Maturitas 75 (2013) 113117

Contents lists available at SciVerse ScienceDirect

Maturitas
journal homepage: www.elsevier.com/locate/maturitas

Review

Lifestyle predictors of healthy ageing in men

Marita Sdergren
Centre of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden

a r t i c l e i n f o a b s t r a c t

Article history: With ageing populations a major challenge is to maintain physical and cognitive function, quality of
Received 15 January 2013 life and independence. The literature does not only indicate important gender differences in lifestyle
Received in revised form 22 February 2013 behaviours, but also how these behaviours might affect health outcomes. The current review has a male
Accepted 25 February 2013
perspective when exploring lifestyle predictors of healthy ageing, such as physical activity and sedentary
behaviours, smoking, diet and alcohol consumption. This review shows that not only do men with healthy
lifestyles survive longer, but also with good health and disability is postponed and compressed into fewer
Keywords:
years at the end of life. It is also clear that physical activity and smoking in midlife and late adulthood
Health behaviour
Food habits
impact and predict healthy ageing in men. However, healthy ageing has no clear phenotypic denition
Physical activity and more research is needed to establish the impact on dietary and sedentary behaviours on healthy
Smoking ageing in men. Adoption of healthier lifestyles could result in postponement of age associated diseases
Older adults and/or the slowing down of the ageing process. Consequently, this allows independent living for a longer
period of time and would reduce the burden to social and health care sectors.
2013 Elsevier Ireland Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
2. Lifestyle factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1. Physical activity, exercise, and sedentary behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.1. Physical activity and physical function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.2. Physical activity and cognitive function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.1.3. Sedentary behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
2.2. Smoking and alcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
2.3. Dietary behaviours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
3.1. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

1. Introduction older populations. The major challenge, with ageing populations

is to maintain physical and cognitive functions, quality of life and
Worldwide, it is well-recognized that the population is ageing independence.
and that this will have signicant economic and social impacts [1,2]. Ageing is a continuous process, that includes loss of functional
Accompanying these increasing life expectancies is an awareness capability and changes that depend on numerous genetic, environ-
of the need to promote positive ageing and healthy lifestyles for mental, and lifestyle factors [3]. Ageing is usually viewed as being
distinct from major chronic diseases, but there are often shared
exposure factors or mechanisms, for example, oxidative processes
Correspondence address: Centre of Family Medicine, Department of Neurobio-
that cause mutations in DNA. A study by Newman et al. showed a
logy, Care Sciences and Society, Karolinska Institutet, Alfred Nobels all 12, SE-141
graded relationship between the extent of vascular disease and the
83 Huddinge, Sweden. Tel.: +46 70 7360221. likelihood of an individual maintaining good health and function
E-mail address: marita.sodergren@ki.se as they age [4]. Previous studies have also found that an increased

