The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: secondary analysis of a randomized controlled trial

Abstract

Background: Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations.

Methods: We analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70-89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years.

Results: For both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58-1.1) and 0.77 (0.62-0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71-3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88-1.7), but this difference did not achieve statistical significance (P-interaction, 0.670).

Conclusions: Intervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations.

Trial registration: ClinicalTrials.gov identifier NCT01072500 .

Keywords: Hospitalizations; Mobility disability; Physical activity; Randomized controlled trial.

Figures

Fig. 1

Flow of participants through the study. *Participants who did not receive the allocated intervention (i.e., attended no intervention sessions). †For participants who did not have any major mobility disability (MMD) assessments, we assigned 1 hour of follow-up time, because we knew that they were able to complete the 400-m walk at baseline. SPPB Short Physical Performance Battery

Fig. 2

Associations between any hospitalization and (a) onset of major mobility disability (MMD) and (b) recovery from MMD according to study group and severity of functional limitations. CI confidence interval, SPPB Short Physical Performance Test

Fig. 3

Effect of Physical Activity on (a) onset of major mobility disability (MMD) and (b) recovery from MMD according to hospital exposure and severity of functional limitations. CI confidence interval, SPPB Short Physical Performance Test