Abstract
Objectives
To quantify the longitudinal change in stair climb performance (a measure indicative of both physical function and muscle power), determine whether physical activity is related to slower decline in performance, and to identify factors that modify the longitudinal change in performance among women from midlife to late life.
Design
Longitudinal cohort study with up to 15 study visits.
Setting
Two sites of the Study of Women’s Health Across the Nation.
Participants
Black (n=411) and white (N=419) women followed from median age 47.0 (44.6–49.6) to 62.0 (55.8–65.3) years.
Interventions
N/A.
Measurements
Performance on a stair climb test (ascend/descend 4 steps, 3 cycles) was timed. Physical activity (PA) was assessed using the Kaiser Physical Activity Survey (KPAS; possible range 0–15 points). Sociodemographic and health factors were assessed via self-report. BMI was calculated with measured height and weight. Mixed-effects regression modeled longitudinal change in stair climb performance.
Results
Average baseline stair climb time was 18.12 seconds (95% CI: 17.83–18.41), with 0.98% (95% CI: 0.84%–1.11%) annual slowing. In fully adjusted models, higher levels of PA were associated with faster stair climb times (2.09% faster per point higher, 95% CI: −2.87%–1.30%), and black women had 5.22% (95% CI: 2.43%–8.01%) slower performance compared to white women. Smoking, financial strain, diabetes, osteoarthritis, fair/poor health, and stroke were associated with 3.36% (95% CI: 0.07%–6.65%), 7.56% (95% CI: 4.75%–10.37%), 8.40% (95% CI: 2.89%–13.92%), 8.46% (95% CI: 5.12%–11.79%), 9.16% (95% CI: 4.72%–13.60%), and 16.94% (95% CI: 5.37%–28.51%) slower performance, respectively. In separate models, higher BMI (per 1-unit), osteoarthritis, fair/poor health, and diabetes, were each associated with 0.06% (95% CI:0.04%–0.08%), 0.48% (95% CI:0.12%–0.84%), 0.81% (95% CI:0.35%–1.28%), and 0.84% (95% CI:0.22%–1.46%), additional slowing per year over time.
Conclusion
Significant declines in function were evident as women transitioned from midlife to early late life. Declines were amplified by indicators of poor health, emphasizing the importance of health in midlife for promoting healthy aging.
Similar content being viewed by others
References
Sowers MF, Tomey K, Jannausch M, et al. Physical functioning and menopause states. Obstet Gynecol. 2007;110(6):1290–1296.
Tseng LA, El Khoudary SR, Young EZ, et al. The association of menopause status with physical function: The study of women’s health across the nation. Menopause. 2012;19(11):1186–1192.
Avis NE, Colvin A, Bromberger JT, et al. Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women’s Health Across the Nation. Menopause. 2009;16(5):860–869.
El Khoudary SR, McClure CK, VoPham T, et al. Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning: The Study of Women’s Health across the Nation. J Gerontol A Biol Sci Med Sci. 2014;69(8):1011–1017.
Sowers M, Pope S, Welch G, Sternfeld B, Albrecht G. The association of menopause and physical functioning in women at midlife. J Am Geriatr Soc. 2001;49(11):1485–1492.
Ylitalo KR, Herman WH, Harlow SD. Performance-based physical functioning and peripheral neruopathy in a population-based cohort of women at midlife. Am J Epidemiol. 2013;177(8):810–817.
Sowers M, Jannausch ML, Gross M, et al. Performance-based physical functioning in African-American and Caucasian Women at Midlife: Considering body composition, quadriceps strength, and knee osteoarthritis. Am J Epidemiol. 2006;163(10):950–958.
Tomey K, Sowers MF, Harlow SD, Jannausch M, Zheng H, Bromberger J. Physical functioning among mid-life women: Associations with trajectory of depressive symptoms. Social Science & Medicine. 2010;71(2010):1259–1267.
Ylitalo KR, Karvonen-Gutierrez CA, Fitzgerald N, et al. Relationship of race-ethnicity, body mass index, and economic strain with longitudinal self-report of physical functioning: The Study of Women’s Health Across the Nation. Ann Epidemiol. 2013;23(7):401–408.
Kirkness CS, Ren J. Race differences: Use of walking speed to identify community-dwelling women at risk for poor health outcomes—Osteoarthritis Initiative Study. Phys Ther. 2015;95(7):955–965.
