Association between Health-Related Physical Fitness and Incident Hypertension among the Elderly in Wuhan: A Seven-Year Cohort Study

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Methods: A 7 years large-scale cohort study were conducted. The baseline survey was conducted in 2015, with participants aged 65 or above from Wuhan city. The follow-up for this study was conducted as part of the annual physical examination survey for elderly individuals in Wuhan City, with outcome follow-ups conducted in 2018, 2019, 2020, 2021, and 2022, respectively. Chi-square test and multivariate cox regression analysis was conducted to assess the relationship. Results: 695 people's hypertension status have tracked, the incidence of hypertension is 36.4%. The patients are significantly weak in chair sit-and-reach (2.60±0.89 VS 2.8±1.13, P=0.028), 30 seconds arm curl (2.13±1.16 VS 2.26±0.93, P=0.024) , and stronger in back scratch (3.53±1.05 VS 3.74, P=0.009), better 30 seconds chair stand (β:-0.155, HR:0.86, 95%CI: 0.74-0.99, P<0.05) and back scratch (β:-0.140, HR:0.87, 95%CI: 0.77-0.97, P<0.05) abilities shown as protective factors of hypertension. Conclusions: Better lower muscle strength and up body flexibility are protective factors of hypertension. To decrease the hypertension incidence, elder people were recommended to perform exercises targeting these two dimensions. Hypertension Health Related Physical Fitness Cohort Study Elder Population Figures Figure 1 1. Introduction Hypertension is a serious public health issue needs to be given high priority to conduct prevention strategy.[ 1 ] In China, up to 52.6% people aged 60 and older have hypertension in 2022.[ 2 ] For the elder people over 65, hypertension is the leading risk for CVD, stroke and all-cause mortality. Hypertensive heart disease has risen in ranking from 17th to 10th among the causes of years of life lost (YLL).[ 3 ] And hypertension also poses a significant economic burden on families and society. The average direct medical costs cost of illness were $ 467.2 and $ 9393.3 in rural areal, and the total cost of hypertension in one remote province was around $ 231.7 million.[ 4 , 5 ] Therefore, it is necessary to actively explore preventive measures for hypertension in the elderly population. In general, it has been recognized that regularly physical activity has benefit on blood presser control.[ 2 ] However, the effects of different type of physical exercise on blood pressure control are vary. Compared with land exercise and high intensive physical activities, aquatic physical exercise and moderate exercise show better effect, on decreasing in blood pressure.[ 6 – 9 ] The isometric handgrip and leg exercise have larger effect sizes than endurance training and dynamic resistance training in reducing diastolic blood pressure and systolic blood pressure.[ 10 ] It is evident that different forms of exercise exert varying effects on blood pressure, which may be attributed to the distinct dimensions of health related physical fitness enhanced by different types of physical activities. Health relate physical fitness (HRPF) is defined as the ability to be energetic and alert during daily activities without feeling excessively fatigued, while also being capable of enjoying leisure time interests and coping with unpredictable emergencies.[ 11 , 12 ] Physical fitness is the outcome of exercise and can also serve as a reference indicator for exercise guidance. HRPF include five aspect, body composition, muscular strength, muscular endurance, flexibility, and cardio-respiratory fitness.[ 11 – 15 ] There are evidences that better body flexibility and higher muscle strength could reduce the risk of hypertension.[ 16 – 18 ] And cardio-respiratory fitness show an inversely associated with occurrence of hypertension by using a non-exercise algorithm.[ 19 ] However the current literature, there is a gap in accurately assessing the concept of HRPF, as most studies have only considered one or two components of HRPF, and not sufficient researches have evaluated flexibility.[ 20 ] Based on this, we propose the hypothesis that different dimensions of HRPT have different relationships with hypertension and conducted a 7 years large-scale cohort study on it. 2. Materials and methods 2.1 Study design and participants This study was a cohort study, conduct by the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control. The baseline survey was conducted in 2015, with participants from 3 to 5 communities within 7 administrative districts selected through a multi-stage stratified random sampling method from among Wuhan city's 17 administrative districts. The inclusion criteria for this study are: permanent community residents aged 65 and above who have signed the informed consent form. The exclusion criteria are: individuals with severe illnesses that prevent them from participating in HRPF assessments; and those with severe mental illnesses. The follow-up for this study was conducted as part of the annual physical examination survey for elderly individuals in Wuhan City, with outcome follow-ups conducted in 2018, 2019, 2020, 2021, and 2022, respectively. 2.2 Health related-Physical fitness (HRPT) assessment The HRPT assessment base on the ACSM's Guidelines for Exercise Testing and Prescription (Ninth Edition) by the American College of Sports Medicine (ACSM).[ 21 ] Totally 7 index were included: OLB, 30 seconds chair stand test, chair sit-and-reach test, 30 seconds arm curl test, 2 minutes step test, back scratch test and 8-foot up-and-go test. 2.3 Outcomes assessment The primary endpoint of this study comprised two possibilities: (1) development of new-onset hypertension, or (2) the end of follow-up (whichever occurred first). New-onset hypertension is deemed to have occurred if any of the following conditions are met: taking anti-hypertensive medication, self-reported physician diagnosis, or blood pressure values above 140/90 mmHg during routine physical examinations. Follow-up termination could occur due to either non-hypertensive death or loss to follow-up. Mortality data were obtained from the Wuhan Death Surveillance System. Loss to follow-up was operationally defined as individuals who remained untraceable after at least three attempts to contact them via home visits, telephone calls, or inquiries through community health workers. The follow-up duration was calculated as the time from the baseline survey to either the onset of hypertension or the end of follow-up. 2.4 Statistical analysis The statistical analysis in this study was conducted using R software. Data distribution expressed as mean and standard deviation; the difference between group are test by using chi-square test. Multivariate cox regression analysis was conducted to assess the relationship between every single physical fitness indicator and incident hypertension. Cox regression analyses included one unadjusted and two adjusted models, statistically significant criteria defined as P < 0.05 2.5 Covariates assessment Covariates included participant's general characteristics were evaluated through a self-designed questionnaire, encompassing name, age, gender, marital status, educational background, history of chronic illnesses (including hypertension, diabetes, stroke, cardiovascular disease, hyperglycemia, fall, and other primary chronic conditions), levels of physical activity, and smoking habits. Participants’ physical data (including height, weight, body mass Index, waist circumference, hip circumference, waist-to-Hip ratio (WHR), heart rate, blood pressure) collect through physical examinations conducted by qualified nurse. Beside these, important covariates on HRPT and hypertension included Sociodemographic characteristics and Health-related factors. In this research, age, gender, physical exercise, smoking status, fall were included in adjust models. 