Impact of adherence to a lifestyle-integrated programme on physical function and behavioural complexity in young older adults at risk of functional decline: a multicentre RCT secondary analysis

A Stefanie Mikolaizak, Kristin Taraldsen, Elisabeth Boulton, Katharina Gordt, Andrea Britta Maier, Sabato Mellone, Helen Hawley-Hague, Kamiar Aminian, Lorenzo Chiari, Anisoara Paraschiv-Ionescu, Mirjam Pijnappels, Chris Todd, Beatrix Vereijken, Jorunn L Helbostad, Clemens Becker, A Stefanie Mikolaizak, Kristin Taraldsen, Elisabeth Boulton, Katharina Gordt, Andrea Britta Maier, Sabato Mellone, Helen Hawley-Hague, Kamiar Aminian, Lorenzo Chiari, Anisoara Paraschiv-Ionescu, Mirjam Pijnappels, Chris Todd, Beatrix Vereijken, Jorunn L Helbostad, Clemens Becker

Abstract

Context: Long-term adherence to physical activity (PA) interventions is challenging. The Lifestyle-integrated Functional Exercise programmes were adapted Lifestyle-integrated Functional Exercise (aLiFE) to include more challenging activities and a behavioural change framework, and then enhanced Lifestyle-integrated Functional Exercise (eLiFE) to be delivered using smartphones and smartwatches.

Objectives: To (1) compare adherence measures, (2) identify determinants of adherence and (3) assess the impact on outcome measures of a lifestyle-integrated programme.

Design, setting and participants: A multicentre, feasibility randomised controlled trial including participants aged 61-70 years conducted in three European cities.

Interventions: Six-month trainer-supported aLiFE or eLiFE compared with a control group, which received written PA advice.

Outcome measures: Self-reporting adherence per month using a single question and after 6-month intervention using the Exercise Adherence Rating Scale (EARS, score range 6-24). Treatment outcomes included function and disability scores (measured using the Late-Life Function and Disability Index) and sensor-derived physical behaviour complexity measure. Determinants of adherence (EARS score) were identified using linear multivariate analysis. Linear regression estimated the association of adherence on treatment outcome.

Results: We included 120 participants randomised to the intervention groups (aLiFE/eLiFE) (66.3±2.3 years, 53% women). The 106 participants reassessed after 6 months had a mean EARS score of 16.0±5.1. Better adherence was associated with lower number of medications taken, lower depression and lower risk of functional decline. We estimated adherence to significantly increase basic lower extremity function by 1.3 points (p<0.0001), advanced lower extremity function by 1.0 point (p<0.0001) and behavioural complexity by 0.008 per 1.0 point higher EARS score (F(3,91)=3.55, p=0.017) regardless of group allocation.

Conclusion: PA adherence was associated with better lower extremity function and physical behavioural complexity. Barriers to adherence should be addressed preintervention to enhance intervention efficacy. Further research is needed to unravel the impact of behaviour change techniques embedded into technology-delivered activity interventions on adherence.

Trial registration number: NCT03065088.

Keywords: geriatric medicine; public health; sports medicine; telemedicine.

Conflict of interest statement

Competing interests: SM and LC own a share in the spin-off company of the University of Bologna, mHealth Technologies s.r.l. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

