Biology of Sport

High-intensity recreational physical activity modifies the association between sedentary time and frailty: NHANES 2007–2018

Yiming Zhang 1
,
Feiran Yang 1
,
Jeffrey William Ripley-Gonzalez 2, 3
,
Yuhang Liu 4
,
Yang Gao 1
,
Jialing Tang 1
,
Siyao Gao 1

  1. Department of Physical Education, Central South University, Changsha, 410083, P. R. China

  2. Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital, Central
    South University, Changsha, Hunan, China

  3. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha,
    Hunan, China

  4. School of Physical Education, Wuhan Sports University, Wuhan, 430079, P. R. China

Biol Sport. 2027;44:85–104

DOI: https://doi.org/10.5114/biolsport.2026.162402
Data publikacji online: 2026/09/16
Article file
7_05354_Article.pdf
Confronting perimenopausal women’s knowledge of coronary heart disease with their health behaviours. Controversial role of hormone replacement therapy in the protection of coronary heart disease
  1. Hubbard RE, Theou O. Frailty: enhancing the known knowns. Age Ageing. 2012; 41(5):574–575.
  2. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in Older Adults: A Nationally Representative Profile in the United States. J Gerontol a Biol Sci Med Sci. 2015; 70(11):1427–34.
  3. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019; 394(10206):1365–1375.
  4. Barrera A, Rezende LFM, Sabag A, Keating CJ, Rey-Lopez JP. Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review. Healthcare (Basel). 2023; 12(1):22.
  5. Morales DR, Guthrie B, Downes TJ, McAllister DA, Hanlon P. Applicability of the electronic frailty index in younger and older adults in England: a populationbased cohort study. Lancet Healthy Longev. 2025; 6(8):100752.
  6. Morales DR, Guthrie B, Downes TJ, McAllister DA, Hanlon P. Applicability of the electronic frailty index in younger and older adults in England: a populationbased cohort study. Lancet Healthy Longev. 2025; 6(8):100752
  7. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019; 394(10206):1376–1386.
  8. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017; 14(1):75.
  9. Yang L, Cao C, Kantor ED, Nguyen LH, Zheng X, Park Y, et al. Trends in Sedentary Behavior Among the US Population, 2001–2016. Jama. 2019; 321(16):1587–1597.
  10. Onagbiye S, Guddemi A, Baruwa OJ, Alberti F, Odone A, Ricci H, et al. Association of sedentary time with risk of cardiovascular diseases and cardiovascular mortality: A systematic review and meta-analysis of prospective cohort studies. Prev Med. 2024; 179:107812.
  11. Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev. 2023; 103(2):1137–1191.
  12. Mo Y, Zhou Y, Chan H, Evans C, Maddocks M. The association between sedentary behaviour and sarcopenia in older adults: a systematic review and meta-analysis. Bmc Geriatr. 2023; 23(1):877.
  13. Alexe DI, Saha S, Choudhary PK, Alexe CI, Choudhary S, Tohănean DI. Exercise Snacks as a Strategy to Interrupt Sedentary Behavior: A Systematic Review of Health Outcomes and Feasibility. Healthcare (Basel). 2025; 13(24):3216.
  14. Balducci S, D’Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, et al. Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. Jama. 2019; 321(9):880–890.
  15. Cao C, Friedenreich CM, Yang L. Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors. JAMA Oncol. 2022; 8(3):395–403.
  16. Ekelund U, Tarp J, Fagerland MW, Johannessen JS, Hansen BH, Jefferis BJ, et al. Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med. 2020; 54(24):1499–1506.
  17. Rosolek B, Alexe DI, Gawlik K, Panaet EA, Mihai I, Antohe BA, et al. Exploring the Relationship Between Low Back Pain, Physical Activity, Posture, and Body Composition in Older Women. Healthcare (Basel). 2025; 13(9):1054.
  18. Kehler DS, Hay JL, Stammers AN, Hamm NC, Kimber DE, Schultz ASH, et al. A systematic review of the association between sedentary behaviors with frailty. Exp Gerontol. 2018; 114:1–12.
  19. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised metaanalysis of data from more than 1 million men and women. Lancet. 2016; 388(10051):1302–1310.
  20. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting Time, Physical Activity, and Risk of Mortality in Adults. J Am Coll Cardiol. 2019; 73(16):2062–2072.
  21. Zhang A, Li Y, Zhou J, Zhang Y, Xie S, Shao H, et al. Association between daily sitting time and sarcopenia in the US population: a cross-sectional study. Arch Public Health. 2025; 83(1):5.