2.6 Ethics The ethics committee of Wuhan Centre for Disease Prevention and Control has censored the study process and has given the permit. 3. Result 3.1 General Characteristics of Participation The baseline survey included 2100 residences, among which 949 were enrolled for follow-up in this study. The remaining 1149 residences were excluded due to hypertension at baseline, and an additional 2 were excluded due to lack of HRPF test results. Among the remaining 949 participants, 254 were lost to follow-up for reasons such as moving out of the area, deaths not related to hypertension, unable to contact. Ultimately, 695 participants completed the follow-up and included in analysis. (Fig. 1 ) The General Characteristics of participation has shown in Table 1 , the average age of sample is 72.4, 267(28.1%) has reported lack of exercise, 190 (20.0%) has reported regular smoking, 98(10.3%) has reported suffer from fall-related injuries. Comparing with male, female has significantly lower smoking rate, height, weight, BMI, SBP and DBP, and higher fall rate. Table 1 General Characteristics of Participation N = 949 Male (n = 479, 50.47%) Female (n = 470, 49.53%) p Age (𝑥̅± SD ) Lack of exercise (n, %) Yes No Smoking (n, %) Yes No Fall (n, %) Yes No Height (𝑥̅± SD ) Weight (𝑥̅± SD ) BMI (𝑥̅± SD ) WC (𝑥̅± SD ) HC (𝑥̅± SD ) WHR (𝑥̅± SD ) Heart Rate (𝑥̅± SD ) BP (𝑥̅± SD ) SBP DBP 72.4 (5.18) 267 (28.1%) 682 (71.9%) 190 (20.0%) 759 (80.0%) 98 (10.3%) 849 (89.5%) 1.60 (0.08) 60.5 (10.7) 23.6 (3.40) 86.1 (9.59) 95.2 (8.46) 0.91 (0.06) 76.6 (10.8) 135 (18.5) 79.1 (10.7) 72.6 (5.16) 126 (26.3%) 353 (73.7%) 181 (37.8%) 298 (62.2%) 30 (6.3%) 448 (93.5%) 1.65 (0.06) 64.1 (10.4) 23.4 (3.37) 86.5 (9.32) 95.2 (8.23) 0.91 (0.06) 76.9 (11.4) 137 (19.2) 80.4 (11.1) 72.1 (5.20) 141 (30.0%) 329 (70.0%) 9 (1.9%) 461 (98.1%) 68 (14.5%) 401 (85.3%) 1.54 (0.06) 56.8 (9.63) 23.7 (3.43) 85.7 (9.84) 95.1 (8.70) 0.90 (0.06) 76.2 (10.2) 133 (17.6) 77.7 (10.1) 0.091 0.233 <0.001 <0.001 <0.001 <0.001 0.049 0.086 0.765 0.051 0.290 0.047 <0.001 WC: Waist Circumference, HC: Hip Circumference, WHR: Waist-to-Hip Ratio, BP:Blood Pressure, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure 3.2 Health-Related Physical Fitness(x ± SD) The HRPT level has shown in the Table 2 . Compared with male, female significantly weak in OLB (1.36 VS 1.56, P = 0.009 ), 30 seconds chair stand (2.57 VS 2.81, P < 0.001), chair sit-and-reach (4.64 VS 4.52, P = 0.008), 30 seconds arm curl (2.11 VS 2.25, P < 0.015), 2 minutes step (2.44 VS 2.64, P = 0.011). Table 2 Health-Related Physical Fitness N = 949 Male (n = 479, 50.47%) Female (n = 470, 49.53%) p OLB (s) 30 Seconds Chair Stand (reps) Chair Sit-and-Reach (cm) 30 Seconds Arm Curl (reps) 2 Minutes Step (reps) Back Scratch (cm) 8-Foot Up-and-Go (s) 1.46 (0.97) 2.69 (1.07) 4.58 (1.03) 2.18 (0.99) 2.54 (1.04) 3.59 (1.07) 2.82 (1.03) 1.56 (1.11) 2.81 (1.10) 4.52 (1.02) 2.25 (1.06) 2.64 (1.07) 3.55 (1.05) 2.81 (1.04) 1.36 (0.79) 2.57 (1.03) 4.64 (1.03) 2.11 (0.90) 2.44 (1.00) 3.63 (1.10) 2.83 (1.02) 0.009 < 0.001 0.008 0.015 0.011 0.20 0.386 3.3 Health-Related Physical Fitness and Incident Hypertension In the participants we have tracked 695 people's hypertension status.(Table 3 ) Among them 253 have hypertension, the incidence of hypertension is 36.4%. The patients are significantly weak in chair sit-and-reach (2.60 ± 0.89 VS 2.8 ± 1.13, P = 0.028), 30 seconds arm curl (2.13 ± 1.16 VS 2.26 ± 0.93, P = 0.024), and stronger in back scratch (3.53 ± 1.05 VS 3.74, P = 0.009) Table 3 Participants HRPT and Hypertension Incident N = 695 hypertension (n = 253, 36.4%) Non-hypertension (n = 442, 63.6%) p OLB (s) 30 Seconds Chair Stand (reps) Chair Sit-and-Reach (cm) 30 Seconds Arm Curl (reps) 2 Minutes Step (reps) Back Scratch (cm) 8-Foot Up-and-Go (s) 1.48 (0.98) 2.73 (1.05) 4.63 (1.01) 2.21 (1.02) 2.62 (1.03) 3.66 (1.06) 2.76 (0.98) 1.53 (1.03) 2.60 (0.89) 4.52 (1.07) 2.13 (1.16) 2.60 (1.03) 3.53 (1.05) 2.86 (0.94) 1.46 (0.95) 2.80 (1.13) 4.70 (0.97) 2.26 (0.93) 2.64 (0.97) 3.74 (1.06) 2.70 (1.00) 0.426 0.028 0.087 0.024 0.336 0.009 0.060 3.4 Multivariate Cox Regression Analysis on Hypertension and HRPT We utilized four Cox proportional hazards models to analyze each physical fitness indicator. Model 1: an unadjusted model; Model 2: adjusted for gender and age; Model 3: adjusted for exercise, smoking, and fall history. The result has shown in Table 4 , in unadjusted Model 1, 30 seconds chair stand (β:-0.171 HR: 0.84, 95%CI: 0.74–0.97, P < 0.05), chair sit-and-reach (β:-0.122, HR: 0.88, 95%CI: 0.79–0.99, P < 0.05) and back scratch (β:-0.148, HR:0.86, 95%CI:0.77–0.97, P < 0.05) were identified as protective factors for hypertension. In the adjusted Model 2, 30 seconds chair stand(β: -0.171 HR༚0.84, 95%CI:0.74–0.97,P < 0.05), chair sit-and-reach(β༚-0.128, HR༚0.88, 95%CI:0.78–0.99, P < 0.05),back scratch(β:-0.149, HR༚0.86, 95%CI:0.77–0.97, P < 0.05) remained consistent with model 1, serving as protective factors for hypertension. There were some changes in Model 3, 30 seconds chair stand (β:-0.155, HR:0.86, 95%CI: 0.74–0.99, P < 0.05) and back scratch(β:-0.140, HR:0.87, 95%CI: 0.77–0.97, P < 0.05) continued to show as protective factors, however chair sit-and-reach no longer exhibited statistical significance in this model. Table 4 Multivariate cox regression analysis on the hypertension and HRPT Model β HR(95%CI) P OLB Model 1 Model 2 Model 3 0.058 0.070 0.099 1.06(0.94–1.19) 1.07(0.95–1.21) 1.10(0.98–1.25) 0.336 0.249 0.111 30 Seconds Chair Stand Model 1 Model 2 Model 3 -0.171 -0.167 -0.155 0.84(0.74–0.97) 0.85(0.74–0.97) 0.86(0.74–0.99) 0.014 0.019 0.030 Chair Sit-and-Reach Model 1 Model 2 Model 3 -0.122 -0.128 -0.119 0.88(0.79–0.99) 0.88(0.78–0.99) 0.89(0.79-1.00) 0.040 0.034 0.051 30 Seconds Arm Curl Model 1 Model 2 Model 3 -0.119 -0.114 -0.078 0.89(0.77–1.03) 0.89(0.77–1.04) 0.93(0.79–1.08) 0.110 0.131 0.320 2 Minutes Step Model 1 Model 2 Model 3 -0.027 -0.016 -0.010 0.97(0.86–1.10) 0.98(0.87–1.12) 0.99(0.87–1.12) 0.675 0.805 0.879 Back Scratch Model 1 Model 2 Model 3 -0.148 -0.149 -0.140 0.86(0.77–0.97) 0.86(0.77–0.97) 0.87(0.77–0.97) 0.012 0.012 0.019 8-Foot Up-and-Go Model 1 Model 2 Model 3 0.109 0.106 0.095 1.12(0.99–1.26) 1.11(0.98–1.26) 1.10(0.97–1.24) 0.080 0.091 0.131 Model 1 unadjusted, Model 2 Adjusted for Gender and Age;Model 3 Adjusted for Exercise, Smoking and Fall Incidents 4. Discussion This study explored the relationship between HRPT and incident hypertension in the elderly population using a large cohort study. From Participants’ HRPT data and cox regression result, it is significantly that better perform in 30 seconds chair stand, chair sit-and-reach and back scratch are associated with a reduced incidence of hypertension. Chair sit-and-reach and back scratch are indicators representing up body flexibility in HRPT.[ 22 ] Thus, better flexibility is a protective factor for hypertension. Previously research conducted in Japan, has accordance with us that good flexibility related to lower incidence of hypertension.[ 23 ] Another study, which assessed 566 adults, revealed that individuals over 40 classified as poor flexibility, systolic blood pressure have a 5 mmHg higher than those with good flexibility.[ 24 ] The mechanism that flexibility indicators to hypertension development involves associations with three intermediate parameters: arterial stiffness, arterial remodeling, and parasympathetic nervous activity dominance.