Body Weight and Cardio-respiratory Fitness: Predictors of Physical Function Capacity among Older Adults

doi:10.21203/rs.3.rs-5220351/v1

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Body Weight and Cardio-respiratory Fitness: Predictors of Physical Function Capacity among Older Adults

https://doi.org/10.21203/rs.3.rs-5220351/v1

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The purpose of this study was to determine the extent to which body weight and cardio-respiratory endurance predict physical functional capacity of older adults in rural Ghana. This quantitative cross-sectional study sampled 998 aged (60yrs+) participants using a multistage sampling method. The senior fitness test battery, international physical activity questionnaire short form for elderly, weighing scale and tape measure were used to collect the data. The independent t-test and multiple regression analyses were applied the data. The results indicated that physical activity levels were minimal among both men and women older adults, but women were more overweight, had reduced cardio-respiratory function and physical function capacity. Body mass index and cardio-respiratory endurance are significant predictors of physical function capacity of the older adults. Education on the health benefits needs to be provided by health professionals who should also encourage these older adults to regularly participate in physical activity.

Older adults

cardio-respiratory function

body weight

physical function

physical activity

Ageing is a normal part of human life, and everyone is likely to grow old. The process of ageing comes with limitations, including physical functional abilities (WHO, 2019). This becomes more apparent with the increase in body weight and compromised cardio-respiratory function. According to Magyari et al. (2018), body composition and cardio-respiratory endurance are two most studied physical fitness components that affect physical functional capacity of older adults. These authors explained physical functional capacity as person's ease of performing physical and motor activities of daily living. Meanwhile, physical activity, exercise, rest, and nutrition are key elements that must be taken seriously by individuals irrespective of age to promote physical function capacity. Exercise is a systematic, repetitive body movement, the goal is to enhance or maintain fitness, but physical activity comprises any movement of the skeletal muscles that results in energy expenditure (Garber et al., 2011). Thus, physical activity and exercise, nutrition, and rest are important determinants of body composition and cardio-respiratory endurance (Magyari et al., 2018). The believe is that, these variables help individuals to transit into healthy ageing.

Ageing is a process that can be healthy or unhealthy, and characterized by decline in cardiovascular function (Bolton, & Rajkumar, 2019), increased blood pressure, compromised body composition, decreased muscle mass (sarcopenia), increased adiposity, and muscle fat infiltration, all leading to a decrease in functional capacity of the individual (Carbone et al., 2017). The age-related decline in physical function capacity resulting from reduced mobility and needed efforts to perform daily activities could ultimately lead to avoidance of meaningful physical activity and exercise, resulting in sedentary living. This predisposes the individual to cardiovascular diseases (CVDs), obesity, and other forms of disabilities (Magyari et al., 2018).

The ageing bracket is increasing globally. For instance, the United Nation Department of Economic and Social Affairs, Population Division (2019) reported that there were 703 million people age 65 years or older globally in the year 2019. Accordingly, the figure is expected to be more than doubled, reaching 1.5 billion by 2050. In Northern America and Western Asia, the number of elderly people is projected to climb at the quickest rate, from 29 million in 2019 to 96 million in 2050 (an increase of 226%). The second fastest rise in the number of older persons is expected in “sub-Saharan Africa, to grow from 32 million in 2019 to 101 million in 2050 [218%]” (United Nation Department of Economic and Social Affairs, Population Division, 2019, p.5).

Unfortunately, the ageing population is likely to increase the burden of chronic illnesses in all economies globally. According to the United Nations Population Division (2019), it is envisaged that the number of older adults with non-communicable diseases will also increase, with more disabilities and decline in physical functional abilities globally, with CVDs as part of the three leading causes of deaths. The case in low-and-middle-income countries (LMIC) is worse, as WHO (2019) revealed that over 80 percent of deaths relating to CVDs occurred in these countries including Ghana.

Sub-Saharan Africa (SSA) has a population rapidly reaching one billion (Saghir, & Santoro, 2018). In addition, the UN estimated that 4.9 percent of the total population of persons living in SSA as at 2015 were 60 years and over, a proportion projected to reach 7.6 percent by 2050. Unlike most western countries where there is supportive built environment for exercise, SSA’s built environment is not exercise friendly, thereby increasing the avoidance of physical activity and exercise among the aged in particular (Wendel-Vos et al., 2010). The worse is that, it is estimated that more than 60% of the population of older adults in SSA have at least one or more physical functional limitations. Therefore, governments in Africa and the African Union (AU) need to pay attention to the rise in the number of older adults and make pragmatic interventions that will save and preserve their lives (Wendel-Vos et al., 2010). Among such interventions could be providing exercise education and creating exercise friendly environments where people can exercise safely.

