Association between daily activity/exercise and frailty in Chinese older adults: a cross-sectional study based on the CLHLS survey

Association between daily activity/exercise and frailty in Chinese older adults: a cross-sectional study based on the CLHLS survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between daily activity/exercise and frailty in Chinese older adults: a cross-sectional study based on the CLHLS survey Linyan Dai, Yangyang Tang, Yihong Guo, Xia Lai, Xingsheng Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5356008/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Feb, 2025 Read the published version in BMC Geriatrics → Version 1 posted 4 You are reading this latest preprint version Abstract Objectives: To explore the association between daily activity/exercise and frailty among Chinese older adults. Methods: According to the cross-sectional data obtained in the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018, 13080 adults were selected. Logistic regression was employed to explore the association between physical activity/exercise and frailty, by also considering the type and frequency of activities/exercises, and the prevalence of frailty. Results: The incidence of frailty in elderly female participants was higher than that in male participants ( P =0.000); Participants with older age ( P =0.001), lower years of education ( P =0.022), living with someone ( P =0.000), poorer economic status ( P =0.000), and low BMI ( P =0.000) had a greater tendency of frailty. Older adults were at lower risk of frailty whether they were doing tai chi, square dancing, gardening, pet ownership, playing cards, socializing, or housework ( P <0.005), and appeared to be more protected by housework (OR=0.096, 95% CI 0.083-0.110, P =0.000). The risk of frailty was lower in older adults with previous physical labor (OR=0.846, 95% CI 0.744-0.962, P =0.011) and previous physical activity (OR=0.817, 95% CI 0.711-0.938, P =0.004). Conclusions: Older adults who took part in daily activity/exerciseseemed to have lower frailty risk. Activity/exercise like tai chi, housework, square dancing, gardening, pet ownership, playing cards, socializingwas associated with reduced frailty risk, with housework showing strong protection. The richer the type of activities or exercise engaged in, the lower the risk of debilitation. Older adults with a history of physical labor or activity had a lower frailty risk. Frailty Daily activity/exercise The Chinese Longitudinal Healthy Longevity Survey (CLHLS) Cross-sectional study Figures Figure 1 Introduction Exercise is associated with numerous benefits, including improved cardiovascular function [ 1 ] , enhanced muscle strength [ 2 ] , and better mental well-being [ 3 ] . Frailty is a complex geriatric syndrome characterized by decreased physiological reserve and increased vulnerability to stressors. It is often accompanied by symptoms such as weakness, slow walking speed, low physical activity, and unintentional weight loss [ 4 ] . This stage characterized by high susceptibility to low power stressors and high risk for adverse outcomes (e.g., disability and its associated consequences like hospitalization, institutionalization, or death) while still maintaining potential for recovery [ 5 ] . WHO defines healthy aging as “the process of developing and maintaining the functional ability that enables wellbeing in older ages” [ 6 ] . Preventing or delaying the decline in functional status, the progression to disability, and its characteristic loss of personal self-sufficiency has been one of the main classical but continuing goals of geriatric medicine [ 4 ] . Increasing evidence reports the benefits yielded by exercise and multimodal interventions on the functional status of older people [ 7 ] . Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity [ 8 ] . Studies have shown that appropriate exercise interventions can play a significant role in preventing and reversing frailty [ 9 ] . For example, resistance training has the best potential to reduce frailty in older adults [ 10 ] .And long-term exercise training results in a reduced mortality risk in clinical populations [ 11 ] . Community-based exercise intervention is superior to minimal intervention for improving health status in pre-frail older adults [ 12 ] . Understanding the impact of exercise on frailty is of great importance. By implementing effective exercise programs, we may be able to enhance the quality of life and independence of frail individuals, reducing the burden on healthcare systems. Methods 1.1. Study data The data in our study were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018. The CLHLS is a national survey for Healthy Aging to explore the impact of common health-related factors on outcomes among Chinese people. This study covers elderly survey subjects of all age groups aged 65 and above in more than 500 sample areas in 22 provinces, municipalities and autonomous regions across the country. This survey collected information consisting of demographic data, social and economic status, self-assessment of health-related quality, exercise, cognitive function, depressive symptoms, anxiety, performance in activities of daily living, chronic disease, and drugs. Detailed information about CLHLS has been published previously. 1.2. Data definitions Frailty —Using CLHLS data, a 38-item frailty index (FI) was created based on a validated and published method. (See APPENDIX for the details) These items were chosen as they were all relevant to health status and tended to become more prevalent with age but were not fully universal in older people. Most of the items had a binary option and were scored as 0 (absence) or 1 (present). To the items with ordinal options, e.g., always, often, sometimes, seldom, and rarely or never, we assigned 0, 0.25, 0.5, 0.75, and 1 to them respectively. The FI score, which ranged from 0 to 1, was calculated for each responder as the total of the item scores divided by the number of items they possessed. Participants were disqualified if they possessed fewer than 30 items. After calculating the FI score, we used the following cutoff points from a previous study to classify participants as non-frail (FI ≤ 0.25) and frail (FI > 0.25) . Daily activities/exercises —In the CLHLS questionnaire, respondents would answer the following specific questions: 1) exercise or not at present; 2) exercise or not in the past; 3) done labor work before; 4) take part in daily