[ 25 – 29 ] These factors induce alterations in vascular structure, arterial remodeling, or the release of vasodilatory metabolites, such adaptive changes contribute to a reduction in vascular resistance, thereby potentially decreasing the incidence of hypertension.[ 25 – 27 , 30 – 33 ] Our result on lower body strength keep accordance with literature. There are statistic evidences that a higher RMS (Relative muscle strength) value could reduced risk of hypertension.[ 17 – 18 ] Furthermore, this relationship persists in subgroups with histories of diabetes, hyperlipidemia, and obesity, even after adjusting for covariates.[ 17 – 18 ] The mechanisms that muscle strength indicators to hypertension development involves associations with two intermediate parameters: insulin resistance and loss of skeletal muscle mass.[ 17 , 34 – 37 ] The former may result in sympathetic nervous system excitation, decreased renal vasoconstriction, and increased renal tubular sodium reabsorption, ultimately contributing to elevated blood pressure.[ 17 , 35 , 36 , 38 – 42 ] The latter may increase the risk of vascular damage and arterial stiffness, thereby elevating vascular resistance and potentially leading to hypertension.[ 37 , 43 – 51 ] Based on our research, it is recommended that elderly population engage in exercises aimed at enhancing body flexibility and lower body muscle strength as a preventive measure against the onset of hypertension. Previous research has highlighted the importance of physical exercise for the health of the elderly, as it plays a significant role in reducing the incidence of various chronic diseases and premature death.[ 52 , 53 ] however, for the elderly population, paying attention to HRPT a is of greater importance. Because comparing with mere physical activity, HRPT is more robust risk factor cardiovascular disease, for instance with increased physical activity, the risk is reduced by approximately 25%, but with improved physical fitness, the risk is decreased by roughly 60%.[ 54 ] Therefore, training for physical flexibility and muscular strength should be recommended in both primary and secondary prevention of diseases to enhance the effectiveness of hypertension prevention among the population. Thus for elder population, emphasizing physical exercise to enhance these two fitness dimensions is crucial for hypertension prevention. For muscle strength, it is recommend that old population conduct resistance training and aerobic exercise.[ 55 – 59 ] Regarding exercise intensity, it is recommend that every week engaging in at least 150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous-intensity aerobic exercise, or an combination of moderate-to-vigorous exercise at least 10 minutes every time.[ 60 ] To enhance body flexibility, a six-week static stretching, which involves performing bilateral stretches five times per week, with each session lasting 30 minutes and short-term Pilates training (5 or 10 weeks), long-term Pilates training (6 months) and yoga are effectively.[ 61 – 65 ] Combining two fitness dimensions, Tai Chi and Square Stepping Exercise can simultaneously improve both physical flexibility and muscle strength.[ 66 – 67 ] It should be noted that the nutrition support with the exercise had shown better improvement.[ 68 ] 5. Conclusions Our study is a large-scale cohort study explore the different dimensions of HRPT have different relationships with hypertension. We found that better lower muscle strength and up body flexibility are protective factors of hypertension. To decrease the disease incidence and release the disease burden on health system, it is more effectively focus on comprehensions HRPT index relative training than no purpose physical exercise. 6. Limitation Our study is a cohort study, we encountered a high loss-to-follow-up rate of 36.4%. Among those lost to follow-up, the probability of death due to physical conditions or illnesses is relatively high, resulting in the exclusion of a significant number of potential hypertension cases from the statistical analysis, which introduces bias into the study results. Additionally, during the survey, some elderly individuals had a lack of clear understanding of the concept of hypertension, leading to potential misreporting, which may also impact the study findings. Declarations Conflicts of interest The authors have no conflicts of interest to declare. Acknowledgments This work were supported by Wuhan Science and Technology Bureau and the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control. Ethical approval and consent to participate The ethics committee of Wuhan Centre for Disease Prevention and Control has censored the study process and has given the permit (NO.WHCDCIRB-K-2021058). Informed consent was obtained from every participants. Funding This work were funded by Wuhan Science and Technology Bureau's Knowledge Innovation Special Project (NO.2022020801020594 and NO.2023020201010205) Author Contribution WL, YZ and XL contributed to the study design, analysis,and interpretation of data and drafted the manuscript. YY, WZ, SK, SZ, TY, LW performed data acquisition. YG and MY participated in the design andcoordination of the study and revised the manuscript. All authors read and approved the final manuscript. Acknowledgement This work were supported by Wuhan Science and Technology Bureau and the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control. References Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005 Jan 15–21;365(9455):217 – 23. 10.1016/S0140-6736(05)17741-1 . PMID: 15652604. Ren Y, Shi J, Qiao Y, Gu Y, Li Y, Liu Y, Cheng Y, Liu Y. 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Lipid-Induced Insulin Resistance in Skeletal Muscle: The Chase for the Culprit Goes from Total Intramuscular Fat to Lipid Intermediates, and Finally to Species of Lipid Intermediates. Nutrients. 2016;8(8):466. Park M, Kaddai V, Ching J, et al. A Role for Ceramides, but Not Sphingomyelins, as Antagonists of Insulin Signaling and Mitochondrial Metabolism in C2C12 Myotubes. J Biol Chem. 2016;291(46):23978–88. Ochi M, Kohara K, Tabara Y, et al. Arterial stiffness is associated with low thigh muscle mass in middle-aged to elderly men. Atherosclerosis. 2010;212:327–32. König M, Buchmann N, Seeland U, Spira D, Steinhagen-Thiessen E, Demuth I. Low muscle strength and increased arterial stiffness go hand in hand. Sci Rep. 2021;11(1):2906. 10.1038/s41598-021-81084-z . PMID: 33536474; PMCID: PMC7859241. Dos Santos MR, Saitoh M, Ebner N, Valentova M, Konishi M, Ishida J, et al. Sarcopenia and endothelial function in patients with chronic heart failure: results from the studies investigating comorbidities aggravating heart failure (SICA-HF). J Am Med Dir Assoc. 2017;18:240–5. 10.1016/j.jamda.2016.09.006 . Peterson MD, Duchowny K, Meng Q, Wang Y, Chen X, Zhao Y. Low normalized grip strength is a biomarker for cardiometabolic disease and physical disabilities among US and Chinese adults. J Gerontol Biol Sci Med Sci. 2017;72:1525–31. 10.1093/gerona/glx031 . Buchmann N, Spira D, König M, Demuth I, Steinhagen-Thiessen E. Frailty and the metabolic syndrome: results of the Berlin Aging Study II (BASE-II). J Frailty Aging. 2019;8:169–75. 10.14283/jfa.2019.15 . Orkaby AR, Lunetta KL, Sun FJ, Driver JA, Benjamin EJ, Hamburg NM, et al. Cross-sectional association of frailty and arterial stiffness in community-dwelling older adults: the framingham heart study. J Gerontol Biol Sci Med Sci. 2019;74:373–9. 10.1093/gerona/gly134 . Dalle S, Rossmeislova L, Koppo K. The role of inflammation in age-related sarcopenia. Front Physiol. 2017;8:1045. 10.3389/fphys.2017.01045 . Lee JH, Jun HS. Role of Myokines in Regulating Skeletal Muscle Mass and Function. Front Physiol. 2019;10:42. 