Relationship of Objectively-Measured Habitual Physical Activity to Chronic Inflammation and Fatigue in Middle-Aged and Older Adults

Barbara Nicklas

Daniel Beavers

Shannon Mihalko

Gary Miller

Richard Loeser

Stephen Messier

Background:

Habitual (non-exercise) physical activity (PA) declines with age, and aging-related increases in inflammation and fatigue may be important contributors to variability in PA.

Methods:

This study examined the association of objectively-measured PA (accelerometry over 7 days) with inflammation (plasma interleukin-6 and C-reactive protein) and with self-reported fatigue (SF-36 Vitality) at baseline and 18 months after a diet-induced weight loss, exercise, or diet-induced weight loss plus exercise intervention in 167 overweight/obese, middle-aged, and older adults.

Results:

At baseline, individuals with higher plasma interleukin-6, as well as those who reported feeling less energetic (more fatigued), took less steps per day and had lower PA energy expenditure and minutes of light and moderate–vigorous PA (p < .05 for all). At the 18-month follow-up, inflammation was lower in both weight loss groups, fatigue was reduced in all three groups with larger decreases in the combined group, and mean levels of habitual PA were not changed in any group. In longitudinal analyses with all groups combined, we found that participants reporting larger increases in vitality (eg, declines in fatigue) had greater increases in PA (p < .05 for all). Also, changes in steps/d and physical activity energy expenditure were indirectly associated with changes in interleukin-6 (β [SEM] for steps/d = −565 [253]; β [SEM] for physical activity energy expenditure = −22.4 [10.17]; p < .05).

Conclusions:

Levels of habitual PA are lower in middle-aged and older adults with higher levels of chronic inflammation and greater self-reported fatigue. In addition, participants who experienced greater declines in inflammation during the interventions had greater declines in fatigue and larger increases in PA.

Funding

This work was supported by an independent research grant from the National Institutes of Health (R01 AR052528), as well as the Wake Forest University Claude D. Pepper Center Older Americas Independence Center (P30-AG21332) and Wake Forest University General Clinical Research Center (M01-RR07122); and General Nutrition Centers, Inc.

Conflict of Interest

None to declare.

^{Section on Gerontology and Geriatric Medicine, J. Paul Sticht Center on Aging, Department of Internal Medicine, and}

^{Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.}

^{Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.}

^{Thurston Arthritis Research Center and the Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill.}

^{Corresponding author.}

Address correspondence to Barbara J. Nicklas, PhD, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157. E-mail: ude.htlaehekaw@salkcinb

Decision Editor: James Goodwin, MD

Received 2016 Mar 24; Accepted 2016 Jun 22.

Abstract

Background:

Habitual (non-exercise) physical activity (PA) declines with age, and aging-related increases in inflammation and fatigue may be important contributors to variability in PA.

Methods:

Results:

Conclusions:

Keywords: Accelerometry, C-reactive protein, Interleukin-6, SF-36 Vitality subscale

Abstract

Physical activity (PA) is comprised of both “purposeful” exercise, as well as non-exercise movement comprised primarily of mobility-related activities occurring throughout the day. This habitual (non-exercise) activity declines across the lifespan (1), an observation that is biologically inherent to aging, as it is evident even among highly fit older exercisers (2) and is observed across species (3). Habitual PA is inversely related to sedentary behavior (sitting or lying down), and more sedentary behavior is associated with worse physical function and loss of mobility in older adults, even independent of structured exercise (4–6).

Despite the fundamental ubiquitous nature of reduced habitual PA with age, very little is known regarding the biological, environmental, and/or psychosocial factors that contribute to one’s propensity to move and to inter-individual variation in movement. An important factor underlying less habitual activity may be fatigue, or the subjective lack of physical and/or mental energy (7). Fatigue also increase with age (8,9), and some studies report an association between fatigue and low levels of PA and greater sedentary behavior (10–17). However, the biological link between fatigue and sedentary behavior is not known. Acute inflammation from infection results in fatigue (ie, “sickness behavior”) and chronic inflammation underlies fatigue symptoms common to specific diseases (18–21). Aging is characterized by an increasingly elevated pro-inflammatory state, but one that is far below that observed during acute infections or disease states (22–24). This persistent, low-grade inflammation is likely a contributing factor to loss of muscle function and onset of disability with age (25,26); however, its role in fatigue and reduced PA is less studied (14,15,27,28).

The purpose of this study was to determine the cross-sectional and longitudinal relationships of objectively-measured habitual PA to biomarkers of inflammation and self-reported fatigue in middle-aged and older adults. We examined these relationships using baseline and follow-up data collected from participants before and 18 months after either: diet-induced weight loss alone, exercise alone, or diet-induced weight loss plus exercise. We hypothesized that individuals with higher inflammation would report feeling more fatigued and have lower levels of PA at baseline; and that individual changes in habitual PA over the 18 months of intervention would be associated with individual changes in inflammation and fatigue, independent of treatment arm.

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