Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial
Creators: name: Jansen, Carl-Philipp
name: Nerz, Corinna
name: Labudek, Sarah
name: Gottschalk, Sophie
name: Kramer-Gmeiner, Franziska
name: Klenk, Jochen
name: Dams, Judith
name: König, Hans-Helmut
name: Clemson, Lindy
name: Becker, Clemens
name: Schwenk, Michael
Publisher: name: Universität Ulm
Year: 2021
Subjects: subject: Fall prevention
subject: Non-inferiority trial
subject: Fall risk
subject: Intervention costs
subject: Physical activity promotion
subject: ACTIVITY EXPOSURE
subject: OLDER-ADULTS
subject: MOBILITY
subject: DDC 570 / Life sciences
subject: DDC 610 / Medicine &amp; health
subject: Equivalence Trial
subject: Risk
subject: Älterer Mensch (60-70 Jahre)
subject: Mobilität
subject: Risiko

description: Abstract Background The ‘Lifestyle-integrated Functional Exercise’ (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. Methods Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant’s home (LiFE), followed by two “booster” phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. Results Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under “real world” assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. Conclusions Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. Trial registration The study was preregistered under clinicaltrials.gov (identifier: NCT03462654) on March 12th 2018