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Title: Translating the lifestyle interventions and independence for elders clinical trial to older adults in a real-world community-based setting

Author
item REID, KIERAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LAUSSEN, JONATHAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BHATIA, KARAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item ENGLUND, DAVIS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item KIRN, DYLAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item PRICE, LORI LYN - Tufts Medical Center
item MANINI, TODD - University Of Florida
item LIU, CHRISTINE - Boston University
item KOWALESKI, CHRISTOPHER - City Of Somerville Council On Aging
item FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of Gerontology Medical Science
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/17/2018
Publication Date: 7/16/2018
Citation: Reid, K.F., Laussen, J., Bhatia, K., Englund, D., Kirn, D.R., Price, L., Manini, T., Liu, C., Kowaleski, C., Fielding, R.A. 2018. Translating the lifestyle interventions and independence for elders clinical trial to older adults in a real-world community-based setting. Journal of Gerontology Medical Science. https://doi.org/10.1093/gerona/gly152.
DOI: https://doi.org/10.1093/gerona/gly152

Interpretive Summary: Older adults who lose their mobility experience a poorer quality of life, are less likely to remain independent in the community and have higher rates of chronic disease, falls and mortality. Recent high impact findings from the Lifestyle Interventions and Independence for Elders (LIFE) study demonstrated that a program of physical activity reduced the onset of major mobility disability in at-risk older adults by up to 28%. Despite the public health significance of this study, a critical unanswered question now concerns whether the LIFE study findings can be successfully translated to benefit broader populations of at-risk older adults in real-world community settings. In the current investigation, we addressed this key knowledge gap by conducting the ENGAGE pilot study (ENhancing independence using Group-based community interventions for healthy AGing in Elders). ENGAGE represents the first formal attempt to translate the benefits of the LIFE clinical trial to a real-world community based setting. We specifically targeted the recruitment of vulnerable older adults with severe mobility limitations from an urban community-based senior center setting. Our major findings revealed that, compared to a health education control intervention, it was safe and feasible to translate PA into the existing infrastructure of an urban community-based senior center. In addition, we demonstrated that PA was associated with better preservation of mobility, clinically important improvements in quality of life, significant improvements in executive cognitive functioning, notable increases in objectively-derived estimates of physical activity and a large reduction in the occurrence of falls. Overall, our novel approach and resultant findings from ENGAGE are very encouraging. We conclude by emphasizing that larger-scale translational studies should be performed to extend the public health impact and further disseminate PA to reach broader populations of vulnerable older adults in a wider variety of community-based settings.

Technical Abstract: Background: The Lifestyle Interventions and Independence for Elders (LIFE) clinical trial demonstrated that a structured program of physical activity (PA) reduced mobility-disability in older adults by up to 28%. It remains unknown whether the benefits of LIFE PA can be translated to mobility-limited older adults in real world community-based settings. To address this knowledge gap, we conducted the ENGAGE pilot study and examined the safety, feasibility and preliminary effectiveness of translating LIFE PA to a community-based senior center. Methods: Forty older adults with severe mobility limitations (age: 76.9 +/- 7.3yrs; BMI: 32.7 +/- 8 kg/m^2; 85% female; short physical performance battery (SPPB) score: 6.3 +/- 2.2) were randomized to 24 weeks of PA or a health education (HE) control intervention. Results: Community-based PA was safe (serious adverse events: PA: 0 vs. HE: 2; non-serious adverse events: PA: 3 vs. HE: 1) and participants successfully adhered to the PA intervention (65.2%). Compared to HE, PA participants who attended >/= 25% of scheduled visits had meaningful and sustained mobility improvements at follow-up (between group SPPB score differences: ~ 0.7 units). Conclusions: ENGAGE has demonstrated the preliminary safety, feasibility and effectiveness of LIFE PA in a real-world community-based setting. Larger scale translational studies are needed to further disseminate the benefits of LIFE PA to vulnerable older adults in a variety of community-based settings.