The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: Secondary analysis of a randomized controlled trial

Thomas M. Gill*, Daniel P. Beavers, Jack M. Guralnik, Marco Pahor, Roger A. Fielding, Michelle Hauser, Todd M. Manini, Anthony P. Marsh, Mary M. McDermott, Anne B. Newman, Heather G. Allore, Michael E. Miller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations. Methods: We analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70-89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years. Results: For both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58-1.1) and 0.77 (0.62-0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71-3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88-1.7), but this difference did not achieve statistical significance (P-interaction, 0.670). Conclusions: Intervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations. Trial registration: ClinicalTrials.gov identifier NCT01072500.

Original languageEnglish (US)
Article number65
JournalBMC Medicine
Volume15
Issue number1
DOIs
StatePublished - Mar 28 2017

Funding

The Lifestyle Interventions and Independence for Elders Study is funded by cooperative agreement U01AG22376 from the National Institutes of Health (NIH) and National Institute on Aging; 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), University of Pittsburgh (P30AG024827), and Yale University (P30AG021342); and the NIH/NCATS CTSA at Stanford University (UL1RR025744), 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 No. 58-1950-4-003. LIFE investigators are also partially supported by the following: TMG is the recipient of an Academic Leadership Award (K07AG3587) from the National Institute on Aging, and MH is supported by training grant T32HL007034 from the NIH.

Keywords

  • Hospitalizations
  • Mobility disability
  • Physical activity
  • Randomized controlled trial

ASJC Scopus subject areas

  • General Medicine

Fingerprint

Dive into the research topics of 'The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: Secondary analysis of a randomized controlled trial'. Together they form a unique fingerprint.

Cite this