10.3389/fphys.2019.00042 . PMID: 30761018; PMCID: PMC6363662. Dvoretskiy S, Lieblein-Boff JC, Jonnalagadda S, Atherton PJ, Phillips BE, Pereira SL. Exploring the association between vascular dysfunction and skeletal muscle mass strength and function in healthy adults: a systematic review. Nutrients. 2020. 10.3390/nu12030715 . Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801–9. 10.1503/cmaj.051351 . PMID: 16534088; PMCID: PMC1402378. American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 1998;30(6):992–1008. PMID: 9624662. Williams P. Physical fitness and activity as separate heart disease risk factors: A meta-analysis. Med Sci Sports Exerc. 2001;33:754–61. 10.1097/00005768-200105000-00012 . Granacher U, Gollhofer A, Hortobagyi T, Kressig RW, Muehlbauer T. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med. 2013;43(7):627–41. 10.1007/s40279-013-0041-1 . Gschwind YJ, Kressig RW, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr. 2013;13:105. 10.1186/1471-2318-13-105 . PMID: 24106864; PMCID: PMC3852637. Chen N, He X, Feng Y, Ainsworth BE, Liu Y. Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. Eur. 2021;18:23. Negm AM, Lee J, Hamidian R, Jones CA, Khadaroo RG. Management of sarcopenia: a network meta-analysis of randomized controlled trials. J Am Med Dir Assoc. 2022;23:707–14. Marzuca-Nassr GN, Alegría-Molina A, SanMartín-Calísto Y, Artigas-Arias M, Huard N, Sapunar J, Salazar LA, Verdijk LB, van Loon LJC. Muscle Mass and Strength Gains Following Resistance Exercise Training in Older Adults 65–75 Years and Older Adults Above 85 Years. Int J Sport Nutr Exerc Metab. 2023;34(1):11–19. 10.1123/ijsnem.2023-0087 . PMID: 37875254. World Health Organization. Global Recommendations on Physical Activity for Health. World Health Organization; ‎Geneva, Switzerland: 2010. [(accessed on 04 August 2019)]. Available online: http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng Ferreira GN, Teixeira-Salmela LF, Guimarães CQ. Gains in flexibility related to measures of muscular performance: impact of flexibility on muscular performance. Clin J Sport Med. 2007;17(4):276 – 81. 10.1097/JSM.0b013e3180f60b26 . PMID: 17620781. Geremia JM, Iskiewicz MM, Marschner RA, Lehnen TE, Lehnen AM. Effect of a physical training program using the Pilates method on flexibility in elderly subjects. Age (Dordr). 2015;37(6):119. doi: 10.1007/s11357-015-9856-z. Epub 2015 Nov 17. PMID: 26578459; PMCID: PMC5005875. Segal NA, Hein J, Basford JR. The effects of Pilates training on flexibility and body composition: an observational study. Arch Phys Med Rehabil. 2004;85:1977–81. 10.1016/j.apmr.2004.01.036 . Sekendiz B, Altun Ö, Korkusuz F, Akın S. Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. J Bodyw Mov Ther. 2007;11:318–26. 10.1016/j.jbmt.2006.12.002 . Gonçalves LC, Vale RG, Barata NJ, Varejão RV, Dantas EH. Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners. Arch Gerontol Geriatr. 2011 Sep-Oct;53(2):158–62. Epub 2010 Dec 16. PMID: 21167613. Sadeghian F, Zolaktaf V, Shigematsu RA. Comparison between Effects of Square-Stepping Exercise and Tai Chi Chuan on Functional Fitness and Fear of Falling in Older Women. Aging Clin Exp Res. 2023;35:827–34. 10.1007/s40520-023-02367-1 . Shigematsu R, Okura T. A Novel Exercise for Improving Lower-Extremity Functional Fitness in the Elderly. Aging Clin Exp Res. 2006;18:242–8. 10.1007/BF03324655 . Shen Y, Shi Q, Nong K, Li S, Yue J, Huang J, Dong B, Beauchamp M, Hao Q. Exercise for sarcopenia in older people: A systematic review and network meta-analysis. J Cachexia Sarcopenia Muscle. 2023;14(3):1199–211. 10.1002/jcsm.13225 . Epub 2023 Apr 14. PMID: 37057640; PMCID: PMC10235889. Additional Declarations No competing interests reported. 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12:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6303691/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6303691/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25635-3","type":"published","date":"2025-11-27T15:58:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82149919,"identity":"1c935456-7de0-47a1-b982-94274abfbb67","added_by":"auto","created_at":"2025-05-07 07:12:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29064,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFlow chart of \u0026nbsp;cohort study\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6303691/v1/f21caab915354a2ca164ef9d.png"},{"id":97179205,"identity":"d6dba1cd-ac91-44b8-b804-c0ca1053fe34","added_by":"auto","created_at":"2025-12-01 16:14:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1000541,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6303691/v1/1d8a792d-5bd9-4689-ae78-502a9071bd45.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between Health-Related Physical Fitness and Incident Hypertension among the Elderly in Wuhan: A Seven-Year Cohort Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHypertension is a serious public health issue needs to be given high priority to conduct prevention strategy.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In China, up to 52.6% people aged 60 and older have hypertension in 2022.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] For the elder people over 65, hypertension is the leading risk for CVD, stroke and all-cause mortality. Hypertensive heart disease has risen in ranking from 17th to 10th among the causes of years of life lost (YLL).[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] And hypertension also poses a significant economic burden on families and society. The average direct medical costs cost of illness were \u003cspan\u003e$\u003c/span\u003e 467.2 and \u003cspan\u003e$\u003c/span\u003e 9393.3 in rural areal, and the total cost of hypertension in one remote province was around \u003cspan\u003e$\u003c/span\u003e 231.7\u0026nbsp;million.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Therefore, it is necessary to actively explore preventive measures for hypertension in the elderly population.\u003c/p\u003e \u003cp\u003eIn general, it has been recognized that regularly physical activity has benefit on blood presser control.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] However, the effects of different type of physical exercise on blood pressure control are vary. Compared with land exercise and high intensive physical activities, aquatic physical exercise and moderate exercise show better effect, on decreasing in blood pressure.[\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The isometric handgrip and leg exercise have larger effect sizes than endurance training and dynamic resistance training in reducing diastolic blood pressure and systolic blood pressure.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] It is evident that different forms of exercise exert varying effects on blood pressure, which may be attributed to the distinct dimensions of health related physical fitness enhanced by different types of physical activities.\u003c/p\u003e \u003cp\u003eHealth relate physical fitness (HRPF) is defined as the ability to be energetic and alert during daily activities without feeling excessively fatigued, while also being capable of enjoying leisure time interests and coping with unpredictable emergencies.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Physical fitness is the outcome of exercise and can also serve as a reference indicator for exercise guidance. HRPF include five aspect, body composition, muscular strength, muscular endurance, flexibility, and cardio-respiratory fitness.[\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] There are evidences that better body flexibility and higher muscle strength could reduce the risk of hypertension.[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] And cardio-respiratory fitness show an inversely associated with occurrence of hypertension by using a non-exercise algorithm.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] However the current literature, there is a gap in accurately assessing the concept of HRPF, as most studies have only considered one or two components of HRPF, and not sufficient researches have evaluated flexibility.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Based on this, we propose the hypothesis that different dimensions of HRPT have different relationships with hypertension and conducted a 7 years large-scale cohort study on it.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eThis study was a cohort study, conduct by the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control.\u003c/p\u003e \u003cp\u003eThe baseline survey was conducted in 2015, with participants from 3 to 5 communities within 7 administrative districts selected through a multi-stage stratified random sampling method from among Wuhan city's 17 administrative districts. The inclusion criteria for this study are: permanent community residents aged 65 and above who have signed the informed consent form. The exclusion criteria are: individuals with severe illnesses that prevent them from participating in HRPF assessments; and those with severe mental illnesses.\u003c/p\u003e \u003cp\u003eThe follow-up for this study was conducted as part of the annual physical examination survey for elderly individuals in Wuhan City, with outcome follow-ups conducted in 2018, 2019, 2020, 2021, and 2022, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Health related-Physical fitness (HRPT) assessment\u003c/h2\u003e \u003cp\u003e The HRPT assessment base on the ACSM's Guidelines for Exercise Testing and Prescription (Ninth Edition) by the American College of Sports Medicine (ACSM).[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Totally 7 index were included: OLB, 30 seconds chair stand test, chair sit-and-reach test, 30 seconds arm curl test, 2 minutes step test, back scratch test and 8-foot up-and-go test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcomes assessment\u003c/h2\u003e \u003cp\u003eThe primary endpoint of this study comprised two possibilities: (1) development of new-onset hypertension, or (2) the end of follow-up (whichever occurred first). New-onset hypertension is deemed to have occurred if any of the following conditions are met: taking anti-hypertensive medication, self-reported physician diagnosis, or blood pressure values above 140/90 mmHg during routine physical examinations. Follow-up termination could occur due to either non-hypertensive death or loss to follow-up. Mortality data were obtained from the Wuhan Death Surveillance System. Loss to follow-up was operationally defined as individuals who remained untraceable after at least three attempts to contact them via home visits, telephone calls, or inquiries through community health workers. The follow-up duration was calculated as the time from the baseline survey to either the onset of hypertension or the end of follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis in this study was conducted using R software. Data distribution expressed as mean and standard deviation; the difference between group are test by using chi-square test. Multivariate cox regression analysis was conducted to assess the relationship between every single physical fitness indicator and incident hypertension. Cox regression analyses included one unadjusted and two adjusted models, statistically significant criteria defined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Covariates assessment\u003c/h2\u003e \u003cp\u003eCovariates included participant's general characteristics were evaluated through a self-designed questionnaire, encompassing name, age, gender, marital status, educational background, history of chronic illnesses (including hypertension, diabetes, stroke, cardiovascular disease, hyperglycemia, fall, and other primary chronic conditions), levels of physical activity, and smoking habits. Participants\u0026rsquo; physical data (including height, weight, body mass Index, waist circumference, hip circumference, waist-to-Hip ratio (WHR), heart rate, blood pressure) collect through physical examinations conducted by qualified nurse.\u003c/p\u003e \u003cp\u003eBeside these, important covariates on HRPT and hypertension included Sociodemographic characteristics and Health-related factors. In this research, age, gender, physical exercise, smoking status, fall were included in adjust models.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Ethics\u003c/h2\u003e \u003cp\u003eThe ethics committee of Wuhan Centre for Disease Prevention and Control has censored the study process and has given the permit.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 General Characteristics of Participation\u003c/h2\u003e \u003cp\u003eThe baseline survey included 2100 residences, among which 949 were enrolled for follow-up in this study. The remaining 1149 residences were excluded due to hypertension at baseline, and an additional 2 were excluded due to lack of HRPF test results. Among the remaining 949 participants, 254 were lost to follow-up for reasons such as moving out of the area, deaths not related to hypertension, unable to contact. Ultimately, 695 participants completed the follow-up and included in analysis. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe General Characteristics of participation has shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the average age of sample is 72.4, 267(28.1%) has reported lack of exercise, 190 (20.0%) has reported regular smoking, 98(10.3%) has reported suffer from fall-related injuries. Comparing with male, female has significantly lower smoking rate, height, weight, BMI, SBP and DBP, and higher fall rate.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Characteristics of Participation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;949\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;479, 50.47%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;470, 49.53%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eLack of exercise\u003c/b\u003e (n, %)\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e (n, %)\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e\u003cb\u003eFall\u003c/b\u003e (n, %)\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e\u003cb\u003eHeight\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eWC\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eHC\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eWHR\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eHeart Rate\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eBP\u003c/b\u003e (\u0026#119909;̅\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003cp\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eDBP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.4 (5.18)\u003c/p\u003e \u003cp\u003e267 (28.1%)\u003c/p\u003e \u003cp\u003e682 (71.9%)\u003c/p\u003e \u003cp\u003e190 (20.0%)\u003c/p\u003e \u003cp\u003e759 (80.0%)\u003c/p\u003e \u003cp\u003e98 (10.3%)\u003c/p\u003e \u003cp\u003e849 (89.5%)\u003c/p\u003e \u003cp\u003e1.60 (0.08)\u003c/p\u003e \u003cp\u003e60.5 (10.7)\u003c/p\u003e \u003cp\u003e23.6 (3.40)\u003c/p\u003e \u003cp\u003e86.1 (9.59)\u003c/p\u003e \u003cp\u003e95.2 (8.46)\u003c/p\u003e \u003cp\u003e0.91 (0.06)\u003c/p\u003e \u003cp\u003e76.6 (10.8)\u003c/p\u003e \u003cp\u003e135 (18.5)\u003c/p\u003e \u003cp\u003e79.1 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.6 (5.16)\u003c/p\u003e \u003cp\u003e126 (26.3%)\u003c/p\u003e \u003cp\u003e353 (73.7%)\u003c/p\u003e \u003cp\u003e181 (37.8%)\u003c/p\u003e \u003cp\u003e298 (62.2%)\u003c/p\u003e \u003cp\u003e30 (6.3%)\u003c/p\u003e \u003cp\u003e448 (93.5%)\u003c/p\u003e \u003cp\u003e1.65 (0.06)\u003c/p\u003e \u003cp\u003e64.1 (10.4)\u003c/p\u003e \u003cp\u003e23.4 (3.37)\u003c/p\u003e \u003cp\u003e86.5 (9.32)\u003c/p\u003e \u003cp\u003e95.2 (8.23)\u003c/p\u003e \u003cp\u003e0.91 (0.06)\u003c/p\u003e \u003cp\u003e76.9 (11.4)\u003c/p\u003e \u003cp\u003e137 (19.2)\u003c/p\u003e \u003cp\u003e80.4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.1 (5.20)\u003c/p\u003e \u003cp\u003e141 (30.0%)\u003c/p\u003e \u003cp\u003e329 (70.0%)\u003c/p\u003e \u003cp\u003e9 (1.9%)\u003c/p\u003e \u003cp\u003e461 (98.1%)\u003c/p\u003e \u003cp\u003e68 (14.5%)\u003c/p\u003e \u003cp\u003e401 (85.3%)\u003c/p\u003e \u003cp\u003e1.54 (0.06)\u003c/p\u003e \u003cp\u003e56.8 (9.63)\u003c/p\u003e \u003cp\u003e23.7 (3.43)\u003c/p\u003e \u003cp\u003e85.7 (9.84)\u003c/p\u003e \u003cp\u003e95.1 (8.70)\u003c/p\u003e \u003cp\u003e0.90 (0.06)\u003c/p\u003e \u003cp\u003e76.2 (10.2)\u003c/p\u003e \u003cp\u003e133 (17.6)\u003c/p\u003e \u003cp\u003e77.7 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003cp\u003e0.233\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.086\u003c/p\u003e \u003cp\u003e0.765\u003c/p\u003e \u003cp\u003e0.051\u003c/p\u003e \u003cp\u003e0.290\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eWC: Waist Circumference, HC: Hip Circumference, WHR: Waist-to-Hip Ratio, BP:Blood Pressure, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Health-Related Physical Fitness(x\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/h2\u003e \u003cp\u003eThe HRPT level has shown in the Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Compared with male, female significantly weak in OLB (1.36 VS 1.56, P\u0026thinsp;=\u0026thinsp;0.009 ), 30 seconds chair stand (2.57 VS 2.81, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chair sit-and-reach (4.64 VS 4.52, P\u0026thinsp;=\u0026thinsp;0.008), 30 seconds arm curl (2.11 VS 2.25, P\u0026thinsp;\u0026lt;\u0026thinsp;0.015), 2 minutes step (2.44 VS 2.64, P\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth-Related Physical Fitness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;949\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;479, 50.47%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;470, 49.53%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOLB (s)\u003c/p\u003e \u003cp\u003e30 Seconds Chair Stand (reps)\u003c/p\u003e \u003cp\u003eChair Sit-and-Reach (cm)\u003c/p\u003e \u003cp\u003e30 Seconds Arm Curl (reps)\u003c/p\u003e \u003cp\u003e2 Minutes Step (reps)\u003c/p\u003e \u003cp\u003eBack Scratch (cm)\u003c/p\u003e \u003cp\u003e8-Foot Up-and-Go (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46 (0.97)\u003c/p\u003e \u003cp\u003e2.69 (1.07)\u003c/p\u003e \u003cp\u003e4.58 (1.03)\u003c/p\u003e \u003cp\u003e2.18 (0.99)\u003c/p\u003e \u003cp\u003e2.54 (1.04)\u003c/p\u003e \u003cp\u003e3.59 (1.07)\u003c/p\u003e \u003cp\u003e2.82 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.56 (1.11)\u003c/p\u003e \u003cp\u003e2.81 (1.10)\u003c/p\u003e \u003cp\u003e4.52 (1.02)\u003c/p\u003e \u003cp\u003e2.25 (1.06)\u003c/p\u003e \u003cp\u003e2.64 (1.07)\u003c/p\u003e \u003cp\u003e3.55 (1.05)\u003c/p\u003e \u003cp\u003e2.81 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36 (0.79)\u003c/p\u003e \u003cp\u003e2.57 (1.03)\u003c/p\u003e \u003cp\u003e4.64 (1.03)\u003c/p\u003e \u003cp\u003e2.11 (0.90)\u003c/p\u003e \u003cp\u003e2.44 (1.00)\u003c/p\u003e \u003cp\u003e3.63 (1.10)\u003c/p\u003e \u003cp\u003e2.83 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.20\u003c/p\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Health-Related Physical Fitness and Incident Hypertension\u003c/h2\u003e \u003cp\u003eIn the participants we have tracked 695 people's hypertension status.(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Among them 253 have hypertension, the incidence of hypertension is 36.4%. The patients are significantly weak in chair sit-and-reach (2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89 VS 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13, P\u0026thinsp;=\u0026thinsp;0.028), 30 seconds arm curl (2.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 VS 2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93, P\u0026thinsp;=\u0026thinsp;0.024), and stronger in back scratch (3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05 VS 3.74, P\u0026thinsp;=\u0026thinsp;0.009)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants HRPT and Hypertension Incident\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;695\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ehypertension (n\u0026thinsp;=\u0026thinsp;253, 36.4%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eNon-hypertension\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;442, 63.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOLB (s)\u003c/p\u003e \u003cp\u003e30 Seconds Chair Stand (reps)\u003c/p\u003e \u003cp\u003eChair Sit-and-Reach (cm)\u003c/p\u003e \u003cp\u003e30 Seconds Arm Curl (reps)\u003c/p\u003e \u003cp\u003e2 Minutes Step (reps)\u003c/p\u003e \u003cp\u003eBack Scratch (cm)\u003c/p\u003e \u003cp\u003e8-Foot Up-and-Go (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.48 (0.98)\u003c/p\u003e \u003cp\u003e2.73 (1.05)\u003c/p\u003e \u003cp\u003e4.63 (1.01)\u003c/p\u003e \u003cp\u003e2.21 (1.02)\u003c/p\u003e \u003cp\u003e2.62 (1.03)\u003c/p\u003e \u003cp\u003e3.66 (1.06)\u003c/p\u003e \u003cp\u003e2.76 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.53 (1.03)\u003c/p\u003e \u003cp\u003e2.60 (0.89)\u003c/p\u003e \u003cp\u003e4.52 (1.07)\u003c/p\u003e \u003cp\u003e2.13 (1.16)\u003c/p\u003e \u003cp\u003e2.60 (1.03)\u003c/p\u003e \u003cp\u003e3.53 (1.05)\u003c/p\u003e \u003cp\u003e2.86 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.46 (0.95)\u003c/p\u003e \u003cp\u003e2.80 (1.13)\u003c/p\u003e \u003cp\u003e4.70 (0.97)\u003c/p\u003e \u003cp\u003e2.26 (0.93)\u003c/p\u003e \u003cp\u003e2.64 (0.97)\u003c/p\u003e \u003cp\u003e3.74 (1.06)\u003c/p\u003e \u003cp\u003e2.70 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.087\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.336\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Multivariate Cox Regression Analysis on Hypertension and HRPT\u003c/h2\u003e \u003cp\u003eWe utilized four Cox proportional hazards models to analyze each physical fitness indicator. Model 1: an unadjusted model; Model 2: adjusted for gender and age; Model 3: adjusted for exercise, smoking, and fall history. The result has shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, in unadjusted Model 1, 30 seconds chair stand (β:-0.171 HR: 0.84, 95%CI: 0.74\u0026ndash;0.97, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), chair sit-and-reach (β:-0.122, HR: 0.88, 95%CI: 0.79\u0026ndash;0.99, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and back scratch (β:-0.148, HR:0.86, 95%CI:0.77\u0026ndash;0.97, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were identified as protective factors for hypertension. In the adjusted Model 2, 30 seconds chair stand(β: -0.171 HR༚0.84, 95%CI:0.74\u0026ndash;0.97,P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), chair sit-and-reach(β༚-0.128, HR༚0.88, 95%CI:0.78\u0026ndash;0.99, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05),back scratch(β:-0.149, HR༚0.86, 95%CI:0.77\u0026ndash;0.97, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) remained consistent with model 1, serving as protective factors for hypertension. There were some changes in Model 3, 30 seconds chair stand (β:-0.155, HR:0.86, 95%CI: 0.74\u0026ndash;0.99, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and