Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project)

Abstract

ObjectiveTo determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia.DesignEvaluator blinded, randomised controlled trial.Setting16 clinical sites across 11 European countries, January 2016 to 31 October 2019.Participants1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls).InterventionsThe multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months.Main outcome measuresThe primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes.ResultsMean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; P<0.001) and 1.0 point (95% confidence interval 0.5 to 1.6 points; P<0.001) in favour of the multicomponent intervention at 24 and 36 months, respectively. The decline in handgrip strength at 24 months was smaller in women assigned to the multicomponent intervention than to control (0.9 kg, 95% confidence interval 0.1 to 1.6 kg; P=0.028). Women in the multicomponent intervention arm lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 months (95% confidence interval 0.10 to 0.39 kg; P<0.001) and 36 months (0.26 to 0.73 kg; P<0.001), respectively. Serious adverse events occurred in 237/605 (39.2%) participants assigned to the multicomponent intervention and 216/600 (36.0%) controls (risk ratio 1.09, 95% confidence interval 0.94 to 1.26). In participants with SPPB scores of 8 or 9, mobility disability occurred in 46/155 (29.7%) in the multicomponent intervention and 38/159 (23.9%) controls (hazard ratio 1.25, 95% confidence interval 0.79 to 1.95; P=0.34).ConclusionsA multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people.Trial registrationClinicalTrials.gov NCT02582138.

Effect of Physical Activity/Exercise on Oxidative Stress and Inflammation in Muscle and Vascular Aging

“…Exercise is a subset of physical activity, being planned, structured and repetitive [ 150 ], and its benefits have been extensively studied. Exercise improves different parameters in older adults, such as strength [ 153 , 154 ] and physical function [ 154 , 155 ], and reduces disability [ 28 , 30 ], as well as preventing falls and fall-associated injuries [ 156 ], demonstrating that lengthy interventions are safe [ 157 ]. Even in older adults who meet the sarcopenia criteria, physical exercise significantly improves strength (assessed by grip strength, knee extension and chair test), physical functioning (timed up and go test and gait speed) and muscle mass [ 158 ].…”

“…Alternatively, due to the multiorgan and biological systems that are involved in the frailty syndrome, the inclusion of different types of exercise, such as strength, aerobic, balance or flexibility, could be the best intervention for this type of patient [ 30 , 154 , 169 , 170 , 171 ]. In line with this, recent research has been published with data from the SPRINTT study (Sarcopenia and Physical Frailty in Older People: Multi-component Treatment Strategies) conducted in community-dwelling older adults with a mean age of 78.9 years with physical frailty who also met the sarcopenia criteria.…”

“…In the pathway leading from robustness to frailty and disability, several approaches have been assessed. Among them, physical exercise is probably the most successful, as has been shown in several randomized controlled trails [ 28 , 29 , 30 ], usually as part of multimodal combinatory interventions and including the prevention/reversion of frailty [ 9 ]. In fact, it has been suggested that avoiding the prescription of exercise programs to older people could be considered unethical [ 31 ].…”

Protein Intake and Frailty in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

“…This indicates that the results were not adjusted for numerous covariables, including physical activity levels [62], oral health [65], and the presence of comorbidities [66]. Particularly, recent findings from the SPRINTT project showed that a multicomponent intervention, which involved a daily protein intake of at least 1.0-1.2 g/kg of BW and a physical activity intervention, reduced the incidence of mobility disability in older adults with physical frailty and sarcopenia [67]. Thirdly, the limited number of included studies did not allow meta-regression, dose-response, risk of bias, or "trim and fill" analyses to be conducted.…”

Effect of Ankle Weights as a Frailty Prevention Strategy in the Community-Dwelling Elderly: A Preliminary Report

“…Instructor-led gymnastics classes are reportedly safer and more effective than self-directed efforts and self-assessment, and are better able to improve physical function than home-based exercise programs [ 2 , 4 ]. In addition, classes that add nutritional counseling and other services [ 5 ] and programs such as the “In Balance program” in the Netherlands [ 6 ], which includes an educational component and physical exercises focused on balance and muscle strength, are considered to be more effective. However, widespread implementation of these classes is unlikely in the near future because of systemic shortfalls in facilities, staffing, and funding, and insufficient performance as per the Cost Performance Index.…”