activity/exercise now below: tai chi, square dancing, garden work, raising domestic animals/pet, playing cards/mah-jongg, social activities, housework. In our study. We examined the risk of frailty in older adults at that moment responding to the questionnaire who were currently exercising or engaged in any of the above-mentioned activity/exercise types, stratified according to the frequency and the number of concurrent activities/exercises. We also examined the risk of frailty in older adults who had done labor work and had exercised for a long time in the past. Covariates —Demographic characteristics, socioeconomic status, and health-related variables were included as covariates, including Gender (female or male), age (65 to 75, 76 to 85, 86 to 95 or 96 and older), region (city or rural), years of schooling (0, 1 to 6, 7 to 9, 10 to 12 or 13 and longer), living status (alone or not) , economic situation (wealthy or not), drinking and smoking status before (yes or no), BMI (low, normal, and over). 1.3. Statistical analysis IBM SPSS 25.0 statistical software was used for data analysis. Count data were expressed as frequencies and percentages. Descriptive statistics were employed to calculate characteristics. Comparisons between the 2 groups (frailty and non-frailty) were made by Chi -test. Every single covariate received univariate logistic regression analysis to calculate the risk degree of frailty. Then, multivariate logistic regression analysis was used to correct for gender, age, years of schooling, living status, economic situation, and BMI. The two-sided test level α= 0.05. Odds ratios (ORs) with 95% confidence intervals (CIs) were presented to show the strength and direction of the association. The criterion for statistical significance was set at P ≤0.05. Results 2.1. Demographic characteristics A total of 10380 subjects, with an average age of 83.7 years, were included in this study, comprising 7068 females (54%) and 6012 males (46%). There were 5483 cases (41.9%) in the frailty stage and 7597 cases (58.1%) in the non-frailty stage. The incidence of frailty was higher in female than male patients ( P =0.000); older ( P =0.001); lower years of education ( P =0.022); living with someone ( P =0.000); poorer ( P =0.000); lower BMI ( P =0.000). Details are shown in Table 1. Table 1. Demographic characteristics. Variable n ( %) No frailty (n=7597) Frailty (n=5483) c 2 P value Gender Male 4035 (53.1) 1977 (36.1) 373.006 0.000 Female 3562 (46.9) 3506 (63.9) Age (years) 65-75 1925 (26.1) 1289 (24.1) 16.187 0.001 76-85 2324 (31.5) 1616 (30.3) 86-95 1848 (25) 1376 (25.8) ≥96 1289 (17.5) 1059 (19.8) Residence city 1092 (17.1) 835 (17.4) 0.170 0.680 Rural 5308 (82.9) 3975 (82.6) Years of schooling (years) 0 2953 (45.6) 2172 (45.8) 11.444 0.022 1-6 2132 (32.9) 1650 (34.8) 7-9 695 (10.7) 482 (10.2) 10-12 426 (6.6) 261 (5.5) At least 13 276 (4.3) 173 (3.7) Living status Living with house member(s) 3719 (78.7) 3280 (81.8) 12.803 0.000 Living alone 1006 (13.2) 731 (18.2) Economic situation Wealthy 6966 (92.3) 4698 (86.6) 109.314 0.000 Not wealthy 585 (7.7) 724 (13.4) Smoked in the past No 3283 (69.7) 2731 (68.2) 2.516 0.113 Yes 1425 (30.3) 1276 (31.8) Drank in the past No 3470 (74) 2934 (73.8) 0.022 0.881 Yes 1221 (26) 1040 (26.2) BMI (kg/m 2 ) Low 765 (10.3) 1153 (23.3) 400.608 0.000 Normal 3896 (52.6) 2415 (48.7) Overweight/Obesity 2741 (37) 1389 (28) 2.2. Relationship between exercise and frailty. Older adults who were exercising at the time of answering the questionnaire had a lower risk of frailty than those who were not exercising, but no difference was found after correction for confounders ( P= 0.978). After correction, older adults were at lower risk of frailty whether they were doing tai chi, square dancing, gardening, pet ownership, playing cards, socializing, or housework ( P <0.005), and appeared to be more protected by housework (OR=0.096, 95% CI 0.083-0.110, P =0.000) . The higher the exercise frequency was, the lower the risk of frailty was ( P <0.05). The risk of frailty was lower in older adults with previous physical labor (OR=0.846, 95% CI 0.744-0.962, P =0.011) and previous physical activity (OR=0.817, 95% CI 0.711-0.938, P =0.004). (Figure 1) Discussion The purpose of this cross-sectional study was to analyze the association between daily activity/exercise performed and frailty in the Chinese elderly population, which has provided valuable insights into the relationship and have several implications. 3.1 Association between daily activity/exercise and frailty risk reduction. We found that engaging in a wide range of daily activities was associated with a reduced frailty risk. This includes not only traditional forms of exercise like tai chi, square dancing, gardening, and pet ownership but also social activities such as playing cards and socializing, and even routine household chores like housework. Tai chi [ 13 ] , a popular form of exercise in China, combines slow, controlled movements with deep breathing and concentration, which may contribute to improved balance, muscle strength, and cardiovascular function. Square dancing, another common activity, also showed a significant association with reduced frailty. The energetic and rhythmic movements in square dancing may enhance physical fitness and social interaction. Gardening activities involve physical exertion such as digging, watering, and bending, which can improve muscle strength and flexibility. Pet ownership may encourage physical activity through walking the pet and provide emotional support, both of which could contribute to better health and reduced frailty. Playing cards and social activities also had a significant impact on frailty risk reduction. These activities not only involve some degree of physical movement, such as handling cards, but also provide social interaction, which is beneficial for mental well-being. Notably, housework emerged as a particularly strong protector against frailty. Housework encompasses a variety of physical tasks such as sweeping, mopping, dusting, and lifting objects, which engage multiple muscle groups and improve overall physical function. Additionally, the routine nature of housework may provide a sense of purpose and accomplishment, contributing to mental well-being. This finding highlights the importance of considering daily activities as a form of exercise, especially for older adults who may have limited access to formal exercise programs. 