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Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial
Study Questions:
Is a long-term structured physical activity program more effective than a health education program in reducing the risk of major mobility disability?
Methods:
The LIFE (Lifestyle Interventions and Independence for Elders) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, with the study ending in December 2013. Participants were in the program for an average of 2.6 years. Participants were recruited from urban, suburban, and rural communities at eight centers throughout the United States. Participants were men and women between the ages of 70 and 89 years who were sedentary and had physical limitations (defined as a score on the Short Physical Performance Battery of 9 or below), but were able to walk 400 meters. Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/week) and at home (3-4 times/week) 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 of interest was major mobility disability objectively defined by loss of ability to walk 400 meters.
Results:
A total of 1,635 men and women (mean age 78.9 years, 67.2% women, 17.6% African American, average body mass index [BMI] 30.2 kg/m2) were included in the study. Based on the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaires, through the 24-month follow-up visit (the minimum planned intervention duration for all participants), the physical activity intervention maintained a 104-minute difference in walking and weight training activities compared with the health education group during the initial 2 years of follow-up. Based on accelerometry data, the physical activity intervention maintained a 40-minute/week difference in moderate physical activity, compared with the health education group during 2 years of follow-up. 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% confidence interval [CI], 0.69-0.98; p = 0.03). 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 = 0.006). 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).
Conclusions:
The investigators concluded that 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.
Perspective:
This large-scale study of older adults suggests that a structured program of physical activity improves mobility and thus reduces disability. The investigators observed a higher number of hospitalizations than would be observed in a younger cohort and a trend toward more hospitalizations among those randomized to the physical activity program. This included a trend toward cardiovascular events; however, this was not statistically significant. Thus, the benefits of this program among sedentary older adults may outweigh the risks for many patients.
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