et al^Citation30	The SHARP-P pilot trial examined physical and cognitive training interventions on cognitive decline risk in older adults. (RCT)	73	The interventions produced marked changes in cognitive and physical performance measures and retention rates exceeded 90%. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants.
Australian Longitudinal Study of Aging (ALSA); Andrews et al^Citation31	The study utilized MacArthur criteria to classify subgroups based on function and compared them across various domains using ALSA data. (Observational population study)	1403	Lower levels of exercise and physical performance were linked to lower levels of functioning.
Effects of aerobic exercise on mild cognitive impairment; Baker et al^Citation32	This study investigates the impact of aerobic exercise on cognition and Alzheimer’s biomarkers in older adults with mild cognitive impairment, while considering sex as a predictive factor. (RCT)	33	For women, aerobic exercise improved performance on multiple tests of executive function, increased glucose disposal during the metabolic clamp, and reduced fasting plasma levels of insulin, cortisol, and brain-derived neurotrophic factor.
Physical activity and cognitive functioning among older Indian adults; Kumar et al^Citation33	This study explored the link between physical activity and cognitive functioning in older adults in India, considering potential confounders and analyzing gender differences. Data from the Longitudinal Ageing Study in India (2017–2018) and propensity score matching were used to assess cognitive impairment across various domains.	31,464	The results demonstrate the possible beneficial effects of frequent physical activity on cognitive functioning among older persons. Regular physical activity can be considered as an effective lifestyle factor to promote healthy cognitive aging.
Physical activity improves verbal and spatial memory in older persons; Nagamatsu et al^Citation34	In a study, 86 women aged 70–80 with probable MCI underwent a 6-month training program involving aerobic exercise, resistance training, or balance and tone training. MRI scans and memory tests were conducted before and after the program. (RCT)	86	The results demonstrate a significant correlation between spatial memory performance and overall physical capacity after intervention in the aerobic training group.
Self-reported health and leisure time physical activity on mortality among an ageing population; Opdal et al^Citation35	The Tromsø Study followed 12,241 participants aged 25–97 from 1994 to 2015, analyzing the link between physical activity and self-reported health using a random coefficient model. (Observational population study)	12,241	Being sedentary was associated with an increased risk of mortality in the ageing cohort. Both hard and light physical activity were positively associated with self-reported health.
Effect of physical activity on RBD, depression, and cognitive flexibility in healthy aged people; Lerche et al^Citation36	In a study involving 667 individuals, both cross-sectional and longitudinal analyses were conducted over six years. Participants were categorized based on their weekly sports activity, and various markers and parameters were compared to assess prodromal indicators, cognitive abilities, and task performance. (Cross-sectional and a subgroup longitudinal study)	667	The cognitive flexibility, depressive symptoms, and sleep are all indicators of a potential ongoing neurodegenerative process and are all positively impacted by physical exercise in sports.
Physical activity and memory functions; Ruscheweyh et al^Citation37	A study examined how varying intensity levels of physical activity impacted episodic memory in healthy elderly individuals through a six-month intervention with medium or low-intensity exercise or control group, measuring various factors such as fitness, memory score, neurotrophin, and catecholamine levels, alongside brain imaging scans at baseline and post-intervention. (Longitudinal study)	62	The results demonstrate that an increase in physical activity led to improved episodic memory performance in older person individuals. To achieve this aim, no high-intensity exercise was required.
Adults in their middle and later years and successful aging through physical activity; Lin et al^Citation38	Fifteen community-based cohort studies (189,192 participants aged 43.9–79.0 years) were assessed using the Newcastle-Ottawa Scale for quality, sourced from Pubmed, Web of Science, and Embase databases. (Observational population study)	189,192	This meta-analysis discovered that physical activity helps middle-aged and older persons age well.

