Written Evidence Submitted by
Dr Charlotte Campbell at CLOSER, the home of longitudinal research (UCL Social Research Institute) (HAP0110)

House of Commons Health and Social Care Committee Inquiry – Healthy Ageing: physical activity in an ageing society

Response from CLOSER, the home of longitudinal research (UCL Social Research Institute)

Authors: Dr Charlotte Campbell, CLOSER Policy Research Fellow, and Parasala Jagadeesan, CLOSER Education & Training Intern.

Reviewers: Rob Davies, Head of Policy and Dialogue; Jay Dominy, Public Affairs Manager; Professor Jennifer Symonds, Director

1. About us:

1.1.  CLOSER, the home of longitudinal research[1], is the UK’s partnership of leading social and biomedical longitudinal population studies and works to increase their visibility, use and impact. Our partner studies[2] comprise national and regional studies from across the UK. CLOSER partner studies include the British Birth Cohort Studies, English Longitudinal Study of Ageing, Health and Employment After Fifty, Generation Scotland, Northern Ireland Cohort for the Longitudinal Study of Ageing, Whitehall II, Understanding Society – the UK Household Longitudinal Study, and more.

1.2.  CLOSER has been funded by the UKRI Economic and Social Research Council (ESRC) since 2012 and is based at the UCL Social Research Institute.

2. Our reason for submitting evidence:

2.1.  CLOSER represents multiple longitudinal population studies across the UK. These national scientific assets follow the same people and households over time, often from birth, collecting a wide array of data and information about study participants, which enable researchers and policymakers to explore people’s complex lives and how changes in society affect health, community and education. CLOSER’s strategic position in the research landscape and birds’ eye view of the UK’s longitudinal population studies makes it an ideal vehicle for identifying and communicating evidence to inform policy.

2.2.  The UK’s longitudinal population studies are recognised as vital sources of evidence on how life circumstances, experiences and behaviours affect people across their life, providing insights into individual short and long-term change and the relationship between different elements of people’s complex lives that cannot be obtained from any other data sources. They allow researchers to explore how different groups vary, and how and why people’s lives change, enabling a greater understanding of the difference between causal relationships and correlation.

2.3.  Several UK longitudinal population studies have collected data about healthy ageing and physical activity, including:

• The 1946 National Survey of Health and Development (NSHD)[3]
• The 1958 National Child Development Study (NCDS)[4]
• The 1970 British Birth Cohort (BCS70)[5]
• The English Longitudinal Study of Ageing (ELSA)[6]
• Health and Employment After Fifty (HEAF)[7]
• The Hertfordshire Cohort Study (HCS)[8]
• The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA)[9]
• Understanding Society: the UK Household Longitudinal Study[10]
• Whitehall II[11]

2.4.  Research using these studies has identified risk factors for physical inactivity in older adulthood, including socioeconomic disadvantage, poor health, and history of other health-risk behaviours, as well as critical periods where intervention may be most beneficial. As longitudinal population studies follow individuals over their life course, they provide unique evidence on the long-term trends in physical activity and factors in earlier life that contribute to physical activity patterns in older age. These studies have also identified barriers to older people increasing their physical activity, namely poor health, lack of social support or history of physical activity, and the local environment.

2.5.  Our response draws on data and evidence from multiple UK longitudinal population studies to provide insights on questions 1 to 4 in the call for evidence.

Responses to the inquiry questions

1. What are the opportunities in public health to promote physical activity to prevent physical and mental ill health at a population-level as people begin to age and help them remain healthy into older age? How can this be delivered?

