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Physical Capability and Musculoskeletal Ageing

Which factors through the course of life promote and protect adult  physical capability and musculoskeletal health, and which increase  vulnerability to accelerated decline?  


Research programme: Physical capability and musculoskeletal ageing 

Programme leader: Professor Diana Kuh 

Programme Leader Track: Dr Rachel Cooper  

MRC Studentship: Elizabeth Wloch

Other LHA scientists: Dr David Bann, Professor Rebecca HardyProfessor Marcus Richards, Dr Mai Stafford (Programme Leader Track)

External collaborators:

Maintaining physical capability (the capacity to undertake the physical activities of daily living) and musculoskeletal function for the maximal period of time as we grow older are important aspects of healthy ageing, enabling people to be active and independent for longer. Low levels or accelerated loss of capability or musculoskeletal function pose threats to independence and quality of life, are major causes of frailty, disability and death, and impact greatly on health care spending. The ultimate purpose of this programme is to provide evidence to inform the likely timing, intensity and type of future interventions to promote healthy ageing or delay functional decline. This programme addresses the MRC strategic research priority for 2009-14 to improve the chances of living a long and healthy life by driving forward interdisciplinary research addressing health and wellbeing from childhood to older age.

This programme takes a life course approach, investigating biological and social factors from early life that influence later life physical capability and musculoskeletal ageing in population cohorts, in particular in the MRC National Survey of Health and Development (NSHD). Studies in NSHD and other cohorts have provided evidence that childhood socioeconomic conditions, physical growth and maturation, and motor and cognitive development affect objective measures of midlife capability, such as grip strength, standing balance and chair rise performance, in addition to the cumulative effects of adult health behaviours and socioeconomic conditions. We have developed collaborations with experts in endocrinology, telomere biology and genetics through the HALCyon inter-cohort research programme for greater insights on the biology of ageing in respect of physical capability. So far these collaborations have found evidence that physical performance in later life is related to greater diurnal variability in cortisol, a stress hormone; and also that there are no clear associations between a range of common single nucleotide polymorphisms that had been previously associated with other ageing traits.

Main objectives

There is a growing recognition of the importance of the role of muscle in health and disease, the dissociation of muscle mass and function with age, and the role of fat mass in moderating the links between muscle, physical performance, disability and disease. Using new data recently collected or planned, the research themes for the next five years are to:

  • capture the change in muscle strength and physical performance and the progression to disability and frailty during the transition from midlife to old age and then to investigate the lifetime factors (from societal to underlying biology) that drive these changes, or modify their consequences for everyday life;
  • investigate the effects of lifetime body size, socioeconomic conditions, physical activity and other health behaviours, and reproductive function on bone and muscle mass at 60-64 years and their clinical correlates, osteoporosis, fracture risk and sarcopenia; 
  • incorporate new data on joints and osteoarthritis at the next data collection, and study the long-term effects on these of adiposity, muscle strength and metabolic function;
  • investigate, with specialist collaborators, the biological mechanisms that underlie musculoskeletal ageing, initially focusing on endocrine senescence, and capitalising on the new genomic, epigenomic, metabolomic and neurodegenerative markers as they become available. 

Key publications:


Bann D, Wills A, Cooper R, Hardy R, Sayer AA, Adams J, Kuh D on behalf of the NSHD scientific and data collection team. Birth weight and growth from infancy to adolescence in relation to fat and lean mass in early old age: findings from the MRC National Survey of Health and Development. International Journal of Obesity 2013 June.

Cooper R, Stafford M, Hardy R, Aihie Sayer A, Ben-Shlomo Y, Cooper C, Craig L, Deary IJ, Gallacher J, McNeill G, Starr JM, Kuh D and Gale CR on behalf of the HALCyon study team. Physical capability and subsequent positive mental wellbeing in older people: findings from five HALCyon cohorts. Age 2013: DOI: 10.1007/s11357-013-9553-8.

Kuh D, Wills AK, Shah I, Prentice A, Hardy R, Adams J, Ward K, Cooper C on behalf of the NSHD scientific and data collection teams. Growth from birth to adulthood and bone phenotype in early old age: a British birth cohort study. Journal of Bone and Mineral Research 2013 Jun 12.

Hardy R, Cooper R, Sayer AA, Ben-Shlomo Y, Cooper C, Deary IJ, Demakakos P, Gallacher J, Martin RM, McNeill G, Starr JM, Steptoe A, Syddall H, Kuh D on behalf of the HALCyon study team.  Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme.  PLoS one 2013;8(2):e56483.

Hurst L, Cooper R, Richards M, Stafford M, Kuh D on behalf of the NSHD scientific and data collection team. Lifetime socioeconomic inequalities in physical and cognitive ageing. American Journal of Public Health 2013 Sep;103(9):1641-8.

Murray ET, Ben-Shlomo Y, Tilling K, Southall H, Aucott P, Kuh D, Hardy R. Area deprivation across the life course and physical capability in mid-life: findings from the 1946 British Birth Cohort.  American Journal of Epidemiology 2013 Aug 1;178(3):441-50.

Wills AK, Black S, Cooper R, Coppack RJ, Hardy R, Martin KR, Cooper C, Kuh D. Life course body mass index and risk of knee osteoarthritis at the age of 53 years: evidence from the 1946 British birth cohort study. Annuals of Rheumatic Disease 2012 May;71(5):655-60.

This study was one of the first to examine the influence of BMI across the whole of life on knee OA and to investigate formally different life course models of association. The findings show that risk of knee OA accumulates from exposure to high BMI through adulthood.

Birnie K, Cooper R, Martin RM, Kuh D, Aihie Sayer A, Alvarado BE, Bayer A, Christensen K, Cho S, Cooper C, Corley J, Craig L, Deary IJ, Demakakos P, Ebrahim S, Gallacher J, Gow AJ, Gunnell D, Haas S, Hemmingsson T, Inskip H, Jang S, Noronha K, Osler M, Palloni A, Rasmussen F, Santos-Eggimann B, Spagnoli J, Starr J, Steptoe A, Syddall H, Tynelius P, Weir D, Whalley LJ, Zunzunegui MV, Ben-Shlomo Y, Hardy R on behalf of the HALCyon study team. Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis. PLoS ONE 2011;6(1):e15564.

This study included all possible evidence (i.e. data not only from the few existing published papers and eight HALCyon studies but also from a number of unpublished studies) and found robust and generalisable associations between poorer childhood circumstances and lower capability levels.

Cooper R, Mishra, G, Kuh D. Physical Activity Across Adulthood and Physical Performance in Midlife: Findings from a British Birth Cohort. American Journal of Preventive Medicine 2011 Oct;41(4):376-84. 

This study applied our method of testing different life course models to the study of physical activity across adulthood and produced clear evidence of cumulative benefits for physical performance but not strength. The findings highlight that the general population (especially women) probably do not undertake the correct type or intensity of activity to be beneficial for upper body strength. This paper was one of the most downloaded articles in the journal in 2011.

Cooper R, Kuh D, Hardy R; Mortality Review Group; FALCon and HALCyon Study Teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. British Medical Journal. 2010 Sep 9;341:c4467.

This study provided robust and consistent evidence for associations between physical capability and mortality, and confirmed that these simple objective measures are potentially clinically useful markers of ageing. The paper received wide media coverage further raising the profile and highlighting the importance of these measures.

Kuh D, Cooper R, Hardy R, Guralnik J, Richards M; Musculoskeletal Study Team. Lifetime cognitive performance is associated with midlife physical performance in a prospective national birth cohort study. Psychosomatic Medicine 2009 Jan;71(1):38-48.

This study was one of the first to examine cognitive and physical performance longitudinally, and in a sample where confounding by age is not a limitation and confounding by co-morbidity is not yet a major limitation due to the younger relative age of the sample.

For a full list of publications from 2007-2012 please click here.

For more recent publications please look on our findings page which can be found by clicking here.

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