Sedentary Lifestyle, Risk of Disability, Aging
Conditions
Keywords
Aging, Physical Activity, Exercise, Sedentary Lifestyle, Mobility, Disability, Falls, Cost effectiveness, Behavioral counseling
Brief summary
Based upon promising results from a pilot study among 424 sedentary older adults who were randomized to a physical activity intervention or a successful aging health education intervention, a Phase 3 multi-center randomized controlled trial is being conducted to compare a moderate-intensity physical activity program to a successful aging health education program in 1,600 sedentary older adults who are followed for an average of 2.7 years. The primary aim was to assess the long-term effects of the proposed interventions on the primary outcome of major mobility disability, defined as inability to walk 400 m.
Detailed description
As life expectancy in the United States continues to rise, the maintenance of physical independence among older Americans has emerged as a major clinical and public health priority. Efficient and reliable locomotion, or the ability to move without assistance, is a fundamental feature of human functioning. Older people who lose mobility are less likely to remain in the community, have higher rates of morbidity, mortality, and hospitalizations and experience a poorer quality of life. Several studies have shown that regular physical activity improves physical performance, but definitive evidence showing that mobility disability can be prevented was lacking. A Phase 3 randomized controlled trial was needed to fill this evidence gap. The LIFE Study was a Phase 3, multicenter randomized controlled trial (RCT) designed to compare a moderate-intensity physical activity program to a successful aging health education program in 1,600 sedentary older persons who are followed for an average of 2.7 years. The primary outcome was major mobility disability, defined as inability to walk 400 m. Secondary outcomes include cognitive function based on the Digit Symbol Substitution Test (DSST) and the Hopkins Verbal Learning Test (HVLT); serious fall injuries; persistent mobility disability; the combined outcome of major mobility disability or death; disability in activities of daily living; and cost-effectiveness. Tertiary outcomes include the combined outcome of mild cognitive impairment or dementia, a composite measure of the cognitive assessment battery, physical performance within pre-specified subgroups defined on the basis of race, gender and baseline physical performance, sleep-wake disturbances, dyspnea, ventilatory capacity, cardiopulmonary events, and cardiovascular events. The physical activity intervention consists primarily of walking at moderate intensity, lower extremity resistance exercises, balance exercises, stretching and behavioral counseling. The successful aging intervention consists of health education seminars regarding health-related matters and upper extremity stretching exercises. This trial provides definitive evidence regarding whether physical activity is effective and practical for preventing major mobility disability. These results will have crucial implications for public health prevention in a rapidly aging society, and will fill an important gap in knowledge for practicing evidence-based geriatric medicine. The study will also yield valuable information concerning the efficacy and effectiveness of physical activity across a broad spectrum of important health outcomes. The study will impact both clinical practice and public health policy, and will, therefore, benefit individuals and society. The Coordinating Center was at the University of Florida and the Data Management Analysis and Quality Control Center (DMAQC) was at Wake Forest University School of Medicine. The 8 field sites participating in the LIFE Study are University of Florida, Gainesville, Florida; Northwestern University, Chicago, Illinois; Pennington Biomedical Research Center, Baton Rouge, Louisiana; University of Pittsburgh, Pittsburgh, Pennsylvania; Stanford University, Palo Alto, California; Tufts University, Boston, Massachusetts; Wake Forest University, Winston-Salem, North Carolina; and Yale University, New Haven, Connecticut.
Interventions
The physical activity intervention consists primarily of walking at moderate intensity, lower extremity resistance exercises, balance exercises, stretching and behavioral counseling.
The successful aging intervention consists of health education seminars regarding health-related matters and upper extremity stretching exercises.
