ABSTRACT & COMMENTARY
For Seniors, Regular Exercise Provides Disability Benefits
By Rahul Gupta, MD, MPH, FACP
Clinical Assistant Professor, West Virginia University School of Medicine, Charleston, WV
Dr. Gupta reports no financial relationships relevant to this field of study.
SYNOPSIS: In a study of vulnerable elderly population at risk for disability, a structured, moderate-intensity physical activity program compared with a health education program significantly reduced major mobility disability.
SOURCE: Pahor M, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA 2014;311:2387-2396.
The proportion of senior citizens is increasing faster than any other age group, and by the year 2050, it is expected that more than 80 million people in the United States will be over age 65. The number of Americans over age 85 will also reach record levels. From a public health perspective, the central challenge would be to balance the goal of maximizing quantity of life with the goal of maximizing quality of life. Fundamental to the quality of life is the ability for elderly individuals to preserve the capacity to remain functionally independent and thus prevent disability. With the aging process, maintaining the ability to be physically active is crucial since research demonstrates that individuals who are regularly physically active report better overall health, lower health care expenditures, and fewer mobility limitations than their peers who are sedentary.1,2 On the other hand, older adults who lose their mobility have higher rates of disease, disability, and death. However, when it comes to identifying proven specific interventions aimed at preventing or delaying the onset of mobility disability over an extended period of time, the research is surprisingly limited.
In their study, Pahor et al conducted a multicenter, randomized trial consisting of 1635 sedentary men and women aged 70-89 years from communities at eight centers throughout the United States. The average age of the participants was 78.9 years, more than half (about 67%) were women, and nearly 18% were African American. Participants were randomly divided into two groups. In the physical activity group, 818 men and women participated in a moderate-intensity physical activity program that included aerobic, resistance, and flexibility training activities. In the health education group, 817 adults attended workshops on topics relevant to their age group and performed upper extremity stretching exercises. The physical activity group gradually worked up to the goal of 150 minutes of weekly activity, including 30 minutes of brisk walking, 10 minutes of lower extremity strength training, 10 minutes of balance training, and large muscle flexibility exercises. The comparison group participated in weekly health education workshops for the first 26 weeks, followed by monthly sessions thereafter and performed 5-10 minutes of upper body stretching and flexibility exercises in each session. Participants remained with their assigned programs for an average of 2.6 years.
Researchers found that compared with the health education group, physical activity programs reduced the risk of major mobility disability by 18% (hazard ratio [HR], 0.82; P = 0.03) in an elderly, vulnerable population. Similar benefits were also demonstrated for persistent mobility disability (HR, 0.72; P = 0.006) and the combined outcome of major mobility disability or death (HR, 0.82; P = 0.02). However, physical activity did not decrease the death rate, although the sample size for this event did not reach statistical significance. The participants receiving the physical activity intervention were better able to maintain their ability to walk without assistance for 400 meters, or about a quarter of a mile.
It is well-known that the benefits of recommended moderate-intensity physical activity in the elderly may be multifold and include improved strength, conditioning, flexibility, mobility, physiological benefits in several chronic conditions as well as reduced likelihood of falls and several mental health disorders.3 Regular physical activity has also been shown to reduce the risk of developing certain cancers (colon, breast) and other medical conditions such as cardiovascular disease, hypertension, stroke, type 2 diabetes, osteoporosis, and obesity. With aging, aerobic capacity, muscle mass, and strength all decline, which may have a significant negative impact on the elderly individuals’ ability to perform daily activities. Moderate-intensity physical activity programs, including muscle strengthening activities, may allow the maintenance of adequate functional status resulting in lesser disability. While previous studies have demonstrated decreased mortality along with a greater likelihood of healthy aging as a result of regular physical activity, the study was not able to replicate this particular finding and perhaps more research is needed in this area.4 However, it is abundantly clear that each older adult patient can benefit from physical activity and that participation in any amount of physical activity will result in some health benefit, especially in those with existing chronic conditions. These study findings indicate that a structured, moderate-intensity physical activity program compared with a health education program has the potential to reduce major mobility disability over an extended period of time among older adults at risk for disability. Perhaps it is time to not just educate but ensure that our senior population of patients is receiving this benefit in their community setting.
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