A regular exercise program along with expert dietary advice is linked to reduced mobility problems in frail, community-dwelling older people, one trial has found.
The results were published in the BMJ.
The combination of aerobic (walking), strength, flexibility and balance exercises along with personalized nutritional counseling reduced mobility disability by 22% over three years.
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US and EU data indicate that approximately 13% of adults aged 70 and over living in the community have a mobility disability, which is linked to poor quality of life, admission to hospital or institutional care, and death, as well as higher health care costs. .
It is therefore important to find safe and effective ways to preserve the mobility of older people at risk of later decline.
The researchers therefore designed the SPRINTT trial to investigate whether a combined physical activity intervention with technological support and nutritional counseling prevents mobility impairments in frail older people compared to healthy aging education. .
Their findings are based on 1,519 men and women (mean age 79) with physical frailty and sarcopenia (a combination of reduced physical function and low muscle mass) recruited from 16 clinical sites in 11 European countries between 2016 and 2019. .
Physical frailty and sarcopenia were defined as having a physical performance battery score (SPPB) of 3 to 9 points (score between 0 and 12, with lower scores indicating poor physical function) and low levels of muscle mass, but able to independently walk 400 meters in 15 minutes.
A total of 760 participants were randomized to the intervention, 759 received training in healthy aging (controls), and all were followed for up to 36 months.
The intervention group received moderate-intensity physical activity sessions twice a week at a center and up to four times a week at home, alongside personalized nutritional counseling. Activity was measured by an actimeter worn on the thigh.
Controls received healthy aging training once a month and a brief, instructor-led program of upper body stretching exercises or relaxation techniques.
Among participants with SPPB scores of 3 to 7 at the start of the trial, mobility disability occurred in 47% of those assigned to the intervention and 53% of the controls.
Persistent motor disability (inability to walk 400 m twice in a row) occurred in 21% of intervention participants, compared with 25% of controls.
SPPB scores increased more in the intervention group than in controls at 24 months and 36 months (mean differences of 0.8 and 1 point, respectively).
Women in the intervention group lost less muscle strength (0.9 kg at 24 months) and less muscle mass (0.24 kg and 0.49 kg at 24 months and 36 months, respectively) than control women , but no significant difference between the groups was observed in men.
However, the risk of adverse events was higher in intervention participants (56%) than in controls (50%).
In a separate analysis of participants with better mobility (SPPB scores of 8 or 9 at the start of the trial), the intervention did not affect the risk of developing reduced mobility and had marginal effects on physical performance .
Researchers acknowledge some limitations. For example, older people with significant cognitive deficits were not included and almost all participants were white, so the results may not apply to other ethnic groups.
However, retention and adherence to interventions were high compared to other similar trials, and their use of validated tests in a geographically and culturally diverse group of frail older people across Europe, suggests that the results are robust. .
As such, they conclude that such an intervention “can be proposed as a strategy to preserve the mobility of older people at risk of disability”.
This new evidence supports the benefits of structured physical activity in community-dwelling older adults, says Thomas Gill of the Yale School of Medicine in a linked editorial.
He acknowledges that translating even the best-designed trial results into clinical practice can be difficult, but says that these results, along with those of another large US trial (the LIFE study), “provide compelling evidence that Mobility in the community can be preserved in vulnerable older people through structured physical activity, with walking as the primary modality.”
He notes that the cost-effectiveness of the LIFE program “has been found to be comparable to that of many commonly recommended medical treatments.”
Confirmation of these findings in SPRINTT “would further strengthen the case for the development, implementation and support of community-based physical activity programs to preserve the independent mobility of vulnerable older people,” he concludes.
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