Sponsors
Study design
Eligibility
Inclusion criteria
1. age 70 to 89 years; (2) summary score \<10 on the short physical performance battery (SPPB) (45% are \<8);90 (3) sedentary lifestyle; (4) ability to complete the 400 m walk test without an assistive device; and (5) willingness to be randomized to either intervention group.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Major Mobility Disability, Defined as Incapacity to Walk 400 Meters | Median 2.7 years/Average 2.6 years | The primary outcome of major mobility disability was defined as the inability to complete a 400-m walk test within 15 minutes without sitting and without the help of another person or walker. Use of a cane was acceptable. Participants were asked to walk 400 m at their usual pace, without overexerting, on a 20 meter course for 10 laps (40 meters/lap). Participants were allowed to stop for up to 1 minute for fatigue or related symptoms. When major mobility disability could not be objectively measured because of the inability of the participant to come to the clinic and absence of a suitable walking course at the participant's home, institution, or hospital, an alternative adjudication of the outcome was based on objective inability to walk 4 meters in less than 10 seconds, or self-, proxy-, or medical record-reported inability to walk across a room. If participants met these alternative criteria, they would not be able to complete the 400 meter walk within 15 minutes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Persistent Mobility Disability (Assessed Every 6 Months) | Median 2.7 years/Average 2.6 years | The assessment of major mobility disability (the inability to complete a 400-m walk test within 15 minutes without sitting and without the help of another person or walker. Use of a cane was acceptable. Participants were asked to walk 400m at their usual pace, without overexerting, on a 20 meter course for 10 laps (40 meters/lap). Participants were allowed to stop for up to 1 minute for fatigue or related symptoms. When MMD could not be objectively measured because of the inability of the participant to come to the clinic and absence of a suitable walking course at the participant's home, institution, or hospital, an alternative adjudication of the outcome was based on objective inability to walk 4 meters in less than 10 seconds, or self-, proxy-, or medical record-reported inability to walk across a room. If participants met these alternative criteria, they would not be able to complete the 400 m walk within 15 minutes.) at two consecutive time points or MMD followed by death. |
Countries
United States
Participant flow
Recruitment details
1,635 participants were randomized over 21-months, with the target of 1,600 reached late Nov 2011. The 1st randomization occurred 3/12/10, and the final randomization on 12/27/11. Participants in the recruitment pipeline completed screening and testing visits and were randomized; hence, the total randomized exceeded the target.
Participants by arm
| Arm | Count |
|---|---|
| Physical Activity The physical activity intervention consists primarily of walking at moderate intensity, lower extremity resistance exercises, balance exercises, stretching and behavioral counseling. | 818 |
| Successful Aging The successful aging intervention consists of health education seminars regarding health-related matters and upper extremity stretching exercises. | 817 |
| Total | 1,635 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 2 | 2 |
| Overall Study | Lost to Follow-up | 5 | 2 |
| Overall Study | Withdrawal by Subject | 17 | 10 |
Baseline characteristics
| Characteristic | Physical Activity | Successful Aging | Total |
|---|---|---|---|
| 3MSE Score, 0-100 scale, mean | 91.5 units on a scale STANDARD_DEVIATION 5.6 | 91.6 units on a scale STANDARD_DEVIATION 5.5 | 91.5 units on a scale STANDARD_DEVIATION 5.5 |
| Age, Continuous | 78.7 years STANDARD_DEVIATION 5.2 | 79.1 years STANDARD_DEVIATION 5.2 | 78.9 years STANDARD_DEVIATION 5.2 |
| Body Mass Index, mean | 30.1 kg/m^2 STANDARD_DEVIATION 5.9 | 30.3 kg/m^2 STANDARD_DEVIATION 6.2 | 30.2 kg/m^2 STANDARD_DEVIATION 6.1 |
| Cancer | 178 participants | 192 participants | 370 participants |
| CHAMPS 18 Total Score | 15.9 hours/week STANDARD_DEVIATION 32.1 | 18.2 hours/week STANDARD_DEVIATION 33.8 | 17.0 hours/week STANDARD_DEVIATION 33 |
| Chronic lung disease | 130 participants | 123 participants | 253 participants |
| Diabetes/High Blood Sugar | 198 participants | 216 participants | 414 participants |
| Diastolic Blood Pressure | 68.7 mmHg STANDARD_DEVIATION 10.3 | 67.7 mmHg STANDARD_DEVIATION 10.1 | 68.2 mmHg STANDARD_DEVIATION 10.2 |
| Education College (13-17) | 321 participants | 320 participants | 641 participants |
| Education Elementary School (k-8) | 15 participants | 17 participants | 32 participants |
| Education High school/equivalent (9-12) | 248 participants | 236 participants | 484 participants |
