In the Journals

Physical activity intervention improved mobility in older adults

A long-term, structured physical activity program reduced the overall burden of major mobility disability in elderly patients, according to study data.

“Maintaining independent mobility is an important goal of clinical medicine and public health, especially among older persons, who are at the greatest risk for disability,” Thomas M. Gill, MD, of the Yale School of Medicine and colleagues, wrote.

They added, “The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone.”

Gill and colleagues conducted a single-blinded, parallel-group trial to assess how a structured physical activity program affected the number of elderly patients who showed signs of major mobility disability (MMD) burden during an extended period in comparison to a health education program. In addition, the risk for transitions into and out of MMD were compared between programs.

Between February 2010 and December 2013, 1,635 sedentary patients between the ages of 70 years and 89 years from eight centers in the United States were evaluated. These patients had functional limitations, but could walk 400 meters unassisted. They were randomly separated into two intervention groups: physical activity (n = 818); and health education (n = 817).

The investigators characterized MMD as the inability to walk 400 meters. Participants were assessed every 6 months for MMD for up to 3.5 years, with a median follow-up duration of 2.7 years.

Results showed a significantly reduced proportion of patient assessments indicating MMD in the physical activity group in comparison to the health education group (0.13 vs. 0.17). In addition, the burden of MMD was substantially lowered by 25% ([confidence interval [CI], 10% to 37%) in the physical activity group compared to the health education group (P = 0.002).

A multistate model analysis determined hazard ratios for comparing physical activity with health education: transition from no MMD to MMD was 0.87 (CI, 0.64 to 0.89); no MMD to death was 0.52 (CI, 0.10 to 2.67); MMD to no MMD was 1.33 (CI, 0.99 to 1.77); and for MMD to death was 1.92 (CI, 1.15 to 3.30).

“The current study provides strong evidence that the Lifestyle Intervention and Independence for Elders (LIFE) physical activity intervention reduced the overall MMD burden over an extended period, in part through enhanced recovery after an occurrence of disability and a diminished risk for subsequent disability episodes,” Gill and colleagues concluded. “These results highlight the long-term value of the LIFE physical activity intervention in promoting independent mobility among vulnerable older persons.”

In an accompanying editorial, Patricia P. Katz, PhD, of the University of California, San Francisco, and Russell Pate, PhD, of the University of South Carolina, note the results of this study strengthen the mounting evidence on the benefits of physical activity.

“Because the evidence of the benefits of physical activity is unequivocal, efforts to encourage the uptake and maintenance of activity are critical,” they wrote. Katz and Pate assert health care professionals are an integral part in the lifestyle change process as they are the “most influential sources of advice;” however, more knowledge and training on physical activity counseling among physicians is necessary.

“Prescribing exercise may be just as important as prescribing medications — perhaps even more important in some cases,” they wrote. “However, clinicians need training, tools and support for this effort. It is time for medical schools to start preparing students to prescribe exercise as effectively as they prescribe statins, and for health systems to support physicians in addressing inactivity just as they provide support in addressing other health risks.” – by Alaina Tedesco

Disclosures: Gill and colleagues report funding from the National Institute on Aging and the NIH. Please see full studies for complete lists of disclosures.

A long-term, structured physical activity program reduced the overall burden of major mobility disability in elderly patients, according to study data.

“Maintaining independent mobility is an important goal of clinical medicine and public health, especially among older persons, who are at the greatest risk for disability,” Thomas M. Gill, MD, of the Yale School of Medicine and colleagues, wrote.

They added, “The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone.”

Gill and colleagues conducted a single-blinded, parallel-group trial to assess how a structured physical activity program affected the number of elderly patients who showed signs of major mobility disability (MMD) burden during an extended period in comparison to a health education program. In addition, the risk for transitions into and out of MMD were compared between programs.

Between February 2010 and December 2013, 1,635 sedentary patients between the ages of 70 years and 89 years from eight centers in the United States were evaluated. These patients had functional limitations, but could walk 400 meters unassisted. They were randomly separated into two intervention groups: physical activity (n = 818); and health education (n = 817).

The investigators characterized MMD as the inability to walk 400 meters. Participants were assessed every 6 months for MMD for up to 3.5 years, with a median follow-up duration of 2.7 years.

Results showed a significantly reduced proportion of patient assessments indicating MMD in the physical activity group in comparison to the health education group (0.13 vs. 0.17). In addition, the burden of MMD was substantially lowered by 25% ([confidence interval [CI], 10% to 37%) in the physical activity group compared to the health education group (P = 0.002).

A multistate model analysis determined hazard ratios for comparing physical activity with health education: transition from no MMD to MMD was 0.87 (CI, 0.64 to 0.89); no MMD to death was 0.52 (CI, 0.10 to 2.67); MMD to no MMD was 1.33 (CI, 0.99 to 1.77); and for MMD to death was 1.92 (CI, 1.15 to 3.30).

“The current study provides strong evidence that the Lifestyle Intervention and Independence for Elders (LIFE) physical activity intervention reduced the overall MMD burden over an extended period, in part through enhanced recovery after an occurrence of disability and a diminished risk for subsequent disability episodes,” Gill and colleagues concluded. “These results highlight the long-term value of the LIFE physical activity intervention in promoting independent mobility among vulnerable older persons.”

In an accompanying editorial, Patricia P. Katz, PhD, of the University of California, San Francisco, and Russell Pate, PhD, of the University of South Carolina, note the results of this study strengthen the mounting evidence on the benefits of physical activity.

“Because the evidence of the benefits of physical activity is unequivocal, efforts to encourage the uptake and maintenance of activity are critical,” they wrote. Katz and Pate assert health care professionals are an integral part in the lifestyle change process as they are the “most influential sources of advice;” however, more knowledge and training on physical activity counseling among physicians is necessary.

“Prescribing exercise may be just as important as prescribing medications — perhaps even more important in some cases,” they wrote. “However, clinicians need training, tools and support for this effort. It is time for medical schools to start preparing students to prescribe exercise as effectively as they prescribe statins, and for health systems to support physicians in addressing inactivity just as they provide support in addressing other health risks.” – by Alaina Tedesco

Disclosures: Gill and colleagues report funding from the National Institute on Aging and the NIH. Please see full studies for complete lists of disclosures.