back scratch(β:-0.140, HR:0.87, 95%CI: 0.77\u0026ndash;0.97, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) continued to show as protective factors, however chair sit-and-reach no longer exhibited statistical significance in this model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate cox regression analysis on the hypertension and HRPT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eModel\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eHR(95%CI)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOLB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003cp\u003e0.070\u003c/p\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.06(0.94\u0026ndash;1.19)\u003c/p\u003e \u003cp\u003e1.07(0.95\u0026ndash;1.21)\u003c/p\u003e \u003cp\u003e1.10(0.98\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003cp\u003e0.249\u003c/p\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30 Seconds Chair Stand\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.171\u003c/p\u003e \u003cp\u003e-0.167\u003c/p\u003e \u003cp\u003e-0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84(0.74\u0026ndash;0.97)\u003c/p\u003e \u003cp\u003e0.85(0.74\u0026ndash;0.97)\u003c/p\u003e \u003cp\u003e0.86(0.74\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChair Sit-and-Reach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.122\u003c/p\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003cp\u003e-0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88(0.79\u0026ndash;0.99)\u003c/p\u003e \u003cp\u003e0.88(0.78\u0026ndash;0.99)\u003c/p\u003e \u003cp\u003e0.89(0.79-1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30 Seconds Arm Curl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.119\u003c/p\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003cp\u003e-0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89(0.77\u0026ndash;1.03)\u003c/p\u003e \u003cp\u003e0.89(0.77\u0026ndash;1.04)\u003c/p\u003e \u003cp\u003e0.93(0.79\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003cp\u003e0.131\u003c/p\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 Minutes Step\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.027\u003c/p\u003e \u003cp\u003e-0.016\u003c/p\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97(0.86\u0026ndash;1.10)\u003c/p\u003e \u003cp\u003e0.98(0.87\u0026ndash;1.12)\u003c/p\u003e \u003cp\u003e0.99(0.87\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003cp\u003e0.805\u003c/p\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBack Scratch\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.148\u003c/p\u003e \u003cp\u003e-0.149\u003c/p\u003e \u003cp\u003e-0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86(0.77\u0026ndash;0.97)\u003c/p\u003e \u003cp\u003e0.86(0.77\u0026ndash;0.97)\u003c/p\u003e \u003cp\u003e0.87(0.77\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8-Foot Up-and-Go\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003cp\u003e0.106\u003c/p\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.12(0.99\u0026ndash;1.26)\u003c/p\u003e \u003cp\u003e1.11(0.98\u0026ndash;1.26)\u003c/p\u003e \u003cp\u003e1.10(0.97\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003cp\u003e0.091\u003c/p\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eModel 1 unadjusted, Model 2 Adjusted for Gender and Age;Model 3 Adjusted for Exercise, Smoking and Fall Incidents\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study explored the relationship between HRPT and incident hypertension in the elderly population using a large cohort study. From Participants\u0026rsquo; HRPT data and cox regression result, it is significantly that better perform in 30 seconds chair stand, chair sit-and-reach and back scratch are associated with a reduced incidence of hypertension.\u003c/p\u003e \u003cp\u003eChair sit-and-reach and back scratch are indicators representing up body flexibility in HRPT.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Thus, better flexibility is a protective factor for hypertension. Previously research conducted in Japan, has accordance with us that good flexibility related to lower incidence of hypertension.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Another study, which assessed 566 adults, revealed that individuals over 40 classified as poor flexibility, systolic blood pressure have a 5 mmHg higher than those with good flexibility.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] The mechanism that flexibility indicators to hypertension development involves associations with three intermediate parameters: arterial stiffness, arterial remodeling, and parasympathetic nervous activity dominance.[\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] These factors induce alterations in vascular structure, arterial remodeling, or the release of vasodilatory metabolites, such adaptive changes contribute to a reduction in vascular resistance, thereby potentially decreasing the incidence of hypertension.[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur result on lower body strength keep accordance with literature. There are statistic evidences that a higher RMS (Relative muscle strength) value could reduced risk of hypertension.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Furthermore, this relationship persists in subgroups with histories of diabetes, hyperlipidemia, and obesity, even after adjusting for covariates.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] The mechanisms that muscle strength indicators to hypertension development involves associations with two intermediate parameters: insulin resistance and loss of skeletal muscle mass.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] The former may result in sympathetic nervous system excitation, decreased renal vasoconstriction, and increased renal tubular sodium reabsorption, ultimately contributing to elevated blood pressure.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] The latter may increase the risk of vascular damage and arterial stiffness, thereby elevating vascular resistance and potentially leading to hypertension.[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44 CR45 CR46 CR47 CR48 CR49 CR50\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBased on our research, it is recommended that elderly population engage in exercises aimed at enhancing body flexibility and lower body muscle strength as a preventive measure against the onset of hypertension.\u003c/p\u003e \u003cp\u003ePrevious research has highlighted the importance of physical exercise for the health of the elderly, as it plays a significant role in reducing the incidence of various chronic diseases and premature death.[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] however, for the elderly population, paying attention to HRPT a is of greater importance. Because comparing with mere physical activity, HRPT is more robust risk factor cardiovascular disease, for instance with increased physical activity, the risk is reduced by approximately 25%, but with improved physical fitness, the risk is decreased by roughly 60%.[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] Therefore, training for physical flexibility and muscular strength should be recommended in both primary and secondary prevention of diseases to enhance the effectiveness of hypertension prevention among the population.\u003c/p\u003e \u003cp\u003eThus for elder population, emphasizing physical exercise to enhance these two fitness dimensions is crucial for hypertension prevention. For muscle strength, it is recommend that old population conduct resistance training and aerobic exercise.