| Education No formal eduction | 7 participants | 6 participants | 13 participants |
| Education Other | 32 participants | 26 participants | 58 participants |
| Education Post Graduate | 194 participants | 208 participants | 402 participants |
| Education Unknown | 1 participants | 4 participants | 5 participants |
| Heart Attack/Coronary/MI | 60 participants | 69 participants | 129 participants |
| Heart failure/congestive heart failure | 26 participants | 45 participants | 71 participants |
| High blood pressure/hypertension | 573 participants | 578 participants | 1151 participants |
| Pacemaker | 33 participants | 33 participants | 66 participants |
| Race/Ethnicity, Customized African American | 163 participants | 125 participants | 288 participants |
| Race/Ethnicity, Customized Asian | 7 participants | 8 participants | 15 participants |
| Race/Ethnicity, Customized Hispanic | 31 participants | 30 participants | 61 participants |
| Race/Ethnicity, Customized Other/Mixed | 10 participants | 17 participants | 27 participants |
| Race/Ethnicity, Customized Refused/Missing | 3 participants | 2 participants | 5 participants |
| Race/Ethnicity, Customized White | 604 participants | 635 participants | 1239 participants |
| Sex: Female, Male Female | 547 Participants | 551 Participants | 1098 Participants |
| Sex: Female, Male Male | 271 Participants | 266 Participants | 537 Participants |
| Stroke | 57 participants | 52 participants | 109 participants |
| Systolic Blood Pressure | 127.9 mmHg STANDARD_DEVIATION 18.1 | 127.0 mmHg STANDARD_DEVIATION 17.8 | 127.4 mmHg STANDARD_DEVIATION 18 |
| Total Cholesterol | 179.3 mg/dL STANDARD_DEVIATION 39.6 | 178.5 mg/dL STANDARD_DEVIATION 39.9 | 178.9 mg/dL STANDARD_DEVIATION 39.8 |
| Total SPPB Score | 7.4 units on a scale STANDARD_DEVIATION 1.6 | 7.3 units on a scale STANDARD_DEVIATION 1.6 | 7.4 units on a scale STANDARD_DEVIATION 1.6 |
| Weight (kg) | 81.9 kg STANDARD_DEVIATION 18.4 | 82.0 kg STANDARD_DEVIATION 19.3 | 81.9 kg STANDARD_DEVIATION 18.8 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 181 / 818 | 88 / 817 |
| serious Total, serious adverse events | 404 / 818 | 373 / 817 |
Outcome results
Major Mobility Disability, Defined as Incapacity to Walk 400 Meters
The primary outcome of major mobility disability was defined as the inability to complete a 400-m walk test within 15 minutes without sitting and without the help of another person or walker. Use of a cane was acceptable. Participants were asked to walk 400 m at their usual pace, without overexerting, on a 20 meter course for 10 laps (40 meters/lap). Participants were allowed to stop for up to 1 minute for fatigue or related symptoms. When major mobility disability could not be objectively measured because of the inability of the participant to come to the clinic and absence of a suitable walking course at the participant's home, institution, or hospital, an alternative adjudication of the outcome was based on objective inability to walk 4 meters in less than 10 seconds, or self-, proxy-, or medical record-reported inability to walk across a room. If participants met these alternative criteria, they would not be able to complete the 400 meter walk within 15 minutes.
Time frame: Median 2.7 years/Average 2.6 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Physical Activity | Major Mobility Disability, Defined as Incapacity to Walk 400 Meters | 246 participants |
| Successful Aging | Major Mobility Disability, Defined as Incapacity to Walk 400 Meters | 290 participants |
Persistent Mobility Disability (Assessed Every 6 Months)
The assessment of major mobility disability (the inability to complete a 400-m walk test within 15 minutes without sitting and without the help of another person or walker. Use of a cane was acceptable. Participants were asked to walk 400m at their usual pace, without overexerting, on a 20 meter course for 10 laps (40 meters/lap). Participants were allowed to stop for up to 1 minute for fatigue or related symptoms. When MMD could not be objectively measured because of the inability of the participant to come to the clinic and absence of a suitable walking course at the participant's home, institution, or hospital, an alternative adjudication of the outcome was based on objective inability to walk 4 meters in less than 10 seconds, or self-, proxy-, or medical record-reported inability to walk across a room. If participants met these alternative criteria, they would not be able to complete the 400 m walk within 15 minutes.) at two consecutive time points or MMD followed by death.
Time frame: Median 2.7 years/Average 2.6 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Physical Activity | Persistent Mobility Disability (Assessed Every 6 Months) | 120 participants |
| Successful Aging | Persistent Mobility Disability (Assessed Every 6 Months) | 162 participants |