3.2 The role of activity/exercise frequency and combination The results also emphasized the importance of exercise frequency. We observed that the higher the exercise frequency, the lower the frailty risk. Reports early showed that older people who perform more than 180 min of weekly exercise report better health-related quality of life [ 14 ] . This indicates that regular and consistent physical activity is crucial for maintaining good health and reducing the risk of frailty [ 15 ] . Furthermore, the combined performance of multiple activities provided greater protection against frailty. The debilitating protection was greatest when four of these activities were performed simultaneously. There was report that overuse of the remaining muscles, leads to an earlier onset of fatigue which, in turn, hastens the shift from an independent to a dependent lifestyle [ 16 ] . And our study also showed a gradual decline in the protection against frailty from more than 5 simultaneous activities. 3.3 The influence of physical labor and activity history Our study also found that older adults with a history of physical labor and previous physical activity had a lower frailty risk. It is worth underscoring that regular exercise augments skeletal muscle mass by increasing glucose levels. Higher glucose levels boost insulin action resulting in improved insulin resistance [ 17 ] . Also, there was evidence that exercise (last over 1 year) had reduced the number of falls and fall-associated injuries, and improves physical function and cognition in older population [ 11 ] . These findings underline the importance of a lifetime of physical activity and suggest that early intervention and promotion of exercise can have long-term benefits for health. In addition, we found that most of the Chinese elderly population performed aerobic exercise, with little strength and power training, which may be related to the questionnaire setting or the population's own selection bias regarding activities/exercise. According to the previous study [ 18 ] , aerobic exercise seems to be more effective than resistance training in modulating the immune system and inflammatory markers among the elderly population. However, a recent study reported that a 12-week combined anaerobic and aerobic exercise program may improve insulin resistance, IGF-1, growth hormone (GH), and DHEA-S levels in elderly Korean women [ 19 ] . De-titrating individualized exercise programs for elderly populations is difficult to implement, and multimodal exercise that includes aerobic exercise, strength and power training, flexibility and balance training seems to be more appropriate for the frail elderly population to maintain their function and prevent the onset of disability. 3.4 Limitations and future research directions Despite these findings above, our study has several limitations. Firstly, as a cross-sectional study, it only provides a snapshot of the relationship between daily activities/exercises and frailty at a given point in time and cannot establish causality. Cohort studies and intervention-controlled trials are needed to further explore their relationship. Secondly, the study did not strictly define exercise intensity. This may have affected the accuracy of our results as different exercise intensities can have varying effects on frailty. Future research should incorporate objective measures of exercise intensity, such as heart rate monitors or metabolic equivalents (METs), to better understand the relationship between exercise intensity and frailty. Finally, further research should also focus on understanding the mechanisms underlying the association between exercise and frailty, such as the role of muscle strength, inflammation, and hormonal changes. By addressing these limitations and conducting further research, we can gain a more comprehensive understanding of the relationship between exercise and frailty and develop more effective strategies for promoting healthy aging. Declarations F u nding The Chongqing Municipal Science and Technology Bureau (CSTB2022 TIAD-KPX0188) supported this study. Conflict of interest The authors declare that they have no conflict of interest. Human Ethics and Consent to Participate declarations The study complies with the current laws of the country in which it was performed. The CLHLS is publicly available, and all procedures involving research study participants were approved by the biomedical ethics committee of Peking University (IRB00001052–24713074). All participants signed written consent forms to participate in the study. References Seals DR, Nagy EE, Moreau KL. Aerobic exercise training and vascular function with ageing in healthy men and women. J Physiol. 2019. 597(19): 4901-4914. Fyfe JJ, Hamilton DL, Daly RM. Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations. Sports Med. 2022. 52(3): 463-479. Wong M, Ou KL, Chung PK, Chui K, Zhang CQ. The relationship between physical activity, physical health, and mental health among older Chinese adults: A scoping review. Front Public Health. 2022. 10: 914548. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019. 394(10206): 1365-1375. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019. 394(10206): 1376-1386. Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016. 387(10033): 2145-2154. Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014. 311(23): 2387-96. Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox Biol. 2020. 35: 101513. Talar K, Hernández-Belmonte A, Vetrovsky T, Steffl M, Kałamacka E, Courel-Ibáñez J. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Clin Med. 2021. 10(8): 1630. Sun X, Liu W, Gao Y, et al. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age Ageing. 2023. 52(2): afad004 [pii]. García-Hermoso A, Ramirez-Vélez R, Sáez de Asteasu ML, et al. Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sports Med. 2020. 50(6): 1095-1106. Lim H, Jani N, Pang WT, Lim E. Community-based exercises improve health status in pre-frail older adults: A systematic review with meta-analysis. BMC Geriatr. 2024. 24(1): 589. Huang CY, Mayer PK, Wu MY, Liu DH, Wu PC, Yen HR. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev. 2022. 82: 101747. Kaushal N, Langlois F, Desjardins-Crépeau L, Hagger MS, Bherer L. Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults. Clin Interv Aging. 2019. 14: 209-217. Nagata CA, Garcia PA, Hamu T, et al. Are dose-response relationships of resistance training reliable to improve functional performance in frail and pre-frail older adults? A systematic review with meta-analysis and meta-regression of randomized controlled trials. Ageing Res Rev. 2023. 