How changes in sedentary lifestyle behavior are associated with functional disabilities in Chinese older adults: Results from a longitudinal study (2008–2018)

Sedentary behavior has been linked to frailty and functional limitations in older Chinese adults, yet little is known about how changes in such behavior influence subsequent functional status, including activities of daily living (ADL) and instrumental ADL (IADL). We analyzed data from four waves (2008–2018) of the Chinese Longitudinal Healthy Longevity Study (n = 12,840; aged ≥ 65). Changes in the frequency of sedentary activities –, reading newspapers/books, playing cards/mahjong, and watching TV/listening to the radio –, were measured across two survey waves. Cox two-state regression models were used to estimate the associations between these changes and functional limitations in ADL, IADL, and combined ADL + IADL. Increased reading frequency was associated with lower risks of functional decline in ADL, IADL, and combined ADL + IADL (HRs around 0.73–0.78, all p < .05). More frequent participation in cards/mahjong showed similar protective effects. In contrast, decreased TV/radio use was linked to a higher risk of functional decline. Urban – rural differences emerged: in urban areas, decreased reading was associated with higher hazards of both newly emerged and sustained functional limitations in IADL and ADL + IADL (all HRs > 1). Changes in frequency of sedentary behavior were associated with functional status in later life. Promoting mentally engaging activities may help maintain ADL and IADL independence, especially in urban settings.