Physical activity, weight and functional limitations in elderly Spanish people: the National Health Survey (2009–2014)

Abstract

Background

The purpose of this study was to analyze physical activity (PA), functional limitations, weight status, self-perceived health status and disease or chronic health problems in older people aged 65 and over using the European Health Survey in Spain (EHSS) conducted one in 2009 and one in 2014.

Methods

This study included 12,546 older people, 6026 [2330 men and 3696 women; age (Mean, SD) =75.61 ± 7.11 years old] in 2009 and 6520 [2624 men and 3896 women; age (Mean, SD) =75.90 ± 7.59 years old] in 2014. The sample was divided into three age groups: 65–74 years old, 75–84 years old and ≥85 years old.

Results

In 2014, participants exhibited lower values for moderate PA, and self-perceived health status compared to 2009. Moreover, in 2014 more people with disease or chronic health problems, and severe difficulty walking 500 m without assistance were found and severe difficulty going up and down 12 stairs than people in 2009. In relation to weight status there were no significant differences between older people in 2009 and 2014.

Conclusions

From 2009 to 2014, the PA levels of Spanish older people have decreased, while the BMI has not increased. That fact is in consonance with a worst perception of health status in 2014 and with an increase of their disease levels. The current data highlight the importance of incorporating exercise programmes at an early stage of ageing in order to preserve physical performance, and to prevent the negative consequences of ageing.

Introduction

Western Europe has one of the world’s oldest populations.¹ In Spain, life expectancy is 78.9 years for men and 84.9 years for women.² Ageing has been associated with frailty and functional limitation due to three factors: an irreversible biological process, deconditioning due to a sedentary lifestyle and comorbidity effects.³

Along with ageing, there is impairment in the functional reserve, increasing sensitivity to external aggressions causing fragility, sarcopenia, falls, disability and hospitalization, with a deterioration in quality of life⁴ and physical fitness.⁵ These decrements have been associated with increased incidence of type 2 diabetes,⁶ cardiovascular disease⁷ and risk of falls.⁸

Obesity and physical inactivity are major universal public health concerns in older people and physical activity (PA) has shown the largest impact on survival, with the strongest inverse relationship between body mass index (BMI) and mortality.⁹ Promotion of regular PA is one of the main non-pharmaceutical measures proposed for older people, who often show a low rate of PA.¹⁰ The PA has been widely recommended due to its positive effects on the maintenance and/or increase in skeletal muscle mass and strength, and in aerobic fitness.^5,11

Several studies have shown that in older people, moderate PA reduces mortality, has a positive effect on prevention of coronary heart disease, reduction in blood pressure and prevention of stroke, as well as type 2 diabetes, a reduced risk of developing dementia, could prevent falls and improve quality of life.^10,12–14 Therefore, PA is the main indicator of health in the elderly. The PA declines with age,¹⁵ so the elderly age groups were less likely to be regularly active, and women were less likely than men to achieve regular PA.¹⁶ However, Bauman et al.¹⁵ showed that there are different patterns of PA in relation to sex and age, with most countries showing younger men more active than younger women, but this sex difference was less marked among older adults.

In the Spanish population, a previous study found an increase in leisure-time PA in the older population during a 20-year follow up (1986–2006).¹⁷ However, a recent study of the Spanish population showed that people over 70 exhibited higher percentages of low PA and reduced values of high PA.¹⁸ In this regard, Gomez-Cabello et al.¹⁹ in a study of non-institutionalized people aged 65 or over from Spain, showed that 84.3% of the population can be categorized as overweight and/or obese (46.7% and 37.6%, respectively); 67% of the elderly Spanish population had an increased percentage of fat mass and >56% suffered from central obesity.

A strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Therefore, lifestyle seems to be a determinant factor in the development of obesity among elderly people. Obesity and being overweight are associated with higher levels of functional limitation in elderly people when compared to normal-weight individuals regardless of PA status,²⁰ although PA is associated with significantly lower physical and functional limitations in obese older adults.²¹

From a public health perspective, taking the above information into account, the purpose of this study was to analyze physical activity (PA), functional limitations, weight status, self-perceived health status and disease or chronic health problems in older people aged 65 and over using the European Health Survey in Spain (EHSS) conducted one in 2009 and one in 2014.

Methods

Study design

To carry out this descriptive, cross-sectional study, we used secondary data from the 2009²² and 2014²³ EHSS through self-reported information. The EHSS is carried out on a representative sample of non-institutionalized Spaniards aged 16 years or over, through a personal interview, executed by the National Statistics Institute (Instituto Nacional de Estadística—INE) and the Ministry of Health, Social Services and Equality (Ministerio de Salud, Servicios Sociales e Igualdad—MSSI). The EHSS uses a probabilistic multistage sampling with stratification of the first-stage units (census sections) and the second-stage units (main family dwellings), with the final units (individuals) being selected by means of random routes and sex- and age-based quotas. These data concerning the EHSS are available and anonymized on the INE and MSSI websites.^22,23 The study population was restricted to persons over 65 years of age. The people with conducting the survey have been trained in basic communication skills and had specific training on the use of the questionnaire.

Participants

This study included 12,546 older people, 6026 [2330 men and 3696 women; age (Mean, SD) =75.61 ± 7.11 years old] in 2009 and 6520 [2624 men and 3896 women; age (Mean, SD) =75.90 ± 7.59 years old] in 2014. For data analysis, the sample was divided into three age groups: 65–74, 75–84 and ≥85 years old. As this analysis was conducted on a de-identified, public-use dataset it was not necessary to seek the approval of an ethics committee, according to Spanish legislation. Informed consent was given by all participants before they took part in the survey.

Instruments

The data collection instruments used by the INE and MSSI were the 2009²² and 2014 EHSS.²³ In this survey, participants are asked about their PA, functional limitations, health self-perception, disease or health problem chronic or long lasting and anthropometric characteristics such as body mass, height and BMI: weight (kg)/height (m)². The BMI was categorized according to World Health Organization (WHO) criteria (<18.5 kg/m², underweight; 18.5–24.9 kg/m², normal-weight; 25.0–29.9 kg/m², overweight; and ≥ 30 kg/m², obese).²⁴ Physical activity was defined as the level of self-reported engagement in moderate activity in a typical week: both days/week and h/week, and walking for 10 min (days/week). Moderate PA was defined as PA that causes breathing somewhat more heavily than normal, and may include carrying light weights, riding a bicycle at normal speed, sport or gardening. In addition, fitness was assessed by two types of functional outcomes or functional limitations: the ability to walk 500 m without assistance and to go up and down 12 stairs.

Statistical analysis

Data were analyzed using SPSS (v.19.0) for Windows (SPSS Inc., Chicago, USA) and the significance level was set at P < 0.05. The data are shown in descriptive statistics for mean, standard deviation (SD) and percentage (%). The chi-squared test was used to compare nominal variables between groups (2009 vs. 2014 and male vs. female). An analysis of variance (ANOVA) was conducted to detect between-group differences at 2009 and 2014 in relation to sex, age-adjusted in continuous variables, and the Mann–Whitney U test was performed for ordinal variables.

Results

Table 1 shows age, anthropometrics variables, PA and self-perceived health status in relation to sex and survey year. The mean age increased significantly between 2009 and 2014, from 75.61 to 75.90 years for the whole sample (P < 0.05), from 74.83 to 75.04 years (P ≥ 0.05) for males and from 76.11 to 76.48 years for females (P < 0.05). Moreover, across the whole sample, elderly people in 2014 displayed significantly higher values for body mass, and height than elderly people in 2009. In 2014, older people exhibited lower values of moderate PA and self-perceived health status compared to 2009. In relation to sex, males had higher body mass (P < 0.05), lower moderate PA (P < 0.001) and lower self-perceived health status (P < 0.01) than in 2009. Females were taller, engaged in lower levels of moderate PA and a lower self-perceived health status than in 2009. In whole sample, compliance with PA recommendations was 27.5% and 20% (P < 0.001) in 2009 and 2014, respectively. No significant differences were found between males (25.1%vs.24.2%, P ≥ 0.05, in 2009 and 2014, respectively), however females in 2014 showed lower percentages of compliance with PA recommendations than in 2009 (29.1%vs.17.2%, P < 0.001).