References

    1. Sherrington C, Michaleff ZA, Fairhall N, et al. . Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 2017;51:1750–8. 10.1136/bjsports-2016-096547
    1. Nyman SR, Victor CR. Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2012;41:16–23. 10.1093/ageing/afr103
    1. Hughes KJ, Salmon N, Galvin R, et al. . Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis. Age Ageing 2019;48:185–95. 10.1093/ageing/afy164
    1. World Health Organisation . Adherence to long-term therapies. Geneva, 2003.
    1. Aronson JK. Compliance, concordance, adherence. Br J Clin Pharmacol 2007;63:383–4. 10.1111/j.1365-2125.2007.02893.x
    1. Hawley-Hague H, Horne M, Skelton DA, et al. . Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes. BMJ Open 2016;6:e011560. 10.1136/bmjopen-2016-011560
    1. Yang Y, Boulton E, Todd C. Measurement of adherence to mHealth physical activity interventions and exploration of the factors that affect the adherence: Scoping review and proposed framework. J Med Internet Res 2022;24:e30817. 10.2196/30817
    1. Clemson L, Fiatarone Singh MA, Bundy A, et al. . Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012;345:e4547. 10.1136/bmj.e4547
    1. Weber M, Belala N, Clemson L, et al. . Feasibility and effectiveness of intervention programmes integrating functional exercise into daily life of older adults: a systematic review. Gerontology 2018;64:172–87. 10.1159/000479965
    1. Mikolaizak AS, Lord SR, Tiedemann A, et al. . Adherence to a multifactorial fall prevention program following paramedic care: predictors and impact on falls and health service use. results from an RCT a priori subgroup analysis. Australas J Ageing 2018;37:54–61. 10.1111/ajag.12465
    1. Picorelli AMA, Pereira LSM, Pereira DS, et al. . Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother 2014;60:151–6. 10.1016/j.jphys.2014.06.012
    1. Knox CR, Lall R, Hansen Z, et al. . Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain: a complier average causal effect approach to the BeST data set. BMC Musculoskelet Disord 2014;15:17. 10.1186/1471-2474-15-17
    1. Taraldsen K, Mikolaizak AS, Maier AB, et al. . Protocol for the PreventIT feasibility randomised controlled trial of a lifestyle-integrated exercise intervention in young older adults. BMJ Open 2019;9:e023526. 10.1136/bmjopen-2018-023526
    1. Taraldsen K, et al. . Digital technology to deliver a lifestyle-integrated exercise intervention in young Seniors—The PreventIT feasibility randomized controlled trial 2020;2.
    1. Schwenk M, Bergquist R, Boulton E, et al. . The adapted lifestyle-integrated functional exercise program for preventing functional decline in young seniors: development and initial evaluation. Gerontology 2019;65:362–74. 10.1159/000499962
    1. Boulton E, Hawley-Hague H, French DP, et al. . Implementing behaviour change theory and techniques to increase physical activity and prevent functional decline among adults aged 61-70: the PreventIT project. Prog Cardiovasc Dis 2019;62:147–56. 10.1016/j.pcad.2019.01.003
    1. Newman-Beinart NA, Norton S, Dowling D, et al. . The development and initial psychometric evaluation of a measure assessing adherence to prescribed exercise: the exercise adherence rating scale (EARS). Physiotherapy 2017;103:180–5. 10.1016/j.physio.2016.11.001
    1. Fairhall N, Sherrington C, Cameron ID, et al. . A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial. J Physiother 2017;63:40–4. 10.1016/j.jphys.2016.11.007
    1. Jette AM, Haley SM, Coster WJ, et al. . Late life function and disability instrument: I. development and evaluation of the disability component. J Gerontol A Biol Sci Med Sci 2002;57:M209–16. 10.1093/gerona/57.4.M209
    1. Paraschiv-Ionescu A, Büla CJ, Major K, et al. . Concern about falling and complexity of free-living physical activity patterns in Well-Functioning older adults. Gerontology 2018;64:603–11. 10.1159/000490310
    1. Haley SM, Jette AM, Coster WJ, et al. . Late life function and disability instrument: II. development and evaluation of the function component. J Gerontol A Biol Sci Med Sci 2002;57:M217–22. 10.1093/gerona/57.4.M217
    1. Paraschiv-Ionescu A, Perruchoud C, Buchser E, et al. . Barcoding human physical activity to assess chronic pain conditions. PLoS One 2012;7:e32239. 10.1371/journal.pone.0032239
    1. Paraschiv-Ionescu A, Perruchoud C, Rutschmann B, et al. . Quantifying dimensions of physical behavior in chronic pain conditions. J Neuroeng Rehabil 2016;13:85. 10.1186/s12984-016-0194-x
    1. Zhang W, Schwenk M, Mellone S, et al. . Complexity of daily physical activity is more sensitive than conventional metrics to assess functional change in younger older adults. Sensors 2018;18:1:2032. 10.3390/s18072032
    1. Jonkman NH, Del Panta V, Hoekstra T, et al. . Predicting trajectories of functional decline in 60- to 70-year-old people. Gerontology 2018;64:212–21. 10.1159/000485135
    1. Jonkman NH, Colpo M, Klenk J, et al. . Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: pooled analysis of four European cohort studies. BMC Geriatr 2019;19:179. 10.1186/s12877-019-1192-1