  22. Zhou H, Nie J, Cao Y, Diao L, Zhang X, Li J, et al. Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults. BMC Public Health. 2024; 24(1):1069.
  23. . Liao J, Hu M, Imm K, Holmes CJ, Zhu J, Cao C, et al. Association of daily sitting time and leisure-time physical activity with body fat among U.S. adults. J Sport Health Sci. 2024; 13(2):195–203.
  24. Li Y, Di X, Liu M, Wei J, Li T, Liao B. Association between daily sitting time and kidney stones based on the National Health and Nutrition Examination Survey (NHANES) 2007–2016: a crosssectional study. Int J Surg. 2024; 110(8):4624–4632.
  25. Kwok WS, Khalatbari-Soltani S, Dolja-Gore X, Byles J, Tiedemann A, Pinheiro MB, et al. Leisure-Time Physical Activity and Falls With and Without Injuries Among Older Adult Women. Jama Netw Open. 2024; 7(1):e2354036.
  26. Mayo A, O’Brien MW, Godin J, Kehler DS, Kimmerly DS, Theou O. Can an active lifestyle offset the relationship that poor lifestyle behaviours have on frailty? Arch Gerontol Geriatr. 2024; 127:105556.
  27. Hakeem FF, Bernabé E, Sabbah W. Association Between Oral Health and Frailty Among American Older Adults. J Am Med Dir Assoc. 2021; 22(3):559–563.e2.
  28. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008; 8:24.
  29. Shah SJ, Oreper S, Jeon SY, Boscardin WJ, Fang MC, Covinsky KE. Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. Proc Natl Acad Sci U S A. 2023; 120(7):e2209414120.
  30. Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K. Frailty in NHANES: Comparing the frailty index and phenotype. Arch Gerontol Geriatr. 2015; 60(3):464–470.
  31. Jayanama K, Theou O, Godin J, Mayo A, Cahill L, Rockwood K. Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Med. 2022; 20(1):404.
  32. Ning N, Fan X, Zhang Y, Wang Y, Liu Y, Li Y, et al. Joint association of cardiovascular health and frailty with all-cause and cause-specific mortality: a prospective study. Age Ageing. 2024; 53(7):afae156.
  33. Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, Van Domelen DR, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One. 2012; 7(6):e37696.
  34. Gale CR, Cooper C, Sayer AA. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 2015; 44(1):162–165.
  35. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54(24):1451–1462.
  36. Kellmann M, Bertollo M, Bosquet L, Brink M, Coutts AJ, Duffield R, et al. Recovery and performance in sport: consensus statement. Int J Sports Physiol Perform. 2018;13(2):240–245.
  37. Katzmarzyk PT, Powell KE, Jakicic JM, Troiano RP, Piercy K, Tennant B. Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee. Med Sci Sports Exerc. 2019; 51(6):1227–1241.
  38. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006; 54(6):991–1001.
  39. Cesari M, Penninx BW, Pahor M, Lauretani F, Corsi AM, Rhys Williams G, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol a Biol Sci Med Sci. 2004; 59(3):242–248.
  40. Nunes EA, Stokes T, McKendry J, Currier BS, Phillips SM. Disuse-induced skeletal muscle atrophy in disease and nondisease states in humans: mechanisms, prevention, and recovery strategies. Am J Physiol Cell Physiol. 2022;322(6):C1068–C1084.
  41. Bålsrud P, Ulven SM, Christensen JJ, Ottestad I, Holven KB. Inflammatory markers and frailty in home-dwelling elderly, a cross-sectional study. BMC Geriatr. 2024; 24(1):175.
  42. Caldo-Silva A, Furtado GE, Chupel MU, Bachi ALL, de Barros MP, Neves R, et al. Effect of Training-Detraining Phases of Multicomponent Exercises and BCAA Supplementation on Inflammatory Markers and Albumin Levels in Frail Older Persons. Nutrients. 2021; 13(4):1106.
  43. Ross R, Chaput JP, Giangregorio LM, Janssen I, Saunders TJ, Kho ME, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2020; 45(10 (Suppl. 2)):S57–s102.
  44. Zhou Y, Zhu J, Huang Y, Ma Y, Liu Y, Wu K, et al. Physical activity, sedentary behavior, and the risk of frailty and falling: A Mendelian randomization study. Scand J Med Sci Sports. 2024; 34(2):e14582.
  45. Kehler DS. The impact of sedentary and physical activity behaviour on frailty in middle-aged and older adults. Appl Physiol Nutr Metab. 2018; 43(6):638.
  46. Martínez-Montas GF, Sanz-Matesanz M, Benítez-Sillero JD, Martínez-Aranda LM. Prevention and Mitigation of Frailty Syndrome in Institutionalised Older Adults Through Physical Activity: A Systematic Review. Healthcare (Basel). 2025; 13(3):276.
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