Abstract
BackgroundAmong older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations.MethodsWe analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70–89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years.ResultsFor both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58–1.1) and 0.77 (0.62–0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71–3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88–1.7), but this difference did not achieve statistical significance (P-interaction, 0.670).ConclusionsIntervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations.Trial registrationClinicalTrials.gov identifier NCT01072500.
Highlights
Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization
To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations
For the initial onset of major mobility disability (MMD), participants in the physical activity group were more likely than those in the health education group to be hospitalized, and they had a greater number of hospital admissions and days hospitalized
Summary
Disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderateintensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. Prior observational research has shown that disability among older persons is often precipitated by intervening illnesses and injuries leading to hospitalization [1]. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, in comparison with a health education program, a structured moderate-intensity physical activity program significantly reduced the occurrence of a major mobility disability (MMD; hazard ratio [HR] 0.82), defined as the inability to walk 400 m, over an average follow-up of 2.6 years among 1635 sedentary persons aged 70–89 years who had functional limitations [5]. Participants who were randomized to the physical activity group were more likely to be hospitalized than those who were randomized to the health education group, this difference did not achieve statistical significance [5]
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