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Title: The Lifestyle Interventions and Independence for Elders (LIFE) study, randomized trial of physical activity: Effect on the prevention of major mobility disability

Author
item PAHOR, MARCO - University Of Florida
item GURALNIK, JACK - University Of Florida
item AMBROSIUS, WALTER - Wake Forest University
item BLAIR, STEVEN - University Of South Carolina
item BONDS, DENISE - National Heart, Lung And Blood Institute(NHLBI, NIH)
item CHURCH, TIMOTHY - Pennington Biomedical Research Center
item ESPELAND, MARK - Wake Forest University
item FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item GILL, THOMAS - Yale School Of Medicine
item GROESSL, ERIK - University Of California
item KING, ABBY - Stanford University
item KRITCHEVSKY, STEPHEN - Wake Forest University
item MANINI, TODD - University Of Florida
item MCDERMOTT, MARY - Northwestern University
item MILLER, MICHAEL - Wake Forest University
item NEWMAN, ANNE - University Of Pittsburgh
item REJESKI, JACK - Wake Forest University
item ROMASHKAN, SERGEI - National Institute On Aging (NIA, NIH)
item SINK, KAYCEE - Wake Forest University
item WILLIAMSON, JEFF - Wake Forest University

Submitted to: Journal of the American Medical Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/10/2014
Publication Date: 5/27/2014
Citation: Pahor, M., Guralnik, J.M., Ambrosius, W.T., Blair, S., Bonds, D.E., Church, T.S., Espeland, M.A., Fielding, R.A., Gill, T.M., Groessl, E.J., King, A.C., Kritchevsky, S.B., Manini, T.M., Mcdermott, M.M., Miller, M.E., Newman, A.B., Rejeski, J.W., Romashkan, S., Sink, K.M., Williamson, J.D. 2014. The Lifestyle Interventions and Independence for Elders (LIFE) study, randomized trial of physical activity: Effect on the prevention of major mobility disability. Journal of the American Medical Association. 311(23):2387-2396.

Interpretive Summary: Older adults with reduced mobility are at increased risk of losing their independence. There is limited evidence suggesting that regular exercise or physical activity may help maintain independence and prevent disability. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single blinded randomized trial and was conducted to examine the effects of physical activity on the prevention of age-related disability. We randomized a volunteer sample of 1,635 sedentary men and women aged 70-89 years who had physical limitations to either a twice weekly supervised moderate-intensity physical activity program or a health education program for a period of 2 to 4 years. Major mobility disability (defined as the inability to walk 400 meters) occurred in 30.1% (n=246/818) in the physical activity group and 35.5% (n=290/817) in the health education only group. These data suggest that physical activity reduced the development of major mobility disability by 18% in older persons with physical limitations. Regular moderate-intensity physical activity should be recommended for vulnerable older adults to prevent the development of major mobility disability and the loss of independence.

Technical Abstract: In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining if physical activity prevents or delays mobility disability. To test the hypothesis that a long-term structured physical activity program is more effective than a successful aging health education program in reducing the risk of major mobility disability. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single blinded randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.7 years. Participants were recruited from urban, suburban and rural communities at 8 field centers throughout the US. We randomized a volunteer sample of 1,635 sedentary men and women aged 70-89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. Participants were randomized to a structured moderate intensity physical activity program done in a center and at home that included including aerobic, resistance and flexibility training activities or to a successful aging health education program. The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. Incident major mobility disability occurred in 30.1% (n=246/818) of physical activity and 35.5% (n=290/817) of successful aging participants [HR 0.82, 95% CI (0.69, 0.98), p=0.03]. The secondary endpoint of major mobility disability or death was experienced by 264/818 (32.3%) physical activity and 309/817 (37.8%) successful aging participants (HR=0.82; 95% CI 0.70-0.97; p=0.02). Serious adverse events were reported by 404/818 (49.4%) of the physical activity and 373/817 (45.7%) of the successful aging participants (Risk Ratio=1.08; 95% CI 0.98-1.20). Physical activity prevents major mobility disability in older persons with physical limitations. Regular moderate intensity physical activity should be recommended for vulnerable older adults to prevent the development of major mobility disability.