Physical Activity Program Can Reduce Major Mobility Disability in Older Adults

Older adults at risk for disability who participated in a physical activity program were able to reduce the occurrence of major mobility disability and persistent mobility disability compared to individuals who only participated in a health education program, according to a recent study [JAMA. 2014; DOI:10.1001/jama.2014.5616].

Mobility is a critical issue for older adults because it is often essential for independent living. Studies have found that older adults who lose mobility have a greater risk of morbidity, disability, and mortality. However, according to the authors of this study, previous studies have not assessed whether physical activity can help prevent or delay mobility disability.

Researchers in this multicenter study used a single-blind design to evaluate the effect of a long-term structured physical activity program in reducing the risk of major mobility disability in sedentary older adults. The LIFE [Lifestyle Interventions and Independence for Elders] study was a randomized trial with participants from 8 centers across the United States that focused on the participants’ ability to walk 400 meters.

For study inclusion, participants were required to be sedentary men and women between 70 and 89 years of age who had no major cognitive impairment; could walk at least 400 meters in <15 minutes without sitting, leaning, or receiving help from another person or walker; and were at high risk for developing mobility disability based on functional limitations to the lower extremities.

Participants (n=1635) were then randomized to the physical activity group or the health education program group. Participants in the physical activity group (n=818) did strength, flexibility, and balance training in addition to having a goal of walking at least 150 minutes per week. They were asked to
attend 2 center-based visits per week and participate in home-based activity 3 to 4 times per week.
Participants in the health education program group (n=817) attended weekly workshops on health education for 26 weeks and then had monthly educational sessions. Workshop topics included issues such as negotiating the healthcare system, nutrition, and how to travel safely.

The primary outcome of the study was major mobility disability, which researchers defined as the ability to no longer walk 400 meters. The staff who assessed walking ability were blind to the study and separate from the intervention team. The average time of participation was 2.6 years.

Researchers found that the physical activity intervention significantly reduced major mobility disability in participants compared with the health education program group. They reported that 30.1% of participants in the major mobility disability group ultimately lost the ability to walk 400 meters during the study period, while 35.5% did so in the health education group (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.69-0.98; P=.03).

Physical activity also had an impact on persistent mobility disability. According to the study’s findings, 14.7% of the people in the physical activity group developed persistent mobility disability, while 19.8% of those in the health education program group were determined to have persistent mobility disability (HR, 0.72; 95% CI, 0.57-0.91; P=.006).

While the physical activity intervention reduced major and persistent mobility, the researchers did find that participants in the physical activity group had a higher rate of inpatient hospitalizations during the study (49.4%); however, the difference was not significant.

Using a questionnaire, the researchers found that the physical activity group maintained a 104-minute difference in walking and weight training activities during a 24-month follow-up period compared to the health education program group (95% CI, 92-116; P<.001). The average minutes per week for the physical activity group was 218 minutes (95% CI, 210-227; average change from baseline 138 minutes; 95% CI, 129-146).

According to the study’s authors, there were limitations. For instance, the researchers did not assess the benefit of physical activity for people with high levels of physical functioning or those with cognitive deficits. The study also only had an average follow-up time of 2.6 years, which does not fully cover the 9-year average life expectancy of their study group.—Jill Sederstrom