Dysregulation of the hypothalamic pituitary adrenal (HPA) axis and physical performance at older ages: an individual participant meta-analysis.
The association between functioning of the hypothalamic pituitary adrenal (HPA) axis and physical performance at older ages remains poorly understood. We carried out meta-analyses to test the hypothesis that dysregulation of the HPA axis, as indexed by patterns of diurnal cortisol release, is associated with worse physical performance. Data from six adult cohorts (ages 50-92 years) were included in a two stage meta-analysis of individual participant data. We analysed each study separately using linear and logistic regression models and then used meta-analytic methods to pool the results. Physical performance outcome measures were walking speed, balance time, chair rise time and grip strength. Exposure measures were morning (serum and salivary) and evening (salivary) cortisol. Total sample sizes in meta-analyses ranged from n=2146 for associations between morning Cortisol Awakening Response and balance to n=8448 for associations between morning cortisol and walking speed. A larger diurnal drop was associated with faster walking speed (standardised coefficient per SD increase 0.052, 95% confidence interval (CI) 0.029, 0.076, p<0.001; age and gender adjusted) and a quicker chair rise time (standardised coefficient per SD increase -0.075, 95% CI -0.116, -0.034, p<0.001; age and gender adjusted). There was little evidence of associations with balance or grip strength. Greater diurnal decline of the HPA axis is associated with better physical performance in later life. This may reflect a causal effect of the HPA axis on performance or that other ageing-related factors are associated with both reduced HPA reactivity and performance.
School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, UK.
Michael P
MP
Gardner
Stafford
S
Lightman
Avan Aihie
AA
Sayer
Cyrus
C
Cooper
Rachel
R
Cooper
Dorly
D
Deeg
Shah
S
Ebrahim
John
J
Gallacher
Mika
M
Kivimaki
Meena
M
Kumari
Diana
D
Kuh
Richard M
RM
Martin
Geeske
G
Peeters
Yoav
Y
Ben-Shlomo
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology*; D016138:Walking / Q000502:physiology
D006854:Hydrocortisone