Table 1

Age, anthropometrics variables, physical activity and self-perceived health status in relation to survey year and sex (mean ± SD)

	2009	2014		2009		2014
	All	All	P value	Male	Female	Male	Female
	n = 6026	n = 6520		n = 2330	n = 3696	n = 2624	n = 3896
Age (years)	75.61 (7.11)	75.90 (7.59)	0.029	74.83 (6.87)	76.11 (7.21)	75.04 (7.20)	76.48 (7.79)*
Body mass (kg)	71.34 (12.41)	71.70 (12.77)	0.046	76.91 (11.71)	67.77 (11.50)	77.52 (11.72)*	67.62 (11.86)*
Body height (cm)	162.02 (8.55)	162.42 (8.42)	0.002	168.33 (7.10)	157.63 (6.47)	168.60 (6.74)	158.00 (6.51)**
BMI (kg/m2)	27.25 (4.27)	27.21 (4.29)	0.763	27.17 (3.73)	27.31 (4.61)	27.26 (3.76)	27.17 (4.64)
To walk for 10 min (days/week)a	4.34 (3.09)	4.41 (2.98)	0.520	4.95 (2.90)	3.95 (3.13)	4.92 (2.85)	4.06 (3.01)
Moderate PA (h/week)	3.10 (6.20)	1.50 (3.40)	<0.001	2.59 (5.53)	3.43 (6.58)	2.00 (4.20)***	1.17 (2.69)***
Moderate PA (days/week)a	1.96 (2.92)	1.31 (2.39)	<0.001	1.72 (2.79)	2.10 (3.00)	1.58 (2.63)	1.13 (2.20)***
Self-perceived health status (1–5)a	2.86 (0.96)	2.75 (0.96)	<0.001	2.68 (0.91)	2.97 (0.97)	2.61 (0.93)**	2.84 (0.97)***

a

U Mann–Whitney test.

*

P < 0.05.

**

P < 0.01.

***

P < 0.001 indicates significant differences in relation to male or female people in the 2009 year.

Weight status was shown in figures 1, 2 and 3. There were no significant differences between older people in 2009 and 2014. In the whole sample, the overweight and obesity prevalence in 2009 and 2014 were 46.1%/23.6% and 44.7%/23.2%, respectively. In male were 51.4%/21.0% and 50.6%/21.1% in 2009 and 2014, respectively. In female were 42.4%/25.5% and 40.5%/24.6% in 2009 and 2014, respectively.

Figure 1

Weight status in the total sample

Figure 2

Weight status in older male people

Figure 3

Weight status in older female people

Table 2 shows anthropometric variables, PA and self-perceived health status in relation to survey year, sex and age group. In the 65–74 (2014) age group, males and females showed lower values of moderate PA and self-perceived health than in 2009, however, males and females undertook walking for 10 min on more days per week. In the 75–84 age group (2014), males and females showed lower values of moderate PA, in addition, females exhibited lower self-perceived health than 2009 females. In the ≥85 age group (2014), males had a higher BMI than in 2009; females also showed lower values of moderate PA and days per week walking for 10 min than in 2009.

