doi:10.1136/bjsports-2020-103720engAlcazar, J.Navarrete-Villanueva, D.Mañas, A.Gómez-Cabello, A.Pedrero-Chamizo, R.Alegre, L.M.Villa, G.Gusi, N.González-Gross, M.Casajús, J.A.Vicente-Rodriguez, G.Ara, I."Fat but powerful'' paradox: association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre studyART-2021-124151Objectives: To assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the fat but powerful'' (F+P) (or fat but fit'') paradox in older adults. Methods: A total of 2563 older adults (65 €''91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated. Results: According to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively). Conclusion: Powerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.2021http://zaguan.unizar.es/record/10218310.1136/bjsports-2020-103720http://zaguan.unizar.es/record/102183oai:zaguan.unizar.es:102183British Journal of Sports Medicine 55, 21 (2021), 103720 [8 pp.]by-nchttp://creativecommons.org/licenses/by-nc/3.0/es/info:eu-repo/semantics/openAccess