Longitudinal Association Between Healthy Aging and Physical Activity Using an Outcome-Wide Approach
건강노화와 신체활동 간 종단적 연관성: 광범위 결과 접근 방식으로
- 주제(키워드) Healthy Aging , Physical Activity , Outcome-wide approach , Generalized Estimating Equation
- 주제(DDC) 610
- 발행기관 아주대학교 일반대학원
- 지도교수 Yunhwan Lee
- 발행년도 2026
- 학위수여년월 2026. 8
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000036661
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background: Physical activity is a modifiable lifestyle factor that may contribute to healthy aging. However, healthy aging is multidimensional, and the association between physical activity and healthy aging may differ across indicators, domains, and overall index-level outcomes. This study examined the longitudinal association between physical activity and healthy aging using an outcome-wide approach. Methods: Using longitudinal data from the Korean Urban Rural Elderly（KURE） study, this study analyzed 3,481 older adults. Healthy aging was assessed at the indicator, domain, and Healthy Aging Index levels. Physical activity was measured using WHO-Defined Physical Activity and International Physical Activity Questionnaire （IPAQ）. Outcome-wide longitudinal regression analysis and Outcome-wide longitudinal Generalized Estimating Equation （GEE） analysis were conducted, with adjustment for prior physical activity, baseline healthy aging status, and covariates. False Discovery Rate （FDR）, Bonferroni correction, and Inverse Probability Weighting （IPW） analysis were applied. Results: In the Outcome-wide longitudinal regression analysis, WHO-Defined Physical Activity was positively associated with the Healthy Aging Index and the physical, psychological, and social domains after False Discovery Rate （FDR） correction, and the association with the Healthy Aging Index remained significant after Bonferroni correction. International Physical Activity Questionnaire （IPAQ） was positively associated with the Healthy Aging Index and the physical domain after Bonferroni correction. In contrast, the Outcome-wide longitudinal GEE analysis showed more heterogeneous associations, including several negative associations at the domain and indicator levels. No GEE results remained significant after Bonferroni correction. These findings were consistent in the IPW-adjusted analysis. Conclusions: Physical activity was associated with better subsequent healthy aging in regression analyses, particularly at the index and domain levels, while GEE analyses suggested more complex time-dependent patterns. These findings support physical activity as a key modifiable factor for healthy aging and suggest the importance of community and policy strategies that promote accessible and age-appropriate physical activity among older adults.
more목차
Ⅰ. Introduction 1
A. Background 1
B. Study aim and Hypothesis 3
C. Literature review 6
1. Healthy Aging 6
2. Physical Activity 8
3. Outcome-wide Longitudinal Design 10
Ⅱ. Methods 12
A. Study Design 12
B. Study Population 14
C. Assessment of Healthy Aging Outcomes 15
D. Assessment of Physical Activity 19
E. Covariates 21
F. Statistical Analysis 23
1. Descriptive Analysis 23
2. Missing Data and Follow-up Status 23
3. Outcome-Wide Longitudinal Regression Analysis 24
4. Outcome-Wide Longitudinal GEE Analysis 24
5. Multiple Testing Correction and E-value Analysis 25
6. Sensitivity Analysis 26
a） IPW Weighted Outcome-Wide Longitudinal Regression Analysis 26
b） IPW Weighted Outcome-Wide Longitudinal GEE Analysis 27
7. Statistical Software 27
Ⅲ. Results 29
A. General Characteristics of the Study Participants 29
B. Physical Activity and Healthy Aging Outcomes Characteristics of the Study Participants 31
C. Missing Data and Follow-up Status 33
D. Outcome-Wide Longitudinal Regression Analysis 36
1. Outcome-Wide Longitudinal Regression Between WHO-Defined Physical Activity and the Healthy Aging Outcomes 36
2. Outcome-Wide Longitudinal Regression Between IPAQ and the Healthy Aging Outcomes 38
E. Outcome-Wide Longitudinal GEE Analysis 41
1. Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Index 41
2. Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Domains 44
a） WHO-Defined Physical Activity 45
b） IPAQ 48
3. Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Indicators 51
a） WHO-Defined Physical Activity 51
b） IPAQ 53
Ⅳ. Discussion 57
A. Summary of Results 57
1. Interpretation of Outcome-wide Longitudinal Regression Results 57
2. Interpretation of Outcome-wide Longitudinal GEE Results 59
3. Interpretation of Consistency and Differences Between the Two Analysis Results 61
B. Comparison with Existing Literature 62
C. Explanation of Possible Mechanisms 65
D. Interpretation of Unexpected or Analogous Results 66
E. Limitations of the Study 69
F. Strengths of the Study 73
Ⅴ. Conclusion 75
Reference 78
Appendix 90
A. IPW Weighted Outcome-Wide Longitudinal Regression Analysis 90
1. IPW Weighted Outcome-Wide Associations Between WHO-Defined Physical Activity and the Healthy Aging Outcomes 90
2. IPW Weighted Outcome-Wide Associations Between IPAQ and the Healthy Aging Outcomes 91
B. IPW Weighted Outcome-Wide Longitudinal GEE Analysis 91
1. IPW Weighted Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Index 92
2. IPW Weighted Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Domains 93
a） WHO-Defined Physical Activity 94
b） IPAQ 94
3. IPW Weighted Outcome-Wide GEE Results for Physical Activity Measures and Longitudinal Changes in the Healthy Aging Indicators 95
a） WHO-Defined Physical Activity 95
b） IPAQ 95
