A canonical correlation analysis on the relationship between functional fitness and health-related quality of life in older adults
Introduction
With the progress of civilisation and industrialisation, the average life expectancy has increased dramatically during the 20th century (World Health Organization, 2011). However, this dramatic increase in life expectancy did not come with a proportionate increase in quality of life, particularly in older adults (Brown, 2015). One of the strongest determinants to maintain a high quality of life among older adults is the maintenance of good health (Forsén et al., 2010). Because of the ageing-related degradations in physical and cognitive functioning (Chung, Zhao, Liu, & Binh, 2016; James, Wilson, Barnes, & Bennett, 2011), older adults are often reported with social difficulties, mental problems (e.g., depression), chronic disease, and declined ability to live independently (Charles & Carstensen, 2010; Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013; Hung, Ross, Boockvar, & Siu, 2011).This would detrimentally influence older adults’ health and quality of life.
Among various definitions on quality of life, health-related quality of life (HRQOL) is a multi-dimensional concept involving both physical and mental functioning (Wanderley, Silva, Marques, Oliveira, Mota, & Carvalho, 2011). Functional fitness (FF), which is defined as having the physical capacity to perform normal daily activities safely and independently without undue fatigue (Rikli & Jones, 2013), has been determined crucial for maintaining HRQOL in older adults (Takata et al., 2010). Additionally, there is a burgeoning popularity of FF complementing HRQOL in ageing-related studies (Chou, Hwang, & Wu, 2012). Both these findings to some extent indicate the close relationship between FF and HRQOL. Moreover, ageing-associated declines have been reported in both FF (Chung et al., 2016) and HRQOL (Hsu, Chen, Kuo, Fan, Lee, & Hsu, 2014), and a comprehensive understanding about their relationship would facilitate developing and implementing specific interventions.
A review of the extant literature indicated that most research has focused on the associations between each fitness component and the subdimensions of HRQoL. For example, Wanderley et al. (2011) found that older adults with higher aerobic endurance capacity reported higher scores in physical functioning, role limitations due to physical problems, and vitality, whereas those with superior upper arm muscle strength were more likely to score higher on RP and VT. Additionally, Samuel, Rowe, Hood, and Nicol (2012) reported moderate correlations between muscle strength and some specific dimensions of HRQoL (e.g. physical functioning) among older adults in the community. All of the preceding evidence has indicated specific associations between the various subdimensions of FF and HRQoL. However, both HRQoL and FF are multidimensional concepts, necessitating examination of relationships between overall FF and overall HRQoL, and exploration of the key subdimensions that would influence their overall relationships. To date, few studies have performed such examinations, hampering the understanding of relationships between overall FF and overall HRQoL.
Additionally, because the samples in previous studies mainly comprised women (Hsu et al., 2014, Wanderley et al., 2011), the generalisability of the results may be compromised as a consequence of potential sex differences. According to the limitations of existing research findings, this study was conducted to explore the relationship between overall FF and overall HRQoL in older men and women separately, and to identify the key subdimensions of FF and HRQoL influencing their overall relationship. Results from this study can facilitate comprehensively understanding the relationships between FF and HRQOL and generating critical insight into HRQOL improvement from the perspective of FF enhancement.
Section snippets
Study design
This is a cross-sectional, parallel study of a group of older adults recruited from a programme named ‘Functional Fitness Norms in Hong Kong Older Adults’ with the main purpose of establishing norms of FF for the older adults in different age groups.
Participants
Participants were recruited from multiservice senior centres located in various Hong Kong communities (Kowloon = 8, New Territories = 10, and Hong Kong Island = 4) through a convenience sampling method. Eligible participants were those who self-reported
Results
According to the inclusion and exclusion criteria, 93 out of the 944 recruited participants were not eligible to be included in the study. Therefore, the following results are from the 851 qualified older adults (men = 402, women = 449). Table 1 presents the main demographic and clinical characteristics of the participants. Overall, this group of participants had an average age of 74.4 years (men = 74.3 years, women = 74.4 years). The men had a lower body fat percentage than that of the women, which is
Discussion
Previous studies have largely evaluated the relationships between subdimensions of fitness performance and HRQoL (Takata et al., 2010, Wanderley et al., 2011). To our knowledge, this is the first study where the relationships between overall FF and overall HRQoL were examined. The results from this study revealed positive, moderate relationships between overall FF and overall HRQoL in both older men (canonical correlation = 0.350) and women (canonical correlation = 0.456). To a certain extent, this
Conclusions
Positive and moderate relationships exist between FF and HRQOL in older adults, with FF significantly influencing HRQoL (particularly PF). The main FF components that influence the relationships between FF and HRQOL in men are balance and agility and aerobic endurance, whereas in women, the components are balance and agility and lower extremity muscle strength.
Findings from this study confirm that the overall FF is positively associated with overall HRQOL, which is known but has not been
Conflict of interest
The authors declare no competing interests.
Acknowledgements
The authors would like express their sincere thanks to all the participants and testers for their invaluable attendance and effort that helped to complete this research project.
This study was funded by a faculty research grant from Hong Kong Baptist University; reference FRG2/13-14/035.
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