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A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial.

ABSTRACT: BACKGROUND:The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)-a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD. METHODS:Older adults at risk for MMD (N = 1,022, mean age = 78.7 years) were randomized to receive a structured physical activity intervention or health education control. We assessed MMD in 6-month intervals (average follow-up of 2.2 years until incident MMD), with activity assessed at baseline, 6-, 12- and 24-month follow-up via accelerometry. RESULTS:A principal components analysis of 11 accelerometer-derived metrics yielded three components representing lifestyle movement (LM), extended bouts of moderate-to-vigorous physical activity (MVPA), and stationary body posture. LM accounted for the greatest proportion of variance in movement (53%). Within health education, both baseline LM (HR = 0.74; 95% CI 0.62 to 0.88) and moderate-to-vigorous physical activity (HR = 0.69; 95% CI 0.54 to 0.87) were associated with MMD, whereas only LM was associated with MMD within physical activity (HR = 0.74; 95% CI 0.61 to 0.89). There were similar nonlinear relationships present for LM in both physical activity and health education (p < .04), whereby risk for MMD was lower among individuals with higher levels of LM. CONCLUSIONS:Both LM and moderate-to-vigorous physical activity should be central in treatment regimens for older adults at risk for MMD. TRIAL REGISTRATION:clinicaltrials.gov Identifier NCT01072500.

SUBMITTER: Fanning J

PROVIDER: S-EPMC6777081 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial.

Fanning Jason J Rejeski W Jack WJ Chen Shyh-Huei SH Nicklas Barbara J BJ Walkup Michael P MP Axtell Robert S RS Fielding Roger A RA Glynn Nancy W NW King Abby C AC Manini Todd M TM McDermott Mary M MM Newman Anne B AB Pahor Marco M Tudor-Locke Catrine C Miller Michael E ME

The journals of gerontology. Series A, Biological sciences and medical sciences 20191001 11

<h4>Background</h4>The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)-a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD.<h4>Methods</h4>Older adults at risk for MMD (N = 1,022, mean age = 78.7 years) were randomized to receive a structured ph ...[more]

PMID: 30778518

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Project description:ObjectivesTo evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults.DesignSingle-blind two-arm randomized controlled trial.SettingParticipants' homes.ParticipantsParticipants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began.InterventionUp to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months.MeasurementsLife-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months.ResultsParticipants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21).ConclusionLife-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

Project description:BackgroundProvider recommendation is a predictor of colorectal cancer (CRC) screening.PurposeTo compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening.DesignTwo-group RCT with data collected at baseline and 1 week post-intervention.Setting/participantsAfrican-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics.InterventionParticipants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit.Main outcome measuresBetween-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012.ResultsCompared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05).ConclusionsThe computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient-provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP.Trial registrationThis study is registered at www.clinicaltrials.gov NCT00672828.

Dataset Information

A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial.

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A Case for Promoting Movement Medicine: Preventing Disability in the LIFE Randomized Controlled Trial.

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