• Promoting physical activity may be particularly important in helping certain populations remain healthy into older age.
• Research using the Whitehall II study found that physical activity appears to be a particularly important target to prevent dementia in individuals with cardiovascular disease, but the evidence for dementia prevention through physical activity for the general population is inconsistent (1).
• Research using data from the 1946 NSHD showed that poorer physical ability at age 53 was associated with a higher likelihood of retiring for negative reasons and a lower likelihood of participating in other employment after retirement from a main occupation. The possibility for an extended working life is less likely to be realised by those with poorer midlife physical ability (2).
• Among older workers in the Health and Employment After Fifty (HEAF) study, slow walking speed was associated with a fourfold increased risk of a health-related job loss, and was more likely for those who were obese, physically inactive, smoked, in financial hardship, with lower educational attainment, or not in professional occupations (3). Slow walking speed could be used to identify those at particular risk of job loss and for whom physical activity interventions would extend their working lives.
• Patterns of physical activity generally do not change as people age, so interventions should aim to increase physical activity at earlier life stages.
• Data from the English Longitudinal Study of Ageing shows that an individual’s tendency to engage in multiple behaviours that negatively impact their health generally remains stable as they age. Older adults who showed low levels of physical activity, even if they ate healthily and/or abstained from alcohol, had a higher prevalence of complex multimorbidity and endocrine disorders than those who were physically active (8).
• Health and socioeconomic circumstances in early life have long-lasting impacts on physical activity.
• Data from NCDS also showed that physical inactivity links to early life health and socioeconomic disadvantage. In particular, being obese for a longer period and living in a poorer neighbourhood in young adulthood had long lasting associations with inactivity patterns in mid-life (10).
• Transitioning from being inactive to active is beneficial even in older adulthood, and even small increases in activity are beneficial.
• Similarly, ELSA participants (with average age 64 years) who became active or remained active were more likely to achieve “healthy ageing” over 8 years of follow-up (i.e. not develop a major chronic disorder, experience depressive symptoms, and have physical or cognitive impairments) (12).
• Research using The Irish Longitudinal Study on Ageing (TILDA), found that performing as little as 100 minutes per week, or 20 minutes per day, of moderate-intensity activity (e.g. brisk walking) may be sufficient to significantly lower rates of depressive symptoms and odds of major depression over time among older adults (13).
• Remote interventions by telephone may be a viable option to promote physical activity in older adults.
• During the COVID-19 pandemic, participants of the Hertfordshire Cohort Study aged 79 years or older took part in a behavioural intervention via the telephone to promote dietary changes and physical activity, which included the use of Healthy Conversation Skills. Although this small study was not powerful enough to test the efficacy of the intervention on behaviour, 95% of participants completed the intervention, demonstrating the potential of high engagement with such an intervention for this age group (14).
• Policy recommendations for delivery:
• Target promotion of physical activity to at-risk populations, including those with cardiovascular disease and middle-aged adults with poor physical ability.
• Encourage physical activity across the entire life course, understanding that patterns of activity tend to remain similar over time.
• Promote even small increases in physical activity among older adults with flexible, low barrier programmes that can accommodate varying levels of physical ability.

2. What are the opportunities for health services to promote physical activity to reduce the impacts of ill health and reduce the development of multimorbidity and/or frailty in older people who already have a long-term health condition? How can this be delivered? 

• Evidence from UK longitudinal population studies consistently finds that multimorbidity is more likely among those who are more physically inactive.
• In data from ELSA, the prevalence of multimorbidity steadily increased over time among English adults aged 50 and over, with the risk higher the more physically inactive an individual is (4).
• Analyses of ELSA data also found that physical inactivity increased the risk of multimorbidity by 33%, and this risk was 2-3 times higher when combined with obesity or smoking, and 4 times higher when combined with both. Any combination of 2, 3, and 4 or more unhealthy lifestyle factors significantly increased the risk of multimorbidity (5).
• Similar results were found among participants in the Hertfordshire Cohort Study, who were more likely to have poor physical function the higher the number of lifestyle risk factors they exhibited, including low physical activity, poor diet, obesity and smoking (6).
• Lack of physical activity can increase the probability of chronic and complex health problems. However, the reverse is also likely, with worsening health outcomes making it harder to stay active, creating a feedback loop of deteriorating health and low activity (7).
• Adolescence and mid-adulthood may be critical periods to promote physical activity with the aim of reducing multimorbidity in older adults.
• Research using data from the 1958 longitudinal birth cohort study (NCDS) found that leisure time physical activity in adolescence and mid-adulthood had a stronger effect on the risk of multimorbidity than in other periods, with adolescence showing an independent critical effect on this risk (9).
• However, becoming active even in older age is protective against developing or worsening of frailty.
• In ELSA, adults aged 50 and over who participated in physical activity at least once per week had a significantly lower risk of frailty worsening and higher likelihood of frailty improvement, and transitioning from inactivity to activity was associated with a lower risk of frailty (11).
• Policy recommendations for delivery:
• Integrate physical activity promotion into chronic disease prevention programmes, especially for adults aged 50 and over, where inactivity is strongly linked to increasing multimorbidity and frailty.
• Taking a preventative approach, invest in physical activity promotion during adolescence and mid-adulthood, recognising these as critical periods to reduce multimorbidity in later life and reducing future costs for the health service.

