A structured exercise program provides mobility benefits to all older patients, regardless of frailty status

1. The effect of physical activity at reducing the likelihood of major mobility disability (MMD) was not impacted by the baseline frailty status of patients in the study.

2. The physical activity intervention was found to be associated with improvement in the inability of patients to rise from a chair.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Frailty is a common phenomenon that occurs as people age. While there is no universally accepted definition of frailty, it generally refers to increased vulnerability to stressors in older adults, resulting in increased morbidity and mortality. Exercise has been suggested to be a protective factor against frailty. However, there is currently limited research demonstrating the benefits of exercise-based interventions in reducing frailty in older adults. The authors of this study conducted a secondary analysis of a randomized controlled trial to assess the impact of a long-term, structured, moderate-intensity physical activity program on frailty in patients. They also analyzed whether the extent of patient’s frailty has an impact on physical activity with respect to its ability to reduce MMD risk. Generally, it was observed that there are benefits to a structured exercise program in older patients, regardless of their frailty status. Strengths of the study include its robust data analysis and large patient cohort. This study is limited by the inclusion criteria of the randomized controlled trial, Lifestyle Interventions and Independence for Elders (LIFE). Results may not be generalizable to patients younger than the age of 70 or older than 89 years. As well, it is unclear whether results can be extrapolated to patients that are low risk for MMD, as all the patients in the LIFE study had a high risk for MMD.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies

In-Depth [randomized controlled trial]: The authors of this study conducted a secondary analysis of the LIFE randomized controlled trial. A total of 1635 community-dwelling adults, aged 70 to 89 years, with high risk for MMD were included in this study. Statistical analysis was conducted to evaluate differences between the two intervention groups, either physical activity or health education program. The physical activity intervention included walking and strength, balance, and flexibility exercises, while the health education program involved workshops with topics related to older adults. The authors did not observe any statistically significant differences in reducing frailty between the health education versus the exercise group. The physical activity group did have lower prevalence of inability to rise from a chair (2.8 to 5.8% lower) compared to the health education group. Furthermore, inability to rise from a chair was the only frailty criterion that was significantly impacted by the intervention group based on a 24-month follow-up period.

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