In the Journals

Structured exercise program improves mobility in all older adults

Regardless of frailty status, a long-term, structured physical activity intervention reduced the incidence of major mobility disability among older adults, according to a study published in Annals of Internal Medicine.

“Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults,” Andrea Trombetti, MD, from Geneva University Hospitals, Switzerland, and colleagues wrote. “Definitive data from large long-term randomized trials are lacking.”

Trombetti and colleagues performed a secondary analysis of the Lifestyle Interventions and Independence for Elders trial to examine whether a long-term, structured, moderate-intensity physical activity program lowers the risk for frailty, and whether frailty status modifies the reduction in major mobility disability risk from physical activity.

A total of 1,635 community-dwelling adults with functional limitations aged between 70 and 89 years were included in the analysis and randomly assigned to either a program consisting of aerobic, resistance and flexibility activities or a health education program incorporating workshops and stretching exercises.

The researchers used data from the Study of Osteoporotic Fractures to define frailty as demonstrating two or more of the following indications: not being able to rise from a chair five times without help from arms, a reduced energy level and weight loss. They defined major mobility disability as not being able to walk 400 m for up to 3.5 years.

Results indicated that there was no statistically significant difference in frailty risk among the physical activity and health education intervention during 2 years of follow-up (adjusted prevalence difference, –0.021; 95% CI, –0.049 to 0.007]). Participants in the physical activity group showed improvements in the inability to rise from a chair (adjusted prevalence difference, –0.05; 95% CI, –0.081 to –0.02). The beneficial effect of physical activity on the reduction of major mobility disability was not altered by baseline frailty status (P for interaction = 0.91).

“These findings highlight the feasibility and importance of effective long-term, community-based physical activity programs for frail and nonfrail older adults,” Trombetti and colleagues concluded.

In a related editorial, Rebecca T. Brown, MD, MPH, and Kenneth E. Covinsky, MD, MPH, both from the division of geriatrics at the University of California, San Francisco, wrote that these findings call attention to whether frailty should be used as an intermediate outcome in geriatrics research.

“Our understanding of the basic mechanisms of frailty is continuing to evolve,” they wrote. “As this understanding grows, frailty may play an increasingly important role as an intermediate outcome that can elucidate the basic mechanisms by which physical activity improves mobility and functioning among older adults. In the meantime, a continued focus on patient-centered outcomes that directly correspond to improved quality of life for patients — such as mobility and function — is warranted. We thus argue that for now, frailty remains a powerful predictor of patient-centered outcomes but is not yet ready for a role as a full-fledged outcome measure in geriatrics research.” – by Alaina Tedesco

Disclosure: Trombetti, Brown and Covinsky report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

Regardless of frailty status, a long-term, structured physical activity intervention reduced the incidence of major mobility disability among older adults, according to a study published in Annals of Internal Medicine.

“Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults,” Andrea Trombetti, MD, from Geneva University Hospitals, Switzerland, and colleagues wrote. “Definitive data from large long-term randomized trials are lacking.”

Trombetti and colleagues performed a secondary analysis of the Lifestyle Interventions and Independence for Elders trial to examine whether a long-term, structured, moderate-intensity physical activity program lowers the risk for frailty, and whether frailty status modifies the reduction in major mobility disability risk from physical activity.

A total of 1,635 community-dwelling adults with functional limitations aged between 70 and 89 years were included in the analysis and randomly assigned to either a program consisting of aerobic, resistance and flexibility activities or a health education program incorporating workshops and stretching exercises.

The researchers used data from the Study of Osteoporotic Fractures to define frailty as demonstrating two or more of the following indications: not being able to rise from a chair five times without help from arms, a reduced energy level and weight loss. They defined major mobility disability as not being able to walk 400 m for up to 3.5 years.

Results indicated that there was no statistically significant difference in frailty risk among the physical activity and health education intervention during 2 years of follow-up (adjusted prevalence difference, –0.021; 95% CI, –0.049 to 0.007]). Participants in the physical activity group showed improvements in the inability to rise from a chair (adjusted prevalence difference, –0.05; 95% CI, –0.081 to –0.02). The beneficial effect of physical activity on the reduction of major mobility disability was not altered by baseline frailty status (P for interaction = 0.91).

“These findings highlight the feasibility and importance of effective long-term, community-based physical activity programs for frail and nonfrail older adults,” Trombetti and colleagues concluded.

In a related editorial, Rebecca T. Brown, MD, MPH, and Kenneth E. Covinsky, MD, MPH, both from the division of geriatrics at the University of California, San Francisco, wrote that these findings call attention to whether frailty should be used as an intermediate outcome in geriatrics research.

“Our understanding of the basic mechanisms of frailty is continuing to evolve,” they wrote. “As this understanding grows, frailty may play an increasingly important role as an intermediate outcome that can elucidate the basic mechanisms by which physical activity improves mobility and functioning among older adults. In the meantime, a continued focus on patient-centered outcomes that directly correspond to improved quality of life for patients — such as mobility and function — is warranted. We thus argue that for now, frailty remains a powerful predictor of patient-centered outcomes but is not yet ready for a role as a full-fledged outcome measure in geriatrics research.” – by Alaina Tedesco

Disclosure: Trombetti, Brown and Covinsky report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.