https://acpinternist.org/weekly/archives/2022/05/17/1.htm

Exercise interventions associated with improved mobility, physical function in older adults

A randomized controlled trial found that a multicomponent exercise intervention in physically frail patients with sarcopenia improved mobility, while a meta-analysis found power training improved strength more than traditional strength training in healthy older adults.


Two studies found that exercise interventions were associated with improved outcomes in older adults.

The first study, a randomized controlled trial, tested whether a multicomponent intervention was associated with reduced disability from impaired mobility (mobility disability) in physically frail patients with sarcopenia. A total of 1,519 community-dwelling patients at 16 clinical sites in Europe (mean age, 78.9 years; 71.6% women) participated in the study. Patients were included if they had low functional status (defined as a short physical performance battery [SPPB] score from 3 to 9), low appendicular lean mass, and the ability to walk 400 meters independently.

Seven hundred sixty patients were randomly assigned to the intervention, which involved moderately intense physical activity twice weekly at an ambulatory center and up to four times weekly at home, while 759 patients were assigned to the control group and received education on healthy aging once per month. The intervention was tailored using actimetry data, and personalized nutritional counseling was also provided.

The study's primary outcome was mobility disability (inability to independently walk 400 m in <15 min). Patients with baseline SPPB scores of 3 to 7 (n=1,205) were included in the primary comparisons, 605 in the intervention group and 600 in the control group. Those with better function, indicated by SPPB scores of 8 or 9 (155 patients in the intervention group and 159 in the control group) were analyzed separately. The study results were published May 11 by BMJ.

Average follow-up was 26.4 months. Of the patients with baseline SPPB scores of 3 to 7, 46.8% of the intervention group and 52.7% of controls had mobility disability (hazard ratio [HR], 0.78; [95% CI, 0.67 to 0.92]; P=0.005), with persistent mobility disability in 21.0% and 25.0%, respectively (HR, 0.79 [95% CI, 0.62 to 1.01]; P=0.06). The between-group difference in SPPB score was 0.8 point (95% CI, 0.5 to 1.1 points; P<0.001) at 24 months and 1.0 point (95% CI, 0.5 to 1.6 points; P<0.001) at 36 months, both favoring the multicomponent intervention. Rates of serious adverse events were 39.2% in the intervention group and 36.0% in the control group (risk ratio, 1.09; 95% CI, 0.94 to 1.26). Among the patients who had SPPB scores of 8 or 9, 29.7% of those in the intervention group and 23.9% of controls had mobility disability (HR, 1.25 [95% CI, 0.79 to 1.95]; P=0.34).

The researchers noted that almost all participants were White and that patients with significant cognitive deficits weren't included in the trial, among other limitations. They concluded that the multicomponent intervention tested in their study was associated with reduced incidence of mobility disability in physically frail patients with sarcopenia and SPPB scores ranging from 3 to 7. “Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people,” they wrote.

An accompanying editorial said this trial along with previous research provides compelling evidence that structured physical activity, primarily walking, can help preserve mobility in vulnerable community-living older adults. However, the editorialist noted that the definition of physical frailty and sarcopenia used to identify participants has uncertain clinical utility. “To enhance clinical feasibility, slow gait speed (<0.8 m/s) rather than the complete SPPB could be used to identify older people who are at high risk of losing independent mobility,” he wrote.

The second article was a systematic review and meta-analysis of 20 randomized clinical trials comparing power training (defined as strength training with instructions to move the weight as fast as possible in the lifting phase) versus traditional strength training in community-living older adults ages 60 years or older. The primary outcomes were physical function (determined by composite outcomes, such as the Short Physical Performance Battery Score, and power-related single measures of function, such as the Get Up and Go test) and self-reported function (determined by validated questionnaires). Summary effect size measures were calculated and reported as standardized mean differences (SMDs). The results were published May 11 by JAMA Network Open.

The included trials involved 466 adults with a mean age of 70.1 years; 65% were women. Power training was associated with an improvement in physical function in 13 trials involving 383 patients and in self-reported function in three trials involving 85 patients (SMD, 0.30 [95% CI, 0.05 to 0.54] and 0.38 [95% CI, –0.62 to 1.37], respectively). The evidence was considered low certainty for both outcomes.

The authors concluded that power training was associated with modest improvement in physical function versus traditional strength training in community-living older adults based on the included studies but said that larger high-quality randomized controlled trials are needed. “We recommend that future [power training] studies obtain larger and better-justified sample sizes, measure both performance and self-reported functional outcomes, track power during workout sessions using an objective measure, and emphasize the proper conduct and reporting of important methodological domains,” they wrote.

An accompanying commentary agreed that more studies are needed and noted that the meta-analysis raises important questions, such as whether power training is safe for healthy older adults, how long training should continue to achieve optimal benefits, and whether older adults prefer this type of training. “Answering these questions will no doubt result in optimization of the benefits of power training and, importantly, the likelihood of adoption into both clinical practice and the daily exercise routines of older adults,” the commentary authors wrote.