The number of people 60 years and over in Ghana from 2000 to 2010 has reduced from 7.2 percent to 6.5 percent (Ghana Statistical Service, 2010). Despite this reduction, it is projected that the number of older adults will triple by 2030 (Ghana Statistical Service, 2013). According to the GSS District Analytic Report for Kassena Nankana, the number of older adults in the Municipal capital as at 2010 was 9,728 and this number is projected to reach 20,000 by the next census (Ghana Statistical Service, 2013). A longitudinal study by Abdul (2014) on patterns and predictors of mortality in older people (50 years and above) between 2007 and 2010 in the Kassena-Nankana District showed that, physical inactivity and non-communicable diseases (NCDs) were a major predictor causes of death among older adults. Additionally, about 80% of the older adults reported some sort of physical functional limitation. Another a on Self-reported vision and health status among older people in the Kassena-Nankana District by Akuamoah-Boateng (2013) also, showed that over 85% of the participants self-reported at least two or more physical functional limitations. Accordingly, it is believed that there is a change in activities (abandonment of farming and other physically active activities to less physical activity ventures like trading in shops) among the people. Thus, these findings coupled with the rise in number of older adults calls for innovative interventions to promote physical activity and overall physical function capacity and health of these older people. However, there seem to be dearth in evidence of such physical activity and exercise intervention programmes. Therefore, the aim of this study was to determine the extent to which body weight and cardio-respiratory endurance predict physical function capacity of older adults in rural areas of Ghana.

This study employed quantitative cross-sectional design to investigate the role of physical activity, body composition and cardio-respiratory endurance on physical function capacity of the older adults. The population included adults 60 years and older who live in Navrongo, a rural community in Ghana. Navrongo is categorized into four cardinal zones namely, North, South, East and West by the Navrongo Health Research Center (NHRC, 2010). Using a multistage sampling approach, 998 older adults participated in this study. Firstly, using the quota sampling, 60% of males and females were sampled, giving a sample size of 433 males and 565 females. These strata (433 males and 565 females) were then divided into four and assigned to each suburb, making it 108 males and 141 females each for the following zones (North, East and West) except for South which comprised 109 males and 142 females.

Five research assistants were assigned to each cardinal zone for the data collection. Convenient sampling method was used to include participants who were available at the time of visit to each household and were willing to participate in the study. Participants who could read and write signed the consent form, but those who could not read or write, the consent form was explained to them in their local dialect (Kassem and Nanakani) and those who agreed to take part thump printed the consent form before participating in the study. For purposes of anonymity and confidentiality, information that identifies the participants were not obtained. At the end, 998 (108 males and 141 females) were conveniently sampled for the study.

Setting

The Kasena Nankana Municipal is one of Ghana's 260 Metropolitan, Municipal and District Assemblies (MMDAs) in Ghana. The community is a member of the Upper East Region's fifteen (15) Municipalities and Districts, with Navrongo as the regional administrative center. The community shares boundaries with Paga and Bolgatanga, Sandema, and bounded to the north by Burkina Faso. The number of household in Navrongo stood at 32,000 with a total population 109, 944 with 53,676 males and 56,268 females (Ghana Statistical Service, 2013). The main occupation of the people in the community is farming and trading. The built environment is not exercise friendly, promoting a poor culture towards meaningful physical activity and exercise among the people.

Instruments

This study adopted four pre-existing data collection instruments; the Senior Fitness (Functional Fitness Test) battery, Omron weighing scale, tape measure, and international physical activity questionnaire (IPAQ) Elderly short form. Rikli and Jones (2013) created the Senor Fitness Test battery as part of Fullerton University's lifelong wellness programme, as it is frequently called the Fullerton Functional Test. This straightforward, user-friendly battery evaluates older individuals' functional fitness, like the aerobic fitness, strength and flexibility. Within the test battery are specific tests which are reliability coefficients; “chair stand test (.88), arm curl test (.79), sit and reach test (.81), back scratch test (.82), up and go test (.84) and 2-minute step up test (.81)” and a composite reliability of .83 for PFC (Rikli, & Jones, 2013). Reliability coefficients estimated from current data were .79, .80, .77, .78, .80, .79 for chair stand test, arm curl test, sit and reach test, back scratch test, up and go test and 2-minute step up test respectively and .81 for physical functioning capacity, respectively.