91: 102079. Brook MS, Wilkinson DJ, Phillips BE, et al. Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise. Acta Physiol (Oxf). 2016. 216(1): 15-41. Leick L, Lyngby SS, Wojtaszewski JF, Pilegaard H. PGC-1alpha is required for training-induced prevention of age-associated decline in mitochondrial enzymes in mouse skeletal muscle. Exp Gerontol. 2010. 45(5): 336-42. Abd El-Kader SM, Al-Shreef FM. Inflammatory cytokines and immune system modulation by aerobic versus resisted exercise training for elderly. Afr Health Sci. 2018. 18(1): 120-131. Ha MS, Son WM. Combined exercise is a modality for improving insulin resistance and aging-related hormone biomarkers in elderly Korean women. Exp Gerontol. 2018. 114: 13-18. Appendix Appendix not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Feb, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 11 Nov, 2024 Editor assigned by journal 04 Nov, 2024 Submission checks completed at journal 04 Nov, 2024 First submitted to journal 29 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5356008","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376479175,"identity":"90e1dc46-e313-45fc-9171-04c622c489d0","order_by":0,"name":"Linyan Dai","email":"","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Linyan","middleName":"","lastName":"Dai","suffix":""},{"id":376479176,"identity":"9a30e7b2-1da1-4dfc-86ee-844e01ab03e4","order_by":1,"name":"Yangyang Tang","email":"","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yangyang","middleName":"","lastName":"Tang","suffix":""},{"id":376479177,"identity":"70dfa6a8-1332-4f60-9fdb-93982d0e3bfa","order_by":2,"name":"Yihong Guo","email":"","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yihong","middleName":"","lastName":"Guo","suffix":""},{"id":376479178,"identity":"8de97453-53a0-4b1e-8dbc-83b83a7d34cb","order_by":3,"name":"Xia Lai","email":"","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Lai","suffix":""},{"id":376479179,"identity":"01306df0-dca5-47ed-8f0f-d1f4ef7150c5","order_by":4,"name":"Xingsheng Wang","email":"","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xingsheng","middleName":"","lastName":"Wang","suffix":""},{"id":376479180,"identity":"0d9113a1-5221-4884-ae12-57f0584308b8","order_by":5,"name":"Baoshan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACPmYeEHWAgYG9ASzA2EBICxtcC88BYrUwwLRIJBCrhZ334IcPf+7Im0s+fnibh8FGdsMB5mcP8DuML1lyZtszw52z04yteRjSjDccYDM3wK+Fx0Cat+Ew44bbOWzSPAyHEzcc4GGTIKDF+DfPn8P2G26eAWn5T5QWM2keNqDhN3hAWg4Qo4UvzXJm2+HkDWfSjC3nGCQbzzzMZoZXCz//2cM3Pvw5bLvh+OGHN95U2Mn2HW9+hlcLCpBgAAUVM9HqwVpGwSgYBaNgFGABAFnpRLEI7OcrAAAAAElFTkSuQmCC","orcid":"","institution":"Chongqing Emergency Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Baoshan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-10-29 16:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5356008/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5356008/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-05802-2","type":"published","date":"2025-02-26T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69104941,"identity":"8cee2596-e93b-4f71-8d28-755492478c0e","added_by":"auto","created_at":"2024-11-15 16:55:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":165624,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5356008/v1/d3d1ec78db513467f746f401.png"},{"id":77622437,"identity":"201eff8a-644b-4e10-8726-47ffac7c968d","added_by":"auto","created_at":"2025-03-03 16:06:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":699890,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5356008/v1/dfbfda7f-c929-463d-a97c-eb3c26521f36.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between daily activity/exercise and frailty in Chinese older adults: a cross-sectional study based on the CLHLS survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eExercise is associated with numerous benefits, including improved cardiovascular function\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, enhanced muscle strength\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, and better mental well-being \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Frailty is a complex geriatric syndrome characterized by decreased physiological reserve and increased vulnerability to stressors. It is often accompanied by symptoms such as weakness, slow walking speed, low physical activity, and unintentional weight loss \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. This stage characterized by high susceptibility to low power stressors and high risk for adverse outcomes (e.g., disability and its associated consequences like hospitalization, institutionalization, or death) while still maintaining potential for recovery \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWHO defines healthy aging as \u0026ldquo;the process of developing and maintaining the functional ability that enables wellbeing in older ages\u0026rdquo;\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Preventing or delaying the decline in functional status, the progression to disability, and its characteristic loss of personal self-sufficiency has been one of the main classical but continuing goals of geriatric medicine \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Increasing evidence reports the benefits yielded by exercise and multimodal interventions on the functional status of older people \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudies have shown that appropriate exercise interventions can play a significant role in preventing and reversing frailty \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. For example, resistance training has the best potential to reduce frailty in older adults \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.And long-term exercise training results in a reduced mortality risk in clinical populations \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Community-based exercise intervention is superior to minimal intervention for improving health status in pre-frail older adults \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Understanding the impact of exercise on frailty is of great importance. By implementing effective exercise programs, we may be able to enhance the quality of life and independence of frail individuals, reducing the burden on healthcare systems.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1.1.