ABSTRACT
OBJECTIVES: To assess the short- and long-term association of 6 healthy behaviors (not smoking, vigorous to moderate physical activity, healthy diet, adequate sleeping duration, not being sedentary, and daily social interaction) with incident frailty and disability. DESIGN: Prospective population-based study. SETTINGS AND PARTICIPANTS: In 2001, 4008 community-dwelling individuals aged ≥60 years in Spain were recruited. Participants were followed up until 2003, when a short-term phone interview of the remaining 3235 individuals was performed. Then, the participants were followed up until 2009, when a long-term phone interview was conducted with 1309 participants. MEASURES: At baseline, a home interview and a physical examination were conducted to assess healthy behaviors. At baseline and at follow-ups, we ascertained frailty and 4 domains of disability: limitation in instrumental activities of daily living, restriction in daily activities, limitation in mobility, and self-care limitation. RESULTS: In the short-term analyses, vigorous to moderate physical activity and not being sedentary were associated with a reduction in frailty, multivariable odds ratios (OR) (95% confidence interval) 0.55 (0.35-0.85) and 0.43 (0.26-0.72). Vigorous to moderate physical activity and adequate sleeping duration decreased instrumental activities of daily living limitation OR 0.63 (0.44-0.91) and 0.69 (0.53-0.89) as well as self-care limitation OR 0.62 (0.41-0.92) and 0.65 (0.45-0.94). Adequate sleep duration and not being sedentary decreased restriction in daily activities OR 0.67 (0.49-0.90) and 0.57 (0.36-0.91). Vigorous to moderate physical activity and healthy diet decreased limitation in mobility OR 0.58 (0.35-0.96) and 0.73 (0.54-0.97). Considering these 5 healthy behaviors, participants who scored 5 (vs ≤ 2) in the combined score had a lower risk of frailty and disability. In the long-term analyses, results showed the same direction as in short-term analyses. CONCLUSIONS AND IMPLICATIONS: The combination of healthy behaviors is associated with a substantial reduction in the risk of frailty and of most disability outcomes in older adults.