Table 2

Anthropometrics variables, physical activity and self-perceived health status in relation to survey year (mean ±SD), sex and age groups

	2009		2014		2009		2014		2009		2014
	65–74 years		65–74 years		75–84 years		75–84 years		≥85 years		≥85 years
	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
	n = 1208	n = 1640	n = 1380	n = 1745	n = 890	n = 1537	n = 932	n = 1491	n = 232	n = 519	n = 312	n = 660
Age (year)	69.37 (2.97)	69.57 (3.01)	69.25 (2.83)	69.21 (2.81)***	78.78 (2.72)	78.95 (2.77)***	79.27 (2.72)	79.57 (2.72)***	88.09 (3.03)	88.35 (3.21)	88.05 (2.90)	88.70 (3.25)
Body mass (kg)	78.57 (11.49)	69.25 (11.33)	79.19 (11.58)	68.81 (11.94)	75.97 (11.70)	67.72 (11.34)	76.17 (11.53)	67.83 (11.76)	71.42 (10.88)	62.86 (10.92)	73.83 (11.60)	63.93 (11.13)
Body height (cm)	169.01 (7.02)	158.60 (6.20)	169.57 (6.38)*	159.01 (6.21)	167.82 (7.06)	157.20 (6.52)	167.58 (6.88)	157.52 (6.47)	166.44 (7.23)	155.50 (6.53)	167.15 (7.20)	156.11 (6.85)
BMI (kg/m2)	27.50 (3.71)	27.53 (4.61)	27.54 (3.76)	27.29 (4.71)	26.98 (3.71)	27.44 (4.60)	27.08 (3.69)	27.35 (4.61)	25.96 (3.66)	26.05 (4.47)	26.45 (3.83)*	26.36 (4.41)
Walk for 10 min (days/week)a	5.18 ((2.73)	4.46 (2.94)	5.29 (2.60)**	4.87 (2.71)**	4.92 (2.95)	3.85 (3.21)	4.85 (2.94)	3.90 (3.03)	3.85 (3.29)	2.75 (3.16)	3.60 (3.24)	2.33 (2.93)*
Moderate PA (h/week)	3.22 (6.01)	4.48 (7.36)	2.59 (4.62)**	1.77 (3.18)***	2.11 (5.10)	2.98 (6.17)	1.49 (3.73)**	0.82 (2.31)***	1.23 (3.85)	1.55(4.32)	0.90 (3.04)	0.34 (1.42)***
Moderate PA (days/week)a	2.08 (2.91)	2.63 (3.13)	1.93 (2.75)***	1.64 (2.47)***	1.44(2.65)	1.86 (2.91)	1.30 (2.52)***	0.85 (1.99)***	0.95 (2.30)	1. 17(2.52)	0.81 (2.06)	0.39 (1.41)***
Self-perceived health status (1–5)a	2.54 (0.87)	2.84 (0.97)	2.43 (0.87)**	2.65 (0.93)***	2.78 (0.92)	3.05 (0.97)	2.79 (0.93)	2.97 (0.96)**	3.01 (0.97)	3.12 (0.97)	2.90 (0.96)	3.06 (0.98)

a

U Mann–Whitney Test.

*

P < 0.05.

**

P < 0.01.

***

P < 0.001 indicates significant differences in relation to male or female people in 2009 year.

Disease or chronic health problems and functional limitations in relation to survey year and sex are shown in table 3. In relation to the total sample, older people in 2014 had a greater percentage of disease or chronic health problems than older people in 2009 (88.2% in 2014 vs. 83.5% in 2009). Moreover, in 2014 participants reported more severe difficulty walking 500 m without assistance (12.3% in 2014 vs. 8.1% in 2009). In addition, the participants in 2014 reported an increase to severe difficulty going up and down 12 stairs (14.9% in 2014 vs. 10.4% in 2009). Likewise, similar results are exhibited by males and females, according to survey year.