    1. Becker C, Woo J, Todd C. Falls (Chapter 50). In: Michel JB, Beattie BL, Martin F, et al., eds. Oxford textbook of geriatric medicine. 3rd edn. Oxford University Press, 2018. 10.1093/med/9780198701590.003.0050
    1. Allison PD. Missing data. Thousand Oaks, CA: Sage University Press, 2001.
    1. Sun X, Briel M, Walter SD, et al. . Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. BMJ 2010;340:c117. 10.1136/bmj.c117
    1. Stuart EA, Perry DF, Le H-N, et al. . Estimating intervention effects of prevention programs: accounting for noncompliance. Prev Sci 2008;9:288–98. 10.1007/s11121-008-0104-y
    1. Herbert RD, Kasza J, Bo K. Analysis of randomised trials with long-term follow-up. BMC Med Res Methodol 2018;18:48. 10.1186/s12874-018-0499-5
    1. Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park: Sage Publications, 1991.
    1. Peugh JL, Strotman D, McGrady M, et al. . Beyond intent to treat (ITT): a complier average causal effect (CACE) estimation primer. J Sch Psychol 2017;60:7–24. 10.1016/j.jsp.2015.12.006
    1. Lamb SE, Jørstad-Stein EC, Hauer K, et al. . Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc 2005;53:1618–22. 10.1111/j.1532-5415.2005.53455.x
    1. French DP, Olander EK, Chisholm A, et al. . Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review. Ann Behav Med 2014;48:225–34. 10.1007/s12160-014-9593-z
    1. Michie S, Abraham C, Whittington C, et al. . Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol 2009;28:690–701. 10.1037/a0016136
    1. Shier V, Trieu E, Ganz DA. Implementing exercise programs to prevent falls: systematic descriptive review. Inj Epidemiol 2016;3:16. 10.1186/s40621-016-0081-8
    1. Saadat Z, Nikdoust F, Aerab-Sheibani H, et al. . Adherence to antihypertensives in patients with comorbid condition. Nephrourol Mon 2015;7:e29863. 10.5812/numonthly.29863
    1. Marks R, Allegrante JP. Chronic osteoarthritis and adherence to exercise: a review of the literature. J Aging Phys Act 2005;13:434–60. 10.1123/japa.13.4.434
    1. Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. J Sci Med Sport 2014;17:177–82. 10.1016/j.jsams.2013.03.010
    1. Morey MC, Dubbert PM, Doyle ME, et al. . From supervised to unsupervised exercise: factors associated with exercise adherence. J Aging Phys Act 2003;11:351–68. 10.1123/japa.11.3.351
    1. Iliou MC, Blanchard JC, Lamar-Tanguy A, et al. . Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators. Monaldi Arch Chest Dis 2016;86:756. 10.4081/monaldi.2016.756
    1. Alkerwi Ala'a, Schuh B, Sauvageot N, et al. . Adherence to physical activity recommendations and its associated factors: an interregional population-based study. J Public Health Res 2015;4:406. 10.4081/jphr.2015.406
    1. van Gool CH, Penninx BWJH, Kempen GIJM, et al. . Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Rheum 2005;53:24–32. 10.1002/art.20902
    1. Roaldsen KS, Halvarsson A, Sahlström T, et al. . Task-specific balance training improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling: a randomized controlled trial. Clin Rehabil 2014;28:1189–97. 10.1177/0269215514534087
    1. Aguiñaga S, Ehlers DK, Salerno EA, et al. . Home-based physical activity program improves depression and anxiety in older adults. J Phys Act Health 2018;15:692–6. 10.1123/jpah.2017-0390
    1. Brach JS, VanSwearingen JM. Interventions to improve walking in older adults. Curr Transl Geriatr Exp Gerontol Rep 2013;2:230–8. 10.1007/s13670-013-0059-0
    1. Gschwind YJ, Schoene D, Lord SR, et al. . The effect of sensor-based exercise at home on functional performance associated with fall risk in older people - a comparison of two exergame interventions. Eur Rev Aging Phys Act 2015;12:11. 10.1186/s11556-015-0156-5
    1. Lacroix A, Hortobágyi T, Beurskens R, et al. . Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: a systematic review and meta-analysis. Sports Med 2017;47:2341–61. 10.1007/s40279-017-0747-6
    1. Wu G, Keyes L, Callas P, et al. . Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Arch Phys Med Rehabil 2010;91:849–56. 10.1016/j.apmr.2010.01.024
    1. Lord SR, Tiedemann A, Chapman K, et al. . The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 2005;53:1296–304. 10.1111/j.1532-5415.2005.53425.x
    1. Boongird C, Keesukphan P, Phiphadthakusolkul S, et al. . Effects of a simple home-based exercise program on fall prevention in older adults: a 12-month primary care setting, randomized controlled trial. Geriatr Gerontol Int 2017;17:2157–63. 10.1111/ggi.13052
    1. van Overbeeke E, Whichello C, Janssens R, et al. . Factors and situations influencing the value of patient preference studies along the medical product lifecycle: a literature review. Drug Discov Today 2019;24:57–68. 10.1016/j.drudis.2018.09.015
    1. Yardley L, Donovan-Hall M, Francis K, et al. . Attitudes and beliefs that predict older people's intention to undertake strength and balance training. J Gerontol B Psychol Sci Soc Sci 2007;62:P119–25. 10.1093/geronb/62.2.P119

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