\u0026nbsp;Study data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data in\u0026nbsp;our\u0026nbsp;study were derived from the Chinese Longitudinal Health\u0026nbsp;Longevity Survey (CLHLS) in 2018. The CLHLS is a national survey for Healthy Aging to explore the impact of common health-related factors on outcomes among Chinese people. This study covers elderly survey subjects of all age groups aged 65 and above in more than 500 sample areas in 22 provinces, municipalities and autonomous regions across the country. This survey collected information consisting of demographic data, social and economic status, self-assessment of health-related quality, exercise, cognitive function, depressive symptoms, anxiety, performance in activities of daily living, chronic disease, and drugs. Detailed information about CLHLS has been published previously.\u003c/p\u003e\n\u003cp\u003e1.2. Data definitions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrailty\u003c/strong\u003e\u0026mdash;Using CLHLS data, a 38-item\u0026nbsp;frailty index (FI)\u0026nbsp;was created based on a validated and published method. (See APPENDIX for the details)\u0026nbsp;These items were chosen as they were all relevant to health status and tended to become more prevalent with age but were not fully universal in older people.\u0026nbsp;Most of the items had a binary option and were scored as 0 (absence) or 1 (present). To the items with ordinal options, e.g., always, often, sometimes, seldom, and rarely or never, we assigned 0, 0.25, 0.5, 0.75, and 1 to them respectively. The FI score, which ranged from 0 to 1, was calculated for each responder as the total of the item scores divided by the number of items they possessed. Participants were disqualified if they possessed fewer than 30 items. After calculating the FI score, we used the following cutoff points from a previous study to classify participants as non-frail (FI \u0026le; 0.25) and frail (FI \u0026gt; 0.25)\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDaily activities/exercises\u003c/strong\u003e\u0026mdash;In the CLHLS questionnaire, respondents would answer the following specific questions: 1) exercise or not at present; 2) exercise or not in the past; 3) done labor work before; 4) take part in daily activity/exercise now below: tai chi, square dancing, garden work, raising domestic animals/pet, playing cards/mah-jongg, social activities, housework. In our study. We examined the risk of frailty in older adults at that moment responding to the questionnaire who were currently exercising or engaged in any of the above-mentioned activity/exercise types, stratified according to the frequency and the number of concurrent activities/exercises. We also examined the risk of frailty in older adults who had done labor work and had exercised for a long time in the past.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCovariates\u003c/strong\u003e\u0026mdash;Demographic characteristics, socioeconomic status, and health-related variables were included as covariates, including Gender (female or male), age (65 to 75, 76 to 85, 86 to 95 or 96 and older), region (city or rural), years of schooling (0, 1 to 6, 7 to 9, 10 to 12 or 13 and longer), living status (alone or not) , economic situation (wealthy or not), drinking and smoking status before (yes or no), BMI (low, normal, and over).\u003c/p\u003e\n\u003cp\u003e1.3. Statistical analysis\u003c/p\u003e\n\u003cp\u003eIBM SPSS 25.0 statistical software was used for data analysis. Count data were expressed as frequencies and percentages. Descriptive statistics were employed to calculate characteristics.\u0026nbsp;Comparisons between the 2 groups\u0026nbsp;(frailty and non-frailty)\u0026nbsp;were made by\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eChi\u003c/em\u003e-test.\u0026nbsp;Every single covariate received univariate logistic regression analysis to calculate the risk degree of frailty. Then, multivariate logistic regression analysis was used to correct for gender, age, years of schooling, living status, economic situation, and BMI.\u003c/p\u003e\n\u003cp\u003eThe two-sided test level \u0026alpha;= 0.05.\u0026nbsp;Odds ratios (ORs) with 95% confidence intervals (CIs) were presented to show the strength and direction of the association. The criterion for statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026le;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1. Demographic characteristics\u003c/p\u003e\n\u003cp\u003eA total of 10380 subjects, with an average age of 83.7 years, were included in this study, comprising 7068 females (54%) and 6012 males (46%). There were 5483 cases (41.9%) in the frailty stage and 7597 cases (58.1%) in the non-frailty stage. The incidence of frailty was higher in female than male patients (\u003cem\u003eP\u003c/em\u003e=0.000); older (\u003cem\u003eP\u003c/em\u003e=0.001); lower years of education (\u003cem\u003eP\u003c/em\u003e =0.022); living with someone (\u003cem\u003eP\u003c/em\u003e=0.000); poorer (\u003cem\u003eP\u003c/em\u003e=0.000); lower BMI (\u003cem\u003eP\u003c/em\u003e=0.000). Details are shown in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en ( %)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo frailty (n=7597)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty (n=5483)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 393px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e4035 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e1977 (36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e373.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e3562 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e3506 (63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 393px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e65-75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1925 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1289 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e16.