Table 3

Disease or health problem chronic and functional limitations in relation to survey year and sex

		2009	2014	P value	2009		2014
		All	All		Male	Female	Male	Female
Disease or health problem chronic or long lasting (≥6 month) n (%)	Yes	5028 (83.5)	5750 (88.2)*	<0.001	1848 (79.4)	3180 (86.1)	2251 (85.8)*	3499 (89.8)*
	No	993 (16.5)	769 (11.8)*		479 (20.6)	514 (13.9)	373 (14.2)*	396 (10.2)*
	Does not know	5 (0.1)	1 (0.0)		3 (0.1)	2 (0.1)	0 (0.0)	1 (0.0)
Difficulty walking 500 meters without assistance n (%)	No difficulty	3870 (64.2)	4181 (64.1)	<0.001	1699 (72.9)	2171 (58.7)	1896 (72.3)	2285 (58.6)
	Some difficulty	957 (15.9)	1132 (17.4)*		296 (12.7)	661 (17.9)	378 (14.4)	754 (19.4)
	Severe difficulty	490 (8.1)	804 (12.3)*		136 (5.8)	354 (9.6)	240 (9.1)*	564 (14.5)*
	I cannot do it by myself	708 (11.7)	402 (6.2)*		199 (8.6)	509 (13.8)	110 (4.2)*	292 (7.5)*
	Does not know	1(0.0)	1 (0.0)			1 (0.0)		1 (0.0)
Difficulty going up or down 12 stairs n (%)	No difficulty	3046 (50.5)	3728 (57.1)*	<0.001	1473 (63.2)	1573 (42.6)	1762 (67.1)*	1966 (50.4)*
	Some difficulty	1374 (22.8)	1341 (20.6)*		417 (17.9)	957 (25.9)	445 (17.0)	896 (23.0)*
	Severe difficulty	626 (10.4)	969 (14.9)*		177 (7.6)	449 (12.1)	292 (11.1)*	677 (17.4)*
	I cannot do it by myself	976 (16.2)	480 (7.4)*		261 (11.2)	715 (19.3)	125 (4.8)*	355 (9.1)*
	Does not know	4 (0.1)	2 (0.0)		2 (0.1)	2 (0.1)		2 (0.1)

*

Indicates significant differences (P < 0.05) with whole group and male or female people in 2009 year.

Disease or chronic health problems and functional limitations in relation to survey year, sex and age groups are shown in table 4. Taking into account the prevalence of disease or chronic health problems, in 2014 there was a higher prevalence of disease and chronic health problems for both sexes across all age groups compared with participants in 2009. With regard to the difficulty walking 500 m without assistance both male and female across all age groups in 2014 indicated a more percentage of severe level of difficulty than groups in 2009. Finally, when the participants were asked about the difficulty experienced going up and down 12 stairs, both male and female, across different age groups in 2014 indicated higher percentage of severe difficulty than in 2009.

Table 4

Disease or health problem chronic and functional limitations in relation to survey year, sex and age groups

