Structured exercise may offer mobility benefits to all older patients, regardless of frailty

Physicians should consider prescribing physical activity to all older patients, regardless of frailty status, said the authors of a study examining a structured, moderate-intensity physical activity program.

The study, a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) trial, analyzed data from eight U.S. centers for 1,635 community-dwelling adults with functional limitations, ages 70 to 89 years, to determine whether a long-term, structured, moderate-intensity physical activity program was associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability risk.

Patients were randomly assigned to a program consisting of aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercise. Primary outcome measures were frailty, as defined by the Study of Osteoporotic Fractures (SOF) index, at baseline and at six, 12, and 24 months, and major mobility disability, defined as the ability to walk up to 400 m, for up to 3.5 years. Results were published online Jan. 9 by Annals of Internal Medicine.

Over two years of follow-up, the risk for frailty was not statistically significantly different in the physical activity versus the health education group (adjusted prevalence difference, −0.021; 95% CI, −0.049 to 0.007). Among the three criteria of the SOF index, the physical activity intervention was associated with improvement in the ability to rise from a chair five times (adjusted prevalence difference, −0.050; 95% CI, −0.081 to −0.020). Physical activity was associated with reduced incident major mobility disability, but its effect was not modified by baseline frailty status (P=0.91 for the interaction).

The authors noted that their findings might not be widely generalizable and that frailty was not used as a study entry criterion or in randomization, among other limitations. However, they concluded that their findings highlight the feasibility and importance of effective long-term, community-based physical activity programs for frail and nonfrail older adults.

An accompanying editorial questioned whether frailty can be used as an intermediate outcome in geriatrics research.

“In the meantime, a continued focus on patient-centered outcomes that directly correspond to improved quality of life for patients—such as mobility and function—is warranted,” the editorial stated. “We thus argue that for now, frailty remains a powerful predictor of patient-centered outcomes but is not yet ready for a role as a full-fledged outcome measure in geriatrics research.”