Andresen EM, Brownson RC. Disability and health status: Ethnic differences among women in the United States. J Epidemiol Community Health. 2000;54(3):200–206. doi: https://doi.org/10.1136/jech.54.3.200.
Colbert CJ, Almagor O, Chmiel JS, et al. Excess body weight and four-year function outcomes: Comparison of African Americans and whites in a prospective study of osteoarthritis. Arthritis Care Res (Hoboken). 2013;65(1):5–14.
Sternfeld B, Colvin A, Stewart A, et al. The effect of a healthy lifestyle on future physical functioning in midlife women. Med Sci Sports Exerc. 2017;49(2):274–282.
Dugan SA, Everson-Rose SA, Karavolos K, Sternfeld B, Wesley D, Powell LH. The impact of physical activity level on SF-36 role-physical and bodily pain indices in midlife women. J Phys Act Health. 2009;6(1):33–42.
Pettee Gabriel K, Sternfeld B, Colvin A, et al. Physical activity trajectories during midlife and subsequent risk of physical functioning decline in late mid-life: The Study of Women’s Health across the Nation (SWAN). Prev Med. 2017;105:287–294.
Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994. Vital Health Stat 10. 1995;(193 Pt 1)(193 Pt 1):1–260.
Wittink H, Rogers W, Sukiennik A, Carr DB. Physical functioning: Self-report and performance measures are related but distinct. Spine (Phila Pa 1976). 2003;28(20):2407–2413.
Bean JF, Olveczky DD, Kiely DK, LaRose SI, Jette AM. Performance-based versus patient-reported physical function: What are the underlying predictors? Phys Ther. 2011;91(12):1804–1811.
Guralnik JM, Branch LG, Cummings SR, Curb JD. Physical performance measures in aging research. J Gerontol. 1989;44(5):M141–6.
Cress ME, Schechtman KB, Mulrow CD, Fiatarone MA, Gerety MB, Buchner DM. Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc. 1995;43(2):93–101.
Oh-Park M, Wang C, Verghese J. Stair negotiation time in community-dwelling older adults: Normative values and association with functional decline. Arch Phys Med Rehabil. 2011;92(12):2006–2011.
Bendayan R, Cooper R, Wloch EG, Hofer SM, Piccinin AM, Muniz-Terrera G. Hierarchy and speed of loss in physical functioning: A comparison across older U.S. and English men and women. J Gerontol A Biol Sci Med Sci. 2017;72(8):1117–1122.
Chen HY, Wang CY, Lee MY, Tang PF, Chu YH, Suen MW. A hierarchical categorisation of tasks in mobility disability. Disabil Rehabil. 2010;32(19):1586–1593.
Weiss CO, Fried LP, Bandeen-Roche K. Exploring the hierarchy of mobility performance in high-functioning older women. J Gerontol A Biol Sci Med Sci. 2007;62(2):167–173.
Sowers MF, Crawford SL, Sternfeld B, Morganstein D, Gold EB, Greendale GA. SWAN: A multi-center, multi-ethnic, community-based cohort study of women and the menopausal transition. In: Lobo RA, Kelsey J, Marcus R, eds. Menopause: Biology and pathobiology. San Diego, CA: Academic Press; 2000:175–188.
Kurina LM, Gulati M, Everson-Rose SA, et al. The effect of menopause on grip and pinch strength: results from the Chicago, Illinois, site of the Study of Women’s Health across the Nation. Am J Epidemiol. 2004;160:484–491.
Sternfeld B, Ainsworth BE, Quesenberry CP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):313–323.
Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936–42.
Radloff L. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
Boyd JH, Weissman MM, Thompson WD, Myers JK. Screening for depression in a community sample. understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry. 1982;39(10):1195–1200.
Mendes de Leon CF, Beckett LA, Fillenbaum GG, et al. Black-white differences in risk of becoming disabled and recovering from disability in old age: A longitudinal analysis of two EPESE populations. Am J Epidemiol. 1997;145(6):488–497.
Mendes de Leon CF, Barnes LL, Bienias JL, Skarupski KA, Evans DA. Racial disparities in disability: Recent evidence from self-reported and performance-based disability measures in a population-based study of older adults. J Gerontol B Psychol Sci Soc Sci. 2005;60(5):S263–71.
Thorpe RJ,Jr, Koster A, Kritchevsky SB, et al. Race, socioeconomic resources, and late life mobility and decline: Findings from the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci. 2011;66(10):1114–1123.
