Dr. Patrick Doherty,
Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older AdultsThe LIFE Study Randomized Clinical TrialMarco Pahor et al.JAMA 2014; DOI: 10.1001/jama.2014.5616.
This Randomized Clinical Trial (RCT) addressed a major concern in the context of health policy and practice in the elderly by comparing a programme of physical activity against a health education approach in a sedentary population of 1635 men and women aged 70 to 89 years with mobility limitations.The physical activity intervention included a structured, moderate intensity programme, including walking, strength training and flexibility delivered at a centre (twice weekly) and, by participants, at home 3-4 times weekly. The education intervention included a once weekly session over 26 weeks with an optional bi-monthly session thereafter. The primary outcomes were incident of major mobility disability and persistent mobility disability which, following the intervention period, occurred in around 30% and 15% of participants in the physical activity group compared to 35% and 20% in the health education group respectively. A particular strength of the study was the further validation of an objective measure of major mobility disability which is an area of interest for cardiovascular prevention programmes working with elderly populations. Albeit this study showed a positive finding in favour of physical activity there were a greater number of serious adverse events, including hospitalisation and cardiac events, in the physical activity group. This may relate to the variation in dose of activity (exercise), in this vulnerable multi-morbid population, which was much greater in the physical activity group. Equally the lack of specific tailoring of the exercise intensity to the participant’s maximum ability, which would normally be acquired through an exercise tolerance test, may have played a part. This study used a minimal approach to exercise prescription which included titration, from an unknown starting intensity, combined with ‘rating of perceived exertion’ to guide walking and resistance training. More studies with longer duration of follow up using a more robust approach to exercise prescription should be pursued.
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