Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial

Authors: LIU, ZUYUN - Yale University; HSU, FANG-CHI - Wake Forest University; TROMBETTI, ANDREA - Geneva University Hospital; KING, ABBY - Stanford University; LIU, CHRISTINE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MANINI, TODD - University Of Florida; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; PAHOR, MARCO - University Of Florida; NEWMAN, ANNE - University Of Pittsburgh; KRITCHEVSKY, STEPHEN - Wake Forest University; GILL, THOMAS - Yale University

Submitted to: BioMed Central (BMC) Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/12/2018
Publication Date: 10/24/2018
Citation: Liu, Z., Hsu, F., Trombetti, A., King, A.C., Liu, C.K., Manini, T.M., Fielding, R.A., Pahor, M., Newman, A.B., Kritchevsky, S., Gill, T.M. 2018. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BioMed Central (BMC) Medicine. https://doi.org/10.1186/s12916-018-1174-8.
DOI: https://doi.org/10.1186/s12916-018-1174-8

Interpretive Summary: This study was designed to evaluate the effect of a structured physical activity program on cognitive frailty, a combined measure of physical and cognitive capacity, and whether this effect was influenced by the level of inflammation as baseline. To examine this question, we used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter trial conducted at eight US field centers. This study included 1,298 participants between the ages of 70 to 89 years. We observed that participants in the physical activity group had 21% lower risk of worsening cognitive frailty than those assigned to the health education group. The effect of physical activity on cognitive frailty was not influenced by differences in baseline inflammation. These findings suggest that physical exercise may have the potential of reducing cognitive frailty and promoting healthy aging.

Technical Abstract: Background: Whether physical activity can reduce cognitive frailty - a relatively new "compound" phenotype proposed in 2013 and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect. Methods: We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1,635 original randomized sedentary participants (70-89 years), this study included 1,298 participants with data on both cognitive frailty and IL-6 assessments at baseline. Results: After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction= .919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction= .835, .836, .934, and .458, respectively). Conclusions: A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging.