Associations Between 10-Year Physical Performance and Activities of Daily Living Trajectories and Physical Behaviors in Older Adults

Physical function is likely bidirectionally associated with physical activity (PA), sedentary behavior (SB), and sleep. We examined trajectories of physical function as predictors of these behaviors in community-dwelling adults aged ≥65 y without dementia from the Adult Changes in Thought cohort. Exposures were trajectories of physical performance (short Performance-Based Physical Function [sPPF]) and self-reported activities of daily living (ADL) impairment. Outcomes were device-measured PA and SB and self-reported sleep. We fit linear mixed-effects models to define trajectory slopes and intercepts for each functional measure over the prior 10 years. We used multivariable linear regression to investigate the relationship between trajectory features and outcomes, using bootstrap confidence intervals. Participants (N = 905) were 77.6 (SD = 6.9) years old, 55% female, 91% white, and had a median sPPF score of 9 (IQR = [8, 11]) and median impairment of 1 ADL (IQR = [0, 2]) at the time of activity measurement (baseline). Steeper decreases in sPPF (0.3-unit, 25% of the range) were associated with fewer steps (-1180, 95% CI = [-2853, -185]) and less moderate-to-vigorous PA (-15.7 min/day [-35.6, -2.3]). Steeper increases in ADL impairment were associated with 35.0 min/day (4.3, 65.0) additional sitting time, longer mean sitting bout duration (3.5 min/bout [0.8, 6.2]), fewer steps (-1372 [-2223, -638]), less moderate-to-vigorous PA (-13 min/day [-22.6, -5.0]), and more time-in-bed (25.5 min/day [6.5, 43.5]). No associations were observed with light PA or sleep quality. Worsening physical function is associated with lower PA and higher SB, but not with light-intensity movement or sleep quality, supporting the bidirectional nature of the relationship between physical function and physical behaviors.