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e76-85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2324 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1616 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e86-95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1848 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1376 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge;96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1289 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1059 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ecity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1092 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e835 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.680\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5308 (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3975 (82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eYears of schooling (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2953 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2172 (45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e11.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2132 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1650 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e695 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e482 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e426 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e261 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAt least 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e276 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e173 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLiving status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiving with house member(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3719 (78.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3280 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e12.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiving alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1006 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e731 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic situation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWealthy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6966 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4698 (86.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e109.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNot wealthy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e585 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e724 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSmoked in the past\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3283 (69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2731 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e2.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1425 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1276 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDrank in the past\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3470 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2934 (73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1221 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1040 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e765 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1153 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e400.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3896 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2415 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOverweight/Obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2741 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1389 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.2. Relationship between exercise and frailty.\u003c/p\u003e\n\u003cp\u003eOlder adults who were exercising at the time of answering the questionnaire had a lower risk of frailty than those who were not exercising, but no difference was found after correction for confounders (\u003cem\u003eP=\u003c/em\u003e0.978). After correction, older adults were at lower risk of frailty whether they were doing tai chi, square dancing, gardening, pet ownership, playing cards, socializing, or housework (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.005), and appeared to be more protected by housework (OR=0.096, 95% CI 0.083-0.110, \u003cem\u003eP\u003c/em\u003e=0.000) . The higher the exercise frequency was, the lower the risk of frailty was (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The risk of frailty was lower in older adults with previous physical labor (OR=0.846, 95% CI 0.744-0.962, \u003cem\u003eP\u003c/em\u003e=0.011) and previous physical activity (OR=0.817, 95% CI 0.711-0.938, \u003cem\u003eP\u003c/em\u003e=0.004). (Figure 1)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this cross-sectional study was to analyze the association between daily activity/exercise performed and frailty in the Chinese elderly population, which has provided valuable insights into the relationship and have several implications.\u003c/p\u003e \u003cp\u003e3.1 Association between daily activity/exercise and frailty risk reduction.\u003c/p\u003e \u003cp\u003eWe found that engaging in a wide range of daily activities was associated with a reduced frailty risk. This includes not only traditional forms of exercise like tai chi, square dancing, gardening, and pet ownership but also social activities such as playing cards and socializing, and even routine household chores like housework.\u003c/p\u003e \u003cp\u003eTai chi \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, a popular form of exercise in China, combines slow, controlled movements with deep breathing and concentration, which may contribute to improved balance, muscle strength, and cardiovascular function. Square dancing, another common activity, also showed a significant association with reduced frailty. The energetic and rhythmic movements in square dancing may enhance physical fitness and social interaction. Gardening activities involve physical exertion such as digging, watering, and bending, which can improve muscle strength and flexibility. Pet ownership may encourage physical activity through walking the pet and provide emotional support, both of which could contribute to better health and reduced frailty.\u003c/p\u003e \u003cp\u003ePlaying cards and social activities also had a significant impact on frailty risk reduction. These activities not only involve some degree of physical movement, such as handling cards, but also provide social interaction, which is beneficial for mental well-being.\u003c/p\u003e \u003cp\u003eNotably, housework emerged as a particularly strong protector against frailty. Housework encompasses a variety of physical tasks such as sweeping, mopping, dusting, and lifting objects, which engage multiple muscle groups and improve overall physical function. Additionally, the routine nature of housework may provide a sense of purpose and accomplishment, contributing to mental well-being.