Table 3 Studies Correlating Healthy Eating and Healthy Aging

Study	Type of Study	Number of Subjects	Examined Results
Prospective investigation into how often and when older people who live in the community eat breakfast and their risk of developing type 2 diabetes; Carew et al^Citation59	Baseline questionnaire data on weekly breakfast frequency and daily breakfast time were collected from 3747 older adults (aged ≥ 65 y) in the Cardiovascular Health Study. These individuals, without cancer or T2DM, were followed for 17.6 years, and hazard ratios were calculated to assess the relationship with T2DM. (Prospective study)	3747	The majority of participants in the Cardiovascular Health Study (CHS) ate breakfast every day (85.5%), and 73% had their first meal of the day between 7:00 and 9:00. These behaviors were linked to higher socioeconomic status, indicators of a healthier lifestyle, and lower baseline levels of cardiometabolic risk indicators.
Changes in Dietary Quality Overall and the Risk of Type 2 Diabetes Subsequently; Ley et al^Citation60	Over a span of 20 years, 124,607 participants from the Nurses’ Health Study, NHS II, and the Health Professionals Follow-up Study were examined for diabetes risk, with diet quality evaluated using the AHEI score every 4 years. (Three prospective cohorts)	124,607	A reduced risk of type 2 diabetes is linked to an improvement in diet quality overall, whereas a higher risk is linked to a decline. Only a portion of the relationship between diet quality changes and diabetes risk can be attributed to body weight changes.
Greater Healthy Eating Index-2005 scores are linked to fewer depressive symptoms in urban populations; Kuczmarski et al^Citation61	Nutrition data obtained through dietary recalls and the Healthy Eating Index were used to assess diet quality, while depressive symptoms were measured using the CES-D scale. (Diversity across the life span study)	1118	Diet quality and reported depressive symptoms were substantially correlated. However, compared to food quality, education, and sex, income was a noticeably larger predictor of depression.
Healthy Aging findings on the relationship between diet quality and cognitive performance in an urban population; Wright et al^Citation62	In a study involving 2090 African Americans and Whites, researchers analyzed diet quality, race, and poverty’s impact on cognitive performance using baseline data from the HANDLS study. (Diversity across the life span study)	2090	The findings show that among those living below the poverty line, better nutrition quality was linked to better performance on measures of attention and cognitive flexibility, visuospatial ability, and perceptual quickness.
Intake of dietary flavonoids in women at midlife and healthy aging; Samieri et al^Citation63	A study involving 13,818 women from the Nurses’ Health Study examined the relationship between midlife flavonoid intake and healthy aging outcomes at age 70, based on survival and maintenance of key health domains. (Cohort study)	13,818	Women who consumed more of many flavonoid subclasses in the top quintile at midlife had higher odds of aging healthily compared to those in the lowest quintile. Intake of flavonoids, particularly flavones, flavanones, anthocyanins, and flavonols, is higher in midlife and is linked to a higher likelihood of health and wellbeing in those who live to older ages.
Physical Function Impairment in Men and the Alternative Healthy Eating Index; Hagan et al^Citation64	A longitudinal cohort study followed 12,658 men from 2008–2012 to investigate the association between the Alternative Healthy Eating Index-2010 (AHEI) and physical function impairment using multivariable logistic regression models. (Longitudinal cohort study)	12,658	Higher consumption of certain foods like lettuce, broccoli, blueberries, peanuts, walnuts, and other nuts was linked to a lower risk of impairment. A reduced likelihood of physical function impairment was significantly associated with improved overall food quality in this large population of older men. This may be an especially compelling public health justification for older men to change their diets given the importance of physical fitness to good aging and quality of life.
Dietary habits of the healthiest older person in the study on healthy aging; Gu et al^Citation65	A study compared the dietary patterns of 122 super seniors (aged 85+ without major diseases) to 12,626 participants aged 65–86. Logistic regression analyzed the odds of being a super senior based on different dietary patterns. (Cohort study)	122	A western diet, which included French fries, red meat, and processed meat, and a nutrient-rich diet, which featured fruits, vegetables, whole grains, nuts, and seeds in addition to other nutritious food options, were both recognized as two distinct dietary patterns. The likelihood of being a super-senior was associated with higher scores for both dietary trends.
Dietary habits in later life affect the risk of developing cancer and cardiovascular disease; Nobbs et al^Citation66	This study analyzed data from the Australian Longitudinal Study of Ageing (ALSA) to identify dietary patterns and investigate their association with cancer and cardiovascular disease development and mortality. (Longitudinal study)	2087	These findings imply that in people who are free of cancer or CVD at age 70 or older, the development of either condition or mortality from either may be independent of the majority of dietary patterns. Importantly, a correlation between the pattern of “red meat and protein alternatives” and cancer growth and death was found.
Dietary patterns and weight change; Arabshahi et al^Citation67	A study conducted in 1992 and 2007 examined body weight, socio-demographic factors, and lifestyle characteristics, identifying two dietary patterns (‘meat-and-fat’ and ‘fruit-and-vegetable’) using principal component analysis on food frequency questionnaire data. Multivariable regression models were used, adjusting for changes in other variables. (Cohort study)	1186	Males in the highest tertile of the meat-and-fat pattern experienced an average gain in body weight that was more than twice as high as men in the lowest tertile. Males in the top tertile of the fruit-and-vegetable pattern experienced average weight increase that was only roughly half that of men in the lowest tertile. In this cohort, males who followed a diet high in fruit and vegetables gained less weight than those who followed a diet heavy in meat and fat.
Ethnicity, dietary habits, alcohol use, and cardiovascular risk factors in women aged 50 and older; López et al^Citation68	This study utilized cluster analysis to assess diet patterns and their correlation with major cardiovascular disease risk factors in women aged 50 years and older using NHANES 2001–2002 data. (Cross-sectional study)	1313	Six distinct, non-overlapping food patterns were identified by cluster analysis, including those for pasta and yellow vegetables, sweets, beef, starches, fruits, and milk, frozen meals, burritos, and pizza, meat dishes, and soft drinks and poultry. The bulk of the women were placed in the diet plan for sweets group. There were significant correlations between food habits and the main CVD risk variables.

Table 4 Key Studies Examining the Relationship Between Sleep Quality and the Aging Process

Study	Type of Study	Number of Subjects	Examined Results
Subjective sleep quality in noncomplaining elderly subjects; 76. Danker-Hopfe et al^Citation83	This study examines sleep quality in elderly individuals using the PSQI, with 91 subjects participating at baseline and a follow-up study conducted 16±5 months later (82.4% response rate). (Investigative study)	91	According to the findings, sleep quality does not change systematically over the time course of this study.
Work, eat and sleep: towards a healthy ageing; Riethmeister et al^Citation84	A mixed methods design incorporating interviews and focus groups was utilized to develop a questionnaire, which was then administered to 450 offshore workers. Subgroup analyses explored age-related variations in health and work-related aspects. (Semi-structured interviews and focus-group)	450	The qualitative data analysis revealed the value of healthy working surroundings, nutrition, and tiredness management. For a healthy ageing at work and sustained employability program offshore, both qualitative and quantitative evaluations highlighted work, food, and sleep/fatigue management as the most essential program objectives.
The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults; Sivaramakrishnan et al^Citation85	In September 2017, various databases were searched for randomized controlled trials comparing yoga interventions with controls in older adults, focusing on physical function and HRQoL outcomes. (Systematic review and meta-analysis)	22	Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing.
Sleep duration and snoring at midlife in relation to healthy aging; Shi et al^Citation86	The Nurses’ Health Study analyzed participants free of major chronic diseases in 1986 and aged 70 or older in 1995–2001, using logistic regression for odds ratios and confidence intervals in assessing healthy aging. (Prospective cohort study)	121,701	The findings show a non-linear relationship between sleep duration and the likelihood of experiencing good aging. Regular snoring was linked to a 31% lower likelihood of aging healthily, which was mostly caused by a decreased likelihood of not having any severe chronic illnesses.
Sleep duration, snoring habits, and cardiovascular disease risk factors; Mosca et al^Citation87	A CVD screening program in NYC assessed sleep habits and CVD risk factors among participants (n=371), revealing associations through logistic regression. (Investigative study)	371	Sleeping for fewer than six hours each night was linked to a number of traditional and psychosocial CVD risk factors, and snoring was linked to poor HDL cholesterol, probably caused by being overweight or obese.
Daytime sleepiness predicts mortality and cardiovascular disease in older persons; Newman et al^Citation88	This study employs an interview-administered questionnaire to assess health and sleep habits, while continuously monitoring total mortality and cardiovascular disease morbidity and mortality, including incidents of myocardial infarction and congestive heart failure. (Investigative study)	5888	The findings show that myocardial infarction, congestive heart failure, acute cardiovascular disease morbidity and mortality, and mortality were all associated with daytime sleepiness, the only sleep disturbance symptom. These results were more prevalent in women than in men.
Increased risk of heart failure in women with symptoms of sleep-disordered breathing; Ljunggren et al^Citation89	The Sleep and Health in Women study (SHE) followed 5990 women from 2000 to 2011, examining snoring, sleepiness, and heart failure using Swedish national registers. (Population-based cohort study)	5990	During follow-up, 5.3% of women with both snoring and excessive daytime sleepiness developed heart failure, compared to 0.9% in the control group with neither snoring nor excessive daytime sleepiness. Obstructive sleep apnea symptoms, which include snoring and excessive daytime sleepiness, are linked to an increased risk of developing heart failure in women.
Sleep disorders and their impacts on healthy, dependent, and frail older adults; Cochen et al^Citation90	A multidisciplinary review task force examined 106 articles from Ovid Medline to analyze age-related sleep disorders in older adults. (Integrative reviews)	106	Sleep disturbances are common in healthy older adults, with changes in sleep architecture and increased prevalence of sleep disorders. Sleep problems worsen in dependent older adults, including those with Alzheimer’s disease. Further research is needed to understand sleep in frail older adults.
Both habitual short sleepers and long sleepers are at greater risk of obesity; Theorell-Haglöw et al^Citation91	A 10-year follow-up study with 4903 participants examined the relationship between changes in sleep duration and various factors such as obesity, weight gain, and waist circumference increase using logistic regression analysis. (Investigative study)	4903	In women who were older than 40 at the time of the follow-up, there were no correlations between variations in sleep patterns and any markers of obesity. Both habitual short sleepers and habitual long sleepers exhibited a higher prevalence of overall and central obesity among younger women (aged 40 years) than habitual normal sleepers.
Sleep Quality, Duration, and Associated Sexual Function at Older Age; Smith et al^Citation92	This study analyzed data from 2568 men and 1376 women aged 50 years or older, assessing the relationship between sleep quality and sexual function while considering various factors such as age, ethnicity, and health status. (Longitudinal Study)	3944	Moderate sleep quality was linked to an increased risk of erectile dysfunction in men. Sleep quality was not associated with difficulty achieving an orgasm in men, but it was associated with an increased risk of orgasmic difficulty in women.

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