{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:38:29Z","timestamp":1790897909858,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Evidence regarding the dose\u2013response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with\/without frailty. We examined the dose\u2013response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with\/without frailty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65\u201384\u2009years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried\u2019s frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose\u2013response curves were examined using restricted cubic splines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During 3.6\u2009years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)\u25a0min\/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51\u20130.74) was reached at around 3,000\u20134,000 METs\u25a0min\/week. Although the shape of this association was consistent regardless of with\/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300\u2009min\/day) of ST, the HRs for FD increased linearly as ST reached approximately 600\u2009min\/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01\u20131.71) for 1,080\u2009min\/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose\u2013response manner. A significant positive nonlinear dose\u2013response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1357618","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T04:29:58Z","timestamp":1713932998000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Dose\u2013response associations between physical activity and sedentary time with functional disability in older adults with or without frailty: a prospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Satoshi","family":"Seino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Nofuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Hata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoji","family":"Shinkai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Kitamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"key":"ref1","unstructured":"World report on ageing and health2015"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.maturitas.2020.05.018","article-title":"The World Health Organization (WHO) approach to healthy ageing","volume":"139","author":"Rudnicka","year":"2020","journal-title":"Maturitas"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12966-020-01042-2","article-title":"Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group","volume":"17","author":"DiPietro","year":"2020","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4801","DOI":"10.1093\/eurheartj\/ehac572","article-title":"Vigorous physical activity, incident heart disease, and cancer: how little is enough?","volume":"43","author":"Ahmadi","year":"2022","journal-title":"Eur Heart J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1161\/CIRCULATIONAHA.122.061288","article-title":"Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysis","volume":"147","author":"Paluch","year":"2023","journal-title":"Circulation"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1136\/bjsports-2022-105669","article-title":"Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies","volume":"57","author":"Garcia","year":"2023","journal-title":"Br J Sports Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e219","DOI":"10.1016\/S2468-2667(21)00302-9","article-title":"Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts","volume":"7","author":"Paluch","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.jamda.2023.09.028","article-title":"Dose-response relationship of physical activity with all-cause mortality among older adults: an umbrella review","volume":"25","author":"Fukushima","year":"2024","journal-title":"J Am Med Dir Assoc"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1093\/gerona\/glaa046","article-title":"Dose-response association between accelerometer-assessed physical activity and incidence of functional disability in older Japanese adults: a 6-year prospective study","volume":"75","author":"Chen","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s12966-023-01490-6","article-title":"Accelerometer-measured sedentary behavior and risk of functional disability in older Japanese adults: a 9-year prospective cohort study","volume":"20","author":"Chen","year":"2023","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.jamda.2013.03.022","article-title":"Frailty consensus: a call to action","volume":"14","author":"Morley","year":"2013","journal-title":"J Am Med Dir Assoc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1249\/MSS.0000000000003133","article-title":"Dose-response relationships between objectively measured daily steps and mortality among frail and nonfrail older adults","volume":"55","author":"Watanabe","year":"2023","journal-title":"Med Sci Sports Exerc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"73","DOI":"10.2188\/jea.JE20170109","article-title":"A community-wide intervention trial for preventing and reducing frailty among older adults living in metropolitan areas: design and baseline survey for a study integrating participatory action research with a cluster trial","volume":"29","author":"Seino","year":"2019","journal-title":"J Epidemiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"106620","DOI":"10.1016\/j.ypmed.2021.106620","article-title":"Effectiveness of a community-wide intervention for population-level frailty and functional health in older adults: a 2-year cluster nonrandomized controlled trial","volume":"149","author":"Seino","year":"2021","journal-title":"Prev Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1111\/j.1532-5415.2005.53175.x","article-title":"Care-needs certification in the long-term care insurance system of Japan","volume":"53","author":"Tsutsui","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1111\/j.1532-5415.2007.01281.x","article-title":"Japan\u2019s universal long-term care system reform of 2005: containing costs and realizing a vision","volume":"55","author":"Tsutsui","year":"2007","journal-title":"J Am Geriatr Soc"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/1479-5868-8-115","article-title":"Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review","volume":"8","author":"Lee","year":"2011","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref20","unstructured":"Guidelines for Data Processing and Analysis of the Intternational Physical Activity Questionnaire (IPAQ)-Short and Long Forms2005"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2188\/jea.JE20220246","article-title":"Dose-response associations of physical activity and sitting time with all-cause mortality in older Japanese