		2009		2014		2009		2014		2009		2014
		65–74 years		65–74 years		75–84 years		75–84 years		≥85 years		≥85 years
		Male	Female	Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
Disease or health problem chronic or long lasting ≥6month n (%)	Yes	915 (75.7)	1356 (82.7)	1133 (82.1)*	1511 (86.6)*	737 (82.8)	1361 (88.5)	828 (88.8)*	1373 (92.1)*	196 (84.5)	463 (89.2)	290 (92.9)*	615 (93.2)*
	No	291 (24.1)	284 (17.3)	247 (17.9)*	233 (13.4)*	153 (17.2)	175 (11.4)	104 (11.2)*	118 (7.9)*	36 (15.5)	55 (10.6)	22 (7.1)*	45 (6.8)*
	Does not know	2 (0.2)	0 (0.0)	0 (0.0)	1 (0.1)		1 (0.1)		0 (0.0)		1 (0.2)		0 (0.0)
Difficulty walking 500 meters without assistance n (%)	No difficulty	1020 (84.4)	1239 (75.6)	1170 (84.8)	1356 (77.7)	590 (66.3)	786 (51.1)	598 (64.1)	765 (51.4)	89 (38.4)	146 (28.1)	128 (41.1)	164 (24.8)
	Some difficulty	103 (8.5)	245 (14.9)	112 (8.1)	228 (13.1)	144 (16.2)	306 (20.0)	188 (20.2)*	352 (23.6)*	49 (21.1)	110 (21.2)	77 (24.8)	174 (26.3)*
	Severe difficulty	38 (3.1)	71 (4.3)	79 (5.7)*	132 (7.6)*	67 (7.5)	200 (13.0)	96 (10.3)*	266 (17.8)*	31 (13.4)	83 (16.0)	65 (20.9)*	166 (25.2)*
	I cannot do it by myself	47 (3.8)	84 (5.1)	19 (1.4)*	29 (1.6)*	89 (10.0)	245 (15.9)	50 (5.4)*	108 (7.2)*	63 (27.2)	180 (34.7)	41 (13.2)*	155 (23.5)*
	Does not know		1 (0.1)										1 (0.2)
Difficulty going up or down 12 stairs n (%)	No difficulty	934 (77.3)	966 (58.9)	1105 (80.1)	1219 (69.8)*	478 (53.8)	518 (33.7)	553 (59.3)*	620 (41.6)*	61 (26.3)	89 (17.2)	104 (33.3)	127 (19.2)
	Some difficulty	150 (12.4)	388 (23.7)	156 (11.3)	309 (17.7)*	204 (22.9)	449 (29.2)	196 (21.0)*	414 (27.8)	63 (27.2)	120 (23.1)	93 (29.8)	173 (26.1)
	Severe difficulty	57 (4.7)	131 (8.0)	98 (7.1)*	169 (9.7)	83 (9.3)	226 (14.7)	123 (13.3)*	321 (21.5)*	37 (15.9)	92 (17.7)	71 (22.8)*	187 (28.3)*
	I cannot do it by myself	67 (5.6)	154 (9.3)	21 (1.5)*	48 (2.8)*	124 (13.9)	344 (22.4)	60 (6.4)*	136 (9.1)*	70 (30.2)	217 (41.8)	44 (14.1)*	171 (25.9)*
	Does not know		1 (0.1)			1 (0.1)				1 (0.4)	1 (0.2)		2 (0.3)

*

Indicates significant differences (P < 0.05) with male or female people in 2009 year.

Discussion

The purpose of this study was to analyze PA, functional limitation, weight status, self-perceived health status and disease or chronic health problems in older people aged 65 and over using the EHSS conducted in the period 2009–2014. The main finding of this study was that elderly people in 2014 showed a significant reduction in moderate PA, self-perceived health status, and a greater level of disease or chronic health problems than people in 2009. In addition, functional limitations were higher 2014 than 2009, and finally, there were no significant changes in relation to weight status.

This study revealed a reduction in moderate PA from 2009 to 2014 in older Spanish people. This outcome is contrary to that of Palacios-CÃa et al.¹⁷ who found an increase in leisure-time PA in the older Spanish population from 1986 to 2006. The WHO recommends that older adults should do at least 150 min of moderate-intensity PA or at least 75 min of vigorous-intensity PA during the week or an equivalent combination of both.²⁵ In this study, the percentage of women that complied with the recommendations for moderate PA was significantly reduced in 2014. Taking into account age groups, moderate PA declined with age in both 2009 and 2014.

In relation to functional limitations in older people, walking performance is a strong biomarker of health,²⁶ thus gait speed is associated with survival.²⁷ In this regard, the inability and time taken to complete a 400-m walk is a predictor of mortality in older people.²⁸ In this study, older people reported lower percentages of experiencing severe difficulty walking 500 m without assistance, and in going up and down 12 stairs, in both 2009 and 2014. However, there were higher percentages of severe difficult in both variables in 2014 than 2009. Furthermore, this percentage increases along age groups.

