The association of vitamin D supplementation and serum vitamin D levels with physical activity in older adults: Results from a randomized trial

Background: To assess whether vitamin D₃ supplementation attenuates the decline in daily physical activity in low-functioning adults at risk for falls. Methods: Secondary data analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You), a response-adaptive randomized clinical trial. Participants included 571 adults aged 70 years and older with baseline serum 25(OH)D levels of 10–29 ng/mL and elevated fall risk, who wore a wrist accelerometer at baseline and at least one follow-up visit and were randomized to receive: 200 IU/day (control), 1000, 2000, or 4000 IU/day of vitamin D₃. Objective physical activity quantities and patterns (total daily activity counts, active minutes/day, and activity fragmentation) were measured for 7-days, 24-h/day, in the free-living environment using the Actigraph GT9x over up to 24-months of follow-up. Results: In adjusted models, physical activity quantities declined (p < 0.001) and became more fragmented, or “broken up”, (p = 0.017) over time. Supplementation with vitamin D₃ did not attenuate this decline. Changes in physical activity were more rapid among those with baseline serum 25(OH)D <20 ng/mL compared to those with baseline 25(OH)D levels of 20–29 ng/mL (time*baseline 25(OH)D, p < 0.05). Conclusion: In low-functioning older adults with serum 25(OH)D levels 10–29 ng/mL, vitamin D₃ supplementation of 1000 IU/day or higher did not attenuate declines in physical activity compared with 200 IU/day. Those with baseline 25(OH)D <20 ng/mL showed accelerated declines in physical activity. Alternative interventions to supplementation are needed to curb declines in physical activity in older adults with low serum 25(OH)D.