title: 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: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  ClinicalTrials.gov identifier NCT01072500 .
authors.affiliation: Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT, 06519, USA. Thomas.gill@yale.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Beavers
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Pahor
authors.affiliation: Tufts University, Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, USA.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Fielding
authors.affiliation: Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hauser
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Manini
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Marsh
authors.affiliation: Departments of Internal Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.affiliation: Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT, 06519, USA.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D015444:Exercise; D005260:Female; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D019957:Motor Skills Disorders / Q000517:prevention & control*; D016016:Proportional Hazards Models; D016037:Single-Blind Method; D016138:Walking
keywords: Hospitalizations; Mobility disability; Physical activity; Randomized controlled trial