Abstract
Background: 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. Objective: To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD. Design: Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500) Setting: 8 U.S. centers between February 2010 and December 2013. Participants: 1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m. Intervention: Physical activity (n = 818) and health education (n = 817). Measurements: MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years. Results: During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 [95% CI, 0.11 to 0.15]) than the health education (0.17 [CI, 0.15 to 0.19]) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death. Limitation: The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions. Conclusion: A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes. Primary Funding Source: National Institute on Aging, National Institutes of Health.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 833-840 |
| Number of pages | 8 |
| Journal | Annals of internal medicine |
| Volume | 165 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 20 2016 |
Funding
The LIFE study is funded by cooperative agreement U01AG22376 from the NIH and National Institute on Aging and supplement U01AG022376 from the National Heart, Lung, and Blood Institute, and was sponsored in part by the Intramural Research Program. The research is partially supported by the Claude D. Pepper Older Americans Independence Centers at the University of Florida (P30AG028740), Wake Forest University (P30AG21332), Tufts University (P30AG031679), the University of Pittsburgh (P30AG024827), and Yale University (P30AG021342) and by the NIH/National Center for Advancing Translational Sciences Clinical and Translational Science Awards program at Stanford University (UL1RR025744), the University of Florida (U54RR025208), and Yale University (UL1TR000142). Tufts University is also supported by the Boston Rehabilitation Outcomes Center (R24HD065688) and the U.S. Department of Agriculture under agreement 58-1950-4-003. Dr. Gill has received an Academic Leadership Award (K07AG043587) from the National Institute on Aging. Dr. Fielding is partially supported by the U.S. Department of Agriculture, under agreement 58-1950-0-014.
ASJC Scopus subject areas
- Internal Medicine