0378-5122/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.maturitas.2013.02.011
114 M. Sdergren / Maturitas 75 (2013) 113117
central distribution of fat with advancing age are associated with
chronic metabolic and cardiovascular abnormalities [5]. Chronic
diseases such as cardiovascular disease, diabetes, and chronic respi-
ratory diseases are projected by the WHO to become the leading
causes of disability throughout the world by the year 2020 [2]. Three
modiable health risk behaviourslack of physical activity, tobacco
use, and poor nutritionare responsible for much of the illness, suf-
fering, and early death related to chronic diseases [1,2]. In addition,
sedentary behaviours are emerging as an important component of
the physical activity and health equation [6].
The link between physical activity and health has caused a surge
in physical activity research, and the evidence is overwhelming that
physical activity has a protective effect on cardiovascular health
and reduces all-cause mortality [7]. Physical activity has also the
power to attenuate the decline in appendicular lean tissue as an
individual age and to reduce the risk of abdominal adiposity and
degradation of skeletal muscles in the elderly (sarcopenia) [8]. Sev-
eral studies have reported a role for physical activity in preventing
depression and in maintaining cognitive function in older adults
[9,10]. It is also well known that physical activity and a sedentary
lifestyle have opposing effects on telomere length and thus may
slow down or accelerate or the ageing process, respectively [11].
Cigarette smoking is considered to be the number one killer
and is the leading cause of death worldwide [1,2]. There is an
adverse relationship between smoking and functional ability, and
strong and consistent associations have been observed between
sustained smoking from age 50 to 70 and reduced functional abil-
ity at age 75, even after adjustment for physical activity [12,13].
Furthermore, smoking is reported to be positively correlated with
alcohol consumption, and an unhealthy diet [14]. Conversely, older
adults who exercise regularly report a lower intake of dietary fat
compared to non-exercising older adults. It is clear that there are
multiple determinants for healthy ageing, and gender differences
have been observed in various lifestyle behaviours and in how
these behaviours affect health outcomes [15,16]. The current short
review, therefore, takes a male perspective when exploring lifestyle
predictors of healthy ageing.
2. Lifestyle factors
The MEDLINE and EMBASE databases were reviewed for
English-language publications concerning lifestyle predictors of
healthy ageing, such as physical activity and sedentary behaviours,
smoking, diet, and alcohol consumption. Of the studies found, 20
included a signicant number of men and were deemed suitable
for the current analysis (Table 1).
2.1. Physical activity, exercise, and sedentary behaviour
A comprehensive review on exercise and longevity, published in
this journal last year by Gremeaux et al., established that exercise
has the power to partially reverse the effects of the ageing process
on physiological functions and to preserve remaining functional
levels in both elderly men and elderly women [17]. The current
review is built on that work and, focuses on associations between
physical activity, and physical and cognitive function in elderly
men.
2.1.1. Physical activity and physical function
Several studies provide encouraging evidence that disability
prior to death is not an inevitable part of a mans life but may be pre-
vented by physical activity. For example, Leveille et al. showed that
physical activity (reported as walking, gardening, and exercising)
was a key factor in predicting a non-disabled 65-year-old mans
chances of surviving to age 80 and then being non-disabled prior
to death [18]. Also, Lobo et al. showed that institutionalized elderly
men participating in regular exercise programmes (both strength
and aerobic training) elicited a number of favourable responses
that prevent functional decline. Strength training induced signif-
icant changes in body strength and exibility tests, and the aerobic
training improved aerobic endurance, agility and dynamic balance
[19]. Moreover, a combination of smoking and exercise patterns
in midlife and late adulthood has been found to be a predictor
of subsequent disability. Bourke et al., found that exercising and
refraining from cigarette smoking is associated with maintenance
of good health in older men [20]. In addition, Vita et al. assessed
cumulative disability after an average age of 67 years, and showed
that the onset of disability, among non-smoking, exercising men
(low-risk-group) was postponed by more than ve years [21]. Both
cumulative disability and disability in the one or two years before
death were much lower in the low-risk-group than in the high-risk-
group [21]. Similar results were found when examining lifestyle
factors associated with a life-span of 90 or more years and the main-
tenance of late-life function in men [22,23]. Regular exercise and
not smoking remained signicant predictors of physical and men-
tal function even after controlling for cardiovascular disease risk
factors and the presence of subclinical disease [22].
Physical activity can inuence the decline in appendicular lean
tissue and reduce the risk of abdominal adiposity and sarcope-
nia [5]. An increase in physical activity (energy expenditure) was
associated with an attenuation of the decline in appendicular lean
tissue that would normally have been expected over a 10-year
period [5]. Some studies have explored the effect of physical activ-
ity on endocrine function and bone density in men. For example,
one study from Italy suggests that, in ageing men, regular mod-
erate physical activity is associated with higher levels of serum
dehydroepiandrosterone sulfate (DHEAS) and, insulin-like growth
factor-I (IGF-1) and with alterations in thyroid function [24]. Also,
data from a large prospective study examining midlife determi-
nants of future hip fractures in men showed that high levels of
leisure-time physical activity protected against hip fracture [25].
However, neither the study by Ravaglia et al. nor a later exercise
intervention study by Huuskonen et al. could establish a convinc-
ing relation between regular physical activity, sex hormone levels,
and/or bone mineral density in healthy men [24,26].
2.1.2. Physical activity and cognitive function
Dementia and depression are among the most prevalent and dis-
abling psychiatric disorders of later life, and physical activity is an
important protective factor against cognitive decline [27]. A large-
scale prospective cohort study from Canada showed a signicant
protective effect of regular physical activity on the risk of cognitive
impairment and dementia in women [28]. A trend of decreased
risk of cognitive decline with increased physical activity was also
observed in men but not of statistical signicance [28]. On the other
hand, a cross-sectional study of older men (65 years and older)
showed that the likelihood of reporting high levels of psychologi-
cal distress decreased with increasing weekly sessions of physical
activity, regardless of their level of functional limitation [29].
2.1.3. Sedentary behaviour
Recent studies have examined whether there is an association
between sedentary behaviour and healthy ageing that is, inde-
pendent of physical activity levels. Novel ndings suggest that
a sedentary lifestyle is associated with reduced mitochondrial
function and that this is an important determinant of ageing in
skeletal muscles and the development of sarcopenia in the elderly
[30]. Using a large database of middle-aged and older men, Dogra
et al. found evidence for a dose-dependent relationship between
sedentary behaviour and successful ageing that was, independent
of physical activity levels [31]. Thus, sedentary behaviour and
 M. Sdergren / Maturitas 75 (2013) 113117 115

Table 1
Summary of included studies examining healthy ageing in men (n = 20).

