Long-Term Physical Activity Patterns and Risk of Future Frailty: A Systematic Review and Age-Stratified Meta-Analysis

Background/Objectives: Physical activity (PA) interventions have the potential to delay or reverse frailty in older people, and previous meta-analyses have shown that PA reduces frailty risk. However, introduction and maintenance of PA during midlife might be more impactful as a public health intervention to reduce frailty at the population level. This study aimed to evaluate the impact of longitudinal PA patterns on future frailty risk and to examine whether it is modified by age of onset before vs. after 60 years. Methods: We conducted a systematic review and meta-analysis of prospective population-based cohort studies evaluating the effect of longitudinal PA trajectories on frailty risk of community-dwelling adults below and above 60 years at baseline. Risk ratios (RRs) from studies eligible for quantitative synthesis were pooled using random-effects meta-analysis. Results: Ten studies involving 111,714 participants from Europe, Asia, and North America were included in the systematic review and six in the meta-analysis. Relative to long-term physical inactivity, persistent PA trajectory was associated with 44% reduced risk of frailty (RR = 0.56, 95% CI:0.42-0.76) with moderate certainty, while inclining trajectories were associated with a 38% reduced risk (RR = 0.62, 95% CI: 0.57-0.68) with low certainty. Results: were similar for populations > 60 and <60 years at baseline. Conclusions: Sustained or increasing PA patterns over time are associated with lower risk of future frailty. These findings warrant further implementation studies to quantify the impact of public health policies promoting physically active lifestyles in midlife on the burden of frailty in aging populations.