3. What are the key barriers to older people increasing their physical activity and how can they be encouraged and supported to do more?

• Research using data from three UK longitudinal population studies identified a range of factors that were associated with high-impact physical activity among people aged in their 60s, 70s and 80s. Lower levels of physical activity were more likely for older people and women, and individuals with lower education, lack of regular active transport, slower walking speed, and poorer health (15).
• Poor health is a significant barrier to increasing or maintaining physical activity for many older adults.
• Pain is a prevalent concern among older adults, with close to one quarter of adults in ELSA reported experiencing moderate-to-severe general pain at least twice over a 4-year period. Persistent reporting of pain was associated with impaired activities of daily living and objective physical performance, with the strongest effects seen with the combination of hip and knee pain (16).
• There is a bi-directional relationship between sleep and physical activity for older adults, with poor sleep associated with less physical activity, and less physical activity associated with poorer sleep; this effect was found to span over several years (17).
• In research using data from Understanding Society, past engagement in physical activity and walking for pleasure were found to be strong predictors of walking behaviour in older people, underscoring the importance of implementing and sustaining walking interventions across the lifespan. Having close friends and local retail destinations were associated with more weekly walking; however, poor health significantly impeded walking in this demographic, emphasising the need for interventions that offer both physical assistance and social support (18).
• In a qualitative sub-study of Hertfordshire Cohort Study participants, analysis of focus groups identified six themes that appeared to affect older adults’ (aged 74-83 years) participation in physical activity: past life experiences, significant life events, getting older, physical activity environment, psychological/personal factors, and social capital. Overall, the findings emphasised the role of modifiable factors, namely psychological factors, such as self-efficacy (belief in your own competence), motivation and outcome expectancy, and social factors, such as social support and social engagement (19).
• Policy recommendations for overcoming barriers:
• Developing programmes that support health and encourage healthy behaviours across the life course will enable older adults to remain active and avoid a feedback loop of deteriorating health and low physical activity.
• Encourage sustained participation in physical activity across the life course to build habits that persist into older age.
• Facilitate engagement in activities that provide social support as well as physical activity, perhaps through local communities, groups and clubs.

4. How can health services work with social care, the third sector, businesses and local government to support older people to be more physically active and address existing health inequalities?

• Interventions promoting social participation over the life course could result in higher levels of physical activity in older adults.
• In the 1970 British Cohort Study, those who participated in social activities throughout their lives carried out more physical activity and had higher step count at age 42 than those who did little social participation. This highlights the importance of promoting social participation at all ages over the life course, rather than just at particular “sensitive” time points, for example, during adolescence (20).
• Motor skills interventions in childhood and adolescence may promote lifelong leisure-time physical activity.
• Research using data from NCDS showed that better ability at games and faster tapping speed in adolescence were associated with greater participation in leisure-time physical activity (e.g. sports, exercises, other active leisure activities) throughout adult life, from ages 36 to 68 years (21).
• The neighbourhood environment influences how much walking is undertaken by older adults, with more walking seen in central city or town locations with shorter, more walkable, access to multiple destinations.
• In data from the Whitehall II study, more walking was seen in individuals who lived in areas that were more densely populated, with more road traffic and traffic-related air pollution, more public transport, more non-residential buildings, fewer green spaces and closer proximity to shops. The results also showed that residents of socioeconomically advantaged and disadvantaged areas may equally benefit from highly-walkable environments (22).
• Similarly, older adults taking part in Understanding Society were found to walk more if they lived in an area perceived to have higher crime rates, poorer safety, and closer proximity to retail centres (18). This, and the result from the Whitehall II study, is likely reflecting that walking is more common and accessible for older adults who live in more central, densely populated urban areas.
• Policy recommendations for health services:
• Work with local government, charity and other sectors to promote and facilitate social participation across the entire life course, for example, through social prescribing schemes, or supporting community spaces and social clubs.
• Encourage education and youth services to include motor skills and physical activity as a core component of child development.
• Advocate for and help create local neighbourhoods that facilitate walking and active travel, recognising that both advantaged and disadvantaged communities benefit from such spaces.

