Abstract
BACKGROUND: Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation.
METHODS: In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4-9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165.
FINDINGS: Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06-0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls.
INTERPRETATION: For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period.
FUNDING: National Institute for Health Research Public Health Research Programme (13/164/51).
| Original language | English |
|---|---|
| Pages (from-to) | e316-e326 |
| Journal | Lancet Public Health |
| Volume | 7 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 21 Mar 2022 |
Bibliographical note
Funding Information:This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. CES was supported by the NIHR Oxford Health Biomedical Research Centre, and is now a full-time employee of the Alzheimer's Association. We wish to express our thanks to the entire REACT research team, the Clinical Research Networks at each REACT site, and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners: Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John's Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; and the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. We would also like to express our gratitude to our Trial Steering Committee, chaired by Yoav Ben-Shlomo; the Data Management and Ethics Committee, chaired by Dawn Skelton; independent statistician Peter Thomas, who provided hugely valuable expert guidance and support; and Andrew F Hayes, who provided valuable advice on the conduct and interpretation of the moderation and subgroup analyses. Finally, we would like to thank the participants, without whom this research would not have been possible. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.
Funding Information:
This work was supported by the NIHR Public Health Research Programme (13/164/51). HJ-B is funded by the Wellcome Trust (110027/Z/15/Z) and the Oxford NIHR Biomedical Research Centre. CES was supported by the NIHR Oxford Health Biomedical Research Centre, and is now a full-time employee of the Alzheimer's Association. We wish to express our thanks to the entire REACT research team, the Clinical Research Networks at each REACT site, and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners: Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John's Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; and the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. We would also like to express our gratitude to our Trial Steering Committee, chaired by Yoav Ben-Shlomo; the Data Management and Ethics Committee, chaired by Dawn Skelton; independent statistician Peter Thomas, who provided hugely valuable expert guidance and support; and Andrew F Hayes, who provided valuable advice on the conduct and interpretation of the moderation and subgroup analyses. Finally, we would like to thank the participants, without whom this research would not have been possible. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Keywords
- Aged
- Exercise
- Female
- Humans
- Male
- Mobility Limitation
- Quality of Life
- Retirement
- Single-Blind Method
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