On the other hand, obesity is associated with a higher prevalence of functional disability among elderly people,²⁹ moreover, obesity along with a reduction in muscle strength could have a potential additive effect on the poor functional status of the elderly, which seems to be independent of the level of PA.³⁰ Therefore, the low level of functional limitation found in this study may be explained by the fact that older people in both 2009 and 2014 showed low levels of obesity in relation to previous studies.³¹ In addition, the BMI cut point for an increasing risk of disability in the elderly may be higher than 30 kg/m².³² In the current study, BMI values in both 2009 and 2014 were below this cut point. Therefore, obese older people have a significantly higher risk of mobility limitation compared with non-obese persons, independent of lifestyle factors.³³ The prevalence of being overweight and obese did not increase between 2009 and 2014, however, these results were higher compared to those of a previous study of the Spanish adult population where the overall prevalence of overweight was 34.2%, 43.9% in men and 25.7% in women, and the overall prevalence of obesity was 13.6% (it was similar in men and women).³⁴ A possible explanation for this might be that the PA in elderly people is lower than in the young (children, teenagers) and adult population.³⁵ Moreover, there is a relationship between active and sedentary lifestyles and the presence of increased adiposity of non-institutionalized Spanish elderly people.¹⁹

Older people in 2014 showed a reduction in self-perceived health status and a greater number of adults were suffering some sort of disease/chronic health problem than people in 2009. A possible explanation for this might be an association between combinations of unhealthy lifestyle factors with multimorbidity such as PA and obesity.³⁶The findings of the current study support the other findings that showed as multimorbidity was associated with increases in functional limitations in older people.³⁷ A likely possible explanation for this might be that functional limitations are influenced not only by PA, but additionally, muscular strength and muscle mass are related to ageing. Thus, maximal voluntary strength production declines with age and contributes to physical dependence and mortality.³⁸ Sarcopenia is defined as the age-associated reduction of skeletal muscle mass and strength,³⁹ and the term dynapenia is used to further describe the age-related loss of muscle strength and power.⁴⁰ Dynapenia predisposes older adults to an increased risk of functional limitation and mortality.⁴⁰

Finally, a limitation of the present study is related to the measure of PA levels. Individuals were asked for their PA levels in last 7 days, although the European Health Interview Survey is based on the short version of the international physical activity questionnaire (IPAQ), which has been validated in 12 countries; future studies should use objective PA measures, such as accelerometers. In addition, muscular strength and muscle-mass measures are required to explore the associations between PA, morbidity, weight status and functional limitation that could better explain the results of this study. However, the strength of this study is that it included a large population sample.

In conclusion, the PA levels of Spanish older people have decreased from 2009 to 2014, while the BMI has not increased. That fact is in consonance with a worst perception of health status in 2014 and with an increase of their disease levels. The current data highlight the importance of incorporating exercise programmes at an early stage of ageing in order to preserve physical performance, and to prevent the negative consequences of ageing related to health status and diseases prevalence.

Acknowledgements

The authors would like to thank to the Spanish Ministry of Economy and Competitiveness together with the European Fund or Regional Development, Project “AVISaMe” ref.DEP2015-70980-R (MINECO/FEDER, EU).

Funding

This work was supported by the Spanish Ministry of Economy and Competitiveness together with the European Fund or Regional Development, Project “AVISaMe” ref.DEP2015-70980-R (MINECO/FEDER, EU).

Conflicts of interest: None declared.

Key points

• As far as the authors know, this is the first study, with a large sample, analyzing physical activity (PA), weight status, self-perceived health status and functional limitations in older people aged 65 in the period 2009–2014 in Spain.

• This study reveals a reduction in moderate PA from 2009 to 2014 in older Spanish people.

• It reveals a greater level of disease or chronic health problems from 2009 to 2014 in older Spanish people.

• It highlights the importance of incorporating exercise programs at an early stage of ageing in order to preserve physical performance, and to prevent the negative consequences of ageing related to health status and diseases prevalence.

• Finally, governments should favor economic measures to implement programs of exercise at people over 65 in order to preserve physical performance.