ABSTRACTinterventiOns A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises. Main OutCOMe MeasuresSerious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis.results Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction). COnClusiOnsIn this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men.trial registratiOn ClinicalsTrials.gov NCT01072500.
BackgroundData are sparse regarding the value of physical activity (PA) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study.Methods and ResultsCardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates.ConclusionsObjective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.
Objective To evaluate the extent of variability in functional responses among participants in the LIFE study, and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. Design Secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) study. Setting Multicenter U.S. institutions participating in the LIFE study. Participants A volunteer sample of 1635 sedentary men and women aged 70 to 89 years who were able to walk 400 m, but had physical limitations, defined as a score on the Short Physical Performance Battery (SPPB) of ≤9. Interventions Moderate-intensity physical activity (PA, n=818) consisting of aerobic, resistance and flexibility exercises performed both center-based (twice/wk) and in or around the home environment (3-4 times/wk) or health education (HE, n=817) consisting of weekly to monthly workshops covering relevant health information. Main Outcome Measures Physical function: gait speed over 400-m and lower extremity function (SPPB) assessed at baseline, six, twelve, and 24 months. Results Greater baseline physical function (gait speed and SPPB score) was inversely associated with Δ gait speed (regression coefficient β=−0.185, p<0.001) and ΔSPPB score (β=−0.365, p<0.001), while greater number of steps per day measured by accelerometry was positively associated with Δ gait speed (β=0.035, p<0.001) and Δ SPPB score (β=0.525, p<0.001). Other baseline factors associated with positive Δ gait speed and/or SPPB score include younger age (p<0.001), lower body mass index (p<0.001), and higher self-reported physical activity (p=0.002). Conclusions Several demographic and physical activity-related factors were associated with the extent of Δ functional outcomes among participants in the LIFE study. These factors should be considered when designing interventions for improving physical function among older adults with limited mobility.
Objective The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and non-obese older adults. Methods A total of 1453 men and women (age ≥ 70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) non-dynapenic/non-obese (NDYN-NO), (2) dynapenic/non-obese (DYN-NO), (3) non-dynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (FNIH criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least three metabolic syndrome (MetS) criteria and other chronic conditions. Results A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared to DYN-NO groups (55.6 vs 45.1%, p ≤ 0.01) was observed. Waist circumference was also significantly higher in obese groups (DYN-O=114.0±12.9 and NDYN-O=111.2±13.1) than in non-obese (NDYN-NO=93.1±10.7 and DYN-NO=92.2±11.2, p ≤ 0.01); and higher in NDYN-O compared to DYN-O (p = 0.008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared to DYN-O (70.9±10.1 vs 67.7±9.7, p ≤ 0.001). No significant differences were found across dynapenia and obesity status for all other metabolic components (p>0.05). The odds of having metabolic syndrome or its individual components were similar in obese and non-obese, combined or not with dynapenia (non-significant OR [95%CI]). Conclusion Non-obese dynapenic older adults had fewer metabolic disease risk factors than non-obese and non-dynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting metabolic syndrome criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or non-obese older adults.
Background Because chronic kidney disease (CKD) is associated with muscle wasting, older adults with CKD are likely to have physical function deficits. Physical activity can improve these deficits, but whether CKD attenuates the benefits is unknown. Our objective was to determine if CKD modified the effect of a physical activity intervention in older adults. Methods This is an exploratory analysis of the LIFE-P study, which compared a 12-month physical activity program (PA) to a successful aging education program (SA) in older adults. CKD was defined as a baseline eGFR < 60 mL/min/1.73 m2. We examined the Short Physical Performance Battery (SPPB) at baseline, 6 and 12 months. Secondary outcomes included serious adverse events (SAE) and adherence to intervention frequency. Linear mixed models were adjusted for age, sex, diabetes, hypertension, CKD, intervention, site, visit, baseline SPPB, and interactions of intervention and visit and of intervention, visit, and baseline CKD. Results The sample included 368 participants. CKD was present in 105 (28.5%) participants with a mean eGFR of 49.2 ± 8.1 mL/min/1.73 m2. Mean SPPB was 7.38 ± 1.41 in CKD participants; 7.59 ± 1.44 in those without CKD (p = 0.20). For CKD participants in PA, 12-month SPPBs increased to 8.90 (95% CI 8.32, 9.47), while PA participants without CKD increased to 8.40 (95% CI 8.01, 8.79, p = 0.43). For CKD participants in SA, 12-month SPPBs increased to 7.67 (95% CI 7.07, 8.27), while participants without CKD increased to 8.12 (95% CI 7.72, 8.52, p = 0.86). Interaction between CKD and intervention was non-significant (p = 0.88). Number and type of SAEs were not different between CKD and non-CKD participants (all p > 0.05). In PA, adherence for CKD participants was 65.5 ± 25.4%, while for those without CKD was 74.0 ± 22.2% (p = 0.12). Conclusion Despite lower adherence, older adults with CKD likely derive clinically meaningful benefits from physical activity with no apparent impact on safety, compared to those without CKD.
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