\u003c/p\u003e \u003cp\u003eThis finding highlights the importance of considering daily activities as a form of exercise, especially for older adults who may have limited access to formal exercise programs.\u003c/p\u003e \u003cp\u003e3.2 The role of activity/exercise frequency and combination\u003c/p\u003e \u003cp\u003eThe results also emphasized the importance of exercise frequency. We observed that the higher the exercise frequency, the lower the frailty risk. Reports early showed that older people who perform more than 180 min of weekly exercise report better health-related quality of life \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. This indicates that regular and consistent physical activity is crucial for maintaining good health and reducing the risk of frailty \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Furthermore, the combined performance of multiple activities provided greater protection against frailty. The debilitating protection was greatest when four of these activities were performed simultaneously. There was report that overuse of the remaining muscles, leads to an earlier onset of fatigue which, in turn, hastens the shift from an independent to a dependent lifestyle \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. And our study also showed a gradual decline in the protection against frailty from more than 5 simultaneous activities.\u003c/p\u003e \u003cp\u003e3.3 The influence of physical labor and activity history\u003c/p\u003e \u003cp\u003eOur study also found that older adults with a history of physical labor and previous physical activity had a lower frailty risk. It is worth underscoring that regular exercise augments skeletal muscle mass by increasing glucose levels. Higher glucose levels boost insulin action resulting in improved insulin resistance \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Also, there was evidence that exercise (last over 1 year) had reduced the number of falls and fall-associated injuries, and improves physical function and cognition in older population \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. These findings underline the importance of a lifetime of physical activity and suggest that early intervention and promotion of exercise can have long-term benefits for health.\u003c/p\u003e \u003cp\u003eIn addition, we found that most of the Chinese elderly population performed aerobic exercise, with little strength and power training, which may be related to the questionnaire setting or the population's own selection bias regarding activities/exercise. According to the previous study \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, aerobic exercise seems to be more effective than resistance training in modulating the immune system and inflammatory markers among the elderly population. However, a recent study reported that a 12-week combined anaerobic and aerobic exercise program may improve insulin resistance, IGF-1, growth hormone (GH), and DHEA-S levels in elderly Korean women \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. De-titrating individualized exercise programs for elderly populations is difficult to implement, and multimodal exercise that includes aerobic exercise, strength and power training, flexibility and balance training seems to be more appropriate for the frail elderly population to maintain their function and prevent the onset of disability.\u003c/p\u003e \u003cp\u003e3.4 Limitations and future research directions\u003c/p\u003e \u003cp\u003eDespite these findings above, our study has several limitations. Firstly, as a cross-sectional study, it only provides a snapshot of the relationship between daily activities/exercises and frailty at a given point in time and cannot establish causality. Cohort studies and intervention-controlled trials are needed to further explore their relationship.\u003c/p\u003e \u003cp\u003eSecondly, the study did not strictly define exercise intensity. This may have affected the accuracy of our results as different exercise intensities can have varying effects on frailty. Future research should incorporate objective measures of exercise intensity, such as heart rate monitors or metabolic equivalents (METs), to better understand the relationship between exercise intensity and frailty.\u003c/p\u003e \u003cp\u003eFinally, further research should also focus on understanding the mechanisms underlying the association between exercise and frailty, such as the role of muscle strength, inflammation, and hormonal changes. By addressing these limitations and conducting further research, we can gain a more comprehensive understanding of the relationship between exercise and frailty and develop more effective strategies for promoting healthy aging.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003cstrong\u003eu\u003c/strong\u003e\u003cstrong\u003ending\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Chongqing Municipal Science and Technology Bureau (CSTB2022 TIAD-KPX0188) supported this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of\u003c/strong\u003e\u003cstrong\u003einterest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of\u0026nbsp;interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study complies with the current laws of the country in which it was performed. The CLHLS is publicly available, and all procedures involving research study participants were approved by the biomedical ethics committee of Peking University (IRB00001052–24713074). All participants signed written consent forms to participate in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSeals DR, Nagy EE, Moreau KL. Aerobic exercise training and vascular function with ageing in healthy men and women. J Physiol. 2019. 597(19): 4901-4914.\u003c/li\u003e\n \u003cli\u003eFyfe JJ, Hamilton DL, Daly RM. Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations. Sports Med. 2022. 52(3): 463-479.\u003c/li\u003e\n \u003cli\u003eWong M, Ou KL, Chung PK, Chui K, Zhang CQ. The relationship between physical activity, physical health, and mental health among older Chinese adults: A scoping review. Front Public Health. 2022. 10: 914548.\u003c/li\u003e\n \u003cli\u003eHoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019. 394(10206): 1365-1375.\u003c/li\u003e\n \u003cli\u003eDent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019. 394(10206): 1376-1386.