Author Year Country Study name N Age (y) Study design Indicator of healthy
ageing

Hughes et al. 2004 US 54 Mean age, 60.4 at Prospective cohort (+) physical activity
[5] baseline study (10 years)
Leveille et al. 1999 US Established 1097 65 or older at baseline Prospective cohort (+) physical activity
[18] Populations for study (10 years)
Epidemiologic Studies
of Elderly
Lobo et al. [19] 2011 Portugal 185 6692 at baseline Randomized control (+) exercise
trial (1 year)
Burke et al. [20] 2001 US Cardiovascular Health 1299 65 or older at baseline Prospective cohort (+) exercise
Study study (7 years) () smoking
Vita et al. [21] 1998 US 1741 Mean age, 43.0 at Prospective cohort (+) exercise
baseline study (32 years) () smoking
Yates et al. [22] 2008 US Physicians Health 2357 Mean age, 72.0 at Prospective cohort (+) exercise
Study baseline study (16 years) () smoking
(0) alcohol intake
Willcox et al. 2006 US Honolulu Heart 5820 4568 at baseline Prospective cohort () smoking
[23] Program/Honolulu Asia study (40 years)
Aging Study
Ravaglia et al. 2001 Italy 96 Mean age, 62.7 Retrospective cohort (+) physical activity
[24] study (10 years)
Trimpou et al. 2010 Sweden Multifactor Primary 7495 4656 at baseline Prospective cohort (+) physical activity
[25] Prevention Study study (30 years) () smoking
Huuskonen 2002 Finland 140 5362 at baseline Randomized control (0) physical activity
et al. [26] trial (4 years)
Almeida et al. 2006 Australia 601 80 at follow up Prospective cohort (+) physical activity
[27] study (4.8 years) () fat intake
(0) alcohol intake
Laurin et al. 2001 Canada Canadian Study of 4615 65 or older at baseline Prospective cohort (0) physical activity
[28] Health and Aging (40% men) study (5 years)
George et al. 2011 Australia New South Wales 45 17,689 65 or older Cross-sectional study (+) physical activity
[29] and up study
Safdar et al. 2010 US 20 5075 Cross-sectional study (+) physical activity
[30] () sedentary
behaviour
Dogra and 2012 Canada The Healthy Aging 19,538 45 or older Cross-sectional study (+) physical activity
Stathokostas cycle of the Canadian (45% men) () sedentary
[31] Community Health behaviour
Survey
Izumotani et al. 2003 Japan 686 4059 Cross-sectional study () smoking
[32] (0) exercise
(0) alcohol intake
(0) calcium intake
Wardle et al. 2000 UK 1040 Mean age, 51.5 Cross-sectional study (+) fruit and vegetables
[33] (43.8% men) () fat intake
McKeown et al. 2010 US Framingham Heart 2834 3283 Cross-sectional study (+) whole-grain
[34] Study (50.6% men) () rened-grain
Hu et al. [35] 2000 US Health Professionals 44,875 4075 at baseline Prospective cohort (+) prudent diet
Follow-up Study study (8 years) () western diet
Shatenstein 2004 Canada 1990 Enqu te qu b coise 460 5574 Cross-sectional study (+) diet quality
et al. [36] sur la nutrition (47% men)

Note: (+) positively associated, () negatively associated, (0) no association with healthy ageing found.