The Omeron scale and meter tape were used to obtain the weight and height of the participants. Vasold et al. (2019) reported a reliability of .91 for the weighing scale and .90 for the meter tape from test-retest. Data from the current study also yielded reliability coefficient of .88 and .91 for the weighing scale and meter tape, respectively. We also used the IPAQ-Elderly short form to measure the physical activity levels of the older adults, with reliability and validity values of .81 and .84 when tested across six centers in 12 countries (Craig et al., 2003). Moreover, the current study yielded a reliability of .79.

Procedure

The Institutional Review Board of University of Cape Coast granted the ethical clearance for this study (ID-UCCIRB/CES/2022/30). To collect the data, permission was sought from household heads and the purpose of the study well explained to them. Participants were also assured of confidentiality of their information. Also, for purposes of anonymity, names of participants were not taken. Moreover, only older adults who could walk and raise their upper limbs were considered for this study.

First aiders were also on standby during the fitness test to take care of any eventualities. Data was collected from participants at their homes. Physical function capacity for each participant was assessed through the five physical functional test batteries. To assess physical activity levels, participants completed the IPAQ elderly short form survey which asked participants to indicate the number of days in a week they walked, did moderate and vigorous activities and the amount of time spent doing such activities. Cardio-respiratory endurance was measured using 2-minutes step-up test. A 2-minutes test is performed by making a mark of the corresponding mid-point between the iliac crest and the knee on a wall. A participant stands with the shoulder to wall and on the command by the instructor, the participant lifts (step-up) the knees one after the other at the level of the mark on the wall as fast as he/she can. The total number of step-ups taken within 2-minutes are recorded for each participant.

Body composition was assessed using body weight and height to compute for BMI. Body weight was measured to the nearest 0.01km using the omron weighing scale where participants wear a light cloth and without footwear. Height was measured using a meter tape attached to a wall. Each participant (without a footwear) stood with the back on the wall and heels touching the wall. A flat plastic meter rule is then place on the head of the participant in line with the meter tape. The corresponding number was then recorded in meters as the height of the participant. To obtain the BMI of each participant, the weight (kg) was divided by the square of the height in meter (Weight/Height²). The data were collected between August and December, 2022 between 8 AM and 4 PM during weekends when the participants were likely to be at home.

Data Analysis

Data were entered into Statistical Package for Social Science, IBM, version 25 for windows and went through screening process before statistical analysis. Demographic variable (gender) was analysed using frequency and percentages. Physical activity levels of older adults were analysed using frequency and percentages. Moreover, differences in gender by cardio-respiratory endurance and BMI were analysed using independent sampled t-test. Gender is a categorical variable, body composition, cardio-respiratory endurance, physical function capacity and physical activity were measured on a continuous scale, thus, t-test analysis (Mishra et al., 2019). Finally, multiple linear regression was computed to predict physical functioning capacity from cardio-respiratory endurance and body composition values, because these variables included a continuous dependent variable and two independent variables (Chatfield, 2018). We reported correlation, R, R², ANOVA analysis (regression df and residual df, F-ratio and p-value) and the coefficients values (beta-values and p-values).

There were 998 older adults comprising 565 males (56.6%) and 433 females (43.4%) who took part in this study. The results indicate that 470 (47%) participants were physically inactive while 528 (53%) were minimally active (See Table 1). Unfortunately, none of the older adults engaged in health-enhancing physical activity levels. According to the WHO (2019), moderate-to-vigorous levels of physical activity are recommended for health promotion among individuals of all age categories. Therefore, since 47% were physically inactive and 53% being minimally active, the older adults in Navrongo were not meeting the WHO physical activity guidelines of 150 minutes of moderate-to-vigorous intensity of physical activity for at least three times in a week.

Table 1

Physical Activity Levels of Older Adults in Navrongo
Met Range	Description	Frequency	Percentage
< 600	Inactive	470	47%
600–1500	Minimally active	528	53%
> 1500	HEPA	0	0%

Insert Table 1

To determine differences in cardio-respiratory endurance, body composition, and physical function capacity by gender, three different independent sample t-test analyses were calculated. The findings revealed a statistically significant difference in cardio-respiratory endurance between male and female, t = (812) = 19.27, p < .05, where women recorded a lower cardio-respiratory endurance (M = 53.22, SD = 12.51) than the men (M = 70.87, SD = 15.60), hence, women had poor cardio-respiratory fitness levels. Also, there was statistically significant difference in BMI by gender, t (996) = -26.00, p < .05, with women having a higher BMI (M = 27.85, SD = 4.14) than the men (M = 21.28, SD = 3.22). Hence, on average, the females in this group are overweight and, on the brink, of crossing into to obesity class 1. Furthermore, the results showed a statistically significantly difference in physical function capacity by gender, t (833) = 21.92, p < .05, with higher functional capacity for men (M = 101.79, SD = 15.95), than the women (M = 81.02, SD = 13.25), making women susceptible to more functional limitations than the men.

To predict physical function capacity from cardio-respiratory endurance and BMI, a multiple regression analysis was performed. The results indicated statistically significant prediction for physical function capacity of the participants, F (2, 995) = 956.63, p < .05, R = 0.81, R² = .658 and adjusted R = .657 from cardio-respiratory endurance, β = .774, t (995) = 38.56, p < .05) and BMI, β = − .089, t (995) = − 4.44, p < .05). Therefore, cardio-respiratory endurance and BMI are good predictors of physical function capacity among older adults in the Navrongo community (see Table 2 for details).

Table 2

Predicting Physical Functional Capacity from Body Composition and Cardio-respiratory Fitness
Variable	B	Beta	T	p
Constant	47.349	.	17.830	.000
Cardio-respiratory fitness	.837	.774	38.857	.000
Body mass index	− .327	.089	-4.443	.000
R	.811
R²	.658
Adjusted R	.657
F-ratio = 956.63, df = (2, 995), p < .05

The finding reveals that the older adults in Navrongo community were not meeting the WHO physical activity guidelines for health promotion and healthy living. Unfortunately, this situation predisposes these older adults to health challenges including limitations in their daily physical function capabilities. This result is very worrying and alarming because no participants met health-enhancing levels of physical activity levels. Therefore, the adult population in the Navrongo community may be predisposed to metabolic disorders, and other chronic non-communicable diseases such as cancer, diabetes, cerebrovascular, and cardiovascular diseases (WHO, 2019). Physical inactivity among these adults is attributable to a decline in physical activity participation due to ageing (Magyari et al., 2018). We also believe that the shift from active farming to smallholder mechanized farming and trading are increasing the sedentariness among these older adults. Moreover, there is no conscious effort by these older adults to carry out daily strength exerting activities. McPhee et al. (2016) found that age-related declines in physical activity are caused by both social and physiological factors. The avoidance of meaningful physical activity among the elderly is also influenced by physical limitations, disease, and discomfort, as well as retirement coupled with a loss of interest in social activities (including physical activity).

Many rural dwellers who hitherto were engaging in active farming are now ply trading. This is believed to be a result of devastations from climate change that are altering rainfall patterns, and increasing production of poor crop yields (Bibi & Rahman, 2023). Unfortunately, such severe weather conditions especially at the northern Ghana, is likely to push many farmers into trading so they can make some economic gains for personal and family upkeep. Our contention is that trading activities are likely to decrease physical activity lifestyles of these older adults, unlike farming.

Furthermore, McPhee et al. (2016) noted that despite being aware of the advantages of greater physical exercise, many older persons continue to be sedentary and engage in no or very little physical activity. The 53% who are minimally active may have been very active in their youthful days or they still farmers. We are of the view that being physically active as youths might have helped them to transit into minimal healthy active ageing. Thus, efforts at promoting youth physical activity are important for healthy ageing activeness. For instance, a person must perform moderate-to-vigorous physical activity for at least 30 to 60 minutes, three times a week to reach the health-enhancing physical activity levels (WHO, 2019). This, requires extra physical efforts from older adults, which may lead to few or no adult meeting such levels of physical activity, as may be the case with the elderly population in the Navrongo community (Carbone, Lavie, & Arena, 2017). Therefore, there may be the need to study, re-calibrate and re-design health-enhancing exercise threshold for older adults in rural areas and developing countries.

Age-related health issues might also lead to a decline in social interaction, including participation in physical exercise (Bernard et al., 2019). This justification is consistent with the Disengagement Theory of Ageing (Cunning & Henry, 1961), which contends that as persons age, their talents, particularly their capacity to interact with friends and family decline. Consequently, in comparison to the youths, older adults increasingly sever their relationships in their society and become more physically inactive and lonely. However, physical activity, even if initiated later in life, might delay the onset of impairment in the elderly (Lafortune et al., 2016). Additionally, a preventive effect against disability among the elderly can be achieved by engaging in regular physical activity (Moody-Ayers et al., 2005). Moreover, adults in some neighborhood may participate in less physical activity due to a poor constructed neighbourhood environment. Unfortunately, the built environment in Ghana is not exercise-friendly (Wendel-Vos et al., 2010). Unfortunately, the climate crisis is likely to exacerbate the unfriendliness of the environment for regular physical activity (Deshayes, & Périard, 2023). This may further discourages these older adults from regular outdoor physical activities, which are likely the commonest the rural Ghana.

The environment plays a crucial role in promoting physical activity. For instance, WHO (2019) made the case that incorporating physical exercise into daily life, such as walking and cycling may help people to meet recommended levels of physical activity. Moreover, beyond social and individual factors influencing physical activity (Sullivan, & Lachman, 2017), evidence further suggests that well-designed exercise friendly communities are important (Smith et al., 2017). The importance of the built environment needs to therefore, be highlighted since it motivates people to engage in regular physical activity (Smith et al., 2017). Perhaps, such as well-designed walkable path, recreational parks, cycling paths may increase physical activity, which turn to lower the risk of CVDs, obesity, and other disabilities leading improve physical functioning capacity of these older adults (Magyari et al., 2018).

The findings further indicated that the elderly women have low cardio-respiratory function. Older people have substantially higher frequency of CVDs, with gender differentiations. For instance, Malmborg et al. (2021) state that 77.8% of females and 70.8% of males ages 65 and 74 were diagnosed of hypertension between 2013 and 2017. Furthermore, the rates of diagnosed hypertension rose sharply, reaching 80.0% for men and 85.6% for women over age 75. Additionally, among older adults, obesity, gender, and age are particularly linked to hypertension (Hajar, 2016), which disproportionately affect women. Thus, the elderly women in Navrongo community who had low physical activity levels and increased overweight may have hypertension (Hands et al., 2016). This may be due to lower stroke volumes of women and the fact that women are also likely to react emotionally to the discomforts of the neighborhood environment (du Bray et al., 2019). Moreover, Jakovljevic (2018) confirms that the lower heart size of females compared to males is another morphological trait that appears to affect VO₂ max. Elderly women may need extra attention to improve their exercise life and promote their functional capacity.

Our findings also revealed that female older adults are overweight and on the borderline of obesity class 1. This condition predisposes the women to the higher risk of non-communicable diseases such as coronary heart disease, strokes, and hypertension among others. Dogra et al. (2017) claimed that because there are disparities in BMI between the sexes, females are frequently regarded as having a higher risk of experiencing negative health effects and are designated as a high priority category for physical activity interventions. Additionally, increase in weight may result in excess body fat, and more cholesterol deposits in the blood, complicating the health of women such as brain, heart and other organs, resulting in a compromised cardiovascular system (Elagizi et al., 2018). These are likely to increase the risk of hypertension and other chronic health conditions among these women. Thus, it is further found that the older women recorded a mean physical functioning capacity value of 81.02, below the average standard score of 100. Perhaps, these older women are suffering from physical functional limitations, because evidence (Poggiogalle et al., 2019) suggest that age plays a critical role in functional capacity (strength, endurance, agility, and flexibility), making daily activities more challenging among these women and can be completed with advancement in age. Therefore, when physical inactivity becomes prevalent among women, health-related fitness components, like body composition and cardio-respiratory fitness are compromised. This can lead to a decline in physical function capacity, thereby, predisposing the women to high risk of non-communicable diseases, orthopedic problems and other related illnesses.

It is also evident that BMI and cardio-respiratory endurance are good determinants of physical function capacity among these older adults. This finding reflects the statement by Magyari et al. (2018) that body composition and cardio-respiratory endurance are health-related fitness components known to predict physical function capacity among older adults. Physical functioning capacity of individuals is key to their survival, but this could be compromised by being overweight or obese, having a poor cardiovascular fitness and other illnesses. It is that obesity in the elderly, as measured by a high BMI, is substantially associated with a deterioration in functional performance, which could result in disability. One possible explanation is that excess body weight can place additional strain on the joints and muscles, which makes it difficult for individuals to perform physical activities. Additionally, carrying excess weight can increase the risk of developing chronic health conditions such as arthritis, diabetes, and CVDs, which further limit physical activity efforts and impair physical functioning ability of persons (Poggiogalle et al., 2019). As a result, older adults especially women are likely to suffer from physical functional limitations due to their high BMI (Ponti et al., 2020).

The findings of this study have important implications for promoting healthy ageing. Thus, interventions that promote healthy weight management and cardiovascular fitness may help these older adults to maintain their physical independence and improve their overall quality of life (Munt et al., 2017). This may help reduce the burden of dependency, limits both personal, family and national healthcare cost, and minimise pressures on healthcare providers and the entire healthcare system of the nation.

Limitations

Though this study provides very useful findings of physical activity levels, BMI and cardio-respiratory endurance and their relations with physical function capacity of older adults from rural community in a developing nation, there are some limitations. Other variables such as diet, medical conditions, and medication use may affect physical function capacity of these older adults. These variables were, therefore, not controlled and may possibly confound the variables studied. Thus, there is the need to control for many of these confounding variables in an attempt to explore factors influencing physical function capacity of older adults in future studies.

Practical Implications

Increased in body weight, poor cardio-respiratory fitness and physical inactivity are key contributors to the decline in physical function capacity among older adults in rural communities in Ghana. The study suggests that maintaining a healthy weight and engaging in regular physical activity promotes cardiovascular endurance which in turn has a positive impact on physical function capacity of the older adults. Thus, encouraging regular physical activity can help maintain cardiovascular endurance and healthy body weight, which in turn improve physical function ability in these older adults. Therefore, health promotion programmes can be designed to increase physical activity levels, for weight management, dietary behavior changes to promote the overall of these older adults.

Given the importance of cardiovascular endurance to physical function ability, older adults should be encouraged to engage in regular physical activity to maintain their cardiovascular health. Furthermore, for older adults who are experiencing physical limitations due to poor cardiovascular endurance or obesity, need rehabilitation programmes to help improve their physical function ability. These programmes can include exercises that increase cardiovascular endurance, muscular endurance and stabilization, and flexibility to improve overall physical function capacity. Finally, the findings can inform health policies aimed at promoting healthy ageing.

The physical activity levels of older adults in Navrongo community were generally low, with associated high levels of BMI values, low cardio-respiratory fitness and a decline in physical functional capacity especially among elder women. This means that the older adult women in the Navrongo community may suffer serious health consequences because they are predisposed to non-communicable diseases and other illnesses. Moreover, physical function capacity of these older adults is dependent on their body composition and cardio-respiratory endurance. Thus, increasing the likelihood of increased dependency ratio, with the attendant economic and social challenges. Therefore, evidence-based health promotion interventions are needed to promote healthy weight management and cardiovascular fitness to maintain physical independence and improve overall quality of life of these older adults. Future longitudinal research could explore the relationship between these factors and physical function ability and identify additional factors that may impact physical function capabilities of the older adults.

Ethics approval and consent to participate: Ethical clearance and approval were sought from University of Cape Coast Institutional Review Board (ID-UCCIRB/CES/2022/30) for this study.All participants who consented to take part in this study duly signed or thumb printed a consent form provided to them.

Consent for Publication: Informed consent was obtained from all subjects involved in the study. Participants and the heads of households were duly informed and they gave consent and approval that results and findings from this study could be published.

Data Availability Statement: The datasets generated and/or analysed during the current study are available in the Open Science Framework, and it is here: https://osf.io/zvdb2

Competing Interest: Authors declare that they have no competing interest.

Funding: The study received no external funding.

Author Contributions:

Conceptualization and study design: EAA and EWA, Methodology: EAA, EWA, EOS, and MS, Data collection: EAA, EWA, EOS, DA, and SRS, Data analysis: EAA and EWA, Writing - initial manuscript: EAA, Writing - final manuscript: EAA and EWA (with critical feedback provided by EOS, MS, and SRS and DA), Editing and review - All authors edited and considerably reviewed the manuscript, proofread for intellectual content and consented to its publication.

Acknowledgements: The authors thank the people of Navrongo for their cooperation.

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Body Weight and Cardio-respiratory Fitness: Predictors of Physical Function Capacity among Older Adults

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