Physical activity program for older adults linked to long-term improvements in function

A physical activity and behavior maintenance program for older adults with mobility limitations was associated with significant improvements in physical function over time, a randomized controlled trial found.

The Retirement in Action (REACT) trial enrolled adults ages 65 years and older from 35 primary care practices across three sites in England. Participants were not employed full time and had reduced physical function in the lower limbs, defined as a Short Physical Performance Battery (SPPB) score of 4 to 9. Researchers randomly assigned them to receive brief advice (three healthy aging education sessions) or a 12-month, group-based, multimodal program consisting of physical activity (64 one-hour exercise sessions) and behavioral maintenance (21 sessions, 45 minutes each) delivered by charity and community or leisure center staff in local communities. The primary outcome was change in SPPB score at 24 months, analyzed by intention to treat and adjusted for baseline score, age, sex, study site, and exercise group. Results were published March 21 by The Lancet Public Health.

Between June 20, 2016, and Oct. 30, 2017, 777 participants (mean age, 77.6 years; 66% women; mean SPPB score, 7.37) were randomized to the intervention (n=410) and control (n=367) groups. Overall, 334 participants in the intervention group and 628 in the control group provided primary outcome data at 24 months. At the end of follow-up, the adjusted SPPB score was significantly greater in the intervention group (mean, 8.08) than in the control group (mean, 8.08 vs. 7.59, respectively), with an adjusted mean difference of 0.49 (95% CI, 0.06 to 0.92; P=0.014), just below the researchers' predefined clinically meaningful difference of 0.50. One adverse event was related to the intervention (a hip fracture from a fall caused by a chair breaking during an exercise session in the intervention group). The most common unrelated adverse events were heart conditions, strokes, and falls. Among other limitations, masking of the participants to study group was not possible, the authors noted.

A second study, also published March 21 by The Lancet Public Health, found that the REACT program could be considered a cost-effective approach to improve health-related quality of life in older adults at risk of mobility limitations. Researchers conducted cost-effectiveness and cost-utility analyses of the program versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data reported by trial participants at baseline and at six, 12, and 24 months after randomization.

The estimated cost to deliver the 12-month REACT program was £622 per participant (about $822 at current exchange rates). The most substantial cost components were REACT session leader time, venue rent, and REACT program coordinator time. The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT program could offset program delivery costs with a health benefit of 0.04 quality-adjusted life-years within the 24 months of the trial. The study authors noted the risk for recall bias with self-reported quality-of-life data, as well as some missing economic data, among other limitations.

An accompanying editorial comment noted that in order to improve the health and well-being of older people, it is important to implement programs that promote functional mobility, such as the one tested in the REACT trial, and to promote built environments (including homes and urban settings) that are safe, accessible, and encourage walking. “Given the projected increase in the burden of falls for this age group, it is important to address both intrinsic risk factors (via exercise programmes and drug withdrawal) and extrinsic factors, such as the risks posed by the home environment,” the editorialist wrote.