The association of adherence to 24-hour movement guidelines with frailty and mortality: cross-sectional and longitudinal analyses of NHANES data

Abstract

Abstract Background Adherence to the Canadian 24-Hour Movement Guidelines (24 H-MG) has been associated with a reduced risk of developing various chronic conditions. However, its association with frailty and all-cause mortality has not been investigated. Therefore, our primary and secondary objective was to investigate the association between adherence to the 24 H-MG and frailty and mortality, respectively. Methods This study included 2739 individuals (age = 50.6 ± 18.1 years; male = 1370 (50.0%)) from the 2005–2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Frailty was quantified with a 46-item frailty index and analyzed cross-sectionally using linear regression. All-cause mortality data were obtained from the National Death Index and was analyzed prospectively over 10 years using Cox regression. The primary exposure variable was six individual and combined 24 H-MG components including the moderated-to-vigorous physical activity, light physical activity, sedentary time, recreational screen time, sleep, and strength training guidelines. All analyses were stratified into two age groups (younger: 20–64 and older adults 65 + years). Results Our cross-sectional analyses demonstrated an inverse dose-response relationship between the number of individual 24 H-MG components met and frailty level in adults aged 20–64 (β = -0.439 (95% C.I. = -0.551:-0.328)) and 65+ (β = -0.322 (95% C.I. = -0.490:-0.154)). Of the individual guideline components, following the moderate-to-vigorous physical activity (MVPA) guideline in individuals aged 20–64 and the recreational screen time guideline in adults aged 65 + was associated with lower frailty (p < 0.001). There was no clear prospective relationship between adherence to the combined 24 H-MG and mortality. Of the individual guideline components, only meeting the MVPA guideline component in the 65 + group was prospectively associated with reduced mortality risk (HR = 0.48 (95% C.I. = 0.25–0.93)). Conclusion Adherence to the Canadian 24 H-MG may be protective against frailty. Increasing MVPA and decreasing recreational screen time may be important behaviors to consider for frailty prevention and should be investigated further.