[\u003cspan additionalcitationids=\"CR56 CR57 CR58\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e] Regarding exercise intensity, it is recommend that every week engaging in at least 150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous-intensity aerobic exercise, or an combination of moderate-to-vigorous exercise at least 10 minutes every time.[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] To enhance body flexibility, a six-week static stretching, which involves performing bilateral stretches five times per week, with each session lasting 30 minutes and short-term Pilates training (5 or 10 weeks), long-term Pilates training (6 months) and yoga are effectively.[\u003cspan additionalcitationids=\"CR62 CR63 CR64\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e] Combining two fitness dimensions, Tai Chi and Square Stepping Exercise can simultaneously improve both physical flexibility and muscle strength.[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e] It should be noted that the nutrition support with the exercise had shown better improvement.[\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eOur study is a large-scale cohort study explore the different dimensions of HRPT have different relationships with hypertension. We found that better lower muscle strength and up body flexibility are protective factors of hypertension. To decrease the disease incidence and release the disease burden on health system, it is more effectively focus on comprehensions HRPT index relative training than no purpose physical exercise.\u003c/p\u003e"},{"header":"6. Limitation","content":"\u003cp\u003eOur study is a cohort study, we encountered a high loss-to-follow-up rate of 36.4%. Among those lost to follow-up, the probability of death due to physical conditions or illnesses is relatively high, resulting in the exclusion of a significant number of potential hypertension cases from the statistical analysis, which introduces bias into the study results. Additionally, during the survey, some elderly individuals had a lack of clear understanding of the concept of hypertension, leading to potential misreporting, which may also impact the study findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of interest\u003c/h2\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThis work were supported by Wuhan Science and Technology Bureau and the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe ethics committee of Wuhan Centre for Disease Prevention and Control has censored the study process and has given the permit (NO.WHCDCIRB-K-2021058). Informed consent was obtained from every participants.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work were funded by Wuhan Science and Technology Bureau's Knowledge Innovation Special Project (NO.2022020801020594 and NO.2023020201010205)\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eWL, YZ and XL contributed to the study design, analysis,and interpretation of data and drafted the manuscript. YY, WZ, SK, SZ, TY, LW performed data acquisition. YG and MY participated in the design andcoordination of the study and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThis work were supported by Wuhan Science and Technology Bureau and the Disease Burden Innovation Research Department of Wuhan Centre for Disease Prevention and Control.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005 Jan 15\u0026ndash;21;365(9455):217\u0026thinsp;\u0026ndash;\u0026thinsp;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(05)17741-1\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(05)17741-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15652604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen Y, Shi J, Qiao Y, Gu Y, Li Y, Liu Y, Cheng Y, Liu Y. 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PMID: 37057640; PMCID: PMC10235889.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Health Related Physical Fitness, Cohort Study, Elder Population","lastPublishedDoi":"10.21203/rs.3.rs-6303691/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6303691/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e The purpose of this study is to establish robust epidemiological evidence regarding the association between various dimensions of HRPT and hypertension.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A 7 years large-scale cohort study were conducted. The baseline survey was conducted in 2015, with participants aged 65 or above from Wuhan city. The follow-up for this study was conducted as part of the annual physical examination survey for elderly individuals in Wuhan City, with outcome follow-ups conducted in 2018, 2019, 2020, 2021, and 2022, respectively. Chi-square test and multivariate cox regression analysis was conducted to assess the relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e695 people's hypertension status have tracked, the incidence of hypertension is 36.4%. The patients are significantly weak in chair sit-and-reach (2.60±0.89 VS 2.8±1.13, P=0.028), 30 seconds arm curl (2.13±1.16 VS 2.26±0.93, P=0.024) , and stronger in back scratch (3.53±1.05 VS 3.74, P=0.009), better 30 seconds chair stand (β:-0.155, HR:0.86, 95%CI: 0.74-0.99, P\u0026lt;0.05) and back scratch (β:-0.140, HR:0.87, 95%CI: 0.77-0.97, P\u0026lt;0.05) abilities shown as protective factors of hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eBetter lower muscle strength and up body flexibility are protective factors of hypertension. To decrease the hypertension incidence, elder people were recommended to perform exercises targeting these two dimensions.\u003c/p\u003e","manuscriptTitle":"Association between Health-Related Physical Fitness and Incident Hypertension among the Elderly in Wuhan: A Seven-Year Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 07:12:13","doi":"10.21203/rs.3.rs-6303691/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-02T05:20:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-29T08:46:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T07:06:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199524870708683717997248287924576073423","date":"2025-08-24T12:56:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63375385931450738547294225262771036883","date":"2025-08-19T06:49:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244665710132207538899593371951909045021","date":"2025-06-20T01:49:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T10:42:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-07T00:42:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306600873400867369621970640820165312302","date":"2025-06-07T00:16:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161357542704143876332649444913141094321","date":"2025-06-05T07:45:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-29T06:27:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-02T05:02:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-28T02:31:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-28T02:30:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-25T12:06:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88d7c3e7-4c9c-4e66-92f8-3d7a5de5d9a8","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:08:20+00:00","versionOfRecord":{"articleIdentity":"rs-6303691","link":"https://doi.org/10.1186/s12889-025-25635-3","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-11-27 15:58:28","publishedOnDateReadable":"November 27th, 2025"},"versionCreatedAt":"2025-05-07 07:12:13","video":"","vorDoi":"10.1186/s12889-025-25635-3","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25635-3","workflowStages":[]},"version":"v1","identity":"rs-6303691","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6303691","identity":"rs-6303691","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}