Can Structured Physical Activity Reduce the Risk of Mobility Disability Among Frail Older Adults?
Health Letter, October 2014
By Azza AbuDagga, M.H.A., Ph.D.
Older adults are a rapidly growing segment of the U.S. population. Increasingly, older Americans prefer to “age in place,” remaining in their current homes and communities as they age and maintaining some degree of autonomy, dignity and independence. Physical mobility — the ability to walk without assistance — is critical to seniors’ independent living and aging in place.
Numerous studies show that regular physical activity and exercise can benefit various groups and improve health. But until recently, no study has exclusively examined whether physical activity can prevent or delay the loss of physical mobility (known as mobility disability) among frail older adults.
The recent Lifestyle Interventions and Independence for Elders (LIFE) study tested the effect of a structured, balanced and moderate physical activity program among older Americans.
The study was funded by the National Institutes of Health. It was published online on May 27 in the Journal of the American Medical Association.
The LIFE study design and finding
Researchers at eight major U.S. research centers conducted the LIFE study from February 2010 to December 2013. They enrolled more than 1,600 men and women ages 70 to 89 living in rural, suburban and urban communities. At the beginning of the study, all subjects were able to walk about a quarter of a mile in 15 minutes without a walker or the help of another person. But they had sedentary lifestyles, reporting very limited physical activity. The subjects were also at high risk for mobility disability based on standard physical tests.
The subjects were randomly assigned to one of two groups: one that underwent a physical activity program and another that received a health education program. Each group comprised approximately 800 people.
The physical activity program consisted of structured, moderate-intensity physical activity that was balanced among different activities designed to improve or maintain the following parameters of physical fitness: endurance, strength, balance and flexibility. Subjects in this group gradually worked up to the goal of 150 minutes per week of brisk walking (endurance/aerobic physical activity), in addition to 10 minutes of lower-extremity strength training, 10 minutes of balance training, and large-muscle flexibility exercises practiced two times a week. The program took place at a clinic twice a week and at home three or four times a week.
In contrast, the other group received health education focused on topics related to healthy aging. The program included weekly health education workshops for the first 26 weeks, followed by monthly sessions thereafter. This group also performed five to 10 minutes of upper-body stretching and flexibility exercises in each session.
All study subjects were assessed every six months at clinic visits and were followed for an average of 2.6 years. To determine how well the subjects adhered to their assigned program, the researchers monitored attendance at sessions and administered questionnaires in which subjects recorded the number of minutes per week that they were physically active. Additionally, subjects’ activity was recorded a few times during the study using an accelerometer, a small belt device that measures physical activity.
The researchers assessed whether subjects developed major mobility disability, defined as the loss of the ability to walk a quarter-mile without assistance. They found that fewer subjects assigned to the physical activity program developed major mobility disability compared with those in the health education group (30 percent versus 36 percent, respectively). They also found that participants in the physical activity group had about 18 percent lower risk of major mobility disability compared with the other group.
In conclusion, the LIFE study showed that it is never too late for structured physical activity to benefit a substantial portion of frail older adults.
Four types of physical activity
Most people tend to focus on one type of physical activity, thinking that is enough to maintain physical well-being. Instead, the goal should be to be creative and choose a variety of activities targeting endurance, strength, balance and flexibility. Below is a brief description of these four types of physical activity, which are also emphasized in a national physical activity and exercise program for older adults called Go4Life:
- Endurance: These are aerobic physical activities that increase oxygen use to improve heart and lung function and make daily activities easier. They include brisk walking or jogging, yardwork, swimming, biking, climbing stairs or hills, playing tennis, playing basketball and hiking.
- Strength: These activities increase muscle strength and help with everyday activities such as carrying groceries and lifting gardening supplies. Lower-body strength exercises also improve balance. They include lifting or pushing weights and using resistance bands.
- Balance: These physical activities help prevent falls, a common problem in older adults. Many lower-body strength exercises also improve balance. They include standing on one foot, walking heel-to-toe and practicing tai chi (old Chinese exercises that combine deep breathing and relaxation with slow and gentle movements).
- Flexibility: These are stretching exercises that give more freedom of movement for everyday activities such as getting dressed and reaching objects on a shelf. However, they do not improve strength or endurance. They include shoulder and upper arm stretches, calf stretches, and yoga.
A complete guide that incorporates detailed examples and tips for these four types of physical activities can be downloaded for free of charge here, at the National Institute on Aging website.
Steps you can take
Unless otherwise directed by a health care provider, older adults should gradually engage in regular, balanced and moderate-intensity physical activity to prevent physical mobility disability.
Older adults should stop all types of physical activity and seek immediate medical attention if they experience any of the following warning symptoms:
- Pain or pressure in chest, arms, neck or jaw
- Lightheadedness, nausea or weakness
- Shortness of breath
- Pain in legs, calves or back
- Chest palpitations (a fluttering sensation in the chest that may be due to a rapid or irregular heart rate)
 Werner CA. The older population: 2010 census briefs. November 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf.
 Department of Housing and Urban Development. Aging in place: Facilitating choice and independence. Evidence Matters. Fall 2013. http://www.huduser.org/portal/periodicals/em/fall13/highlight1.html.
 Guralnik JM, LaCroix AZ, Abbott RD, et al. Maintaining mobility in late life. Am J Epidemiol. 1993;137(8):845-857. http://aje.oxfordjournals.org/content/137/8/845.short. Accessed August 29, 2014.
 Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA. 2014;311(23):2387-2396. doi:10.1001/jama.2014.5616.
 Go4Life: Try these exercises. http://go4life.nia.nih.gov/try-these-exercises. Accessed August 29, 2014.
 Go4Life from the National Institute on Aging. 4 Types of Exercise. http://go4life.nia.nih.gov/4-types-of-exercise. Accessed August 28, 2014.
 Brender E, Burke AE, Glass RM. JAMA patient page. Fitness for older adults. JAMA. 2008;300(9):1104. doi:10.1001/jama.300.9.