Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial | Geriatrics | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Werner  CA.  The older population.http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf. Accessed May 7, 2014.
Katz  S, Branch  LG, Branson  MH, Papsidero  JA, Beck  JC, Greer  DS.  Active life expectancy.  N Engl J Med. 1983;309(20):1218-1224.PubMedGoogle ScholarCrossref
Branch  LG, Guralnik  JM, Foley  DJ,  et al.  Active life expectancy for 10 000 Caucasian men and women in 3 communities.  J Gerontol. 1991;46(4):M145-M150.PubMedGoogle ScholarCrossref
Lonergan  ET, Krevans  JR.  A national agenda for research on aging.  N Engl J Med. 1991;324(25):1825-1828.PubMedGoogle ScholarCrossref
Guralnik  JM, LaCroix  AZ, Abbott  RD,  et al.  Maintaining mobility in late life.  Am J Epidemiol. 1993;137(8):845-857.PubMedGoogle Scholar
Branch  LG, Jette  AM.  A prospective study of long-term care institutionalization among the aged.  Am J Public Health. 1982;72(12):1373-1379.PubMedGoogle ScholarCrossref
Corti  MC, Guralnik  JM, Salive  ME, Sorkin  JD.  Serum albumin level and physical disability as predictors of mortality in older persons.  JAMA. 1994;272(13):1036-1042.PubMedGoogle ScholarCrossref
Khokhar  SR, Stern  Y, Bell  K,  et al.  Persistent mobility deficit in the absence of deficits in activities of daily living.  J Am Geriatr Soc. 2001;49(11):1539-1543.PubMedGoogle ScholarCrossref
Hirvensalo  M, Rantanen  T, Heikkinen  E.  Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population.  J Am Geriatr Soc. 2000;48(5):493-498.PubMedGoogle Scholar
Lampinen  P, Heikkinen  E.  Reduced mobility and physical activity as predictors of depressive symptoms among community-dwelling older adults.  Aging Clin Exp Res. 2003;15(3):205-211.PubMedGoogle ScholarCrossref
Newman  AB, Simonsick  EM, Naydeck  BL,  et al.  Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability.  JAMA. 2006;295(17):2018-2026.PubMedGoogle ScholarCrossref
Shumway-Cook  A, Patla  A, Stewart  A, Ferrucci  L, Ciol  MA, Guralnik  JM.  Environmental components of mobility disability in community-living older persons.  J Am Geriatr Soc. 2003;51(3):393-398.PubMedGoogle ScholarCrossref
Shumway-Cook  A, Patla  AE, Stewart  A, Ferrucci  L, Ciol  MA, Guralnik  JM.  Environmental demands associated with community mobility in older adults with and without mobility disabilities.  Phys Ther. 2002;82(7):670-681.PubMedGoogle Scholar
Pahor  M, Blair  SN, Espeland  M,  et al.  Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study.  J Gerontol A Biol Sci Med Sci. 2006;61(11):1157-1165.PubMedGoogle ScholarCrossref
Fielding  RA, Rejeski  WJ, Blair  S,  et al.  The Lifestyle Interventions and Independence for Elders Study.  J Gerontol A Biol Sci Med Sci. 2011;66(11):1226-1237.PubMedGoogle ScholarCrossref
Guralnik  JM, Ferrucci  L, Simonsick  EM, Salive  ME, Wallace  RB.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.  N Engl J Med. 1995;332(9):556-561.PubMedGoogle ScholarCrossref
Teng  EL, Chui  HC.  The Modified Mini-Mental State (3MS) examination.  J Clin Psychiatry. 1987;48(8):314-318.PubMedGoogle Scholar
Marsh  AP, Lovato  LC, Glynn  NW,  et al.  Lifestyle interventions and independence for elders study.  J Gerontol A Biol Sci Med Sci. 2013;68(12):1549-1558.PubMedGoogle ScholarCrossref
Borg  G.  Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1988.
Andresen  EM, Rothenberg  BM, Kaplan  RM.  Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults.  Med Care. 1998;36(9):1349-1360.PubMedGoogle ScholarCrossref
Stewart  AL, Verboncoeur  CJ, McLellan  BY,  et al.  Physical activity outcomes of CHAMPS II.  J Gerontol A Biol Sci Med Sci. 2001;56(8):M465-M470.PubMedGoogle ScholarCrossref
