Locomotor disability in a cohort of British men: the impact of lifestyle and disease

Abstract

Background Increasing life expectancy has brought public health concernabout the increase in prevalence of disability in old age. Reducing theprevalence of disability in older age requires the identification ofpreventable or modifiable risk factors earlier in life. We have examinedthe relationship between lifestyle and other potential risk factors inmen aged 40-59 years at screening and locomotor disability 12-14 yearslater to assess whether any of these factors have direct and independentroles in influencing disability in later life.Methods In 1978-1980, a longitudinal study of cardiovascular disease wasinitiated in 7735 men aged 40-59 years drawn from one general practicein each of 24 British towns. The present study concerns 5717 men, 88%of the surviving men who were available to follow-up (i.e. wereregistered with a GP and had an address) and who satisfactorilycompleted the disability section of a follow-up postal questionnaire in1992 (Q92). The main endpoint from the questionnaire was locomotordisability based on self-reported inability in any one or more of thefollowing: to get outdoors, walk 400 m, climb stairs, maintain balance,bend down, or straighten up.Results In the 5717 men (mean age 63 years) who provided information ondisability status, 25.0% reported locomotor disability and the majorityof these men recalled a doctor-diagnosed disease of which cardiovasculardisease was most strongly associated with locomotor disability.Lifestyle factors at screening (smoking, physical inactivity, obesityand heavy drinking) and manual social class were strongly andindependently associated with increased odds of locomotor disability12-14 years later. By contrast, baseline blood pressure and serum totalcholesterol showed little relationship with locomotor disability. Amongmen with diagnosed major cardiovascular disease (stroke, myocardialinfarction, angina or aortic aneurysm) those with locomotor disabilityshowed significantly higher adverse lifestyle factors at screening thanthose who were able. Similarly, adverse lifestyle factors were also seenmore frequently among disabled men with respiratory disease and amongdisabled men with other non-cardiovascular conditions than among theirable counterparts.Conclusions Smoking, obesity, physical inactivity and heavy drinking inmiddle age are strong predictors of locomotor disability in later lifeindependent of the presence of diagnosed disease. Leading a healthylifestyle improves survival and reduces the incidence of disease. Italso reduces the risk of locomotor disability and increases the odds ofbeing disability-free even in the event of developing majorcardiovascular disease.