Thorpe RJ,Jr, Kasper JD, Szanton SL, Frick KD, Fried LP, Simonsick EM. Relationship of race and poverty to lower extremity function and decline: Findings from the Women’s Health and Aging Study. Soc Sci Med. 2008;66(4):811–821.
Lange-Maia B, Strotmeyer E, Harris T, et al. Physical activity and change in long distance corridor walk performance in the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2015;63(7):1348–54.
Fleg J, Morrell C, Bos A, et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation. 2005;112:674–682.
Chiu CJ, Wray LA. Physical disability trajectories in older Americans with and without diabetes: The role of age, gender, race or ethnicity, and education. Gerontologist. 2011;51(1):51–63.
Houston DK, Ding J, Nicklas BJ, et al. Overweight and obesity over the adult life course and incident mobility limitation in older adults: The Health, Aging and Body Composition Study. Am J Epidemiol. 2009;169(8):927–936.
Nightingale EJ, Pourkazemi F, Hiller CE. Systematic review of timed stair tests. J Rehabil Res Dev. 2014;51(3):335–350.
Oh-Park M, Perera S, Verghese J. Clinically meaningful change in stair negotiation performance in older adults. Gait Posture. 2012;36(3):532–536.
Bean JF, Kiely DK, LaRose S, Alian J, Frontera WR. Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults? Arch Phys Med Rehabil. 2007;88(5):604–9.
Ni M, Brown LG, Lawler D, Bean JF. Reliability, validity, and minimal detectable change of four-step stair climb power test in community-dwelling older adults. Phys Ther. 2017;97(7):767–773.
Silva AG, Queiros A, Cerqueira M, Rocha NP. Pain intensity is associated with both performance-based disability and self-reported disability in a sample of older adults attending primary health care centers. Disabil Health J. 2014;7(4):457–465.
Scudds RJ, Østbye T. Pain and pain-related interference with function in older Canadians: The Canadian Study of Health and Aging. Disabil Rehabil. 2001;23(15):654–664.
Weiner DK, Haggerty CL, Kritchevsky SB, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC cohort and implications for the future. Pain Med. 2003;4(4):311–320.
Acknowledgments: The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH. Clinical Centers: University of Michigan, Ann Arbor — Siobán Harlow, PI 2011–present, MaryFran Sowers, PI 1994–2011; Massachusetts General Hospital, Boston, MA — Joel Finkelstein, PI 1999–present; Robert Neer, PI 1994–1999; Rush University, Rush University Medical Center, Chicago, IL — Howard Kravitz, PI 2009–present; Lynda Powell, PI 1994–2009; University of California, Davis/Kaiser — Ellen Gold, PI; University of California, Los Angeles — Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY — Carol Derby, PI 2011–present, Rachel Wildman, PI 2010–2011; Nanette Santoro, PI 2004–2010; University of Medicine and Dentistry — New Jersey Medical School, Newark — Gerson Weiss, PI 1994–2004; and the University of Pittsburgh, Pittsburgh, PA–Karen Matthews, PI. NIH Program Office: National Institute on Aging, Bethesda, MD–Chhanda Dutta 2016–present; Winifred Rossi 2012–2016; Sherry Sherman 1994–2012; Marcia Ory 1994–2001; National Institute of Nursing Research, Bethesda, MD — Program Officers. Central Laboratory: University of Michigan, Ann Arbor — Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating Center: University of Pittsburgh, Pittsburgh, PA — Maria Mori Brooks, PI 2012–present; Kim Sutton-Tyrrell, PI 2001–2012; New England Research Institutes, Watertown, MA — Sonja McKinlay, PI 1995–2001. Steering Committee: Susan Johnson, Current Chair, Chris Gallagher, Former Chair. We thank the study staff at each site and all the women who participated in SWAN.
Author information
Authors and Affiliations
Corresponding author
Additional information
Disclosures: Dr. Kravitz reports grants from National Institutes of Health/National Institute on Aging during the conduct of the study. No other authors have any conflicts to report.
Rights and permissions
About this article
Cite this article
Lange-Maia, B.S., Karvonen-Gutierrez, C.A., Strotmeyer, E.S. et al. Factors Influencing Longitudinal Stair Climb Performance from Midlife to Early Late Life: The Study of Women’s Health Across the Nation Chicago and Michigan Sites. J Nutr Health Aging 23, 821–828 (2019). https://doi.org/10.1007/s12603-019-1254-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-019-1254-2