Potential long-term impact of "On The Move" group-exercise program on falls and healthcare utilization in older adults: an exploratory analysis of a randomized controlled trial

Peter C Coyle, Subashan Perera, Steven M Albert, Janet K Freburger, Jessie M VanSwearingen, Jennifer S Brach, Peter C Coyle, Subashan Perera, Steven M Albert, Janet K Freburger, Jessie M VanSwearingen, Jennifer S Brach

Abstract

Background: Wellness program participation may reduce the risk of falling, emergency department-use, and hospitalization among older adults. "On the Move" (OTM), a community-based group exercise program focused on the timing and coordination of walking, improved mobility in older adults, but its impact on falls, emergency department-use, and hospitalizations remains unclear. The aim of this preliminary study was to investigate the potential long-term effects that OTM may have on downstream, tertiary outcomes.

Methods: We conducted a secondary analysis of a cluster-randomized, single-blind intervention trial, which compared two community-based, group exercise programs: OTM and a seated exercise program on strength, endurance, and flexibility (i.e. 'usual-care'). Program classes met for 50 min/session, 2 sessions/week, for 12 weeks. Older adults (≥65 years), with the ability to ambulate independently at ≥0.60 m/s were recruited. Self-reported incidence of falls, emergency department visitation, and hospitalization were assessed using automated monthly phone calls for the year following intervention completion. Participants with ≥1 completed phone call were included in the analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated (reference = usual-care).

Results: Participants (n = 248) were similar on baseline characteristics and number of monthly phone calls completed. Participants in the seated exercise program attended an average of 2.9 more classes (p = .017). Of note, all results were not statistically significant (i.e. 95% CI overlapped a null value of 1.0). However, point estimates suggest OTM participation resulted in a decreased incidence rate of hospitalization compared to usual-care (IRR = 0.88; 95% CI = 0.59-1.32), and the estimates strengthened when controlling for between-group differences in attendance (adjusted IRR = 0.82; 95% CI = 0.56-1.21). Falls and emergency department visit incidence rates were initially greater for OTM participants, but decreased after controlling for attendance (adjusted IRR = 1.08; 95% CI = 0.72-1.62 and adjusted IRR = 0.96; 95% CI = 0.55-1.66, respectively).

Conclusion: Compared to a community-based seated group exercise program, participation in OTM may result in a reduced risk of hospitalization. When OTM is adhered to, the risk for falling and hospitalizations are attenuated. However, definitive conclusions cannot be made. Nevertheless, it appears that a larger randomized trial, designed to specifically evaluate the impact of OTM on these downstream health outcomes is warranted.

Trial registration: Clinical trials.gov (NCT01986647; prospectively registered on November 18, 2013).

Keywords: Aging; Falls; Healthcare utilization; Mobility; Prevention; Wellness.

Conflict of interest statement

Outside the present work, Dr. Perera received salary support in the past from an unrelated osteoporosis grant to the University of Pittsburgh from Eli Lilly & Co. The authors have no other disclosures to report.

Figures

Fig. 1
Fig. 1
CONSORT diagram for study overview. For flow diagram of the main trial, see reference Brach et al. [5]

