Effectiveness of a community-based physical activity and behaviour maintenance intervention for preventing decline in physical functioning in older people: A pragmatic randomised controlled trial of the REACT (Retirement in Action) intervention
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).
Citation
@article{a2022,
author = {Stathi, A and Greaves, CJ and Thompson, JL and Withall, J
and Ladlow, P and Taylor, G and Medina-Lara, A and Green, C and
Snowsill, TM and Gray, S and Johansen-Berg, H and Sexton, CE and
Bilzon, J and de Koning, JL and Bollen, JC and Moorlock, SJ and
Western, MJ and Demnitz, N and Seager, P and Guralnik, J and
Rejeski, J and Fox, KR},
title = {Effectiveness of a Community-Based Physical Activity and
Behaviour Maintenance Intervention for Preventing Decline in
Physical Functioning in Older People: {A} Pragmatic Randomised
Controlled Trial of the {REACT} {(Retirement} in {Action)}
Intervention},
journal = {Lancet Public Health},
volume = {7},
number = {4},
pages = {e316 - e326},
date = {2022-03-01},
url = {https://tristansnowsill.co.uk/effectiveness-of-a-community-based.html},
doi = {10.1016/S2468-2667(22)00004-4},
langid = {en},
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).}
}