Association between physical activity level and frailty status among community-dwelling older adults with...

To examine the cross-sectional association between physical activity characteristics and frailty status among community-dwelling older adults with multimorbidity, and to provide descriptive evidence for community-level health promotion in this high-risk population.

A cross-sectional survey was conducted among 500 community-dwelling older adults with multimorbidity. Frailty was assessed using the FRAIL scale and classified into three groups: non-frail, pre-frail, and frail. Physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) questionnaire and analyzed across three dimensions: aerobic activity level, strength training, and flexibility exercise. Between-group differences were compared using the chi-square test and the Kruskal-Wallis test. Ordinal logistic regression was used to examine the association between physical activity characteristics and frailty status. Spearman correlation analysis and linear regression were performed as sensitivity analyses.

Significant differences were observed in the distribution of frailty status across physical activity levels, with a clear linear trend (all p < 0.001). In the multivariable analysis, compared with individuals with low activity levels, those who were regularly active but did not meet the recommended level were significantly less likely to be classified into a higher frailty category (OR = 0.23, 95% CI: 0.14-0.39), and this likelihood was further reduced among those who met the recommended activity level (OR = 0.11, 95% CI: 0.06-0.21); the trend test was statistically significant (P for trend < 0.001). Using binary participation indicators, neither strength training nor flexibility exercise showed an independent statistical association with frailty status after adjustment. Sensitivity analyses indicated a moderate negative correlation between physical activity score and total frailty score (rho = -0.454, p < 0.001), which remained significant in linear regression models. This association persisted after further adjustment for disease burden, disease-system count, and disease-system indicators. Exploratory analyses considering disease burden and disease-system categories showed that the inverse association between physical activity level and frailty status remained robust.

Among community-dwelling older adults with multimorbidity, higher physical activity levels were cross-sectionally associated with lower frailty status. Overall physical activity level may better reflect current frailty status than single exercise components. These findings support the value of promoting overall physical activity in community health management, but longitudinal studies are needed to determine whether increasing physical activity can prevent frailty onset or slow frailty progression.