References

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2.              Stafford, M. et al. Physical and cognitive capability in mid-adulthood as determinants of retirement and extended working life in a British cohort study. Scand. J. Work. Environ. Health 43, 15–23 (2017).

3.              Syddall, H. E. et al. Slow walking speed and health-related exit from employment among older workers over 5 years of follow-up: evidence from the Health and Employment After Fifty (HEAF) cohort study. BMJ Open 14, (2024).

4.              Dhalwani, N. N. et al. Long terms trends of multimorbidity and association with physical activity in older English population. Int. J. Behav. Nutr. Phys. Act. 13, (2016).

5.              Dhalwani, N. N. et al. Association between lifestyle factors and the incidence of multimorbidity in an older english population. J. Gerontol. - Ser. Biol. Sci. Med. Sci. 72, 528–534 (2017).

6.              Robinson, S. M. et al. Clustering of lifestyle risk factors and poor physical function in older adults: The Hertfordshire Cohort Study. J. Am. Geriatr. Soc. 61, 1684–1691 (2013).

7.              Singer, L., Green, M., Rowe, F., Ben-Shlomo, Y. & Morrissey, K. Social determinants of multimorbidity and multiple functional limitations among the ageing population of England, 2002–2015. SSM - Popul. Health 8, (2019).

8.              Suhag, A., Webb, T. L. & Holmes, J. Longitudinal clustering of health behaviours and their association with multimorbidity in older adults in England: A latent class analysis. PLoS ONE 19, (2024).

9.              Feter, N., Leite, J. S., Umpierre, D., Caputo, E. L. & Rombaldi, A. J. Multimorbidity and leisure-time physical activity over the life course: a population-based birth cohort study. BMC Public Health 21, (2021).

10.              Pinto Pereira, S. M. & Power, C. Early adulthood determinants of mid-life leisure-time physical inactivity stability and change: Findings from a prospective birth cohort. J. Sci. Med. Sport 21, 720–726 (2018).

11.              Huang, L., Liang, Z. & Chen, H. Association between physical activity and frailty transitions in middle-aged and older adults: a nationwide longitudinal study. Int. J. Behav. Nutr. Phys. Act. 22, (2025).

12.              Hamer, M., Lavoie, K. L. & Bacon, S. L. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. Br. J. Sports Med. 48, 239–243 (2014).

13.              Laird, E., Rasmussen, C. L., Kenny, R. A. & Herring, M. P. Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing. JAMA Netw. Open 6, e2322489 (2023).

14.              Zhang, J. et al. A Healthy Conversation Skills intervention to support changes to physical activity and dietary behaviours in community-dwelling older adults during the COVID-19 pandemic. Perspect. Public Health (2024). doi:10.1177/17579139241262657

15.              Elhakeem, A. et al. Correlates of high-impact physical activity measured objectively in older British adults. J. Public Health U. K. 40, 727–737 (2018).

16.              Yiengprugsawan, V. & Steptoe, A. Impacts of persistent general and site-specific pain on activities of daily living and physical performance: A prospective analysis of the English Longitudinal Study of Ageing. Geriatr. Gerontol. Int. 18, 1051–1057 (2018).

17.              Kong, X. et al. Association of Abnormal Sleep Duration and Sleep Disturbance with Physical Activity in Older Adults: Between- and within-Person Effects. J. Am. Med. Dir. Assoc. 25, 368–374 (2024).

18.              Olsen, J. R. et al. Individual, social and area level factors associated with older people’s walking: Analysis of an UK household panel study (Understanding Society). Soc. Sci. Med. 358, (2024).

19.              Zhang, J. et al. Understanding influences on physical activity participation by older adults: A qualitative study of community-dwelling older adults from the Hertfordshire Cohort Study, UK. PLoS ONE 17, (2022).

20.              Tsoli, S. et al. Life-course social participation and physical activity in midlife: longitudinal associations in the 1970 British Cohort Study (BCS70). Eur. J. Epidemiol. 39, 643–651 (2024).

21.              Elhakeem, A., Hardy, R., Bann, D., Kuh, D. & Cooper, R. Motor performance in early life and participation in leisure-time physical activity up to age 68 years. Paediatr. Perinat. Epidemiol. 32, 327–334 (2018).

22.              Pliakas, T., Wilkinson, P. & Tonne, C. Contribution of the physical environment to socioeconomic gradients in walking in the Whitehall II study. Health Place 27, 186–193 (2014).