Rolland  YM, Cesari  M, Miller  ME, Penninx  BWJH, Atkinson  HH, Pahor  M.  Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults.  J Am Geriatr Soc. 2004;52(6):972-976.PubMedGoogle ScholarCrossref
Guralnik  JM, Ferrucci  L, Pieper  CF,  et al.  Lower extremity function and subsequent disability.  J Gerontol A Biol Sci Med Sci. 2000;55(4):M221-M231.PubMedGoogle ScholarCrossref
Matthew  CE.  Calibration of accelerometer output for adults.  Med Sci Sports Exerc. 2005;37(11)(suppl):S512-S522.PubMedGoogle ScholarCrossref
Therneau  TM, Grambsch  PM.  Modeling Survival Data, Extending the Cox Model. New York, NY: Springer Science; 2000.
Van der Wal  WM, Geskus  RB.  An R package for inverse probability weighting. J Stat Softw. 2011;43(13):1-23. http://www.jstatsoft.org/v43/i13/paper. Accessed May 7, 2014.
Messier  SP, Loeser  RF, Miller  GD,  et al.  Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis.  Arthritis Rheum. 2004;50(5):1501-1510.PubMedGoogle ScholarCrossref
Ettinger  WH  Jr, Burns  R, Messier  SP,  et al.  A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the Fitness Arthritis and Seniors Trial (FAST).  JAMA. 1997;277(1):25-31.PubMedGoogle ScholarCrossref
Berry  MJ, Rejeski  WJ, Adair  NE, Ettinger  WH  Jr, Zaccaro  DJ, Sevick  MA.  A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease.  J Cardiopulm Rehabil. 2003;23(1):60-68.PubMedGoogle ScholarCrossref
Rejeski  WJ, Axtell  R, Fielding  R,  et al.  Promoting physical activity for elders with compromised function.  Clin Interv Aging. 2013;8:1119-1131.PubMedGoogle ScholarCrossref
Studenski  S, Perera  S, Patel  K,  et al.  Gait speed and survival in older adults.  JAMA. 2011;305(1):50-58.PubMedGoogle ScholarCrossref
Physical Activity Guidelines Advisory Committee.  Physical Activity Guidelines Advisory Committee Report. Washington, DC: US Dept of Health and Human Services; 2008.
Szanton  SL, Allen  JK, Seplaki  CL, Bandeen-Roche  K, Fried  LP.  Allostatic load and frailty in the Women’s Health and Aging studies.  Biol Res Nurs. 2009;10(3):248-256.PubMedGoogle ScholarCrossref
Original Investigation
June 18, 2014

Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial

Author Affiliations
  • 1Department of Aging and Geriatric Research,University of Florida, Gainesville
  • 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
  • 3Department of Internal Medicine, Wake Forest University and School of Medicine, Winston-Salem, North Carolina
  • 4Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
  • 5Division of Cardiac Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 6Department of Preventative Medicine, Pennington Biomedical Research Center, Louisiana
  • 7Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
  • 8Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 9Veterans Affairs San Diego Healthcare System, San Diego, California
  • 10Department of Family and Preventive Medicine, University of California, San Diego, San Diego
  • 11Department of Health Research and Policy and Department of Medicine, Stanford University, School of Medicine, Stanford, California
  • 12Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 13Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA. 2014;311(23):2387-2396. doi:10.1001/jama.2014.5616

Importance  In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability.

Objective  To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability.

Design, Setting, and Participants  The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m.

Interventions  Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises.

Main Outcomes and Measures  The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m.

Results  Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]).

Conclusions and Relevance  A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults.

Trial Registration  clinicaltrials.gov Identifier: NCT01072500