adults","volume":"34","author":"Seino","year":"2024","journal-title":"J Epidemiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1016\/S0140-6736(17)31634-3","article-title":"The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study","volume":"390","author":"Lear","year":"2017","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.annepidem.2008.03.008","article-title":"Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study)","volume":"18","author":"Inoue","year":"2008","journal-title":"Ann Epidemiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/ggi.12726","article-title":"Public health approach to preventing frailty in the community and its effect on healthy aging in Japan","volume":"16","author":"Shinkai","year":"2016","journal-title":"Geriatr Gerontol Int"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.jamda.2018.05.012","article-title":"Are the Kihon checklist and the Kaigo-yobo checklist compatible with the frailty index?","volume":"19","author":"Kojima","year":"2018","journal-title":"J Am Med Dir Assoc"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-2318-8-24","article-title":"A standard procedure for creating a frailty index","volume":"8","author":"Searle","year":"2008","journal-title":"BMC Geriatr"},{"key":"ref28","first-page":"31","article-title":"Doctors\u2019 opinion papers in long-term care need certification in Japan: comparison between clinic and advanced treatment hospital setting","volume":"4","author":"Moriyama","year":"2014","journal-title":"Public Policy Adm Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1111\/ggi.13243","article-title":"Identification of dementia using standard clinical assessments by primary care physicians in Japan","volume":"18","author":"Noda","year":"2018","journal-title":"Geriatr Gerontol Int"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"524","DOI":"10.2188\/jea.JE20220084","article-title":"Impact of the first-fourth waves of the COVID-19 pandemic on new applications for long-term care insurance in a metropolitan area of Japan","volume":"32","author":"Seino","year":"2022","journal-title":"J Epidemiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1123\/jpah.2021-0247","article-title":"Predictivity of international physical activity questionnaire short form for 5-year incident disability among Japanese older adults","volume":"18","author":"Kurita","year":"2021","journal-title":"J Phys Act Health"},{"key":"ref32","unstructured":"Terms of reference. OECD project on the distribution of household incomes (2017\/18 collection)"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1002\/sim.3841","article-title":"Dose-response analyses using restricted cubic spline functions in public health research","volume":"29","author":"Desquilbet","year":"2010","journal-title":"Stat Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1001\/jamainternmed.2015.0533","article-title":"Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA","volume":"175","author":"Arem","year":"2015","journal-title":"Intern Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"l4570","DOI":"10.1136\/bmj.l4570","article-title":"Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis","volume":"366","author":"Ekelund","year":"2019","journal-title":"BMJ"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"350","DOI":"10.2188\/jea.JE20200080","article-title":"Older adults\u2019 daily step counts and time in sedentary behavior and different intensities of physical activity","volume":"31","author":"Amagasa","year":"2021","journal-title":"J Epidemiol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1249\/MSS.0b013e31821ece12","article-title":"Compendium of physical activities: a second update of codes and MET values","volume":"43","author":"Ainsworth","year":"2011","journal-title":"Med Sci Sports Exerc"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1093\/pm\/pny263","article-title":"Daily physical activity and functional disability incidence in community-dwelling older adults with chronic pain: a prospective cohort study","volume":"20","author":"Makino","year":"2019","journal-title":"Pain Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1093\/gerona\/glx222","article-title":"The influence of physical activity and sedentary behavior on living to age 85 years without disease and disability in older women","volume":"73","author":"Rillamas-Sun","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1093\/gerona\/glx122","article-title":"The joint associations of sedentary time and physical activity with mobility disability in older people: the NIH-AARP diet and health study","volume":"73","author":"DiPietro","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1093\/ptj\/pzac002","article-title":"Isotemporal substitution of sedentary behavior with moderate to vigorous physical activity is associated with lower risk of disability: a prospective longitudinal cohort study","volume":"102","author":"Chiba","year":"2022","journal-title":"Phys Ther"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1093\/ije\/dyz212","article-title":"Impact of follow-up time and analytical approaches to account for reverse causality on the association between physical activity and health outcomes in UK biobank","volume":"49","author":"Strain","year":"2020","journal-title":"Int J Epidemiol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s10654-020-00707-3","article-title":"Physical activity and all-cause and cause-specific mortality: assessing the impact of reverse causation and measurement error in two large prospective cohorts","volume":"36","author":"Lee","year":"2021","journal-title":"Eur J Epidemiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1136\/bjsports-2016-097210","article-title":"Sedentary time in older adults: a critical review of measurement, associations with health, and interventions","volume":"51","author":"Copeland","year":"2017","journal-title":"Br J Sports Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s12603-021-1634-2","article-title":"The influence of the COVID-19 pandemic on physical activity and new incidence of frailty among initially non-frail older adults in Japan: a follow-up online survey","volume":"25","author":"Yamada","year":"2021","journal-title":"J Nutr Health Aging"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1357618\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T04:30:02Z","timestamp":1713933002000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1357618\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,24]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2024.1357618"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1357618","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,24]]},"article-number":"1357618"}}