Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial

Abstract

Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70-89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10-0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes.

Trial registration: ClinicalsTrials.gov NCT00116194.

Fig 1. Flow of participants through the trial.

Fig 2

Change in 400 m walk gait speed (m/s) compared to baseline gait speed at 6, 12, and 24 months according to quartiles of change physical activity by accelerometry from baseline to 24 months, (a.) physical activity arm alone and (b.) entire group combined (least square means ± SE). Overall effect P < 0.0001. Effects within each time point P < 0.0001.

Fig 3

Change in SPPB score compared to baseline SPPB score at 6, 12, and 24 months according to quartiles of change in physical activity by accelerometry from baseline to 24 months, (a.) physical activity arm alone and (b.) entire group combined (least square means ± SE). Overall effect P < 0.0001. Effects within each time point all P < 0.01(physical activity arm); Effects within each time point all P < 0.06 (month 6, P = 0.06, months 12 and 24, P < 0.0001) (entire group).