physical activity may be independent risk factors for poor health
among ageing men [31].
2.2. Smoking and alcohol consumption
Besides the studies mentioned above that show the health ben-
ets for a combination of exercising and non-smoking in men,
smoking is also an independent factor for healthy ageing in men
[23]. For example, Trimpou et al. reported an increased risk of hip
fractures in men who smoked [25]. A study from Japan that eval-
uated risk factors for osteoporosis in middle-aged men found that
smoking accelerates the reduction of bone density with age [32].
The same study found that calcium intake, exercise, and alcohol
consumption were not signicant determinants of a mans bone
mineral density as he ages [32]. In fact, none of the studies in this
review that included the consumption of alcohol found any associ-
ation between alcohol consumption and physical or mental health
outcomes among ageing men [22,27,32].
2.3. Dietary behaviours
In general, older men tend to have unhealthier diets, i.e. less
fruit and vegetables, and higher fat intake, than their female coun-
terparts [33]. Older men also tend to have a higher intake of rened
grains compared to older women [34]. McKeown et al. examined
if intake of rened- or whole-grains were associated with smok-
ing and alcohol consumption and found that the rates, for smoking
and alcohol consumption were similar among older men regard-
less of whether they consumed more rened grains or more whole
grains [34]. Hu et al. found a increase risk of coronary heart diseases
with a Western dietary pattern, characterized by high intake of
red meat, rened grains, sugar and high-fat dairy products [35]. A
prospective cohort study examined dietary factors associated with
successful mental ageing in Australian men older than the age of 80
[27]. Of those dietary intake assessed (consumption of meat, sh,
full-cream milk, and amount of salt added to meals) only consump-
tion of full-cream milk was inversely related to successful mental
116 M. Sdergren / Maturitas 75 (2013) 113117
health ageing and preservation of cognitive function. The authors
of that study suggest that consumption of full-cream milk could
be associated with lower socioeconomic status and a type of diet
that is poor in essential nutrients such as calcium, iron, magnesium,
folate, and vitamin C. Consumption of full-cream milk might also
alter lipid concentrations and may increase the risk of cognitive
impairment in later life [27]. However, older men tend to report a
lower intake of dairy products than older women [34,35]. Shaten-
stein et al. used a diet quality score to examine determinants of diet
quality and diversity in older Canadian men [36]. They found that
breakfast consumption and eating commercially-prepared meals
were positively associated with diet quality, whereas eating fewer
than three meals daily and the use of dietary supplements were
both found to be negative predictors of diet quality [36].
3. Discussion
This review shows that not only do men with healthy lifestyles
survive longer, but they also do so in good health and tend to suffer
disabilities later and over the course of fewer years at the end of
life. It is also clear that healthy ageing in later life can be predicted
by lifestyle factors assessed in midlife and late adulthood.
It is difcult to compare the studies due to their varying designs,
sample sizes, and methods, so the estimated effects of these lifestyle
factors might, therefore, show signicant variation from one study
to another. However, it is obvious that engaging in regular physi-
cal activity and refraining from smoking is essential to preventing
chronic diseases and delaying natural deterioration due to ageing.
What remains less clear is whether the decline in skeletal muscle
capacity is truly a function of the ageing process or if sedentary
behaviours among older adults could have confounded the results
of previous studies. Although the concepts of sedentary behaviour
and physical inactivity are related, these behaviours are empiri-
cally distinct and should be considered as such. Individuals who are
sedentary for large amounts of time can also be physically active
[6,37,38]. As older adults are among the most sedentary popula-
tion groups, understanding the consequences of prolonged sitting
in ageing men is important [39].
The role of dietary factors in healthy ageing is difcult to
elucidate due to the complex interplay between diet, foods and
nutrients. Analysis of dietary patterns rather than individual foods
or nutrients could be used in nutritional epidemiology to explore
dietary behaviours [40]. In addition, few studies have focused on
healthy ageing in men or differentiate reported results for men
and women. Additional studies are needed to provide more robust
estimates of the effects of lifestyle factors in ageing men. Because
experimental studies in this eld are particularly difcult to under-
take, future research should concentrate on understanding the
causal pathways through which lifestyle factors exert their effects,
and where opportunities exist to affect those pathways. In par-
ticular, these studies should investigate effects of moderators and
mediators, including individual and behavioural determinants. Fur-
thermore, it is fundamental that scientic ndings are constantly
translated into clear messages that can be provided to policy mak-
ers, health care sectors, and society in general.
One should also bear in mind that the studies included in this
review are based on samples of men who were mostly born prior to
the Second World War. Future generations may not age in as good
health as those who are currently over 65 years of age, particularly
because of the rising prevalence of obesity [1,2]. Obesity is a global
phenomenon associated with environmental-, social- and personal
factors such as urbanization and global changes to food availability,
eating habits, and increasingly sedentary activities. The current and
future impacts of obesity on health, health care expenditures, and
human life expectancy are enormous.
3.1. Conclusion
Lifestyle behaviours greatly impact and predict how well men
age, but healthy ageing has no clear phenotypic denition. Adop-
tion of healthier lifestyles could result in postponement of age
associated diseases and/or the slowing down of the ageing process.
Consequently, this allows independent living for a longer period of
time and would reduce the burden to social and health care sectors.
Competing interest
There are no competing interests to declare.
Funding
No funding.
Provenance and peer review
Commissioned and externally peer reviewed.
Acknowledgement
The author was supported by Signhild Engkvists Foundation,
Sweden.
References
[1] United Nations. Political Declaration of the High-Level Meeting of the General
Assembly on the Prevention and Control of non communicable diseases United
Nations; 2011.
[2] WHO. 20082013 Action plan for the global strategy for the prevention and
control of noncommunicable diseases. World Health Organisation; 2008.
[3] Frisard MI, Fabre JM, Russell RD, et al. Physical activity level and physical
functionality in nonagenarians compared to individuals aged 6074 years.
Journals of Gerontology Series A, Biological Sciences and Medical Sciences
2007;62(7):7838.
[4] Newman AB, Arnold AM, Naydeck BL, et al. Successful aging: effect
of subclinical cardiovascular disease. Archives of Internal Medicine
2003;163(19):231522.
[5] Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh
MA. Anthropometric assessment of 10-y changes in body composition in the
elderly. American Journal of Clinical Nutrition 2004;80(2):47582.
[6] Hamilton M, Healy G, Dunstan D, Zderic T, Owen N. Too little exercise and too
much sitting: inactivity physiology and the need for new recommendations on
sedentary behavior. Current Cardiovascular Risk Reports 2008;2(4):2928.
[7] Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mor-
tality: systematic review and doseresponse meta-analysis of cohort studies.
International Journal of Epidemiology 2011;40(5):1382400.
[8] Kohut ML, Cooper MM, Nickolaus MS, Russell DR, Cunnick JE. Exercise and
psychosocial factors modulate immunity to inuenza vaccine in elderly indi-
viduals. Journals of Gerontology Series A, Biological Sciences and Medical
Sciences 2002;57(9):M55762.
[9] He XZ, Baker DW. Body mass index, physical activity, and the risk of decline in
overall health and physical functioning in late middle age. American Journal of
Public Health 2004;94(9):156773.
[10] Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the
risk of subsequent depression for older adults. American Journal of Epidemiol-
ogy 2002;156(4):32834.
[11] Cherkas LF, Hunkin JL, Kato BS, et al. The association between physical activity
in leisure time and leukocyte telomere length. Archives of Internal Medicine
2008;168(2):1548.
[12] Pruchno R, Hahn S, Wilson-Genderson M. Cigarette smokers, never-smokers,
and transitions: implications for successful aging. International Journal of Aging
& Human Development 2012;74(3):193209.
[13] Stvring N, Avlund K, Schultz-Larsen K, Schroll M. The cumulative effect of
smoking at age 50, 60, and 70 on functional ability at age 75. Scandinavian
Journal Of Public Health 2004;32(4):296302.
[14] Le Marchand L, Kolonel LN, Hankin JH, Yoshizawa CN. Relationship of alcohol
consumption to diet: a population-based study in Hawaii. American Journal of
Clinical Nutrition 1989;49(3):56772.
[15] Chen KM, Lin MH, Wang YC, Huang HT, Li CH. A model-based survey of phys-
ical health in community-dwelling older adults. Journal of Nursing Research
2012;20(4):23948.
[16] Thorand B, Baumert J, Kolb H, et al. Sex differences in the prediction of type 2
