Physical activity, nutrition counseling may enhance mobility in frail older adults

Older adults with frailty and sarcopenia who underwent an intervention involving physical activity and nutrition counseling experienced a reduction in incidence of mobility disability, according to findings published in BMJ.

“Mobility is a primary target to maintain function and foster active aging,” Emanuele Marzetti, MD, PhD, a geriatrician at Policlinico Universitario Fondazione Agostino Gemelli in Rome, and colleagues wrote. “Lifestyle interventions are feasible, safe and effective for improving physical function in older adults at risk of mobility disability.”

As part of the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) project, an evaluator-blinded, randomized controlled trial, Marzetti and colleagues evaluated 1,519 community dwelling adults. These adults lived in European countries and were aged 70 years or older with physical frailty and sarcopenia, which the researchers defined as a short physical performance battery (SPPB) score of 3 to 9. The mean age of the study cohort was 78.9 years; 1,088 participants were women.

In total, 760 participants were randomly assigned to moderate-intensity physical activity twice weekly at a center and four times weekly at home, in addition to personalized nutrition counseling. The remaining participants were assigned to a control group with education on healthy aging received once monthly.

The researchers categorized mobility disability as an inability to independently walk for 400 m, or less than 15 minutes. Persistent mobility disability was an inability to walk 400 m two consecutive times. The average follow-up was 26.4 months.

Marzetti and colleagues reported that mobility disability occurred in 46.8% of participants in the intervention group with SPPB scores of 3 to 7. Comparatively, 52.7% of participants in the control group who had SPPB scores of 3 to 7 were considered mobility disabled (HR = 0.78; 95% CI, 0.67-0.92). For participants with SPPB scores of 8 or 9, mobility disability occurred in 29.7% of participants in the intervention group and in 23.9% of participants in the control group (HR = 1.25; 95% CI, 0.79-1.95).

Persistent mobility disability occurred in 21% of participants with SPPB scores of 3 to 7 in the intervention group and 25% of participants with the same scores in the control group (HR = 0.79; 95% CI, 0.62-1.01).

At 24 and 36 months, the intervention group had a greater increase in SPPB scores than the control group (least squares mean difference = 0.8 points; 95% CI, 0.5-1.1 at 24 months; 1 point; 95% CI, 0.5-1.6 at 36 months), according to the researchers. A decline in handgrip strength at 24 months was less pronounced in women assigned to the intervention (P = .028). Moreover, women in the intervention group lost 0.24 kg (95% CI, 0.1-0.39) and 0.49 kg (95% CI, 0.26-0.73) less appendicular lean mass than women in the control group at 24 and 36 months, respectively.

While there was a high rate of serious adverse events, impacting 39.2% of participants assigned to the intervention, this was comparable to the rate of serious adverse events among participants in the control group (36%), according to the researchers.

“U.S. and E.U. data indicate that about 13% of community dwelling adults aged 70 years and older have mobility disability,” Marzetti and colleagues wrote. “Almost half of participants in SPRINTT developed mobility disability over 36 months, indicating that the condition of interest is clinically relevant and identifies an important public health problem.”

They concluded that the findings indicate a multicomponent intervention may be used a strategy to preserve mobility in older people at risk of disability.