Fitness, Fatness And Survival In Older Adults With Intellectual Disabilities. Which One Is Key?

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Older adults with intellectual disabilities have very poor physical fitness levels. Additionally, overweight and obesity are highly prevalent in this population, even more prevalent than in the general population. Both fitness and fatness have been found to be related to survival in the general population. To improve healthy ageing and survival of older adults with intellectual disabilities we need to know which problem requires our main focus. PURPOSE: To determine whether fitness or fatness is more important for survival in older adults with intellectual disabilities. METHODS: As part of the Healthy Ageing and Intellectual Disabilities (HA-ID) study, fitness (comfortable gait speed) and fatness (Body Mass Index) of 874 older adults with intellectual disabilities (≥50 years; 61.4 ± 7.8 years) was measured at baseline. All-cause mortality was collected over a 5-year follow-up period. The relationship between fitness, fatness, and survival was analysed with Kaplan-Meier curves and Cox proportional hazard models. RESULTS: Fitness was significantly related to survival (HR = 0.21, 95% CI = 0.09 - 0.48, p < 0.001), while fatness was not related to survival. People who were unfit and fat were 4.6 (95% CI = 2.0 - 10.7) times more likely to die, and people who were unfit and not fat were 3.6 (95% CI = 1.7 - 7.5) times more likely to die within the follow-up period, than people who were fit, regardless of their fatness. CONCLUSIONS: Being fit is key for survival in older adults with intellectual disabilities. Our results therefore do not support the emphasis seen in research and practice on reducing weight. The focus should primarily be on improving the fitness of older adults with intellectual disabilities to improve healthy ageing and survival.