References

    1. Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, Hamavid H, Horst C, Johnson EK, Joseph J, et al. US spending on personal health care and public health, 1996-2013. JAMA. 2016;316(24):2627–2646. doi: 10.1001/jama.2016.16885.
    1. Weiss AJ, Wier LM, Stocks C, Blanchard J. Healthcare Cost and Utilization Project (HCUP) statistical briefs. Rockville: Agency for Healthcare Research and Quality (US); 2014. Overview of emergency department visits in the United States, 2011: Statistical Brief #174.
    1. Sun R, Karaca Z, Wong HS. Healthcare Cost and Utilization Project (HCUP) statistical briefs. Rockville: Agency for Healthcare Research and Quality (US); 2018. Trends in hospital inpatient stays by age and payer, 2000–2015: statistical brief #235.
    1. Coberley C, Rula EY, Pope JE. Effectiveness of health and wellness initiatives for seniors. Popul Health Manag. 2011;14(Suppl 1):S45–S50. doi: 10.1089/pop.2010.0072.
    1. Brach JS, Perera S, Gilmore S, VanSwearingen JM, Brodine D, Nadkarni NK, Ricci E. Effectiveness of a timing and coordination group exercise program to improve mobility in community-dwelling older adults: a randomized clinical trial. JAMA Intern Med. 2017;177(10):1437–1444. doi: 10.1001/jamainternmed.2017.3609.
    1. Brach JS, Perera S, Gilmore S, VanSwearingen JM, Brodine D, Wert D, Nadkarni NK, Ricci E. Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “on the move” group exercise program in community-dwelling older adults. Contemp Clin Trials. 2016;50:135–142. doi: 10.1016/j.cct.2016.08.003.
    1. Brooks VB. The neural basis of motor control. New York: Oxford University Press; 1986.
    1. Gentile A. Movement sciences. 1. Rockville: Aspen; 1987. Skill acquistion: action, movement, and neuromotor processes; pp. 93–154.
    1. Brach JS, Vanswearingen JM. Interventions to improve walking in older adults. Curr Transl Geriatr Exp Gerontol Rep. 2013;2(4):230–238. doi: 10.1007/s13670-013-0059-0.
    1. VanSwearingen JM, Studenski SA. Aging, motor skill, and the energy cost of walking: implications for the prevention and treatment of mobility decline in older persons. J Gerontol A Biol Sci Med Sci. 2014;69(11):1429–1436. doi: 10.1093/gerona/glu153.
    1. VanSwearingen JM, Perera S, Brach JS, Cham R, Rosano C, Studenski SA. A randomized trial of two forms of therapeutic activity to improve walking: effect on the energy cost of walking. J Gerontol A Biol Sci Med Sci. 2009;64(11):1190–1198. doi: 10.1093/gerona/glp098.
    1. VanSwearingen JM, Perera S, Brach JS, Wert D, Studenski SA. Impact of exercise to improve gait efficiency on activity and participation in older adults with mobility limitations: a randomized controlled trial. Phys Ther. 2011;91(12):1740–1751. doi: 10.2522/ptj.20100391.
    1. Albert SM, King J, Keene RM. Assessment of an interactive voice response system for identifying falls in a statewide sample of older adults. Prev Med. 2015;71:31–36. doi: 10.1016/j.ypmed.2014.12.006.
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982;284(6329):1607–1608. doi: 10.1136/bmj.284.6329.1607.
    1. Harada ND, Chiu V, Stewart AL. Mobility-related function in older adults: assessment with a 6-minute walk test. Arch Phys Med Rehabil. 1999;80(7):837–841. doi: 10.1016/S0003-9993(99)90236-8.
    1. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6:363–375. doi: 10.1123/japa.6.4.363.
    1. Brach JS, Perera S, Studenski S, Katz M, Hall C, Verghese J. Meaningful change in measures of gait variability in older adults. Gait Posture. 2010;31(2):175–179. doi: 10.1016/j.gaitpost.2009.10.002.
    1. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–58. doi: 10.1001/jama.2010.1923.
    1. Perera S, Patel KV, Rosano C, Rubin SM, Satterfield S, Harris T, Ensrud K, Orwoll E, Lee CG, Chandler JM, et al. Gait speed predicts incident disability: a pooled analysis. J Gerontol A Biol Sci Med Sci. 2016;71(1):63–71. doi: 10.1093/gerona/glv126.
    1. Rigler SK, Studenski S, Wallace D, Reker DM, Duncan PW. Co-morbidity adjustment for functional outcomes in community-dwelling older adults. Clin Rehabil. 2002;16(4):420–428. doi: 10.1191/0269215502cr515oa.
    1. Pfuntner A, Wier LM, Steiner C. Healthcare Cost and Utilization Project (HCUP) statistical briefs. Rockville: Agency for Healthcare Research and Quality (US); 2010. Costs for hospital stays in the United States, 2010: Statistical Brief #146.
    1. Hoffman JM, Ciol MA, Huynh M, Chan L. Estimating transition probabilities in mobility and total costs for medicare beneficiaries. Arch Phys Med Rehabil. 2010;91(12):1849–1855. doi: 10.1016/j.apmr.2010.08.010.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Nguyen HQ, Ackermann RT, Maciejewski M, Berke E, Patrick M, Williams B, LoGerfo JP. Managed-Medicare health club benefit and reduced health care costs among older adults. Prev Chronic Dis. 2008;5(1):A14.
    1. Ackermann RT, Williams B, Nguyen HQ, Berke EM, Maciejewski ML, LoGerfo JP. Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members. J Am Geriatr Soc. 2008;56(8):1459–1465. doi: 10.1111/j.1532-5415.2008.01804.x.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere