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Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

ABSTRACT: In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.Participants were randomized to a structured, moderate-intensity physical activity program (n?=?818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n?=?817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P?=?.03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P?=?.006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.clinicaltrials.gov Identifier: NCT01072500.

SUBMITTER: Pahor M

PROVIDER: S-EPMC4266388 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

Pahor Marco M Guralnik Jack M JM Ambrosius Walter T WT Blair Steven S Bonds Denise E DE Church Timothy S TS Espeland Mark A MA Fielding Roger A RA Gill Thomas M TM Groessl Erik J EJ King Abby C AC Kritchevsky Stephen B SB Manini Todd M TM McDermott Mary M MM Miller Michael E ME Newman Anne B AB Rejeski W Jack WJ Sink Kaycee M KM Williamson Jeff D JD

JAMA 20140601 23

<h4>Importance</h4>In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.<h4>Objective</h4>To test the hypothesis that a long-term structured physical activity program is more effective than a health educati ...[more]

PMID: 24866862

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Project description:Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70-89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10-0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes.Trial registrationClinicalsTrials.gov NCT00116194.

Project description:Background and objectivesMany cross-sectional studies have confirmed a link between gait speed and cognitive function. However, it is unknown whether cognitive function plays a role in the onset of major mobility disability (MMD) and if the effects are independent of physical function. This study examined cognitive and physical function as predictors of MMD across an average of 2.6 years of follow-up in community-dwelling older adults with compromised mobility.Research design and methodData were collected from 1,635 participants in the Lifestyle Interventions and Independence for Elders (LIFE) study ages 70-89 years free of MMD at baseline. MMD was assessed every 6 months and defined as the inability to walk 400 m in ≤15 min without assistance or sitting. Cognitive function was assessed at baseline, 18 months, and 24 months using a cognitive battery categorized into four domains: global cognitive function, processing speed, verbal memory, and executive function.ResultsAcross the study duration of 2.6 years, 536 participants (32.8%) developed MMD. Cox Proportional Hazard models indicated a protective relationship for higher baseline processing speed (Hazard Ratio [HR] per standard deviation: 0.86, p = .006), executive function (HR: 0.86, p = .002), and global cognition (HR: 0.85, p = .001) on incidence of MMD adjusted for demographics, intervention, and comorbidities. Results were not significant after adjustment for gait speed. In adjusted longitudinal models, a positive change in processing speed was significantly associated with reduced risk of MMD (HR: 0.52, p < .001) while other domains were not.Discussion and implicationsIn the LIFE study, processing speed at baseline and follow-up was a significant predictor of subsequent MMD although the observed association may be explained by physical function as reflected in gait speed. More studies are needed to understand how cognitive function, alone and in combination with physical function, influences risk of MMD.

Project description:ObjectivesTo examine the relationship between time spent in light physical activity (LPA) and in moderate to vigorous physical activity (MVPA) and the pattern of accumulation on the risk for major mobility disability (MMD) in a large multicenter study of physical activity (PA) and aging, the Lifestyle Interventions and Independence for Elders (LIFE) study.DesignData were collected from individuals randomized to a PA intervention as part of the LIFE study, an eight-center single-blind randomized clinical trial conducted between February 2010 and December 2013.SettingLifestyle Interventions and Independence for Elders Study PARTICIPANTS: Older adult participants (78.4 years; N = 507) at risk for MMD.InterventionAll older adults included in these analyses were randomized to a structured PA intervention that included two center-based plus three to four home-based exercise sessions per week with a primary goal of walking for 150 minutes weekly. Participants attended the intervention for 2.5 years on average.MeasurementsMMD was defined as the inability to complete a 400-m walk within 15 minutes and without assistance. Physical function was assessed via the Short Physical Performance Battery (SPPB). Actigraph accelerometers were used to quantify amount and variability in LPA and MVPA.ResultsIn an adjusted Cox proportional hazards regression, we identified a significant interaction (P = .017) between SPPB score and LPA amount and variability such that more LPA was associated with a reduced risk for MMD among those with higher initial function, as was lower variability (eg, via distributing LPA across the day). The SPPB × MVPA interaction was significant (P = .04), such that more MVPA was associated with lower MMD risk among those with lower function. Finally, greater MVPA variability was associated with lower risk for MMD.ConclusionA prescription of PA for older adults should account for key factors such as physical function and emphasize both amount and pattern of accumulation of PA from across the intensity continuum. J Am Geriatr Soc 68:1476-1483, 2020.

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Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

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Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

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