By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
Dr. Gupta reports no financial relationships relevant to this field of study.
SYNOPSIS: A multicenter, single-blinded, randomized trial demonstrated that a structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not all disability in older adults who experience functional limitations.
SOURCE: Manini TM, Beavers DP, Pahor M, et al. Effect of physical activity on self-reported disability in older adults: Results from the LIFE Study. J Am Geriatr Soc 2017 Feb 7. doi: 10.1111/jgs.14742.
Approximately one in five U.S. adults reports a disability, with state-level prevalence of any disability ranging from 16.4% in Minnesota to 31.5% in Alabama.1 Although etiologies of state-level differences in disability across the nation are unclear, disability prevalence generally is higher in the South. Additionally, disability is associated with a higher prevalence of social determinants of poor health, which also are more common in the South. As per most recent estimates by the CDC, more than 30% of the population ≥ 18 years of age (approximately 75 million adults) report at least one basic action difficulty or complex activity limitation such as dressing and bathing.2 Disability prevalence has been shown to increase with age. More than 60% (26 million Americans ≥ 65 years of age) report at least one basic action difficulty or complex activity limitation. Along with a tremendous effect on quality of life in patients and their caregivers, including the loss of independence, there is a significant financial burden associated with disability. In 2006, these disability-associated healthcare expenditures were estimated at nearly $400 billion, with more than half those costs attributable to non-independent living (e.g., institutional care or personal care services). Increasing the number of activities of daily living disabilities from zero to six can result in a seven-fold increase in healthcare costs. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Thus, as the number of older adults in the United States rises, maintaining health among people with disabilities is important. Preserving functional independence among older Americans has emerged as a major clinical and public health priority.3 Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence demonstrating that major mobility disability can be prevented is lacking.4
Manini et al conducted a multicenter, single-blinded, randomized trial that included 1,635 adults 70-89 years of age. All participants were at high risk for becoming physically disabled. Participants were randomized to a structured, moderate-intensity physical activity (PA) program (n = 818) that included aerobic, resistance, and flexibility exercises or to a health education (HE) program (n = 817). At the beginning of the study, participants could walk about five city blocks (one-quarter of a mile) without assistance. All participants received thorough tests for disability at the beginning of the study and then at six, 12, 24, and 36 months after the study started across three domains: basic activities of daily living, instrumental activities of daily living, and mobility. All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the last month.
Researchers found that study participants in both groups experienced about the same level of disability after the study. Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.1% among PA and 15.2% among HE participants (hazard ratio [HR], 1.0; 95% confidence interval [CI], 0.78-1.29). However, reporting of severe mobility disability (HR, 0.78; 95% CI, 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group when compared with participants in the HE group.
COMMENTARY
The findings demonstrate that compared with a health education program, a structured, moderate-intensity PA program incorporating walking, strength, flexibility, and balance can reduce the risk of severe mobility disability and ratings of difficulty on mobility tasks. This would be the equivalent of reporting improvements in “a lot of difficulty” or “unable” to perform three or more common mobility tasks. However, it is important to note that these positive effects on self-reported mobility did not translate to lower risk of self-reported dependency or disability in basic activities of daily living or disability in instrumental activities of daily living in the study participants. This finding could be because of the way this study was designed, including not being able to examine the several psychosocial, environmental, and other factors that are related to disability occurrence. Although further research in this area is warranted, regular physical activity is a well-accepted approach for the management of severe disability, including that arising from chronic pain, and often is recommended as an adjunct to pharmacotherapy. Prevention of disability for the elderly can be as simple as a two-pronged approach: optimizing functional reserve with daily physical activity, such as a 30-minute walk, along with balance training and muscle strengthening exercises, and preventing common precipitants such as falls, cardiovascular events, and infection through timely and appropriate preventive care (screenings, immunizations, etc.). Finally, when seniors develop a precipitating event, it is critical to intervene early and offer a multidisciplinary, comprehensive approach designed to augment mobility resulting in rapidly enhanced functional outcomes.
REFERENCES
- Courtney-Long EA, Carroll DD, Zhang QC, et al. Prevalence of disability and disability type among adults — United States, 2013. MMWR Morb Mortal Wkly Rep 2015;64:777-783.
- Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. National Center for Health Statistics. Health, United States, 2015. Available at: http://bit.ly/2lSQ5Ly. Accessed March 7, 2017.
- Fielding RA, Rejeski WJ, Blair S, et al. The Lifestyle Interventions and Independence for Elders study: Design and methods. J Gerontol A Biol Sci Med Sci 2011;66:1226-1237.
- Howe TE, Rochester L, Neil F, et al. Exercise for improving balance in older people. Cochrane Database Syst Rev 2011;(11):CD004963. doi: 10.1002/14651858.
Recent trial demonstrated that a structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not all disability in older adults who experience functional limitations.
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