\u003c/li\u003e\n \u003cli\u003eBeard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016. 387(10033): 2145-2154.\u003c/li\u003e\n \u003cli\u003ePahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014. 311(23): 2387-96.\u003c/li\u003e\n \u003cli\u003eAngulo J, El Assar M, \u0026Aacute;lvarez-Bustos A, Rodr\u0026iacute;guez-Ma\u0026ntilde;as L. Physical activity and exercise: Strategies to manage frailty. Redox Biol. 2020. 35: 101513.\u003c/li\u003e\n \u003cli\u003eTalar K, Hern\u0026aacute;ndez-Belmonte A, Vetrovsky T, Steffl M, Kałamacka E, Courel-Ib\u0026aacute;\u0026ntilde;ez J. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Clin Med. 2021. 10(8): 1630.\u003c/li\u003e\n \u003cli\u003eSun X, Liu W, Gao Y, et al. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age Ageing. 2023. 52(2): afad004 [pii].\u003c/li\u003e\n \u003cli\u003eGarc\u0026iacute;a-Hermoso A, Ramirez-V\u0026eacute;lez R, S\u0026aacute;ez de Asteasu ML, et al. Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sports Med. 2020. 50(6): 1095-1106.\u003c/li\u003e\n \u003cli\u003eLim H, Jani N, Pang WT, Lim E. Community-based exercises improve health status in pre-frail older adults: A systematic review with meta-analysis. BMC Geriatr. 2024. 24(1): 589.\u003c/li\u003e\n \u003cli\u003eHuang CY, Mayer PK, Wu MY, Liu DH, Wu PC, Yen HR. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev. 2022. 82: 101747.\u003c/li\u003e\n \u003cli\u003eKaushal N, Langlois F, Desjardins-Cr\u0026eacute;peau L, Hagger MS, Bherer L. Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults. Clin Interv Aging. 2019. 14: 209-217.\u003c/li\u003e\n \u003cli\u003eNagata CA, Garcia PA, Hamu T, et al. Are dose-response relationships of resistance training reliable to improve functional performance in frail and pre-frail older adults? A systematic review with meta-analysis and meta-regression of randomized controlled trials. Ageing Res Rev. 2023. 91: 102079.\u003c/li\u003e\n \u003cli\u003eBrook MS, Wilkinson DJ, Phillips BE, et al. Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise. Acta Physiol (Oxf). 2016. 216(1): 15-41.\u003c/li\u003e\n \u003cli\u003eLeick L, Lyngby SS, Wojtaszewski JF, Pilegaard H. PGC-1alpha is required for training-induced prevention of age-associated decline in mitochondrial enzymes in mouse skeletal muscle. Exp Gerontol. 2010. 45(5): 336-42.\u003c/li\u003e\n \u003cli\u003eAbd El-Kader SM, Al-Shreef FM. Inflammatory cytokines and immune system modulation by aerobic versus resisted exercise training for elderly. Afr Health Sci. 2018. 18(1): 120-131.\u003c/li\u003e\n \u003cli\u003eHa MS, Son WM. Combined exercise is a modality for improving insulin resistance and aging-related hormone biomarkers in elderly Korean women. Exp Gerontol. 2018. 114: 13-18.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Appendix","content":"\u003cp\u003eAppendix not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Frailty, Daily activity/exercise, The Chinese Longitudinal Healthy Longevity Survey (CLHLS), Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-5356008/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5356008/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eTo explore the association between daily activity/exercise and frailty among Chinese older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eAccording to the cross-sectional data obtained in the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018, 13080 adults were selected. Logistic regression was employed to explore the association between physical activity/exercise and frailty, by also considering the type and frequency of activities/exercises, and the prevalence of frailty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eThe incidence of frailty in elderly female participants was higher than that in male participants (\u003cem\u003eP\u003c/em\u003e=0.000); Participants with older age (\u003cem\u003eP\u003c/em\u003e=0.001), lower years of education (\u003cem\u003eP\u003c/em\u003e=0.022), living with someone (\u003cem\u003eP\u003c/em\u003e=0.000), poorer economic status (\u003cem\u003eP\u003c/em\u003e=0.000), and low BMI (\u003cem\u003eP\u003c/em\u003e=0.000) had a greater tendency of frailty. Older adults were at lower risk of frailty whether they were doing tai chi, square dancing, gardening, pet ownership, playing cards, socializing, or housework (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.005), and appeared to be more protected by housework (OR=0.096, 95% CI 0.083-0.110, \u003cem\u003eP\u003c/em\u003e=0.000). The risk of frailty was lower in older adults with previous physical labor (OR=0.846, 95% CI 0.744-0.962, \u003cem\u003eP\u003c/em\u003e=0.011) and previous physical activity (OR=0.817, 95% CI 0.711-0.938, \u003cem\u003eP\u003c/em\u003e=0.004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eOlder adults who took part in daily activity/exerciseseemed to have lower frailty risk. Activity/exercise like tai chi, housework, square dancing, gardening, pet ownership, playing cards, socializingwas associated with reduced frailty risk, with housework showing strong protection. The richer the type of activities or exercise engaged in, the lower the risk of debilitation. Older adults with a history of physical labor or activity had a lower frailty risk.\u003c/p\u003e","manuscriptTitle":"Association between daily activity/exercise and frailty in Chinese older adults: a cross-sectional study based on the CLHLS survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 16:55:42","doi":"10.21203/rs.3.rs-5356008/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-11T07:07:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-04T12:00:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-04T11:56:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-10-29T16:30:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e93ba7be-91b6-4505-8a58-af8343106dfc","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T16:00:53+00:00","versionOfRecord":{"articleIdentity":"rs-5356008","link":"https://doi.org/10.1186/s12877-025-05802-2","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-02-26 15:57:27","publishedOnDateReadable":"February 26th, 2025"},"versionCreatedAt":"2024-11-15 16:55:42","video":"","vorDoi":"10.1186/s12877-025-05802-2","vorDoiUrl":"https://doi.org/10.1186/s12877-025-05802-2","workflowStages":[]},"version":"v1","identity":"rs-5356008","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5356008","identity":"rs-5356008","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}