Longitudinal associations between waking movement behaviors and health-related quality of life in older adults: a compositional data analysis approach.

Objectives: Movement behaviors, such as sedentary behavior (SB), light intensity physical activity (LPA), and moderate to vigorous intensity physical activity (MVPA) are mutually exclusive, in that time spent in one behavior inevitably displaces time spent in another. Yet, few studies have simultaneously considered these health behaviors and their association with health-related quality of life (HRQoL), an important indicator of health and well-being in aging populations. This study aimed to explore the role of waking movement behaviors (i.e., SB, LPA, MVPA) in prospectively predicting HRQoL in older adults. The study further aimed to cross-validate associations between movement behaviors and HRQoL using two different device-based measures of behavior placed on unique body positions.

Methods: Older adults wore accelerometers on the thigh (ActivPAL micro) and waist (Actigraph GT3X-BT) for 14 days to assess waking movement behaviors. Participants subsequently reported HRQoL on the 36-Item Short Form Health Survey (SF-36) six months later. Compositional linear regression and isotemporal substitution models were used to explore longitudinal relationships between movement behaviors and HRQoL.

Results: The movement composition for the sample (N = 202; M_age = 70 years, 72.3% female) consisted of 71-87% SB, 10-26% LPA, and about 3% MVPA depending on the device. For both devices, MVPA was positively associated with Physical Functioning, Pain, and General Health subscales. SB was negatively associated with Physical Functioning, Vitality, Emotional Well-being, and Social Functioning subscales across both devices. LPA generally was not associated with HRQoL indicators. Across both devices, reallocation of between five and 15 min of SB or LPA to MVPA was generally associated with better scores for HRQoL indicators.

Conclusions: Movement compositions were for the most part prospectively associated with HRQoL indicators among older adults, which was driven by positive associations for MVPA and negative associations for SB. Findings were generally consistent across devices, however, discrepancies may be attributable to the differences in the data processing algorithms (activity counts vs. cadence based) and device placement locations. Interventions targeting age-related declines in HRQoL should prioritize promoting increased MVPA at the expense of SB to support health and well-being in old age.