diabetes by inammatory markers: results from the MONICA/KORA Augsburg
case-cohort study, 19842002. Diabetes Care 2007;30(4):85460.
 M. Sdergren / Maturitas 75 (2013) 113117
[17] Gremeaux V, Gayda M, Lepers R, Sosner P, Juneau M, Nigam A. Exercise and
longevity. Maturitas 2012;73(4):3127.
[18] Leveille SG, Guralnik JM, Ferrucci L, Langlois JA. Aging successfully until death
in old age: opportunities for increasing active life expectancy. American Journal
of Epidemiology 1999;149(7):65464.
[19] Lobo A, Carvalho J, Santos P. Comparison of functional tness in elderlies with
reference values by Rikli and Jones and after one-year of health intervention
programs. Journal of Sports Medicine and Physical Fitness 2011;51(1):11120.
[20] Burke GL, Arnold AM, Bild DE, et al. Factors associated with healthy aging:
the cardiovascular health study. Journal of the American Geriatrics Society
2001;49(3):25462.
[21] Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative dis-
ability. New England Journal of Medicine 1998;338(15):103541.
[22] Yates LB, Djouss L, Kurth T, Buring JE, Gaziano JM. Exceptional longevity in
men: modiable factors associated with survival and function to age 90 years.
Archives of Internal Medicine 2008;168(3):28490.
[23] Willcox BJ, He Q, Chen R, et al. Midlife risk factors and healthy survival in men.
JAMA 2006;296(19):234350.
[24] Ravaglia G, Forti P, Maioli F, et al. Regular moderate intensity physical
activity and blood concentrations of endogenous anabolic hormones and
thyroid hormones in aging men. Mechanisms of Ageing and Development
2001;122(2):191203.
[25] Trimpou P, Landin-Wilhelmsen K, Odn A, Rosengren A, Wilhelmsen L. Male
risk factors for hip fracture-a 30-year follow-up study in 7495 men. Osteoporo-
sis International: A Journal Established as Result of Cooperation Between the
European Foundation for Osteoporosis and the National Osteoporosis Founda-
tion of the USA 2010;21(3):40916.
[26] Huuskonen J, Visnen SB, Krger H, et al. Relation of sex hormones to bone
mineral density in middle-aged men during a 4 year exercise intervention trial.
Bone 2002;31(1):516.
[27] Almeida OP, Norman P, Hankey G, Jamrozik K, Flicker L. Successful mental
health aging: results from a longitudinal study of older Australian men. Amer-
ican Journal of Geriatric Psychiatry 2006;14(1):2735.
[28] Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity
and risk of cognitive impairment and dementia in elderly persons. Archives of
Neurology 2001;58(3):498504.
117
[29] George ES, Jorm L, Kolt GS, Bambrick H, Lujic S. Physical activity and psycho-
logical distress in older men: ndings from the New South Wales 45 and up
study. Journal of Aging and Physical Activity 2011;20(3):30016.
[30] Safdar A, Hamadeh MJ, Kaczor JJ, Raha S, Debeer J, Tarnopolsky MA. Aberrant
mitochondrial homeostasis in the skeletal muscle of sedentary older adults.
PLoS ONE 2010;5(5):e10778878.
[31] Dogra S, Stathokostas L. Sedentary behavior and physical activity are indepen-
dent predictors of successful aging in middle-aged and older adults. Journal of
Aging Research 2012:2012.
[32] Izumotani K, Hagiwara S, Izumotani T, Miki T, Morii H, Nishizawa Y. Risk
factors for osteoporosis in men. Journal of Bone and Mineral Metabolism
2003;21(2):8690.
[33] Wardle J, Parmenter K, Waller J. Nutrition knowledge and food intake. Appetite
2000;34(3):26975.
[34] McKeown NM, Troy LM, Jacques PF, Hoffmann U, ODonnell CJ, Fox CS. Whole-
and rened-grain intakes are differentially associated with abdominal visceral
and subcutaneous adiposity in healthy adults: the Framingham Heart Study.
American Journal of Clinical Nutrition 2010;92(5):116571.
[35] Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospec-
tive study of major dietary patterns and risk of coronary heart disease in men.
American Journal of Clinical Nutrition 2000;72(4):91221.
[36] Shatenstein B, Nadon S, Ferland G. Determinants of diet quality among Que-
becers aged 5574. The Journal of Nutrition, Health & Aging 2004;8(2):
8391.
[37] Healy GN, Wijndaele K, Dunstan DW, et al. Objectively measured sedentary
time, physical activity, and metabolic risk: the Australian Diabetes, Obesity
and Lifestyle Study (AusDiab). Diabetes Care 2008;31(2):36971.
[38] Dunstan DW, Barr ELM, Healy GN, et al. Television viewing time and mortal-
ity: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation
2010;121(3):38491.
[39] Gardiner PA, Healy GN, Eakin EG, et al. Associations between television viewing
time and overall sitting time with the metabolic syndrome in older men and
women: the Australian Diabetes, Obesity and Lifestyle study. Journal of the
American Geriatrics Society 2011;59(5):78896.
[40] Tucker KL. Dietary patterns, approaches, and multicultural perspective. Applied
Physiology, Nutrition, and Metabolism 2010;35(2):2118.