# Exercise as it relates to Disease/Effect of structured physical activity on prevention of major mobility disability in older adults

The following is a critique of the original article Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE Study Randomized clinical trial, published by JAMA Network, 2014

## What is the background to the research?

In older adults reduced and/or impaired mobility is a high risk factor for disability, hospitalisation, and sometimes death. Although the prolongation of life is an important health goal in the world, many consider the ability to live independently while still functioning well to be more important. Mobility (defined as the ability to walk without assistance in this study) is extremely important to be able to function independently. Some research suggests that physical activity may help to prevent impaired or reduced mobility in the later stages of the human life although there is no definitive evidence showing this to be the case. Due to these circumstances, this study was undertaken to test that a long-term structured physical activity program can be more successful than a health education program in reducing the risk of major mobility disability.

## Where is the research from?

This research was published in the Journal of the American Medical Association (JAMA), one of the world's top rated medical journals. The study population includes 1635 sedentary men and women aged between 70–89 years old (with some physical limitations) from 8 different field centres around the US.

## What kind of research was this?

The Life study was a multicenter, singleblinded, parallel randomized trial that took place at 8 centres around the US. Using a Randomised Controlled Trial (RCT) was the best choice possible as the RCT is the gold standard for testing and evaluating the effectiveness of first-hand interventions. This is done by comparing the results of a control group to the results of an intervention group to provide more information and to achieve a greater understanding of the study taking place. Through the use of this research method, the researchers have created a unique experiment that provides sufficient data to help gain a clearer understanding into the world of major mobility disability in older adults.

## What did the research involve?
### Setup

Individuals who volunteered for the study were screened with the following criteria being used to select participants who were eligible:
* >70-<90 years of age
* Reporting <20 mins/week of regular physical activity and <125 min/week of moderate exercise
* A score of ≤9 on the Short Physical Performance Battery
* Could walk 400m in ≤15 minutes without sitting, leaning or help from another person
* Could safely participate in the intervention determined by medical history, physical exam and resting ECG
Participants who were selected were then randomly assigned to a physical activity or a health education program.

### Procedure

Each of the groups have a different intervention outlined for them. The physical activity groups' intervention involved walking, with a goal of at least 150 min/week of physical activity (strength, flexibility, & balance). The participants attended 2 center-based visits per week and 3-4 home-based activity. The main goal of these activity sessions was for the participant to be able to reach the goals of walking 30 mins daily at a moderate intensity, 10 mins of mainly lower strength training, 10 mins of balance training, and large muscle group flexibility exercises. Using Borgs scale of self-perceived exertion, participants were asked to walk at an intensity of 13 and lower strength exercises were performed at an intensity of 15-16.
The Health education group focused on successful aging. This group participated in weekly workshops of health education for 26 weeks and then went onto monthly session after. These workshops covered information more than just physical fitness, with topics such as traveling safely, preventive services and screenings recommended per age, negotiating the health care system and so forth. These workshops also included 5–10 minutes of light stretching with an instructor.

### Evaluation of the Study

There are some variables that have possibly skewed some of the results slightly in this near perfect experiment. One of these said variables is the fact that the participant has to make it to the clinic to partake in the walk, as many didn't have the space to do it at home. Some results were also hard to gather as the participants had been hospitalised since the intervention had started due to uncontrollable variables. This may have had an impact on the no. of people in groups and therefore on the percentage of people who improved/got worse.

## What were the basic results?

The results show that participants who participated in the physical activity were less likely to show signs of mobility disability then those who participated in the health education programs (Table 1). To sum it up, participating in physical activity programs is much more efficient then learning about how to do it yourself while trying to reduce the risk of major mobility disability.
Table 1 - Incidents of Mobility disability occurring in each group :
| Type of Incident | Physical Activity (no. of people) | Health Education Program (no. of people) | Difference between groups (95%CI) |
| Incident major mobility disability | 246/818 | 290/817 | 0.69-0.98 |
| Persistent | 120/818 | 162/817 | 0.57-0.91 |
| Serious adverse events | 404/818 | 373/817 | 0.98-1.20 |

## What conclusions can we take from this research?

Exercising adequately at a later age is not being promoted enough. If older adults are not exercising enough or getting enough physical activity done in the week, this greatly increases the chance of major mobility disability occurring. Although this sort of information can be useful at an older age, most of this information should be focused on the younger years of life. If a child/young adult can obtain a good, positive mental attitude towards physical activity at a younger age, they are more likely to maintain this attitude throughout their life and into their old age.

## Practical advice

As mentioned previously, physical activity is crucial in preventing major mobility disability and should not be overlooked just because you may or may not be attending Health education programs. In saying that, I believe that the perfect balance can be found in attending both the health education programs and the physical activity classes. This will help achieve the best outcome for the participating person. Through the health education programs they can learn new exercises and gather more knowledge on dietary needs and so forth, and then with physical activity classes they can put their newfound knowledge to use as well as socialising with other people who are in the situation that they are in. The socialising is important as it will boost the participants mood and help link physical activity with fun and happiness.

## Further information/resources

For more information on the need for exercise and recommended levels of exercise for the elderly population, visiting the World Health Organisation (WHO) page on physical activity and the elderly or the Better Health Channel (physical activity for seniors) can further inform you of other pathways and helpful tips in relation to staying healthy later on in life.

### References

* ↑ Pahor M, Guralnik J, Ambrosius W, Blair S, Bonds D, Church T, Espeland M, Fielding R, Gill T, Groessl E, King A, Kritchevsky S, Manini T, McDermott M, Miller M, Newman A, Rejeski J, Sink K, Williamson J. Effect of structured physical activity on prevention of major mobility disability in older adults" the LIFE Study randomized clinical trial. JAMA (Internet). 2014 Jun 18; 311(23): 2387-2396.
* ↑ Akobeng A. Understanding randomised controlled trials. Archives of Disease in Childhood (Internet). 2005 Apr 22; 90: 840-844.
* ↑ Fielding RA, Rejeski WJ, Blair S, Church T, Espeland MA, Gill TM, Guralnik JM, Hsu FC, Katula J, King AC, Kritchevsky SB, McDermott MM, Miller ME, Nayfield S, Newman AB, Williamson JD, Bonds D, Romashkan S, Hadley E, Pahor M, LIFE Research Group. The Lifestyle Interventions and Independence for Elders Study: design and methods (Internet). Biol Sci Med Sci. 2011 Nov; 66(11):1226-37.(cited 2020 Sep 17)
* ↑ Borg G. Borg's perceived exertion and pain scales (Internet). Human Kinetics. 1998 (cited 2020 Sep 17)
* ↑ World Health Organization. Physical Activity and Older Adults (Internet). 2020 (cited 2020 Sep 16).
* ↑ Better Health Channel. Physical Activity for Seniors (Internet). 2012 (cited 2020 Sep 16).